{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T11:24:29Z","timestamp":1766748269757,"version":"3.37.3"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T00:00:00Z","timestamp":1655251200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Rationale, Aims and Objectives<\/jats:title><jats:p>The concept of patient or case complexity is relevant\u2014and widely used\u2014at 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Applied psychologists in a single urban\/suburban UK National Health Service setting took part in a three\u2010round modified Delphi study. Twenty\u2010eight respondents in Round 1\u00a0gave qualitative data on factors they considered when assessing complexity, which was subject to thematic analysis. Twenty\u2010five respondents in Round 2\u00a0rated how central\/peripheral each theme was to their judgement using Likert scales. In a third round, 20\u00a0respondents addressed discrepancies and possible utilities of the emerging framework.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirteen factors contributing to patient\/case complexity (active severe\/enduring mental health, current coping\/functioning, engagement, forensic history, iatrogenic factors, interpersonal functioning, neurocognitive functioning, physical health, problematic substance use, risk, severity\/chronicity of presenting problems, systemic and socioeconomic factors and trauma) were identified with a high degree of consensus. All were rated as central to complexity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jep.13716","type":"journal-article","created":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T13:04:52Z","timestamp":1655298292000},"page":"682-689","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Understanding complexity in psychological services: A modified Delphi study"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7352-2705","authenticated-orcid":false,"given":"Jenny","family":"Strachan","sequence":"first","affiliation":[{"name":"West Lothian Psychological Therapies Service, NHS Lothian,\u00a0St John's Hospital Livingston UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Greg","family":"Halliday","sequence":"additional","affiliation":[{"name":"Clinical Psychology Training Programme University of Glasgow  Glasgow UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellie","family":"Caldwell","sequence":"additional","affiliation":[{"name":"Department of Clinical Health Psychology NHS Lothian  Edinburgh UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,6,15]]},"reference":[{"volume-title":"The Princess Bride [DVD]","year":"1987","author":"Reiner R","key":"e_1_2_10_2_1"},{"unstructured":"All Party Parliamentary Group. Factsheet 1: complex needs and dual diagnosis. 2020. Accessed 4 August 2014.\u00a0https:\/\/www.turning-point.co.uk\/_cache_7739\/content\/appg_factsheet_1_-_june_2014-5090910000019640.pdf\/","key":"e_1_2_10_3_1"},{"doi-asserted-by":"publisher","key":"e_1_2_10_4_1","DOI":"10.1111\/j.1468-2850.2006.00017.x"},{"doi-asserted-by":"publisher","key":"e_1_2_10_5_1","DOI":"10.1111\/nhs.12320"},{"doi-asserted-by":"publisher","key":"e_1_2_10_6_1","DOI":"10.7748\/nr.23.4.9.s3"},{"key":"e_1_2_10_7_1","first-page":"1","article-title":"Editorial for special issue: complexity within cognitive behaviour therapy","volume":"10","author":"Lomax C","year":"2017","journal-title":"\u00a0Cogn\u00a0Behav\u00a0Ther"},{"key":"e_1_2_10_8_1","first-page":"1","article-title":"Treating complex depressions with cognitive behavioural therapy","volume":"10","author":"Barton S","year":"2017","journal-title":"Cogn\u00a0Behav\u00a0Ther"},{"doi-asserted-by":"publisher","key":"e_1_2_10_9_1","DOI":"10.1037\/ccp0000231"},{"doi-asserted-by":"publisher","key":"e_1_2_10_10_1","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"doi-asserted-by":"publisher","key":"e_1_2_10_11_1","DOI":"10.1001\/archinte.166.10.1092"},{"doi-asserted-by":"publisher","key":"e_1_2_10_12_1","DOI":"10.1192\/bjp.180.5.461"},{"doi-asserted-by":"publisher","key":"e_1_2_10_13_1","DOI":"10.1192\/bjp.183.3.228"},{"unstructured":"Scottish Government. Mental health strategy: 2017\u22122027. 2020. Accessed 4 August 2017.\u00a0https:\/\/www.gov.scot\/publications\/mental-health-strategy-2017-2027\/","key":"e_1_2_10_14_1"},{"doi-asserted-by":"publisher","key":"e_1_2_10_15_1","DOI":"10.1080\/0144341970170401"},{"doi-asserted-by":"publisher","key":"e_1_2_10_16_1","DOI":"10.1002\/jclp.20604"},{"doi-asserted-by":"publisher","key":"e_1_2_10_17_1","DOI":"10.1080\/13611260500069947"},{"key":"e_1_2_10_18_1","first-page":"598","article-title":"The Delphi method","volume":"22","author":"Iqbal S","year":"2009","journal-title":"Psychologist"},{"unstructured":"LinstoneHA TuroffM. The Delphi method: techniques and applications. Reading Mass:\u00a0Addison\u2010Wesley Advanced Book Program 1975. 2002. 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