Abstract
The use of psychosocial forums in paediatric settings has been recommended as a means of providing psychological consultancy. However, no research has explored staff perceptions of these meetings or whether they have a positive impact on patient care. In this study, six members of a paediatric gastroenterology multidisciplinary team were interviewed about their experience of a weekly psychosocial forum using a qualitative approach. The data revealed that staff regarded the forum as an essential and useful part of the service. Staff reported a number of benefits to their clinical work as a result of attending the forum, in addition to the general benefits of having a clinical psychologist available to see patients. However, staff also made recommendations for improving the forum. The results suggest that psychosocial forums may provide an efficient means of delivering specialist psychological consultation for patients with psychological difficulties, in line with Department of Health recommendations for paediatric services. Future research should aim to investigate the effectiveness of psychosocial forums in different settings and to establish the cost-effectiveness of these meetings.
Introduction
The influence of psychological factors on medical outcomes is increasingly recognised (Smith, Kendall, & Keefe, 2002). In many services, there has been a shift towards a more holistic conceptualisation of medical disorders which encapsulates both physical and psychosocial processes (Engel, 1977). As a result, there has been an increased demand for psychologists in a variety of medical settings, and some argue that the area of clinical health psychology has grown more than any other area in clinical psychology in recent years (Latchford, 2006; Sweet, Rozensky, & Tovian, 1991).
The importance of providing psychosocial support in paediatric hospital settings has been emphasised by the Department of Health (2003) in guidance entitled ‘Getting the right start: National Service Framework for children – Standard for hospital services’. This document outlines standards of care for all hospital departments providing care for children, young people and their families. This guidance states that all departments should provide support for patients and their families in coping with illness or disability and that specialist support should be available for individuals struggling with psychological difficulties (Section 3.4 of document).
Despite these recommendations, the demand for psychological support often exceeds supply, which has provoked the need for flexible approaches in delivering psychological input (Latchford, 2006). In medical settings, the role of the clinical psychologist goes beyond direct work with patients to include education, training, research and consultancy with other multidisciplinary team members. One of the aims is to promote a culture of psychological awareness and thus ensure that psychological approaches are applied beyond the confines of direct work with the psychologist (Bryon & Hearst, 2005; Duff & Bryon, 2005).
The provision of indirect consultancy work has the potential to be especially helpful to medical staff who often treat patients with a clear psychological component to their presenting problems. For example, patients seen by paediatric gastroenterology services often have high levels of psychological difficulties across a range of different medical presentations (Brent, Lobato, & LeLeiko, 2008; Clayden, Keshtgar, Carcani-Rathwell, & Abhyankar, 2005; Kim & Ferry, 2004).
Duff and Bryon (2005) state that clinical psychologists should aim to establish weekly psychosocial meetings in paediatric settings in order to provide psychological consultation to multidisciplinary team members. It is proposed that during these meetings members of the team can focus on the psychosocial factors influencing current patient care. Duff and Bryon (2005) state that these meetings should serve a number of functions, including the coordination of referrals, supervision of other team members, teaching opportunities and the arrangement of research collaborations. They also argue that having a regular meeting reinforces the responsibility of all members of staff to consider psychological issues.
Psychologists recommend the use of consultancy approaches, including the use of psychosocial forums, as a routine part of clinical work (e.g. Duff & Bryon, 2005; Llewelyn & Cuthbertson, 2009; Ovretvet, Brunning, & Huffington, 1992). In the United Kingdom, psychosocial forums are integral to the work of many paediatric clinical psychologists. However, there is currently no published research evaluating the effectiveness of psychosocial meetings or how these meetings are perceived by other members of the multidisciplinary team. The aim of this study was to investigate multidisciplinary staff perceptions of a weekly psychosocial forum in a paediatric gastroenterology service. Specifically, the research questions were as follows:
What do staff see as the aims of the forum?
What do staff find helpful or unhelpful about the forum?
