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Understanding complexity in psychological services: a modified Delphi study
  • Jenny Strachan,
  • Greg Halliday,
  • Ellie Caldwell
Jenny Strachan
NHS Lothian

Corresponding Author:[email protected]

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Greg Halliday
University of Glasgow
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Ellie Caldwell
NHS Lothian
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Rationale, aims and objectives The concept of patient or case complexity is relevant – and widely used – at all levels and stages of mental health service provision, but there have been few methodologically robust attempts to define this term. This study aimed to establish a consensus on factors contributing to patient complexity in adult psychological services using Delphi Methodology. Method Applied psychologists in a single urban/suburban UK National Health Service setting took part in a three-round modified Delphi study. Twenty-eight respondents in round one gave qualitative data on factors they considered when assessing complexity, which was subject to thematic analysis. Twenty-five respondents in round two rated how central/peripheral each theme was to their judgement using Likert scales. In a third round, twenty respondents addressed discrepancies and possible utilities of the emerging framework. Results Thirteen factors contributing to patient/case complexity (Active Severe/Enduring Mental Health, Current Coping/Functioning, Engagement, Forensic History, Iatrogenic Factors, Interpersonal Functioning, Neuro-Cognitive Functioning, Physical Health, Problematic Substance Use, Risk, Severity/Chronicity of Presenting Problems, Systemic and Socio-Economic Factors and Trauma) were identified with a high degree of consensus. All were rated as central to complexity. Conclusions We conclude that applied psychologists do have a shared understanding of complexity and make recommendations for further research validating, developing and applying this empirically derived framework. Keywords: psychological, complexity, definition, operationalising, framework development, clinical judgement
22 Jun 2021Submitted to Journal of Evaluation in Clinical Practice
24 Jun 2021Assigned to Editor
24 Jun 2021Submission Checks Completed
29 Aug 2021Reviewer(s) Assigned
11 Dec 2021Review(s) Completed, Editorial Evaluation Pending
26 May 2022Editorial Decision: Accept