Lecture 10 - Culturally Appropriate Interventions Flashcards
What is race?
Biological basis, disputed/discredited evidence
Race science/racial hierarchies, visible/physical diffs
Often externally classified, distinguish large groups, highlight commonalities (human race), may also be self ascribed
What is ethnicity?
Social characteristics of group
Faith/religion, language, traditions
Common ancestry, may share distinctive cultures, some overlap with nationality
What is culture?
Acquired/learned, non-biological, social aspects of human life
Norms, values, beliefs, symbols
Fluid, multi-cultural – societal/individual levels
Terminology: culturally informed/sensitive/appropriate/adapted
Why does culture matter in mental health?
Culture/contexts shape individuals’ mental health
Symptoms/presentation/attribution/meaning
Coping styles, family/community influences, help-seeking behaviours
Stigma, insider/outsider perspectives (marginalisation, racism/discrimination)
Trust
How does culture effect formulation?
Symptom expression: cultural explanation – models of mental illness
Definition of illness: cultural factors related to psychosocial environment
Treatment: what’s acceptable? Impact of culture/cultural identity on clinician patient relationship
How are psychosis rates in ethnic minority groups?
Elevated incidence of psychosis/schizophrenia in migrant/minority groups
Especially for African/Caribbean origin when compared w/ white British
What are negative care pathways?
40% more likely access care via CJS, 37% Black vs 9% White British prisoners have schizophrenia/delusional disorder
4x more MHA detentions
More coercive care: higher rates injectable anti-psychotic medication than White counterparts
Worse clinical/non-clinical outcomes, lack of culturally informed care, culturally naive staff
Lack of psychological therapies, often labelled ‘hard to reach’
What are NICE guidelines for psychosis?
Individualised treatment plan options:
16 planned CBT sessions, Early Intervention in Psychosis (EIP), 10 sessions of Family Intervention (FI)
Alongside antipsychotic medication
What is the evidence for FI in schizophrenia/psychosis care?
Clinically/cost effective, reduces family tension, facilitates engagement/improved clinical care, reduces relapse/readmission rates, decreases lengths of stay in hospital
However:
Uptake low in African/Caribbean/other minoritised groups
Limited evidence for effectiveness/acceptability/accessibility with minoritised groups
Urgent need to develop culturally informed care
What percentage of practitioner psychologists in UK are white?
84% (5% Asian, 2% Black)
What is co-producing research?
Patients/researchers/practitioners/public work together to share power/responsibility from start to end of project
Literature review done to generate typical components of culturally adapted psychosocial interventions to serve as initial framework
Focus groups run with service users/carers/professionals
Structure + core components, address stereotypes/misconceptions of Caribbean cultures, racism
Consensus conference to refine content/outcome/delivery
Experts by experience/profession
What is Culturally-adapted Family Intervention therapy? (CaFI)
10 x 1-hour sessions
Hybrid model (CBT based with BFT)
Delivered by Lead/Co-therapist pair, trained in family work + cultural awareness
Bespoke therapy manual/resources, Family Support Members as therapy partners
CaFI:Digital
What is the Bespoke Training Programme?
Cultural Competency in Family Work: core competence to work with service users/families experiencing psychosis, impact of culture on family work, relationship between racism/discrimination/adversity/psychological distress, power/prejudice in building trusting therapeutic relationships
CaFI Manual: context of CaFI (historical/cultural/social context of African-Caribbean mental health in UK), development of CaFI, CaFI ethos of delivery (shared learning/cultural humility), components/bespoke resources, delivering therapy in research
What were aims of feasibility study?
Evaluate feasibility of culturally adapting/implementing/evaluating Family Intervention with Caribbean origin service users diagnosed with schizophrenia/related psychoses, families + other key stakeholders
Establish feasibility/acceptability of delivering FI with proxy families where service users biological families unavailable
What were the results of the feasibility study?
All service users/families/therapists found CaFI acceptable + would recommend
Service user: improved understanding of illness/symptoms, better function + communication
Family member: increased understanding of diagnosis/condition, better engagement + support with service users
Healthcare Professional: more cultural awareness/understanding of Caribbean people, using CaFI skills/materials in everyday practice
What was the limitation of the feasibility study?
Lack of control group, limited sample size, insufficient power to assess effectiveness, ore culturally-informed therapy resources?
What is the CaFI RCT?
National 54 month RCT with family units of Caribbean/African origin, evaluate cost/clinical effectiveness compared to usual care, embedded process evaluation (implementation barriers, accessibility, fidelity, acceptability)
Started deferred (24 months), COVID, lack of service, closed to recruitment, etc.
What were the implications of the CaFI RCT?
For currently under-represented research/clinical practice, different approaches/same models (funding/reporting/success criteria)
Policy: race equality in mental health, culturally informed care, evidence-based interventions? evidence for cultural adaptation/competence?
Practice: FI w/ multicultural/multi-ethnic populations, individualised/holistic/needs led care, NHS workforce
