Inter-rater reliability of the Team Formulation Quality Rating Scale (TFQS) in inpatient mental health teams

Team formulation is associated with better working relationships between staff and service users. However, there is a need for greater standardization of practice. We aimed to investigate the inter-rater reliability of the Team Formulation Quality Rating Scale (TFQS) and explore what aspects of team formulation practices were most frequently adhered to.

Staff at nine acute mental health wards participated in team formulation sessions facilitated by Health Care Professions Council registered psychologists. Formulation sessions were audio recorded, and raters used recordings to complete the TFQS. At least two raters rated 19 team formulation sessions.

The TFQS demonstrated excellent inter-reliability for the total scale (ICC = .926, 95% CI = .820 to .971) and moderate inter-rater reliability for subsection A (ICC = .660; 95% CI = .278 to .862) and subsection B (ICC = .733; 95% CI = .361 to .898). Overall, the items for 'collaboration' and 'consideration of life events' were rated better in terms of quality, compared with items relating to 'close of meeting' and 'consideration of goals and values' which tended to receive lower quality ratings.

The TFQS is a reliable tool for measuring quality of team formulation within inpatient settings and should be used in future research and clinical practice. Psychometric properties should be assessed across different clinical settings. Training and supervision should ensure that psychologists' formulations incorporate a focus on the individual's goals and values impacting problem development and resolution.