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Mental health and Wellbeing > Week 10 Lecture 10 - Developing Culturally-Appropriate Psychosocial Interventions > Flashcards

Week 10 Lecture 10 - Developing Culturally-Appropriate Psychosocial Interventions Flashcards

1
Q

What is race?

A

*Biological basis
*Visible, physical differences

Often externally-classified:
* Distinguish between large groups of people
* Highlight commonalities ‘human race’

*May also be self-ascribed

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2
Q

What is ethnicity?

A

Social characteristics of a group:
* Faith/religion
* Language
* Traditions

  • Common ancestry
    *May share a distinctive culture
  • Some overlap with nationality
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3
Q

What is culture?

A

*Acquired/learned

Non-biological/social aspects of human
life:
*Norms, Values, Beliefs, Symbols

*‘Fluid’
*Multi-cultural at individual level

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4
Q

In what ways do culture and social contexts shape an individual’s mental health?

A
  • Symptoms, Presentation and Meaning
  • Coping styles
  • Family influences
  • Help-seeking behaviours
  • Stigma
  • Trust
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5
Q

What does cultural formulation highlights the effect of culture on?

A

Symptom expression:
* Cultural Explanations ‘Models’ of mental
illness

Definition of illness:
* Cultural factors related to the psychosocial environment

Treatment
* What is acceptable?
* Impact of culture/cultural identity on the clinician patient relationship

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6
Q

True or False?

In terms of Sz, in the UK, Black African & Caribbean report worse
experience at every level of service

A

True

  • More negative, coercive care pathways
    – More compulsory detention (Mental Health Act)
    – Higher doses psychotropic medication
    – More seclusion, control & restraint
    – Less psychological therapy
    – Longer length of hospital stay
    – More Community Treatment Orders (CTOs)
  • Lack of psychological interventions
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7
Q

What is AESOP?

A

Aetiology & Epidemiology of Schizophrenia and Other Psychoses (Murray, Fearon, Morgan et al)

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8
Q

Murray, Fearon, Morgan et al., conducted the first episode study of schizophrenia and other psychoses (F20-29, F30-33 (ICD-10)) using SCAN (AESOP study)

What was the method?

A
  • Large, 2-year study in 3 centres: London,
    Nottingham & Bristol (9m data)
  • Patient and carer interviews (32%) à biological, social, demographic and neuropsychological data
  • 100+ individuals had a structural MRI brain scan
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9
Q

Murray, Fearon, Morgan et al., conducted the first episode study of schizophrenia and other psychoses (F20-29, F30-33 (ICD-10)) using SCAN (AESOP study)

What were the study aims?

A
  1. Elucidate the overall rates of psychotic
    disorder in 3 UK cities
  2. Confirm and extend previous findings of
    raised rates of psychosis in certain migrant groups in the UK
  3. Explore biological and social risk factors in these populations and their possible
    interactions
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10
Q

Murray, Fearon, Morgan et al., conducted the first episode study of schizophrenia and other psychoses (F20-29, F30-33 (ICD-10)) using SCAN (AESOP study)

What was the study’s findings?

A

Compared with the baseline White British population:

  • Incidence all psychoses higher in Black populations – African-Caribbeans IRR 6.7 (5.4-8.3)
    – Black Africans: IRR 4.1 (3.2-5.3)
  • Narrowly defined schizophrenia (F20)
    – African-Caribbean IRR 9.1 (6.6-12.6)
    – Black African IRR 5.8 (3.9-8.4)
  • Manic psychosis (F30-31)
    – African-Caribbeans IRR 8.0 (4.3- 14.8)
    – Black Africans IRR 6.2 (3.1- 12.1)
  • Depressive psychosis (F32-32)
    – African-Caribbeans: IRR 3.1 (1.5-3.6)
    – Black Africans: IRR 2.1 (0.9-5.0).
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11
Q

Murray, Fearon, Morgan et al., conducted the first episode study of schizophrenia and other psychoses (F20-29, F30-33 (ICD-10)) using SCAN (AESOP study)

What are some potential explanations for the results of this study?

A

Misdiagnosis
– Institutional racism in diagnosis?
– ‘Atypical psychosis’

Biological hypotheses
– Genetic predisposition
– ‘Migration hypothesis’
– Perinatal/obstetric factors
– Cannabis

Psycho-social hypotheses
– ‘Urbanicity’, social deprivation
– Impact of racism
– Attributional style
– Life events and childhood risk

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12
Q

Murray, Fearon, Morgan et al., conducted the first episode study of schizophrenia and other psychoses (F20-29, F30-33 (ICD-10)) using SCAN (AESOP study)

What was the research response to this study?

A

The Culturally-adapted Family Intervention
‘CaFI’ Study

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13
Q

What is Family Intervention (FI) recommended for by NICE? What does this achieve?

