Exploring using outcome measures with different cultural groups - Dr Emma Morris, Dr James Bourne and Philippe Mandin
Dr Emma Morris
Dr James Bourne
CYP IAPT National Conference
5th November 2013
Aim to bring together clinicians, managers and
researchers at an early stage of CYP IAPT to share
their experience of its implementation within
various community groups,
Particular focus on the use of Routine Outcome
Measures (ROMs) across cultures.
First forum (28.02.13): 25 representatives
from London partners, GIFT partnership and
Anna Freud/ UCL.
On-going dialogue to improve and
disseminate good practice.
The experience of Adult IAPT: People from Asian and Black
ethnic groups were under‐represented. (Glover 2010).
IAPT BME Positive Practice Guide 01/2009
Common themes from research:
◦ E.g. Breaking the Circle of Fear 2002 Sainsbury Centre for mental
health, The DOH Inside Outside (2003); DRE program (2005); Dutt
◦ Disparities in mental health care for BME clients.
◦ Higher levels of mental distress exacerbated by social
disadvantage and exclusion and experiences of discrimination.
◦ Clients from BME communities are less likely to be referred for
talking therapies but more likely to be mis-diagnosed, prescribed
medication and compulsorily admitted to hospital
BME samples are frequently under-represented in RCT &
EBP - ‘Evidence informed’ Practice (Clarke 2009)
Recommendations for recording of Ethnicity, community
involvement, clinical training and organisation change
Requires that listed public authorities in
carrying out their functions shall have due
regard to the need to:
eliminate unlawful discrimination
promote equality of opportunity
promote good race relations between
people of different groups
Culture constructs many of our basic
notions taken for granted such as:
◦ Mind / Body
◦ Notions of well-being
(Malik & Mandin 2012)
Engaging with local communities
Validity Of ROM’s across culture
Impact on Therapeutic alliance and
It is important to ensure that the measure used
to track outcomes is valid and does not impact
negatively on engagement.
1. Does the measure make meaning of the
problem in a way that both the clinician and
the young person/family can relate to?
2. Does the young person/family hold any
adverse associations with form filling?
How does my own culture fit with or differ from
the culture of the family I am about to see?
What do I need to know about the culture of this
Might I need to tailor my practice at this stage?
Is it possible that there is some difference in the
way the problem is constructed across
Based on what I know from the referral, what is
the family’s likely relationship to authority/
professional figures, and what is their experience
of form filling?
What language does the form need to be in?
Do I need an interpreter, and have I prepared
them to use ROM?
Might I need to bring an additional alternative
to symptom measurement to the first
Will the first session need to be longer in
order for me to be able to complete the
Explore: How can I explore this family’s
construction of the problem in a way that allows
us to develop a shared understanding?
Acknowledge: How can I acknowledge differences
in the way problems are constructed and
empower families to say in cases where ROM
might not 'fit'?
Address: How can I address issues of power and
Bridging: How can I find a shared language or
understanding that will facilitate completion of
Introduce the idea of measurement. However, if it
is likely that completing ROM might impact on
engagement, do them in the next session. Be
prepared to complete ROM over more than one
session if need be. Prioritise engagement and
building a shared narrative with the family when
selecting which ROM to use.
If your clinical judgement is that using ROM will
have a significant negative impact on treatment,
do not use them- but be sure to discuss this in
supervision and with your cultural lead so that
they are aware of issues within the service and
can feed this back to the broader network.
Discuss in supervision any challenges in
engaging across cultures. With the information
you now have, you can go back to the 'before
session' questions and develop your
understanding of the use of ROM with this family.
We all have a culture; culture is dynamic and
negotiated differently by different individuals.
Clinicians should be curious about the particular
meanings that culture holds for the individual
clients they are seeing and what they choose to
conform to or contest.
it all together: Embedding positive
practice within the organisation
- Describing the local demographic
- Identifying the needs of local communities
- The role of the 'cultural lead'
- Creating a local context for reflexive
practice to develop
- Building relationships, locally and nationally
- Sharing resources and experience, locally
(establishing and embedding
practice, use of
Clinical practice: Exploring,
Bridging and Flexibility
Community Profile of
the family to be seen
linking with resources)
What challenges do you experience in engaging with
children, Young people and families that are from a
different culture than your own (at a personal, practical
and/or organisational level)
Clinical discussion group:
How much do these suggested guidelines resonate with
your own clinical experience? Which questions are most
useful? Which are more challenging?
Organisational discussion group:
To what extent is positive practice embedded within your
organisation already? What are the barriers? What would be
the tasks of your cultural lead?
Department of Health (2008) Commissioning IAPT for the whole community
Improving Access to Psychological Therapies
Glover et al (2010) ‘IAPT – A review of the progress made by sites in the first roll
Jassi, C (2008) IAPT for BME Communities. Advancing Practice in Bedfordshire
Volume 5: Number 3 (2008) ISSN: 1743-1611
Malik & Mandin (2012) Engaging within and across culture In Krause, I,B (Karnac)
Culture & Reflexivity In Systemic Practice
National Institute for Mental Health in England (2003) Inside Outside: Improving
Mental Health Services for Black and Minority Ethnic Communities in England.
Netto, Gaag, Thanki, Bondi & Munro (2001) Perceptions and experiences of
counselling services among Asian people. Joseph Rowntree Foundation. Patel N,
Bennett, Denis M, Dosanjh N, Mahtani A, Miller A, Nadirshaw Z (2000) Clinical
Psychology – Race and Culture: a training manual. Leicester: BPS Books