scholarly journals Culturally adapted Family Intervention (CaFI) for African-Caribbean people diagnosed with schizophrenia and their families: a mixed-methods feasibility study of development, implementation and acceptability

2018 ◽  
Vol 6 (32) ◽  
pp. 1-316 ◽  
Author(s):  
Dawn Edge ◽  
Amy Degnan ◽  
Sarah Cotterill ◽  
Katherine Berry ◽  
John Baker ◽  
...  
Keyword(s):  
Mental Health ◽  
Psychosocial Intervention ◽  
Family Intervention ◽  
Evidence Based ◽  
Service Users ◽  
Culturally Adapted ◽  
Key Stakeholders ◽  
African Caribbean ◽  
Evidence Based Care ◽  
Therapy Sessions

BackgroundAfrican-Caribbean people in the UK experience the highest incidence of schizophrenia and the greatest inequity in mental health care. There is an urgent need to improve their access to evidence-based care and outcomes. Family intervention (FI) is a National Institute for Health and Care Excellence-approved psychosocial intervention. Although clinically effective and cost-effective for schizophrenia, it is rarely offered. Evidence for any research into FI is lacking for ethnic minority people generally and for African-Caribbean people specifically.Aims(1) To assess the feasibility of delivering a novel, culturally appropriate psychosocial intervention within a ‘high-risk’ population to improve engagement and access to evidence-based care. (2) To test the feasibility and acceptability of delivering FI via ‘proxy families’.DesignA mixed-methods, feasibility cohort study, incorporating focus groups and an expert consensus conference.SettingTwo mental health trusts in north-west England.ParticipantsWe recruited a convenience sample of 31 African-Caribbean service users. Twenty-six family units [service users, relatives/family support members (FSMs) or both] commenced therapy. Half of the service users (n = 13, 50%), who did not have access to their biological families, participated by working with FSMs.InterventionsAn extant FI model was culturally adapted with key stakeholders using a literature-derived framework [Culturally adapted Family Intervention (CaFI)]. Ten CaFI sessions were offered to each service user and associated family.Main outcome measuresRecruitment (number approached vs. number consented), attendance (number of sessions attended), attrition (number of dropouts at each time point), retention (proportion of participants who completed therapy sessions), and completeness of outcome measurement.ResultsOf 74 eligible service users, 31 (42%) consented to take part in the feasibility trial. The majority (n = 21, 67.7%) were recruited from community settings, seven (22.6%) were recruited from rehabilitation settings and three (9.7%) were recruited from acute wards. Twenty-four family units (92%) completed all 10 therapy sessions. The proportion who completed treatment was 77.42% (24/31). The mean number of sessions attended was 7.90 (standard deviation 3.96 sessions) out of 10. It proved feasible to collect a range of outcome data at baseline, post intervention and at the 3-month follow-up. The rating of sessions and the qualitative findings indicated that CaFI was acceptable to service users, families, FSMs and health-care professionals.LimitationsThe lack of a control group and the limited sample size mean that there is insufficient power to assess efficacy. The findings are not generalisable beyond this population.ConclusionsIt proved feasible to culturally adapt and test FI with a sample of African-Caribbean service users and their families. Our study yielded high rates of recruitment, attendance, retention and data completion. We delivered CaFI via FSMs in the absence of biological families. This novel aspect of the study has implications for other groups who do not have access to their biological families. We also demonstrated the feasibility of collecting a range of outcomes to inform future trials and confirmed CaFI’s acceptability to key stakeholders. These are important findings. If CaFI can be delivered to the group of service users with the most serious and persistent disparities in schizophrenia care, it has the potential to be modified for and delivered to other underserved groups.Future workA fully powered, multicentre trial, comparing CaFI with usual care, is planned.Trial registrationCurrent Controlled Trials ISRCTN94393315.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 32. See the NIHR Journals Library website for further project information.

scholarly journals An Assets-Based Approach to Co-Producing a Culturally Adapted Family Intervention (CaFI) with African Caribbeans Diagnosed with Schizophrenia and Their Families

2018 ◽  
Vol 28 (Supp) ◽  
pp. 485-492 ◽  
Author(s):  
Dawn Edge ◽  
Paul Grey
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Family Intervention ◽  
Cultural Appropriateness ◽  
Black Clients ◽  
Culturally Adapted ◽  
Health And Illness ◽  
White Therapists ◽  
African Caribbean ◽  
Evidence Based Model

