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This study aims to improve the efficiency of the assessment process within a Step4 Psychological Therapies Service by identifying factors related to assessment non-attendance and service suitability for referred clients.

Referral and assessment information was accessed between October 2019 and March 2020 from Step4 routine service data, electronic client records where necessary and Step4 staff self-report questionnaires.

All clients offered an assessment during this time attended. Findings indicated several factors could influence service suitability in meeting client need. These included individual differences such as readiness to change, which was not necessarily identified at referral or prior to assessment, and potential systemic factors, such as the opt-in procedure, which possibly impeded access. Though the necessity for assessment in clarifying client needs and treatment was indicated, an assessment (from referral to assessment appointment) that led to discharge could take an excess of one working day of service time, associated with considerable opportunity cost to other clients awaiting assessment. Recommendations are made for improving assessment efficiency.

With a high prevalence of poor mental health in the UK, efforts must be made to identify and reduce additional demand upon service time and resources within mental health services to effectively meet people’s needs. Recommendations to improve assessment process efficiency include the use of a standardised referral form, offer of follow-up support procedures, increased client involvement, a streamlined opt-in battery and ongoing monitoring to ensure shared practice between clinicians. These are transferable to other mental health services, with implications for subsequent quality and timeliness of care.

Despite the popularity of team formulation, there is a lack of knowledge about workable implementation in practice. The purpose of this paper is twofold: first, to characterise team formulation, based upon examples from practice; and second, to identify factors perceived to support or obstruct workable implementation in practice.

An online survey recruited UK Clinical Psychologists (n=49) with experience in team formulation from a range of work contexts. Examples of team formulation in practice were analysed using both deductive and inductive framework analysis.

Four novel types of team formulation with different functions and forms are described: case review, formulating behaviour experienced as challenging, formulating the staff-service user relationship and formulating with the service-user perspective. A number of factors perceived to support and obstruct team formulation were identified including team distress, facilitating change, managing difference and informing practice. These were common across team formulation types.

The team formulation types identified could be used to standardise team formulation practice. Several common factors, including managing team distress, were identified as aiding workable implementation across team formulation types. Future research should investigate the key processes and links to outcomes of team formulation in practice.

This paper presents two original, practice-based and practice-informing frameworks: describing, first, novel forms and functions of team formulation and, second, the factors supporting and obstructing facilitation in practice. This paper is the first to highlight the common factors that seem to facilitate workable implementation of team formulation in practice.

Implementing trauma informed care (TIC) for individuals facing homelessness and multiple disadvantage is proposed to help both service users and staff work effectively and therapeutically together. However, the effectiveness of implementing TIC via training is debatable. This study aims to explore the effects of a four-day TIC and psychologically informed environments training package in such services.

The analysis explores the effect of this training on the degree of TIC as measured by the TICOMETER, a psychometrically robust organisational measure of TIC. The study examines group and individual level changes from before training and again at six-month and one-year follow-up time-points.

At the group level analysis, three of the five TICOMETER domains (knowledge and skills, relationships, and policies and procedures) were higher when compared to pre-training scores. The remaining two domains (service delivery and respect) did not improve. Individual-level analysis showed some participants’ scores decreased following training. Overall, the training appeared to modestly improve the degree of TIC as measured by the TICOMETER and these effects were sustained at one-year follow-up.

Findings are limited by the design and low response rates at follow-up.

Training is necessary but not sufficient for the implementation of TIC and needs to be complemented with wider organisational and system-level changes.

This paper is the first UK study to use the TICOMETER.

The purpose of this paper is to explore staff and service users’ perceptions of therapeutic principles within a unique male high secure learning disability therapeutic community (LDTC).

A qualitative approach was adopted using deductive content analysis and inductive thematic analysis. In total, 12 participants took part in a semi-structured interview to explore their perceptions of Haigh’s (2013) quintessence principles and any further additional therapeutic features in the environment not captured by the theory.

