Dr Emma Morris
Dr James Bourne
Philippe Mandin
CYP IAPT National Conference
5th November 2013
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





Aim to bring together clinicians, managers and
researchers at an early stage of CYP IAPT to share
their experi...





The experience of Adult IAPT: People from Asian and Black
ethnic groups were under‐represented. (Glover 2010).
IAP...
Requires that listed public authorities in
carrying out their functions shall have due
regard to the need to:




elimi...
Culture constructs many of our basic
notions taken for granted such as:
◦ Self
◦ Kinship
◦ Mind / Body
◦ Notions of well-b...










Engaging with local communities
Validity Of ROM’s across culture
Impact on Therapeutic alliance and
engage...
It is important to ensure that the measure used
to track outcomes is valid and does not impact
negatively on engagement.
1...







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...







What language does the form need to be in?
Do I need an interpreter, and have I prepared
them to use ROM?
Might...








Explore: How can I explore this family’s
construction of the problem in a way that allows
us to develop a shar...




Introduce the idea of measurement. However, if it
is likely that completing ROM might impact on
engagement, do them ...




Discuss in supervision any challenges in
engaging across cultures. With the information
you now have, you can go bac...
Bringing

it all together: Embedding positive
practice within the organisation









- Describing the local demographic
- Identifying the needs of local communities
- The role of the 'cultural...
Organisational Change
(establishing and embedding
positive practice)
Reflexive
practice, use of
supervision and
curiosity ...
Both Groups:
What challenges do you experience in engaging with
children, Young people and families that are from a
differ...
















Department of Health (2008) Commissioning IAPT for the whole community
Improving Access to Psychol...
Exploring using outcome measures with different cultural groups - Dr Emma Morris, Dr James Bourne and Philippe Mandin
Exploring using outcome measures with different cultural groups - Dr Emma Morris, Dr James Bourne and Philippe Mandin
Exploring using outcome measures with different cultural groups - Dr Emma Morris, Dr James Bourne and Philippe Mandin
Exploring using outcome measures with different cultural groups - Dr Emma Morris, Dr James Bourne and Philippe Mandin
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Exploring using outcome measures with different cultural groups - Dr Emma Morris, Dr James Bourne and Philippe Mandin

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Exploring using outcome measures with different cultural groups - Dr Emma Morris, Dr James Bourne and Philippe Mandin

  1. 1. Dr Emma Morris Dr James Bourne Philippe Mandin CYP IAPT National Conference 5th November 2013
  2. 2.     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.
  3. 3.    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 2011 ◦ 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
  4. 4. 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 5
  5. 5. Culture constructs many of our basic notions taken for granted such as: ◦ Self ◦ Kinship ◦ Mind / Body ◦ Notions of well-being ◦ Treatment (Malik & Mandin 2012)
  6. 6.       Engaging with local communities Validity Of ROM’s across culture Impact on Therapeutic alliance and engagement Clinical skills Political context Organisational change
  7. 7. 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?
  8. 8.      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 particular family? 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 generations? 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?
  9. 9.     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 session? Will the first session need to be longer in order for me to be able to complete the forms?
  10. 10.     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 authority? Bridging: How can I find a shared language or understanding that will facilitate completion of the forms?
  11. 11.   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.
  12. 12.   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.
  13. 13. Bringing it all together: Embedding positive practice within the organisation
  14. 14.       - 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 and nationally
  15. 15. Organisational Change (establishing and embedding positive practice) Reflexive practice, use of supervision and curiosity with the individual. Clinical practice: Exploring, Acknowledging, Addressing Bridging and Flexibility Community Profile of the family to be seen (pre-session thinking, linking with resources)
  16. 16. Both Groups: 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? 
  17. 17.         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 out year’http://www.iapt.nhs.uk/silo/files/iapt-a-review-of-the-progress-madeby-sites-in-the-first-roll8208-out-year.pdf Jassi, C (2008) IAPT for BME Communities. Advancing Practice in Bedfordshire Volume 5: Number 3 (2008) ISSN: 1743-1611 http://www.iapt.nhs.uk/downloads/resources/?keywords=&filter=last_updated&or der=asc&p=1 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. London: DoH. 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 http://www.centreformentalhealth.org.uk/pdfs/breaking_the_circles_of_fear.pdf

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