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Formulation

Formulation. Aims of Choice. Find out what they want Use our knowledge to jointly form an understanding Together choose what will be helpful NOT… Assessing a passive young person and family Handing down a diagnosis and treatment plan. Honest Opinion. Curiosity. Alternatives.

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Formulation

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  1. Formulation

  2. Aims of Choice • Find out what they want • Use our knowledge to jointly form an understanding • Together choose what will be helpful NOT… • Assessing a passive young person and family • Handing down a diagnosis and treatment plan

  3. Honest Opinion Curiosity Alternatives Alternatives Alternatives Next Steps Choice Point Tasks in the Choice appointment/s Assessment and Risk Joint Formulation Goals Engagement in their Choices

  4. Formulation What is the difference between a summary and formulation? • It’s a description and then an explanation of the bio-psycho-social factors that give meaning to the current situation. • It’s the why after the what.

  5. A Summary – a “what” • A 14 yr old girl who is cutting and low in mood • Mum lives with new partner of 2 years with new baby • Some peer conflict • Domestic violence in past – no contact with dad now • Her diabetic control not stable What questions could you ask to get the meaning – the why?

  6. So her “WHY”… • What does she think are the causes of her low mood and cutting? • E.g. she thinks its conflict with her step father • This is a what! What is the why? • This is getting her world view / formulation. • RISK: Abuse?

  7. But is a SHARED formulation! • Lets say we think its an attachment problem • Created by the early diabetic diagnosis, domestic violence, separation from dad and being pushed out now by baby… How could you talk with her about this idea? So that she understands it? Develops it?

  8. Dilemma • How much of this can you / do you do in the Choice appointment? • Enough to • Identify • Agree

  9. Goals • Primary goal? – not to stop cutting but to feel better • This is a WISH… • SO what has to be different to feel better? (relates to formulation) • Could be.. • Bullying stop, mum sticking up for her, closer relationship with baby, some diabetic support, practical anti-cutting tasks

  10. Lean Thinking • Developed from the Toyota Production Model • PUSH • PULL

  11. Milkman • Push – the milkman delivers every day • The delivery rate come from the milkman • Pull – the family puts out a bottle when they need milk • The rate comes from the choice of the family

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