Lecture 10, Culturally-appropriate Interventions Flashcards
Race
Biological basis with visible physical differences.
Often externally classified and can distinguish between large groups of people.
May also be self-ascribed.
Ethnicity
Social characteristics of a group, such as faith, language, and traditions.
Common ancestry and may share a distinctive culture.
Some overlap with nationality.
Culture
Acquired and learned.
Non-biological and includes norms, values, beliefs, and symbols.
Fluid and can vary at an individual level.
Impact of Culture and Social Context on Mental Health
Culture and social contexts shape individuals’ mental health, including symptoms, coping styles, family influences, help-seeking behaviors, stigma, and trust.
NIMH Culture and Diagnosis Group emphasizes the importance of meanings, values, and behavioral norms learned within society and social groups.
Cultural Formation and Mental Health
Symptom expression influenced by cultural explanations and models of mental illness.
Definition of illness influenced by cultural factors related to the psychosocial environment.
Treatment acceptance influenced by cultural factors and the clinician-patient relationship.
Disparities in Mental Health Services for Black African & Caribbean Populations in the UK
Black African & Caribbean individuals experience worse outcomes at every level of service.
More negative care pathways, compulsory detention, higher doses of psychotropic medication, seclusion, control & restraint, less psychological therapy, longer hospital stays, and more Community Treatment Orders (CTOs).
Lack of Psychological Interventions
AESOP study: Investigating rates of psychotic disorders in three UK cities.
Incidence of psychoses higher in Black populations, particularly African-Caribbeans.
Potential explanations include misdiagnosis, biological hypotheses (genetic predisposition, migration, perinatal factors, cannabis), and psycho-social hypotheses (urbanicity, social deprivation, racism, attributional style, life events).
Research Response: The Culturally-Adapted Family Intervention (CaFI) Study
Family Intervention (FI) recommended for schizophrenia and psychoses by NICE.
CaFI study aims to culturally adapt FI for African-Caribbean populations.
Barriers to offering FI include organizational and professional challenges.
African-Caribbeans face additional disadvantages due to high levels of estrangement from their families.
Family Intervention for Psychosis
Should include the person with psychosis or schizophrenia if practical.
Carried out for a duration of 3 months to 1 year.
Involves at least 10 planned sessions.
Takes into account the family’s preference for single-family or multi-family group intervention.
Considers the relationship between the main carer and the person with psychosis.
Has a specific supportive, educational, or treatment function with problem-solving or crisis management components.
CaFI Feasibility Pilot Study
A 3-year NIHR-funded study to culturally adapt, implement, and evaluate Family Intervention for African Caribbean service users diagnosed with schizophrenia and their families.
Aims to test the feasibility and acceptability of delivering CaFI through “proxy families” when biological families are not available.
Phases of the CaFI Study
Phase 1: Culturally-adapting Family Intervention through literature review, focus groups with health professionals, service users, carers, and advocates, and a consensus conference with key stakeholders.
Phase 2: Manual development and training for family therapists, co-therapists, and cultural competency for NHS staff and services.
Phase 3: Feasibility study (proof of concept) delivering and evaluating CaFI, including recruitment, retention, completion, fidelity study, and collecting qualitative and quantitative acceptability data.
Findings of the CaFI Feasibility Study
31 out of 74 eligible service users (42%) were recruited, with the majority recruited from the community and having religious affiliations.
92% of family units completed at least one session, with an average attendance of 7.90 out of ten sessions.
Feasible to collect various outcome data related to symptoms, such as PANSS scores.
CaFI was acceptable to service users, families, family support members, and healthcare professionals, with reported benefits including increased knowledge, better relationships, improved coping skills, and better communication.
Current Study: CaFI-2 Randomized Controlled Trial
Phase 1 focused on refining the intervention, developing digital resources, and training therapists and co-therapists.
Phase 2 involves a randomized controlled trial with a pilot and includes 404 family units, economic and process evaluation.
Recruiting service users with schizophrenia/psychosis and family members from various regions in the UK, including those without contact with their families.
Importance of NHS Ethos, Policy, and Practice
NHS emphasizes equality of access, quality, and outcomes in mental healthcare.
Policy and legislation, such as the 5-year plan for delivering race equality in mental healthcare, tackling health inequalities, and the Equality Act 2010’s Public Sector Duty.
Practice and quality initiatives include NICE Schizophrenia Guidelines, Count Me In Census (CQC), and the Schizophrenia Commission report.
