GUIDELINES: Case Study 1 - Formulation



Appendix 5.2

Writing and Marking Guidelines – Clinical Studies 2 and 3: Intervention and Evaluation (submitted at end of year 1 and mid-point of year 2)

Overview

Please submit with a signed Declaration and a completed Coursework Confidentiality Checklist.

In these clinical study reports you are required to build on the skills developed in Clinical Study 1. Again you are required to formulate a piece of clinical work from your placement from the perspective of two different psychological models. In Clinical Study 2 and 3 you are now required to describe how you have implemented your formulation(s) into the intervention and how you have evaluated the outcome(s). You should offer a clear summarised description of the work that you have conducted and offer evidence, (quantitative and/or qualitative as appropriate) for the outcomes. It is also important that you describe how, as your work progresses, you have revised your formulation(s). The supervisory relationship should also be considered in terms of how it helped to you to shape up your formulations, interventions and the development of the work. It is important that you offer a critique including your personal reflections on the work and the nature of the therapeutic relationship that has developed.

The work will usually be based on psychological therapy and/or other interventions for an individual or couple/family or on work with groups, or with teams or organisations e.g. team development work, supervision or consultation.

You may wish to discuss the suitability of your choice of clinical work with your academic/appraisal tutor, and you may submit a preliminary draft of Study 2 to them for feedback and comment.

General aim

To assess your ability to conduct a substantial piece of clinical work which has employed at least two models in the formulation of the problems and shows the application of at least one model in the work conducted with (a) client(s).

Word limit – 5,000 words including tables and references but excluding appendices. Word guidance for sections is indicative only; you can be flexible with these. If you go more than 10% over word limit this will normally automatically mean a Conditional Pass and the work will be returned for shortening.

Format of report

Abstract: of no more than 250 words

Background and assessment - Include the process of referral, the client/s’ initial presenting problems and strengths/resources and, where relevant, information gained from liaison with client/s’ family members, carers and/or other professionals. Consider the client/s’ and/or key network members’ perspectives on their current situation and expressed needs and hopes. Describe qualitative methods of gathering information and any psychometric measures used at assessment. Note any limitations to opportunities to gather relevant information. Address issues of risk and risk management. Where relevant the assessment should include a genogram and time-line clarifying key events in the client/family’s life that are relevant to the issues to be addressed in the work. Summarise the information gained in terms of predisposing, precipitating, maintaining and protective factors at a range of levels. Ensure that you include all the relevant information that is drawn on in the subsequent formulations. Ensure that you address issues of consent and confidentially (word guidance 1000 words).

 

Brief review of relevant literature: briefly summarise key relevant theoretical and empirical background information to the two formulation models chosen. This will require conceptualisations of the kinds of problems displayed by the client/s within each model, including reference to the evidence base for practice and, where relevant, practice-based evidence which supports the application of each model to an understanding and treatment of the presenting issues (word guidance 500 words).

Formulation - Describe the formulation from each model in turn - formulations should be presented succinctly. They should draw on and be clearly supported by the information presented in the background/assessment of the case (do not repeat material presented in background section though). You may find it useful to consider a preliminary formulation based, for example, on initial referral information and first impressions, followed by a second more detailed formulation based on a more substantial assessment. Describe the development of your thinking; for example in moving from initial impressions to preliminary and subsequent formulations. Attempt to combine your ideas into a brief, integrated summary formulation that can underpin working hypotheses for continuing work/ intervention. Give an indication of how you might negotiate and share your thinking on the formulation with your client(s) or with key people in the client’s network, including the referrer (word guidance 500 words).

 

Interventions/work conducted and evaluation – Explain how the formulations informed your plan for intervention, and how this was negotiated with the client/family. You may choose to describe either how the work progressed in relation to only one of the formulations, or in relation to an integration of both formulations. (NB if you choose to intervene on basis of only one model you must reflect on possible integration in the critical appraisal/ reflection section of the work.) Then describe the work that was conducted, highlighting specific and important features of the work, indicating what changes you have made in your formulation(s) as the clinical work has progressed. Reformulations should highlight key areas where your and the client/s perspectives have changed and the consequences of this. Explain how the ending of the work was planned and conducted. Describe how the work was evaluated (quantitatively and/or qualitatively). It is usually not appropriate to offer a simple session by session account of the work but rather a more conceptual and integrated overview is required (word guidance 1500 words).