All five quintessence principles were identified in the LDTC environment. Some limits to the principle of “agency” were highlighted, with specific reference to difficulties implementing a flattened hierarchy in a forensic setting. Additional therapeutic features were identified including; security and risk, responsivity, and more physical freedom which appear to aid implementation of the quintessence principles.

The study was performed within a single case study design. Therefore, results remain specific to this LDTC. However, the finding of these principles in such a unique setting may indicate Haigh’s (2013) quintessence principles are evident in other TC environments.

This is the first research paper that has attempted to test whether Haigh’s (2013) quintessence principles are evident within a given therapeutic community. The research provides empirical evidence for the quintessence principles in a novel TC setting and suggests recommendations for future research.

The purpose of this paper is to evaluate the effectiveness of psychological treatments and identify required adaptations to increase acceptability and improve outcomes for people with dementia or mild cognitive impairment who experience psychological distress.

The Cochrane Dementia and Cognitive Improvement Group Specialised Register and other databases were searched for eligible studies. Inclusion criteria identified nine randomised controlled trials comparing a psychological intervention (cognitive behavioural therapy, relaxation training therapies, multimodal therapies, psychodynamic therapy, counselling and cognitive rehabilitation) with usual care, with measures of depression and/or anxiety as an outcome. The appraisal of papers was conducted using the Mixed Methods Appraisal Tool. Data was analysed using meta-analysis.

A small, significant effect size before to after intervention was revealed, suggesting that psychological treatments may be effective in reducing psychological distress in people with dementia, with several therapy adaptations identified.

Because of methodological limitations and a small number of studies evaluated, the quality of evidence was low for outcomes for depression, and there were no significant outcomes in anxiety.

The current review offers a unique contribution in identifying specific adaptations deemed helpful in improving the accessibility and acceptability of therapy for people with dementia, suggesting therapy can be adjusted enough to support this client-group. Future studies should use high-quality trials using standardised psychological interventions, of sufficient length, with long-term follow-up and offer of specific adaptations to increase accessibility and outcomes.

The purpose of this systematic review was to address two questions: what is the qualitative evidence for the effects of the Wellness Recovery Action Plan (WRAP) training, as perceived by adults with mental health difficulties using it? What is the quality of qualitative literature evaluating WRAP?

Five electronic reference databases and the EThOS database for unpublished research were systematically searched, as well as two pertinent journals. Study quality was assessed using Critical Appraisal Skills Programme criteria and results analysed using thematic synthesis.

Of 73 studies, 12 qualitative papers met inclusion criteria and were generally good quality. Analyses demonstrated expected findings, such as increased understanding and active management of mental health in the context of group processes. Results also highlighted that WRAP training promoted acceptance and improved communication with professionals. Peer delivery of WRAP was highly valued, with contrasting perceptions of peers and professionals evident. Some cultural considerations were raised by participants from ethnic minorities.

WRAP training participation has positive self-perceived effects beyond those captured by measures of recovery. Broader implications are suggested regarding earlier access to WRAP, professional support and communication between professionals and service users. Recommendations for further research include the relationship between social support and illness self-management and peer-delivered acceptance-based approaches. Multiple time-point qualitative studies could offer insights into WRAP training processes and whether changes are sustained.

As the first review of qualitative evidence regarding WRAP training, value is offered both through increased understanding of outcomes and also guidance for future research.

Work-related stress amongst staff working in direct care roles in mental health and intellectual disability settings is associated with a range of problematic outcomes. There has been a proliferation of research into the use of acceptance and commitment therapy (ACT)-based interventions in this staff population. The purpose of this paper is to review the extant literature.

A systematic search of the literature was conducted, and seven studies identified which met the criteria for inclusion in the review, of which four were eligible for meta-analysis.

Results of the meta-analysis were most convincing for the effectiveness of ACT-interventions to reduce psychological distress within a subgroup of those with higher distress at baseline. There was no statistically significant effect for the amelioration of burnout, nor for an increase in psychological flexibility (a key ACT construct).