Overall, how satisfied are staff with the forum?
Do staff think that the psychosocial forum has influenced their clinical practice and the care that patients receive?
How do they think the psychosocial forum could be improved?
Addressing these aims will allow improvements to be made to the psychosocial forum. In addition, answering these questions may provide useful information for setting up and improving psychosocial forums in other settings.
Method
Design
A qualitative design was preferred over a quantitative approach. This is because qualitative studies are less constrained and so allow for a greater degree of exploration and discovery (Barker, Pistrang & Elliot, 2002). Given the current lack of research and theory in this area, this was considered particularly beneficial. Second, the nature of the investigation involved rich and complex experiences and so using a qualitative design allowed participants more freedom to express their views (Willig, 2001).
An interview format was chosen for several reasons. Using interviews enabled the researcher to ask for clarification, which would not have been possible using other methods, such as questionnaires. This should have increased the likelihood that the interviewee’s meaning was correctly understood, adding validity to any conclusions drawn. The opportunity to clarify responses was especially important as the interviewer does not work in the same service and so some concepts were unfamiliar.
Another reason for using individual interviews was to try to minimise the likelihood of participants conforming to the views of other members of the team. For example, using a focus group could have resulted in participants conforming to the views of colleagues who are perceived to be higher up in the professional hierarchy and therefore the data would not have reflected peoples’ true opinions (Abbasi, 2009).
In order to check the quality of the interview questions, feedback was sought from two members of the multidisciplinary team from different professional backgrounds. These team members did not think that the questions needed changing, although one of these respondents requested that the researcher have some simple closed questions available to help those who would find answering broad questions more difficult, and so these were considered and kept in mind during the interviews. Additionally, a pilot interview was conducted with a different member of the multidisciplinary team. No alterations were required following this interview, and so this participant’s data were included in the analysis. Consent to include the pilot data in the main data set was granted by the pilot participant.
A critical realist position was assumed by the researcher, which asserts that there is an underlying reality but that this reality is investigated through subjective perceptions and interpretations (Mays & Pope, 2000).
Participants
Participants were six members of the multidisciplinary team. A sample size of six was chosen in order to enable the views of staff from a variety of professional backgrounds to be considered, while also being a manageable number for the purposes of data analysis. Morse (2000) has advised that when the nature of the topic under investigation is tightly specified and when participants are articulate and have significant experience in the area under investigation, as is the case in this study, then saturation in the data may occur more quickly. Consequently, a large sample size may not be required. Guest, Bunce, and Johnson (2006) have also provided evidence that the basic components of most themes can be elicited by the analysis of just six interviews in a study aiming to operationalise saturation of the data.
The total multidisciplinary team was composed of 13 members: four paediatricians, five nurses and four allied health professionals. One of the allied health professionals was the clinical psychologist who runs and chairs the forum. The clinical psychologist was not interviewed about the psychosocial forum. Participants had to have attended the forum at least once in the last 6 months in order to participate in the study. All team members who participated had attended the psychosocial forum for at least 6 months. Four participants reported that they attended between one-half and three-quarters of the meetings, and two participants said that they attended at least three-quarters of the meetings.
This study used typical case sampling, as described by Patton (1990), in order to obtain views of a sample typical of the multidisciplinary team. The final sample consisted of one or more members of the three professional groups listed above. Consequently, ‘fair dealing’ was utilised (Mays & Pope, 2000), whereby the recruitment strategy enabled the views of a wide range of professionals to be represented so that the perspective of one professional group was not given as the only way to view the forum.
Procedure
Semi-structured interviews were conducted by the first author (J.L.D.). J.L.D. was a trainee clinical psychologist working in the local area but not working in the Paediatric Service. An interview schedule was utilised; however, it was used flexibly and the ordering of the questions was guided by the answers given by the participant. The interviews ranged in length from around 15 to 30 minutes.
