Natalie talked about how it centred practice on occupation .
Both used the Model of Human Occupation to guide their thinking and found that articulating someone ’ s circumstances through formulation brought new understandings . This change in thinking also altered the language they used when working with people to be more personcentred and friendly , particularly when working in more medical areas of occupational therapy practice .
Natalie spoke of how formulation brought greater collaboration to her practice ; it gave a sense of working with someone .
The time to complete and write a formulation was a challenge in some settings , although with practise , occupational therapists said that they got quicker . It could also be a challenge deciding which people would benefit most from a formulation , such as those needing long or shortterm intervention or those experiencing limited motivation .
All reported the positive impact of formulation on assessment , goals and intervention . The occupational formulation process meant that assessments and goals focused on occupations and formulation provided the stimulus and bridge from one to the other .
Setting a small number of person-centred goals showed positive effects and made outcomes achievable , even in acute faster paced settings .
Using occupational formulation within multidisciplinary teams has generally been a positive experience . In some settings the use of the 5 Ps Model , commonly used in clinical psychology , remained the team ’ s approach .
Richard reported how occupational formulation had , however , brought a new perspective and when shared with some of his team was embraced as being brilliant . Lorrae was excited to report of a colleague who has been presenting formulations and her colleagues now expect her to contribute an occupational formulation in the weekly care planning meeting .
Natalie spoke about how occupational therapy students were beginning to come on placement with some knowledge of occupational formulation and that she is encouraging them to use the structure to lead to the writing of meaningful occupational goals .
What of its future ?
We talked about the future of occupational formulation . Cassie is conducting research to explore how occupational therapists can use formulation in a community paediatric diagnostic team . There are challenges here about the dominance of medical diagnosis , but also the opportunity for new ways of understanding to offer a broader perspective of a child , their interests and their roles .
Lorrae has been implementing and researching occupational formulation in a forensic mental health setting and while evaluation is ongoing , impacts on occupational therapy practice are starting to be seen , including increased understanding of the practice process , application of theory , articulation of reasoning , occupation focus , recovery focus , collaborative care planning and continuity of care .
There were some practical suggestions that can inform the future direction of formulation , including digital versions , greater guidance on how detailed goals should be , how to help people identify goals and when to review a formulation .
The practice and research of occupational formulation and measurable goals continues to contribute to its evolution . As a concept it should deepen our understanding of people using an occupational lens . In practice it should provide a practical way to structure and make explicit our professional reasoning .
For the people we work with it should be an accessible way to make sense of what is going on for them with a way forward .
Brooks R , Parkinson S ( 2017 ) ‘ Occupational formulation : a three-part structure ’. British Journal of Occupational Therapy . 81 ( 3 ): 177- 179
Parkinson S , Brooks R ( 2020 ) A guide to the formulation of plans and goal in occupational therapy . Routledge : Abingdon , Oxon .
Words DR ROB BROOKS , Associate Professor Occupational Therapy , University of Bradford .
34 OTnews February 2023