cnludlow
commented
8 years ago @gabrielperales @TroyMaeder @mcelearr @Shadows666 I just checked out the online site. It looks great. It is already quite functional. I really like what you guys have done. I really like how the colour implies the direction of the relationship. Thanks for all of your efforts.
I think it is already at a stage where we can demonstrate it to the others? I have some feedback. However, if it isn't possible to incorporate these changes by this evening than it isn't a problem.
Colour
Perhaps it might be more useful if symptoms were red, causal factors blue, and treatments green?
Create a new edge
Perhaps this could be relabelled as create a new connection?
Size
I can see that the size of the circles varies based on the intensity. However, it can be hard to notice. Is there a way to slightly exaggerate this more so that the higher intensity is represented by a much larger circle? Perhaps this won't look good?
Clinician agreement
Clinician agreement and client agreement information can be captured. Did you mean 'supervisor' agreement rather than clinician agreement? Or did people think it would be interesting to see how much confidence the clinician has in the factor being true?
Variable information (description box)
In the variable list, perhaps there could be an additional information column (saying Yes or No) if the clinician has entered any information in the description box.
This is an example of a formulation I just made with your program!
mcelearr
TroyMaeder
Future Possible Functions
The formulation program has some current functions such as specifying variable name (i.e., causal factor, symptom, treatment), and specifying each variable's intensity, duration, and strength of relationship.
This entry discusses a range of other possible functions that could be expanded upon in the future:
Iterations
Ideally, formulations are updated as treatment progresses. For example, as the clinician learns more about the patient the clinician updates the formulation. Initially, the clinician may believe that the patient’s depression is caused by current stressors (e.g., parental divorce). However, after some discussion evidence might emerge that the patient is more worried about future dangers linked to a past stressor (e.g., the patient may have been the victim of a robbery in the past, which they continue to worry about). As such, it would be good adding new variables to the formulation. It would be helpful for the clinician, patient, and treatment team to be able to review the past iterations of the formulation. This might be (a) to help others understand past reasoning decisions that have led to the current formulation and (b) for documentation and quality assurance purposes.
Review mode
It would be helpful for future versions of Formulate to have a review mode. There would be three types of reviews (a) with client, (b) supervisor, and (c) with the clinical team.
In the ‘client review mode’ the formulation is shared with the client and the client’s feedback is incorporated into the formulation. Feedback might include things like how important the client thinks certain causal factors are in causing his or her symptoms (the client could also state how important they think certain symptoms are). Additionally, the client could comment on how much they agree with the treatment strategies, and how confident they feel that they could follow through with such strategies. The terms ‘importance’ and ‘confidence’ carry some meaning within psychology, as they are linked to a motivational theory of behaviour change (i.e., research indicates that clients are more successful with behaviour change if they perceive the symptom/behaviour as being important to change, and if they have the confidence to change the symptom/behaviour). Furthermore, the client mode could improve ‘collaborative care’ between patient-and-clinician, which is a factor associated with positive outcomes in treatment.
In the ‘team review mode’ and the ‘supervisor review mode’, the clinician would share the formulation with the team, and the feedback is captured by the formulation program. The program would allow the team to indicate how much they are in agreement with the clinician’s treatment strategies.
Giving treatments an ‘evidence-based rating’ in a clinical audit mode
This one won’t be popular with clinicians. However, it could be very helpful for a clinical audit. All services are required to carry out clinical audits to make sure that treatments are safe and effective.
An auditor or a supervisor could examine ‘treatments’ and give each treatment a grading. For example, the Centre for Evidence-Based Medicine at Oxford has a grading level from A through to D. A treatment with an ‘A’ rating would be based on a randomised controlled trial, and a ‘D’ rating would be a treatment based on expert opinion. So, for example, if a client with OCD is given family therapy , Freudian therapy, or supportive therapy the treatment would be rated as a ‘D’ as there is little evidence that these therapies help people with OCD. However, if the client received a therapy specifically made for OCD which is recommended by the NICE Guidelines (i.e., CBT) then it would be given a grading level of ‘A’.
Clinical audits could then be run be a service, and they would indicate how consistent treatments in the service are with evidence-based principles (e.g., 40% of treatment strategies were given a grading of ‘A’).
Measured Variables
There is a difference between a hypothesised variable and a variable that is measured with a valid and reliable measure (e.g., a depression test). We might say that we have more confidence that a variable is ‘real’ if it has been measured by a valid test. As such, the visualisation could find a way of representing this confidence by either indicating the score in the variable (e.g., a depression symptom could have the number ’70’ in the middle, indicating a t-score of 70 on a depression test). The score could have an asterisk next to it if it is in a ‘clinical range’ to help clinicians understand the meaning of the score.
Treatment Plan Function
There could be a function that asks the clinician to estimate the length of treatment (e.g., 10 sessions, 15 sessions, 20 sessions). Once this has been estimated then the clinician could specify in the treatment variable when they want to target the variable (e.g., session 1, 2, 3, and 4). This could then generate a graphical representation of when certain variables will be targeted, which essentially would be a treatment plan.
History of a variable
A calendar function could be used to specify the history of each variable. For example, a client might have social phobia and agoraphobia. The social phobia symptom might precede the agoraphobia by 2 - 3 years and this could be indicated on a calendar. Furthermore, the agoraphobia might be only quite recent (e.g., past two months).
Types of variables
Mental health clinicians talk about different types of variables or causal factors such as predisposing (i.e., not directly causing but playing a role, such as a parent with schizophrenia), precipitating (i.e., the variable or stressor that triggered the client’s current problems), perpetuating/maintaining (i.e., variables that keep the problem active right now, such as depressive thinking). In addition, it can be helpful representing positive variables/factors (resilience factors), such as high intelligence or a supportive family.