Developing the Biopsychosocial Formulation

The biopsychosocial formulation is important for prioritizing and integrating the information obtained into an explanatory hypothesis that is helpful for the patient, family, and medical team. It must succinctly describe the current problem, place it in context, explain why it has occurred, and offer direction for intervention. The formulation should foster increased understanding and empathy toward the patient and family. Biological, psychiatric, and social dimensions need to be evaluated both separately and in relation to each other (Richtsmeier and Aschkenasy 1988). These dimensions need to be placed in the context of a patient's developmental and life circumstances. The formulation should always include a careful weighing of those factors in the patient's life that promote development and allow for recovery.

The daunting task of organizing and selecting the appropriate biopsychosocial data to be used in a formulation begins with a review of the presenting problems and identification of the two or three ele

Table 3-5. Selected assessment instruments to assess general psychiatric functioning and illness-specific symptoms in the physically ill child

Coping and defenses

Response Evaluation Measure (Steiner et al. 2001)

Weinberger Adjustment Inventory (Weinberger and Schwartz 1990)

Delirium

Delirium Rating Scale-Revised-98 (Trzepacz et al. 2001)

Mini-Mental State Examination (Folstein et al. 1975)

Family functioning

Family APGAR Questionnaire (Smilkstein 1978)

Parental Stressor Scale: Infant Hospitalization (Miles and Brunssen 2003)

Parental Stressor Scale: Neonatal Intensive Care Unit (Miles et al. 1993)

Parental Stressor Scale: Pediatric Intensive Care Unit (Carter and Miles 1989)

Psychosocial Assessment Tool (Pai et al. 2008)

General psychiatric functioning

Behavioral Assessment System for Children, 2nd Edition (W.M. Reynolds et al. 2004)

Child Behavior Checklist (Achenbach 1991)

Functional Disability Inventory (Walker and Greene 1991)

Mini-International Neuropsychiatric Interview-Kid for children and adolescents (Sheehan et al.

1998)

Pediatric Symptom Checklist (Jellinek et al. 1988)

Semi-Structured Clinical Interview for Children and Adolescents (McConaughy and Achenbach

1994)

Pretransplant psychosocial assessment

Pediatric Transplant Rating Instrument (Fung and Shaw 2008)

Quality of life

Child Health Questionnaire (Landgraf et al. 1996)

Cystic Fibrosis Questionnaire (Modi and Quittner 2003)

Pediatric Asthma Quality of Life Questionnaire (Juniper et al. 1996)

Pediatric Quality of Life Inventory (Varni et al. 2003)

Specific psychiatric symptoms

Children's Depression Inventory (Kovacs 1992)

Conners Rating Scales Revised (Conners 2000)

Revised Children's Manifest Anxiety Scale (C.R. Reynolds and Richmond 1985)

University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index (Steinberg et al. 2004)

ments that are most critical to explain. This review can place the events on a timeline based on the presence or absence of predisposing, precipitating, perpetuating, and protective factors (Kline and Cameron 1978). The biopsychosocial approach to the formulation has the advantage of being more accessible to patients, families, and the medical team, who often do not have a detailed understanding of psy-

chodynamic theoretical concepts. The specific components of a biopsychosocial formulation are detailed in the following subsections. These factors are all woven into a clear explanatory model that substantiates the consultant's proposed plan. It should include specifics for the treatment plan, methods of implementation, and an explanation about how the situation will be followed and monitored.

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