Critical appraisal and reflection: Attempt to identify both strengths and potential weaknesses in the formulations and in the clinical work undertaken, and how weaknesses might have been remedied. Identify any personal factors for yourself and contextual factors that may have impacted on your choice and use of the models. Discuss the relative contributions of the models, and the opportunities and constraints for their integration. Consider the relevance of the formulations and the work conducted for the client’s particular life, circumstances and expressed needs and hopes. Reflect on how your relationship with the client/s evolved and changed and the impact of the work on you, including consideration of the role of supervision in the conduct of the work. Ensure that throughout the work you have been sensitive and thoughtful about issues of social inequalities and cultural diversity (word guidance 1250 words).

Appendices - Include an actual or potential summary letter back to the referrer or client, including succinct summary of reason for referral, client(s) priorities and agreed aims/intentions for the work, key findings from assessment, succinct summary of working formulation and of work conducted, including outcomes so far where appropriate, as well as on-going plans for further intervention, if relevant. The letter should be no more than two sides of A4.

If appropriate, include fully anonymised copies of any questionnaires used, or written information gained from the client which is relevant (diaries or sections of transcripts of conversations, e.g. of recorded family therapy sessions). Include anonymised copies of any letters written by you, as well as initial referral letter and, where relevant, other communications, such as reformulation letters.

Clinical Study 2 and 3: Intervention and evaluation - Marking Grid

 

  |Presentation |Abstract |Background and assessment (incl risk assessment) |Use of Literature |Formulation |Intervention and Evaluation |Critical

appraisal and reflection |Referral/

client letter | |

Excellent |Material exceptionally well organised

according to format in

handbook. Tables, figures, etc. very

well placed &

labelled. References all in acceptable format. Excellent writing style.

No typographical,

spelling, grammatical

errors.

Well within word limit.

|Clear and

succinct

summary that

covers all of the main points.

|The difficulties/issues to be explained in the formulation are very clearly described. Sufficient background

information is provided in a very ordered and

structured way to

enable reader to easily follow the formulations. Includes excellent attention to issues of inequality and diversity.

Consent and confidentially very well addressed. Issues of risk and risk management are thoroughly addressed.  

|General claims and

assumptions are very well supported

by references to appropriate

literature. Shows excellent awareness

of key ideas in the relevant area.

|Demonstrates very sound grasp of the models being used. Offers a very plausible and coherent account of the development maintenance of the identified difficulties. The formulation is very well supported by assessment data or other appropriate means.

Excellent awareness of the connections and contrasts between the models in terms of their conceptualisations of the problems.  Excellent ability to integrate formulations. |Intervention very clearly grounded in formulation(s). Excellent concise summary demonstrating that the work was very well conducted. The work shows strong sensitively to the client/s’ needs and priorities. Excellent evaluation of the work: maybe shows particular attention to innovative methods of evaluation and/or particular attention to psychometric properties of any tools proposed. |Shows excellent

awareness of

potential

weaknesses in the formulation

and indicates

how these might be remedied. Excellent discussion of personal position regarding the choices regarding the models, 

differential use of the models, e.g. in how personal factors may have influenced gathering of information and analysis. Very thoughtful consideration of the therapeutic relationship and role of supervision. |Outstanding

letter to referrer or client; very succinct, very

well structured,

very clearly

written and

including all

relevant key

points. | |

Good

|Material well organised

according to format in

handbook. Tables, figures, etc. appropriately placed and

labelled. References in

acceptable format. Clear writing style.

Very few, if any, typographical,

spelling, grammatical

errors. Within word limit.

|Clear succinct

summary that

covers most

of the main points.

  |The difficulties/issues to be explained in the formulation are clearly

described. Sufficient background

information is provided in an ordered and

structured way to

enable reader to follow the formulations. Includes good attention to issues of inequality and diversity.

Consent and confidentially well addressed. Issues of risk and risk management are well addressed.  

  |General claims and

assumptions are supported

by references to appropriate

literature. Shows good awareness

of key ideas in the relevant area.

|Demonstrates sound grasp of the models being used. Offers a plausible and coherent account of the development maintenance of the identified difficulties. The formulation is adequately supported by assessment data or other appropriate means.

