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2. Aims of Choice Find out what they want Use our knowledge to jointly form an understanding Together choose what will be helpful NOT… Assessing a passive young person and family Handing down a diagnosis and treatment plan 2

3. Tasks in the Choice appointment/s 3 Curiosity Honest Opinion Alternatives Choice Point Next Steps Assessment and Risk Engagement in their Choices Goals Joint Formulation

4. Formulation What is the difference between a summary and formulation? Slide 4 It’s a description and then an explanation of the bio-psycho-social factors that give meaning to the current situation. It’s the why after the what.

5. A Summary – a “what” A 14 yr old girl who is cutting and low in mood Mum lives with new partner of 2 years with new baby Some peer conflict Domestic violence in past – no contact with dad now Her diabetic control not stable Slide 5 What questions could you ask to get the meaning – the why?

6. So her “WHY”… What does she think are the causes of her low mood and cutting? E.g. she thinks its conflict with her step father This is a what! What is the why? This is getting her world view / formulation. RISK: Abuse? Slide 6

7. But is a SHARED formulation! Lets say we think its an attachment problem Created by the early diabetic diagnosis, domestic violence, separation from dad and being pushed out now by baby… Slide 7 How could you talk with her about this idea? So that she understands it? Develops it?

8. Dilemma How much of this can you / do you do in the Choice appointment? Enough to Identify Agree Slide 8

9. Goals Primary goal? – not to stop cutting but to feel better This is a WISH… SO what has to be different to feel better? (relates to formulation) Could be.. Bullying stop, mum sticking up for her, closer relationship with baby, some diabetic support, practical anti-cutting tasks Slide 9

10. Lean Thinking Developed from the Toyota Production Model PUSH PULL Slide 10

11. Milkman Push – the milkman delivers every day The delivery rate come from the milkman Pull – the family puts out a bottle when they need milk The rate comes from the choice of the family Slide 11