The study was publicised to staff by the second author (S.B.) at the psychosocial forum, at a monthly service meeting and via email. S.B. is the clinical psychologist who works in the service and who runs the psychosocial forum. However, only J.L.D. transcribed and analysed the data. If a team member expressed an interest in the study, S.B. asked for permission to pass on their details to J.L.D., who then contacted them via email to organise a convenient time for participation.
At the interview itself, the participant was given an information sheet about the study, and after they had taken the opportunity to ask any questions, they were invited to complete a consent form and a sheet of brief background information. Each interview was recorded and the recordings were stored on a password-protected memory stick. J.L.D. did not attend any of the psychosocial meetings so that interpretations of participant responses would not be created using the researcher’s experience of the forum. It was hoped that this enabled J.L.D. to remain curious and to understand each participant’s unique perspective. A reflective log was kept throughout the research process in order to facilitate a reflexive approach.
Data analysis
The data collected from the interviews were analysed using thematic analysis. Thematic analysis is a method which allows for the identification, analysis and reporting of themes within a data set. This method provides a flexible approach to qualitative research and analysis (Braun & Clarke, 2006). The main steps outlined by Braun and Clarke (2006) were followed in this study. First, J.L.D. transcribed all of the interviews and read and re-read the data several times in order to increase familiarisation. Second, initial codes were generated before arranging these codes into themes. Next, these themes were reviewed both in relation to the initial codes and the data set as a whole over several iterations. Finally, the themes were named and definitions for the themes were produced. To enhance the validity of the findings, attention was paid to negative cases (Mays & Pope, 2000). This involves looking through the manuscripts for data which do not fit into an identified theme and discussing these cases.
Ethical considerations
This project was given a favourable ethical opinion by the National Research Ethics Service Committee East of England – Cambridge South.
In this investigation, participants were given information about the study prior to participating, and they were given the opportunity to ask any questions before being invited to take part in the study. Additionally, participants were informed both verbally and in the information provided that they had the right to withdraw at any time.
The issue of confidentiality is especially important because the resulting report contains verbatim quotations. In order to address this, participants were informed about this before taking part (both verbally and on the information sheet), and it was explained that names and places would not be included. J.L.D. also took care in the selection of quotations so as to protect the anonymity of participants as far as possible. The quotations provided are not accompanied by the participant number for this same reason.
Results
The analysis revealed five main themes, each of which had several subthemes (see Figure 1). The five themes were (1) positive overall impression, (2) discussion, (3) main roles of the clinical psychologist, (4) influence on clinical work and (5) timing. The themes and their subthemes are outlined below with supporting quotations.
Five identified themes and associated subthemes.
Theme 1: Positive overall impression
This theme describes staffs’ overall perception of the forum, which revealed a generally positive view in which the forum was seen as a worthwhile and vital resource: I think it’s . . . a core and essential addition to our service . . . I think it’s really an essential forum to have in a department like ours because of the amount of psychosocial issues maybe particularly in gastro you know . . . it’s an essential part of the deal.
As part of the interview, participants also provided a rating of their overall satisfaction with the forum on a scale of 1 to 5, where 1 represented very dissatisfied and 5 represented very satisfied. Responses indicated a good level of current satisfaction, with one participant giving a rating of 3, four participants giving a rating of 4 and one participant giving a rating of 5. Most participants indicated that the forum was good but that there could be some improvements. However, with paying attention to negative cases, the participant who gave the forum a rating of three found individual time with the clinical psychologist more satisfying than attending the forum: if I really need [name of clinical psychologist] I go and see her on my own and I probably would then find that . . . more satisfying than sitting through . . . a lengthy forum.
Theme 2: Discussion
An important aspect of the forum reported by staff was the role of discussion within the forum. Discussion was seen as both an aim and a helpful feature of the forum. Staff described current characteristics of the discussions and suggested additions to future discussions.