Good awareness of the connections and contrasts between the models in terms of their conceptualisations of the problems.  Good ability to integrate formulations.

  |Intervention clearly grounded in formulation(s). Good concise summary of key elements demonstrating that the work was well conducted. The work shows good sensitivity to the client/s’ needs and priorities. Good plans for evaluation of the work. |Shows good

awareness of

potential

weaknesses in the formulation

and indicates

how these might be remedied. Good discussion of personal position regarding the choices regarding the models, differential use of the models, e.g. in how personal factors may have influenced gathering of information and analysis. Thoughtful consideration of the therapeutic relationship and role of the supervisor. 

|Good letter to referrer or client; quite succinct,

fairly well structured,

reasonably

clearly

written and

including

most relevant

key points. | |       

  

Satisfactory |Material reasonably organised

according to format in

handbook. Tables,

figures, etc.

reasonably placed and

labelled. Most references in

acceptable format. Fair writing style.

May be a few typographical

spelling, grammatical

errors. Word limit exceeded by more than 10% but is otherwise reasonably presented.

. |Reasonably clear/concise

summary that

Includes some key points.

  |The difficulties/issues to be explained in the formulation are reasonably

described. Sufficient background

information is provided in a fairly ordered and

structured way to

enable reader to follow the formulations. Includes some attention to issues of inequality and diversity.

Consent and confidentially are reasonably addressed. Issues of risk and risk management are reasonably addressed.

  |Some general claims and assumptions are unsupported

by references. Some

references are inappropriate

or irrelevant. Some key ideas have been overlooked.

|Minor misunderstandings

of the models or their application in formulation. Some parts of the formulation are not adequately explained, or lack

clear support, or rely on misinterpretations of the evidence.

Some ability to integrate formulations, but some issues regarding compatibility are not adequately explained.

Some misunderstandings

of how the models are compatible or otherwise

  |Intervention reasonably grounded in formulation(s). Reasonable concise summary of key elements demonstration that the work was reasonably well conducted. The work shows some sensitivity to the client/s’ needs and priorities. Fair plans for evaluation of the work. |Some gaps in

the

identification of

weaknesses in the formulation and intervention or

how these might

be remedied. Evidence of personal reflection but limited and not differentiated between the models.  

Some consideration of the therapeutic relationship and role of supervision.

 

  |Fair letter to referrer or client;

could be more

succinct or

better structured,

or more clearly written.

Includes some

relevant key

points. | |            

    

Weak |Unacceptable level of

presentation throughout

the work. Word limit exceeded by more than 10% and/or work is rambling or disorganised  |Summary is

Incoherent or

otherwise fails

to convey an understanding of the work.  |Difficulties/issues to be explained in formulation insufficiently

described; and/or background

information provided in incoherent or unstructured way that does not lead on to the formulations; and/or no attention to issues of inequality and diversity; and/or consent and/or confidentially are insufficiently addressed. Issues of risk and risk management insufficiently addressed.

NB if confidentiality is completely compromised ie client identity is clear through full name, address or identifying number, this normally leads to refer; if partially compromised ie first name, service or worker names given, this normally leads to conditional pass. |Insufficient references to

appropriate literature; and/or many unsupported general claims and assumptions; and/or most key ideas have been overlooked; and/or general claims are made that have no support in existing

literature.

|Serious misunderstandings or poor grasp of the models are

evident; and/or major aspects of the

formulation lack sufficient supportive

evidence; and/or formulation is

incoherent, self-contradictory; and/or insufficient ability to integrate formulations; and/or serious misunderstandings in explaining or considering questions of compatibility between the models.

  |Intervention insufficiently grounded in formulation(s); and/or unclear depiction of the work conducted with some indication that the work was not well conducted; insufficient sensitivity to the client/s’ needs and priorities; and/or insufficient plans

for evaluation of

the work. |No significant attempt made to

critically

evaluate the

formulation and intervention; and/or little evidence of awareness of personal and/or contextual factors in the selection and application of the models in the process of formulation; and/or insufficient consideration of the therapeutic relationship and role of supervisor.

 

  |Poor letter to referrer or client; insufficiently succinct

and/or poorly

structured/ written;

and/or misses most essential key points. | |

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