A

NICE recommends FI for schizophrenia and psychoses:

  • Clinically- & cost-effective
  • Reduces family tension
  • Facilitates engagement & improved clinical care
  • Reduces relapse/readmission rates
  • Decreases lengths of stay in hospital
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14
Q

What are some issues with FI?

A
  • Organisational and professional barriers prevent FI being offered
  • African Caribbeans are doubly-disadvantaged due to high levels of
    estrangement from their families
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15
Q

What should FI do?

A
  • Include the person with psychosis or schizophrenia if practical
    – Be carried out for between 3 months and 1 year
    – Include at least 10 planned sessions

– Take account of the whole family’s preference for either single-family intervention or multi-family group
intervention

– Take account of the relationship between the main carer and the person with psychosis or schizophrenia

– Have a specific supportive, educational or treatment function and include negotiated problem solving or crisis
management work

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16
Q

What was the feasibility pilot of the CaFI study?

A

Culturally-acceptable Family Intervention
(CaFI), a 3-year NIHR (HS&DR) funded study to:

  1. Assess the feasibility of culturally-adapting, implementing and evaluating Family Intervention (FI) for African Caribbean service users diagnosed with schizophrenia and their families across a range of clinical settings.
  2. To test the feasibility and acceptability of delivering CaFI via ‘proxy families’ where biological families are not available.
17
Q

What was phase 1 of CaFI?

A

1A Literature review

1B Focus groups
- Health professionals (n=7), service users (n=10), carers & advocates (n=14)
- Mixed group (n=11)

1C Consensus conference
- n=22: key ‘expert’ stakeholders

18
Q

What was phase 2 of CaFI?

A
  • Manual Development
  • Training:
    – Family therapists & co-therapists
    – ‘Proxy families’
    – Cultural competency for NHS staff & services
19
Q

What was the method of phase 3 of CaFI?

A

Feasibility Study (Proof of Concept): Delivering & Evaluating CaFI

Primary outcomes: Recruitment, Retention, Completion

Recruited (n=30) African-Caribbean service users diagnosed with ‘schizophrenia’ and/or families:
– Rehab wards, acute wards, CMHTs (n=10 each)

Delivered 10 x 1 hour long CaFI sessions:
– ‘Shared learning’, stress management, problem-solving

  • Collected outcome data
  • Conducted fidelity study
  • Collected qualitative & quantitative acceptability data
20
Q

What was the sample of phase 3 of CaFI?

A
  • 31 (42%) of 74 eligible service users
  • 26 participated
  • Majority:
    – Recruited from community (n=21, 67.7%)
    – Born in England (n=22, 78.57%)
    – Had religious affiliations (n=22, 81.48%) ,
    principally Christian (n=17, 77%)
    – Male (n=21, 67.7%)
    – Had GCSE or higher qualification n=23 (85.19%)
    – ‘long-term sick’ or registered disabled (51.85%)
  • Mean age 43 (Range: 17 – 81, SD=13.77)
21
Q

What was the findings of phase 3 of CaFI?

A

CaFI was acceptable to service users, their families, FSMs, and healthcare professionals.

  • Over 80% service users agreed they:
    – Had learned something new about psychosis during CaFI
    – Knew more about where to get information
    – Had a better relationships with relatives
  • Perceived benefits included:
    – Increased confidence and self-esteem
    – Greater insight into illness
    – Improved symptoms
    – Improved knowledge and understanding of services
    – Better communication with family and health professionals
    – Improved coping skills including
22
Q

What is CaFI-2?

A

The effect on relapse of Culturally-adapted Family Intervention (CaFI) compared to usual care among Sub-Saharan African & Caribbean people diagnosed with psychosis in the UK: A Randomised
Controlled Trial

23
Q

What was phase 1 in CaFI-2?

A
  • Refine the intervention with key stakeholders
  • New resources to facilitate delivery

– Develop CaFI:Digital in response to COVID-19
– Recruit and train therapists and co-therapists

– Recruit and prepare Family Support Members
* Peer support workers, community members

24
Q

What was phase 2 in CaFI-2?

A

– RCT with internal 12-month pilot
– N=404 family units
– Economic & process evaluation

25
Q

What are family skills programmes?

A
  • aim to strengthen family protective factors e.g., communication that are relevant to their culture
  • includes opportunities for parents and children to spend positive time together
  • focus on relationships and behaviour in practice
26
Q

What did a qualitative exploration of the challenges of parenting children in refugee contaxts find?

A

Challenges with:
- environment
- child specific –> changes in child behaviour
- parent specific –> loss of control, own emotions

27
Q

What did the Bread Wrapper Study (inserting parenting leaflets into bread packets being delivered to refugee camps) find?

A
  • people wanted support –> almost 60% return rate
  • comments wanting more support

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