Current characteristics
Discussing challenging cases
Staff described how one of the main aims of the forum is to discuss patients that they were finding challenging to work with, for example where presenting symptoms were inconsistent with the results of medical investigations. Many of these more challenging cases were thought to have psychological factors impacting upon their presentation. Staff said that discussing these patients was helpful, as they sometimes felt like progress was becoming difficult: it gives you the opportunity to discuss . . . patients, families that have been quite complex and difficult . . . it’s a good opportunity to be able to deal with those more difficult cases where you feel a bit stuck.
Discussing patients as a team
Staff reported that discussing cases as a team was an important aspect of the forum. This involved discussing the case together and listening to alternative viewpoints: it’s quite useful for somebody else to come from a different perspective and say well actually [name of participant] I would have done it this way . . . . . . it’s also very useful to have a forum to be able to express . . . any oddities that you’ve found . . . be able to share it with the team and see . . . whether they agree.
Planning care
Another function of the forum was planning care for patients. Part of this included discussing new referrals to psychology and managing psychology resources: in this meeting we can work out together where best to send this family . . . . . . having the opportunity to debate . . . within the multidisciplinary team and try to come up with a plan that is effective for that family.
Losing focus
Most staff reported that discussion could become unfocused at times. However, there was also recognition that structure can be lost in any meeting and that the clinical psychologist running the forum is good at moving things on: it can become a little bit of a gossip session if we’re not careful, if we’re not focused. [name of clinical psychologist]’s reasonably good at um you know moving on to the next patient.
Suggested additions
Who has the discussion
Some staff reported that having a broader range of professionals represented in the forum would enrich the discussions. However, it was also noted that there might be difficulties in getting these people to attend: What we are missing is a social worker and a school teacher . . . I guess it would be nice to have some additional support from education. I can see that conversation happening over and over again and [name of another colleague] having to struggle with liaising with teachers and schools.
Who is discussed
Some staff also thought that discussing a broader range of cases seen within the service and also an increased focus on inpatients, as opposed to outpatients, would be helpful: I certainly think that inpatients should be more included in the discussion . . . I think the meeting seems to be focusing on the inflammatory bowel disease patients . . . almost entirely taken up by these patients and that other patients are less of a priority.
Theme 3: Main roles of the clinical psychologist
Another theme that emerged from the data was the main roles of the clinical psychologist during the forum. Three main roles were identified and these were seen as aims and helpful features of the forum. Staff also suggested broadening the role to include more teaching.
Advice
One of the main roles of the clinical psychologist was providing recommendations on a wide variety of issues: . . . it’s an opportunity . . . for us to . . . take advice from [name of clinical psychologist] . . . on how we should deal with a particular situation . . . I think it’s to directly speak to [name of clinical psychologist] about patients you have seen and where you perhaps not entirely sure which pathway they should sort of follow now.
Feedback
Another role of the clinical psychologist was to give feedback to the team, for example, regarding an assessment she has done with a patient who was referred to psychology or feedback on the patient’s experience of the referral: it gives us the opportunity . . . to . . . discuss feedback with [name of clinical psychologist] . . . and this means that the next time we see these patients . . . we are able to . . . start from the feedback that we have received.
Updates
Staff stated that one of the aims of the forum was to be kept informed about patients that had been referred to the clinical psychologist, including their progress. This was seen as helpful by staff: so it’s an opportunity really for . . . [name of clinical psychologist] to keep us updated on the patients she is seeing.
Teaching
Some staff requested more teaching input from the clinical psychologist. However, there were also concerns over the limited time available in the psychosocial forum and whether the psychosocial forum was the best context to receive additional teaching: I mean is it the right forum for teaching? . . . you could have a ten minute recent journal or learning point . . . maybe once every two to three months one could have an hour set aside to . . . have a theme . . . I think that would sort of be quite educational.
Theme 4: Influence on clinical work
The fourth theme describes the influence that staff thought the psychosocial forum had on their clinical work.
