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