Conceptual issues are considered including the purpose and treatment targets of ACT interventions, such as supporting valued living rather than diminishing stress per se. Methodological issues are discussed around the measurement of psychological flexibility.

This review makes recommendations for future research and for the implementation of ACT-interventions for work-related stress in these settings.

This paper aims to propose a new robust membrane finite element for the analysis of plane problems. The suggested element has triangular geometry. Four nodes and 11 degrees of freedom (DOF) are considered for the element. Each of the three vertex nodes has three DOF, two displacements and one drilling. The fourth node that is located inside the element has only two translational DOF.

The suggested formulation is based on the assumed strain method and satisfies both compatibility and equilibrium conditions within each element. This establishment results in higher insensitivity to the mesh distortion. Enforcement of the equilibrium condition to the assumed strain field leads to considerably high accuracy of the developed formulation.

To show the merits of the suggested plane element, its different properties, including insensitivity to mesh distortion, particularly under transverse shear forces, immunities to the various locking phenomena and convergence of the element are studied. The obtained results demonstrate the superiority of the suggested element compared with many of the available robust membrane elements.

According to the attained results, the proposed element performs better than the well-known displacement-based elements such as linear strain triangular element, Q4 and Q8 and even is comparable with robust modified membrane elements.

Background: Quality of life is a core concern for cancer patients, which can be negatively affected by illness-related death anxiety; yet understanding of how to appropriately target psycho-oncological interventions remains lacking. We aimed to explore experiential acceptance in cancer patients, and whether acceptance – as an alternative to avoidant coping – was related to and predictive of better quality of life and death anxiety outcomes.

Methods: We used a longitudinal, quantitative design with a follow-up after three months. Seventy-two participants completed a questionnaire-battery measuring illness appraisals, acceptance and non-acceptance coping-styles, quality of life, and death anxiety; 31 participants repeated the battery after three months.

Results: Acceptance was an independent explanatory and predictive variable for quality of life and death anxiety, in the direction of psychological health. Acceptance had greater explanatory power for outcomes than either cancer appraisals or avoidant response styles. Avoidant response styles were associated with greater death anxiety and poorer quality of life.

Conclusions: The findings support the role of an accepting response-style in favourable psychological outcomes, identifying a possible target for future psychological intervention. Response styles that might be encouraged in other therapies, such as active coping, planning, and positive reframing, were not associated with beneficial outcomes.

Data gathered from routine clinical settings is complementary to evidence garnered from controlled efficacy trials. The purpose of this paper is to present individual-level analysis of changes in a group of patients discharged from psychological therapy within an outpatient pain service. The service had recently shifted from a traditional cognitive-behavioural approach to one underpinned by Acceptance and Commitment Therapy.

Reliable and clinically significant change methodology was applied to CORE-10 outcomes for 27 patients discharged during 2013-2014. Outcomes were compared to 2012-2013. A patient satisfaction questionnaire was administered and functional outcomes were collated.

Outcomes were not adversely affected by the shift in service focus as clients demonstrating reliable improvement increased from 2012-2013; 81 per cent reliably improved, 44 per cent made a clinically significant improvement. Increases in returning to work/unpaid activities at post-treatment were noted. The service met a number of NICE quality standards concerning the “relational” aspects of care.

Clinical effectiveness is evaluated through one outcome measure thereby limiting conclusions. The longer term effectiveness of the service remains unclear. Narrow demographic information limits an assessment of any systematic biases in findings. Little is known about treatment drop-outs.

A number of recommendations concerning data collection and future service evaluations are made.

Returning to paid or unpaid activities has a high public health impact.

This paper contributes towards the evidence base for using psychological therapies with clients experiencing chronic pain and related distress. Importantly, the paper complements evidence for general efficacy (from large-scale controlled studies) through an evaluation of real-world effectiveness (i.e. practice-based evidence).