Airing emotions and influence on patient interactions
Some staff said that they found the chance to express their feelings was a valued and helpful aspect of the psychosocial forum and that this in turn helped them to deal more effectively with patients: I think what it’s made me more do is . . . say ok right this is frustrating, just blurt the frustration out, sort that out in my head and then go back to deal with them differently.
Using psychology expertise
Staff described situations in which the clinical psychologist had been able to provide specialist knowledge and that this had been used to inform the care they were providing. Sometimes this included using psychological formulation, and this in turn would help staff to be more tolerant of patients: it just gives you a much better understanding of where they’re coming from and . . . it helps you modify how you might deal with them . . . there is some added value and you know there is advice that we can’t just make up . . . or have already.
Building confidence with difficult situations
Some staff reported that using the psychosocial forum had helped them to further develop skills in dealing with difficult scenarios with patients: it gives you the opportunity to . . . help myself coping in difficult situations . . . I think also feeling able to say to parents, this certainly has come from the psychosocial meeting, ‘I’m sorry but it’s actually your responsibility to do some of it’. You know, I can only do what I can do for your child. You need to support the rest of the way.
Holistic care
Many members of staff thought that the psychosocial forum was a good way of ensuring that the team was focused on using a holistic approach: it is part of offering good quality and um being able to address problems from every perspective . . . I think it [psychosocial forum] gets people focused on . . . more holistic care of the child.
Sensitivity to psychological problems
Some staff thought that attending the psychosocial forum had increased their sensitivity to detecting psychological problems in their patients. However, others did not think they viewed patients any differently and one participant was not sure either way. One participant thought that although it had not changed the way they saw patients, having the psychosocial forum helped to confirm their instinct that psychological factors were important in the patient’s presentation: I think you become more sensitised to the psychosocial issues in families . . . well certainly the meeting has given . . . a lot of reassurance . . . I think it’s fair to say that the vast majority of the patients which we have . . . recognised psychological issues have been confirmed.
Having a psychologist to treat psychological difficulties
Staff spoke about the general influence of having a clinical psychologist readily available and the psychosocial forum was seen as an efficient means of accessing psychology. Staff found the ready availability of a clinical psychologist extremely helpful, and they outlined three main positive benefits for patients as a result although also raised concerns about needing more psychology input in their service.
Earlier psychological intervention
Staff stated that having a clinical psychologist in the team meant that psychological issues would often get dealt with more quickly as there was somewhere to send these patients. The psychosocial forum was generally seen as a useful route to accessing the clinical psychologist: . . . we’ve become much braver at saying this is not primarily a um organic disease . . . because we can say to them look we can refer you to the appropriate person . . . It (psychosocial forum) affects patient outcome in various ways. In one way um by . . . speeding up the therapy which is needed.
Treatment addresses the problem
Staff stated that having a psychologist to treat symptoms which were caused by psychological factors meant that patients could get better and be discharged. In these cases, staff did not think these improvements would be possible using a medical approach: . . . in some of these patients really we’ve been able to make . . . progress in a way which would have been completely impossible to make . . . without the help of psychology.
Prevents unnecessary medical interventions
Staff described how having psychology input reduced the likelihood that patients received unnecessary investigations, treatments or access to other services, such as second opinion doctors or Accident and Emergency. It was explained that access to psychology meant that treatment was more cost-effective in the long term: I think in the long term . . . it’s [psychology] a more efficient cost-effective way of managing these kids . . . it does affect the outcome in the sense that we are saving these patients and these families from unhelpful investigations.
Need for more psychology input
Many members of staff stated that only the most severe cases are able to see the clinical psychologist but that many other patients would benefit from this input. Consequently, staff felt that increasing the number of hours of psychology input would improve the service: I think it is a bit of a worry because there’s lots of patients that could be referred.
Theme 5: Timing
Another major theme which emerged surrounded time in terms of when the meeting occurs and how long it lasts. All participants stated that the timing of the forum was problematic as it occurs during a very busy day and that this could affect the ability of staff to attend. However, there was also recognition that there was not a good alternative time for the forum.