Objective: To determine how to improve the cultural appropriateness and accept­ability of an extant evidence-based model of family intervention (FI), a form of ‘talking treatment,’ for use with African Caribbean service users diagnosed with schizophrenia and their families.Design: Community partnered participa­tory research (CPPR) using four focus groups comprising 31 key stakeholders.Setting: Community locations and National Health Service (NHS) mental health care settings in northwest England, UK.Participants: African Caribbean service us­ers (n=10), family members, caregivers and advocates (n=14) and health care profes­sionals (n=7).Results: According to participants, com­ponents of the extant model of FI were valid but required additional items (such as racism and discrimination and different models of mental health and illness) to im­prove cultural appropriateness. Additionally, emphasis was placed on developing a new ethos of delivery, which participants called ‘shared learning.’ This approach explicitly acknowledges that power imbalances are likely to be magnified where delivery of interventions involves White therapists and Black clients. In this context, therapists’ cultural competence was regarded as funda­mental for successful therapeutic engage­ment and outcomes.Conclusions: Despite being labelled ‘hard-to-reach’ by mainstream mental health services and under-represented in research, our experience suggests that, given the opportunity, members of the African Carib­bean community were highly motivated to engage in all aspects of research. Participat­ing in research related to schizophrenia, a highly stigmatized condition, suggests CPPR approaches might prove fruitful in developing interventions to address other health conditions that disproportionately affect members of this community.Ethn Dis. 2018;28(Suppl 2): 485-492; doi:10.18865/ed.28.S2.485.

scholarly journals Culturally adapted Family Intervention (CaFI): case examples from therapists’ perspectives

2018 ◽  
Vol 11 ◽  
Author(s):  
Katherine Berry ◽  
Christine Day ◽  
Lee D. Mulligan ◽  
Tara Seed ◽  
Amy Degnan ◽  
...  
Keyword(s):  
Family Therapy ◽  
Family Support ◽  
Family Intervention ◽  
Care Team ◽  
Recent Trial ◽  
Case Examples ◽  
Client Group ◽  
Culturally Adapted ◽  
African Caribbean ◽  
Evidenced Based

AbstractThis paper describes three case examples from a recent trial of family intervention specifically designed for people of African-Caribbean descent. These examples, told from the therapists’ perspectives, highlight key components of the intervention and issues that arose in working with this client group. Findings from the study suggest that it is possible to engage this client-group in family therapy similar to traditional evidenced-based family interventions, although as illustrated in the paper, it is important that therapists pay attention to themes that are likely to be particularly pertinent for this group, including experiences of discrimination and mistrust of services. The use of Family Support Members, consisting of members of the person's care team or volunteers recruited from the community, may also help support people to engage in therapy in the absence of biological relatives.

scholarly journals Alternative medicine under the Mental Health Care Act, 2017: Future implications and concerns

2022 ◽  
Vol 07 (01) ◽  
pp. 37-41
Author(s):  
Ramdas Ransing ◽  
Sujita Kumar Kar ◽  
Vikas Menon
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Alternative Medicine ◽  
Mental Healthcare ◽  
Evidence Base ◽  
Evidence Based ◽  
Insufficient Evidence ◽  
Indian Government ◽  
Evidence Based Care

In recent years, the Indian government has been promoting healthcare with an insufficient evidence base, or which is non-evidence-based, alongside delivery of evidence-based care by untrained practitioners, through supportive legislation and guidelines. The Mental Health Care Act, 2017, is a unique example of a law endorsing such practices. In this paper, we aim to highlight the positive and negative implications of such practices for the delivery of good quality mental healthcare in India.

scholarly journals M223. EXPLORING YOUR PERSONAL IDENTITY: USING USER-CENTRED-DESIGN FOR THE DEVELOPMENT OF A NEW INTERVENTION FOR SERVICE USERS WITH COMPLEX MENTAL HEALTH NEEDS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S220-S221
Author(s):  
Lisette Van der Meer ◽  
Tessa Jonker ◽  
Charlotte Wunderink ◽  
Jaap van Weeghel ◽  
Marieke (Gerdina) Pijnenborg ◽  
...  
Keyword(s):  
Mental Health ◽  
Design Process ◽  
Mental Health Professionals ◽  
Psychosocial Intervention ◽  
Health Needs ◽  
Service Users ◽  
Personal Recovery ◽  
Mental Health Needs ◽  
User Centred Design ◽  
Starting Point

