Table Of ContentTeam-Based Shared Formulation
for Psychosis
Adding to the growing literature on shared formulation, the authors provide over two
decades of practice-based evidence for the use of a Shared Assessment, Formulation
and Education (SAFE) approach to working with those with complex mental health and
behavioural needs.
The SAFE approach offers an evidence-informed framework for multidisciplinary
teams to address the needs of those with complex and enduring psychosis for whom current
evidence-based interventions are ineffective in promoting their recovery. Drawing from
richly detailed case studies, the authors provide a range of useful tools and formulation
templates for use by clinicians and professionals alike. They put forward a shared language
to promote a multidisciplinary understanding of service users’ complex needs and a means
of organising treatment into a focused, realistic and targeted approach aimed at reducing
barriers to recovery and allowing individuals to lead personally meaningful lives. The book
focuses predominantly on the treatment of those with psychosis who require bespoke,
multi-theory informed care.
This work will be an invaluable resource to professionals working with this client group,
including clinical and counselling psychologists, psychiatrists and other allied health
professionals.
Alan Meaden is a consultant clinical psychologist with over 25 years of experience working
in designing and researching rehabilitation services. He formed part of the leading research
team in the development of cognitive-behavioural approaches to command hallucinations
and has published extensively in this area. Throughout this period, he continued to work as
a clinician developing clinical insights through his work with service users, their families
and the teams that supported them. After retiring from managing a substantial NHS
psychology service, he continues to work as a freelance consultant, supervisor and trainer.
Andrew Fox is a clinical psychologist working across inpatient recovery and rehabilitation
services. He is also a lecturer in the Centre for Applied Psychology at the University
of Birmingham. Much of his work involves trying to develop an understanding of the
psychology of complex mental health needs in an effort to enhance well-being.
Henna Hussain is a clinical psychologist currently working for Birmingham and Solihull
Mental Health NHS Foundation Trust. Henna works in both a Community Mental Health
Team and in Recovery and Rehabilitation inpatient services. Prior to this, she worked for
two years in addiction services within the same trust.
‘Improving the recovery and quality of life for people with psychosis is nearly always a
team-based responsibility: whether in early intervention, assertive outreach, rehabilitation
or generic mental health teams. I have always been struck by the differences between
teams with the same function in their capacity to absorb and manage risk safely without
jeopardising their fundamental mission to care, empower and promote recovery and well-
being. I’ve never quite been able to put my finger on why teams differ in this way; perhaps
leadership, structure, model fidelity, expectations, etc., let alone how to work with a whole
team to hit the sweet spot. Alan Meaden, Andrew Fox and Henna Hussain have dedicated over
two decades’ work to this task with spectacular results. In this book they demonstrate with
clarity and accessible case material their approach built on a team-based shared formulation,
and how it can provide a solid foundation for interventions delivered by the whole team,
such as relapse prevention, easing distress from the troubled internal world, through to social
recovery. This is the key to the successful translation of evidence-based interventions through
a team platform and is essential reading for all psychosis teams. I cannot recommend it highly
enough.’
Max Birchwood, Professor of Youth Mental Health
at Warwick Medical School, University of Warwick
Team-Based Shared
Formulation for Psychosis
The SAFE Approach
Alan Meaden, Andrew Fox
and Henna Hussain
Cover image: © Image Source/Getty Images
First published 2023
by Routledge
4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
605 Third Avenue, New York, NY 10158
Routledge is an imprint of the Taylor & Francis Group, an informa
business
© 2023 Alan Meaden, Andrew Fox and Henna Hussain
The right of Alan Meaden, Andrew Fox and Henna Hussain to be
identified as authors of this work has been asserted in accordance
with sections 77 and 78 of the Copyright, Designs and Patents
Act 1988.
All rights reserved. No part of this book may be reprinted
or reproduced or utilised in any form or by any electronic,
mechanical, or other means, now known or hereafter invented,
including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from
the publishers.
Trademark notice: Product or corporate names may be trademarks
or registered trademarks, and are used only for identification and
explanation without intent to infringe.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British
Library
Library of Congress Cataloging-in-Publication Data
A catalog record for this book has been requested
ISBN: 978-0-367-53668-8 (hbk)
ISBN: 978-0-367-53667-1 (pbk)
ISBN: 978-1-003-08281-1 (ebk)
DOI: 10.4324/9781003082811
Typeset in Times New Roman
by Apex CoVantage, LLC
Contents
List of Appendices vii
List of Figures viii
List of Tables ix
Acknowledgements x
Note on the Cover Image xi
List of Abbreviations xii
Introduction 1
1 Understanding Risk and Problematic Behaviour in Psychosis 4
2 Getting Started: Assessing and Formulating the Team and
the Service 16
3 Shared Formulation: Principles and Practice in SAFE 28
4 Risk Assessment in SAFE 38
5 Using Early Warning Signs in SAFE 57
6 CARM Revisited 72
7 Planning and Delivering Behavioural Interventions in SAFE 92
8 Using TBCT to Modify the Person’s Internal World 105
9 Intervening Across Internal and External Domains of the
Person’s World 126
vi Contents
10 Using Multiple Shared Formulations to Inform Care
Planning and Intervention 142
11 Applying SAFE to Other Settings 160
12 Measuring Outcomes and Capturing Change 175
Concluding Remarks 189
Appendices 192
References 204
Index 219
Appendices
1 Service Level Formulation Template 194
2 CARM Template for Active Behaviours 196
3 CARM Template for Passive Behaviours 197
4 Static-Dynamic Risk Formulation and Care Plan 198
5 Challenging Behaviour Record Sheet for Psychosis (CBRS-P) 199
6 Resettlement Scale 200
Figures
3.1 The Cognitive ABC Formulation 32
6.1 Timothy’s CARM for Inappropriate Questions and
Sexual Remarks 80
6.2 Sandra’s CARM for Passive Behaviours 86
6.3 CARM-Informed Service User and Staff ABC 90
8.1 CARM Formulation of Luke Not Using a Mobile Phone 124
11.1 Emma’s CARM for Taking an Overdose 170
Tables
1.1 ABC Formulation 14
4.1 Evidence-Based START Strength and Vulnerability Items for
Each Area 46
5.1 Rakeem’s Team-Based Stress Management Plan 61
5.2 Steve’s EWS-R Plan for Physical Violence Towards Others
(e.g. punching, hitting) 69
7.1 Paul’s PBS Plan 98
7.2 Paul’s CBRS-PPBS 100
8.1 Steve’s ABC 112
8.2 Steve’s Staff’s ABC 113
8.3 Steve’s ABC TBCT Plan 114
10.1 Steve’s SLF 145
10.2 Steve’s SMART Goal for Community Integration 146
10.3 Steve’s START Items for Key and Critical Areas 147
10.4 Steve’s Static-Dynamic Risk Formulation and Care
Plan – Physical Assault (with or without weapons) 152
10.5 Otis’s Key and Critical Area Items for Substance Use and Suicide 156
10.6 Otis’s Static-Dynamic Risk Formulation and Care Plan 157
10.7 Otis’s SMART Goal for Developing a Social Network 158
11.1 Richard’s Team-Based Safety Plan 166
11.2 Emma’s EWS-R Plan for Taking Overdoses 171
12.1 Linking Assessment Recommendations to Care Plan Monitoring 179
12.2 Jocelyn’s Service Level Reformulation Changes 183
12.3 Changes in START Areas 185
12.4 Changes in START Item-Rating Supporting Evidence 186