Discussion
The aim of this study was to investigate staff perceptions of a weekly psychosocial forum in a paediatric gastroenterology service. Interviews about the forum were conducted with six team members in order to investigate (1) staff perceptions of the aims of the forum, (2) helpful and unhelpful aspects, (3) staff satisfaction, (4) the forum’s influence on clinical practice and patient care, and (5) possible improvements. The findings are summarised below.
Positive aspects of the psychosocial forum
The results of this study show that staff saw the psychosocial forum as a core and helpful part of the service. Staff valued the chance to discuss plans for patient care and difficult cases as a team, and they also valued advice, feedback and updates from the clinical psychologist. Staff saw these roles of the clinical psychologist and the team discussion as forming the aims for the meeting. These roles appear to map onto the objectives of coordinating referrals and supervision of other team members, as outlined by Duff and Bryon (2005). Duff and Bryon (2005) also discuss some of the pitfalls of working as a psychosocial professional within a medical environment. However, the comments from team members indicated a positive working relationship between the team members and the clinical psychologist.
Another key finding was that staff listed a number of positive benefits to patient care as a result of attending the psychosocial forum. First, staff explained a number of effects that attending the forum had had on their own clinical work. These included the chance to incorporate psychological expertise gleaned from the forum into their clinical work and the fact that attending the forum generally helped to maintain a focus on holistic care within the team. It is widely accepted by different professional groups that holistic care is essential in Paediatrics (e.g. Kemper, 2000), and the findings of this study appear to support Duff and Bryon’s (2005) assertion that this approach can be facilitated through the presence of psychosocial professionals.
Staff also talked about difficult clinical situations that they had experienced and how the forum had been an opportunity to build skills in dealing with difficult scenarios with patients and also to air difficult emotions, which in turn would help them to deal more effectively with patients. Some staff thought that attending the forum had also increased their sensitivity to psychological issues in patients, although some staff thought that this skill had remained the same. However, for one participant, having a forum to air these concerns provided reassurance that their hunch had been correct. Duff and Bryon (2005) suggest that supervision is one purpose of the forum. Having a space to increase reflective capacity regarding the impact of psychosocial issues with a psychologist may form one important part of this supervision process (British Psychological Society, 2008).
Staff also described the general advantages of having a clinical psychologist available to see patients and staff saw the psychosocial forum as an efficient means of accessing this part of the service. The main benefits to patient care were (a) earlier psychological intervention, (b) having a treatment which actually addresses the cause of the problem and (c) the prevention of unnecessary medical investigations. Staff outlined that access to psychology was more cost-effective in the long term as a result of these benefits. The link between appropriate, timely intervention and cost savings has been especially emphasised in a recent government review of early intervention approaches (Allen, 2011). With an increasing emphasis on cost-effectiveness in modern health care, the benefits outlined by staff in this study support the role of clinical psychology in paediatric settings. However, quantitative cost-effectiveness studies in paediatric psychology are sparse (e.g. Kaplan & Groessl, 2002) despite their importance in demonstrating the added value of psychology input in order to ensure that commissioners purchase these services. Such studies may also provide evidence to support the addition of more psychology resource, as was requested by the team.
Negative aspects of the forum and areas for improvement
While staff were satisfied with the forum overall, two main concerns were raised. First, the timing of the meeting was problematic, as it occurs on a very busy day. Second, staff said that focus could be lost during the meeting. These factors appeared to be related, as the fact that the day was so busy meant that losing focus was even more frustrating to staff. Duff and Bryon (2005) emphasise the importance of placing psychosocial forums carefully within the schedules of the team. However, in this department, there did not appear to be a better alternative time slot available.