Abstract Background Introduction: As a human being we give meaning to our stories, in relation to the social and physical context. For people with severe and complex mental health needs, who have been dependent on (intensive) residential psychiatric support for a long time, it is possible that talents and qualities disappear because this part of their identity has been buried under a long psychiatric history. This can result in people’s identity becoming limited to ‘patient’, and the experience of life as meaningless. Objectives For these service-users, few interventions aimed at personal recovery are available that match their cognitive and communicative skills. In this project, we developed a new psychosocial intervention to stimulate self-reflection and personal recovery. Methods The development of the intervention took place through a “user-centred-design process” (UCD). UCD is an iterative design process in which the needs and wishes of the user are the starting point, and they remain central in the product design circle. Throughout the whole design process, service users, significant others, mental health professionals, peer support workers, artists, and researchers collaborate in order to design a first testable prototype. For each step of design process, we organized focus group meetings and brainstorm sessions with all stakeholders as well as individual interviews with service users. Based on the input in these meetings and interviews, the design was adapted. This was done for each consecutive step, which made the whole design process iterative by nature. Results A new psychosocial intervention entitled “This Is Me” was developed as a “journey of discovery” through the lives of service users at both verbal and non-verbal levels. From the UCD process four basic principles underlying the intervention were disentangled that have been incorporated in the intervention: 1) “gaining new experiences”, 2) “attention for (self)stigma”, 3) “equal treatment as a person”, 4) “uniqueness of the individual”. This resulted in an intervention in which service-users, together with a teammate, engage in new experiences. Moreover, they are prompted to reflect on these experiences upon their return. With this process, we aim to support people in (re)discovering roles, talents and characteristics to broaden the identity from ‘patienthood’ to ‘personhood’. Discussion Conclusions: UCD was a useful method for the development of a new psychosocial intervention targeting identity for people with complex mental health needs. The process resulted into new knowledge about factors that are important in the (re)development of identity. In addition, we will present the first results of a pilot study in which we assessed the feasibility and effectiveness of the intervention.

scholarly journals Emergent life events in the delivery of a caregiver-mediated evidence-based intervention for children with autism spectrum disorder in publicly funded mental health services

Autism ◽  
2020 ◽  
Vol 24 (5) ◽  
pp. 1286-1299
Author(s):  
Teresa Lind ◽  
Anna S Lau ◽  
Christopher Gomez ◽  
Adriana Rodriguez ◽  
Karen Guan ◽  
...  
Keyword(s):  
Mental Health ◽  
Autism Spectrum Disorder ◽  
Life Events ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Health Intervention ◽  
Spectrum Disorder ◽  
Evidence Based ◽  
Mental Health Intervention ◽  
Therapy Sessions

Mental health clinicians often report significant challenges when delivering evidence-based interventions in community settings, particularly when unexpected client stressors (or emergent life events) interfere with the therapy process. The current study sought to extend the study of emergent life events to children with autism spectrum disorder by examining the occurrence and impact of emergent life events in the context of a collaborative, caregiver-mediated intervention for reducing challenging behaviors in children with autism spectrum disorder, An Individualized Mental Health Intervention for ASD (AIM HI). Participants included 38 child–clinician dyads enrolled in a community effectiveness trial of An Individualized Mental Health Intervention for ASD. Video recordings of 100 therapy sessions were coded for caregiver-reported emergent life events and clinician adherence to the Individualized Mental Health Intervention for ASD protocol. Results indicated that mild to severe emergent life events were reported in 36% of sessions, and were reported for 58% of children at some point during treatment. Greater number of child comorbid diagnoses and less clinician experience were both significantly associated with a higher number of caregiver-reported emergent life events. There was no significant link between emergent life events and clinician adherence to the Individualized Mental Health Intervention for ASD protocol. Findings offer implications for evidence-based intervention implementation, particularly the importance of incorporating clinician training in addressing complex presentations and crises in the context of evidence-based interventions. Lay abstract Mental health clinicians often report significant challenges when delivering evidence-based interventions (EBI) in community settings, particularly when unexpected client stressors (or emergent life events; ELEs) interfere with the therapy process. The current study sought to extend the study of ELEs to children with Autism Spectrum Disorder (ASD) by examining the occurrence and impact of ELEs in the context of a collaborative, caregiver-mediated intervention for reducing challenging behaviors in children with ASD. This intervention was An Individualized Mental Health Intervention for children with ASD (referred to as AIM HI). Participants included 38 clinicians and child clients who were enrolled in a community effectiveness trial of AIM HI. Video recordings of 100 therapy sessions were coded for caregiver-reported ELEs and also how well clinicians adhered to the AIM HI protocol. Results indicated that mild to severe ELEs were reported in 36% of therapy sessions, and were reported for 58% of children at some point during the intervention. Children who had a greater number of diagnoses (in addition to the autism diagnosis) tended to have more ELEs. In addition, clinicians with less years of experience tended to have sessions with more ELEs. There was no significant link between ELEs and how well clinicians adhered to the AIM HI protocol. Findings offer implications for the implementation of EBI, particularly the importance of incorporating clinician training in addressing complex presentations and crises in the context of EBIs.