Most participants were able to suggest some improvements to the forum. First, some staff suggested that a broader range of people should attend the meeting, such as social workers, teachers and ward staff. Seeing the child and family from additional perspectives may help ensure that formulations are even more holistic, in line with recommendations for Paediatric care (Kemper, 2000). Furthermore, some staff thought that a broader range of patients should be discussed, such as a greater focus on inpatients. Some participants suggested that the clinical psychologist could provide some more teaching input. The inclusion of teaching slots within the psychosocial forum is also recommended by Duff and Bryon (2005). However, there were also concerns from staff over how this would fit into the meeting.
Implications for clinical practice in other settings
The results of the study suggest that the staff in this team saw the psychosocial forum as a useful and essential addition to the service. Additionally, staff were able to outline a number of benefits to their clinical practice as a result of attending the forum. This is one of the key findings of the study. This suggests that psychosocial forums can provide a useful indirect way of providing psychological input to families in a health-care context where there is often limited access to psychology services. The use of psychosocial forums may help ensure that psychological support is provided to more families that come into contact with paediatric services, in line with Department of Health (2003) guidance.
The two unhelpful aspects of the forum appear to reflect the time pressure that staff are under in medical settings, which means that care needs to be taken in setting up psychosocial forums so that they are as convenient as possible to staff and so that meetings are focused. Staff placed high value on the perspectives of a wide variety of professionals, as reflected in their request for other professional groups to attend the meeting, and so forums should aim to invite a broad variety of professionals involved in the child’s care. The arrangement of teaching input appears to be valued by staff. However, decisions on whether the psychosocial forum is the best time to provide this need to be reached with the staff team.
Study limitations and directions for future research
This is the first study to explore staff perceptions of a psychosocial forum in a medical setting, despite the widespread use of these meetings. Consequently, there are no other studies with which to compare the current findings to date.
One limitation of this study is that the views of only one team were explored and future research could investigate staff perceptions of psychosocial forums in different settings. Staff in different medical settings may be dealing with different psychosocial issues, and so it remains for future research to see whether psychosocial forums are as valued in addressing these concerns in these other settings.
The results could have been made more robust by having another researcher analyse the data in order to provide triangulation (Mays & Pope, 2000). The interviews were also relatively short (15–30 minutes), which may have reflected the time pressures inherent in working in a medical setting. Lengthy one-to-one discussions may also be more familiar to psychology professionals but may feel more unusual to non-psychologists, and this may have influenced the shorter duration of some of the interviews.
It is also important to consider whether different responses would have been obtained if the interviewer had not been a trainee clinical psychologist. It is possible that staff were more likely to focus on positive aspects of the psychosocial forum as the interviewer was from the same professional group as the person that runs the meetings. Future research could use a clinician from a different professional group to evaluate psychosocial forums run by psychologists. Additionally, future qualitative studies could involve clinicians from different professional backgrounds in the data analysis phase in order to obtain multiple professional perspectives on the data set, which would further enrich the findings.
The fact that a trainee clinical psychologist conducted the interviews could also have been an advantage. First, J.L.D. had no prior experience of psychosocial forums or of working in Paediatrics. Consequently, this lack of experience may have reduced expectations about the study results and increased openness to a variety of perspectives. Second, the study findings are more likely to have been framed within a psychological perspective, which may aid communication of the study results to psychologists that might be trying to set up or improve psychosocial forums within their own service.
The data suggested a number of clinical benefits as a result of both the general input of clinical psychology in paediatric settings and also as a result of attending the psychosocial forum. Future research should rely on both qualitative and quantitative analyses to further explore these clinical benefits and to investigate the cost-effectiveness of these resources. As this is the first published study to evaluate a psychosocial forum in a medical setting, it may be helpful to conduct more qualitative studies in different settings and then to review key themes across studies. These key themes could then be investigated quantitatively through developing quantitative measures of staff experiences of psychosocial forums. Additionally, using the expert knowledge of team members regarding the clinical benefits of psychosocial forums could guide quantitative research exploring the cost-effectiveness of psychosocial forums.
Footnotes
Funding
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.