scholarly journals Need to Culturally Adapt and Improve Access to Evidence-Based Psychosocial Interventions for Canadian South-Asians: A Call to Action

2020 ◽  
pp. 1-11
Author(s):  
Farooq Naeem ◽  
Tasneem Khan ◽  
Kenneth Fung ◽  
Lavanya Narasiah ◽  
Jaswant Guzder ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Emotional Health ◽  
South Asians ◽  
Psychosocial Interventions ◽  
Health Problems ◽  
Evidence Based ◽  
Psychosocial Determinants ◽  
Culturally Adapted ◽  
Cognitive Behaviour

Research into social determinants of mental and emotional health problems highlighted the need to understand the cultural factors. Mental health of immigrants is influenced by a variety of cultural, psychological, social, and economic factors. There is some evidence to suggest that South Asian people have higher rates of mental and emotional health problems than the rest of the Canadian population. Limited research also suggests that psycho-social factors are highly likely to be responsible for these high rates of mental health problems. These psychosocial factors may be impeding access and engagement with the services. These socially determined emotional and mental health problems are more likely to respond to psychosocial interventions than biological treatments. Evidence-based psychosocial interventions such as Cognitive Behaviour Therapy (CBT) and Acceptance and Commitment Therapy (ACT) might offer the way forward. CBT can be offered in a low-cost, low intensity format in a variety of settings, thus addressing the attached stigma. However, these interventions need to be culturally adapted, as these are underpinned by a Western value system. CBT has been culturally adapted and found to be effective in this group elsewhere. This opinion paper describes the need to enhance research on psychosocial determinants of the mental and emotional health problems, status, and the psychosocial determinants of health amongst South Asians in Canada to inform our understanding of the cultural specificity of psychosocial interventions.

Identifying research priorities for older people’s mental health services

2019 ◽  
Vol 23 (2) ◽  
pp. 89-100 ◽  
Author(s):  
Luke Emrich-Mills ◽  
Laura Louise Hammond ◽  
Emma Rivett ◽  
Tom Rhodes ◽  
Peter Richmond ◽  
...  
Keyword(s):  
Mental Health ◽  
Older Adult ◽  
Health Research ◽  
Research Priorities ◽  
Clinical Staff ◽  
Service Users ◽  
Content Type ◽  
Adult Mental Health ◽  
Key Stakeholders ◽  
Research Questions

PurposeIncluding the views of service users, carers and clinical staff when prioritising health research can ensure future projects are meaningful and relevant to key stakeholders. One National Health Service Foundation Trust in England, UK undertook a project to identify the top 10 research priorities according to people with experience using or working in services for dementia and older adult mental health. The paper aims to discuss these issues.Design/methodology/approachService users with dementia and mental health difficulties; informal carers, family and friends of service users; clinical staff working in the Trust. Participants were surveyed for research ideas. Ideas were processed into research questions and checked for evidence. Participants were then asked to prioritise their personal top 10 from a long list of research questions. A shortlist of 26 topics was discussed in a consensus workshop with a sample of participants to decide on the final top 10 research priorities.FindingsA total of 126 participants provided 418 research ideas, leading to 86 unique and unanswered research questions. In total, 58 participants completed interim prioritisation, 11 of whom were invited to the consensus workshop involving service users, carers and clinical staff. The final top 10 priorities were dominated by topics surrounding care, psychosocial support and mental health in dementia.Research limitations/implicationsFuture research from the Trust and collaborating organisations can use these results to develop relevant projects and applications for funding.Originality/valueThis project has demonstrated the possibility of including key stakeholders in older adult mental health research priority setting at the local level.

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