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Culturally-adapted Family Intervention (CaFI) for African Caribbeans with schizophrenia and their families: A feasibility study of implementation and acceptability


Summary of Research
African Caribbeans have the highest prevalence of schizophrenia, most difficult relationships with mental health services and greatest persistent inequalities in care of all ethnic groups in the UK(1-3). The National Institute for Health and Clinical Excellence (NICE) recently updated schizophrenia guidelines(4); highlighting the lack of evidence-based psychological interventions for ethnic minorities in general and African Caribbeans in particular.
Responding to NICE recommendations(4), we propose a cultural-adaptation of an existing evidence based family intervention (FI)(5) for African Caribbeans that can be delivered at different phases of recovery and across different clinical settings. Our proposal aims to: i) culturally-adapt an existing family intervention(5), ii) test the feasibility of recruitment and implementation iii) evaluate its accessibility and acceptability among African Caribbean patients and their families. We shall test the intervention in hospital (acute and rehabilitation wards) and community settings (Community Mental Health Teams (CMHTs) – including individuals on Community Treatment Orders (CTOs)). Delivering the intervention via ‘proxy families’ (trusted individuals nominated by patients where there is little or no contact with biological families) potentially addresses an important access barrier for African Caribbeans who are especially likely to experience family disruption(6). Our approach therefore represents an innovative response to current inferior access and inequality of provision experienced by this ‘hard-to-reach’ group.

Our rationale is that:
1. Successful implementation of FI will facilitate and improve engagement in services for African Caribbean patients with schizophrenia and related disorders (ICD F20-29)(7).
2. Better and earlier engagement will improve access to a range of evidence-based interventions thus improving outcomes.
3. Successful implementation of FI in this group will pave the way to improving access to evidence-based care for other socially-excluded and ‘hard-to-reach’ groups.

Research Questions
1. How can existing evidence-based family intervention (FI) be culturally-adapted for African Caribbeans with schizophrenia and related disorders?
2. Is it feasible for culturally-adapted FI to be delivered in hospital and community settings?
3. Can 'proxy families' serve as acceptable alternatives where biological families are unavailable?
4. Will culturally-adapted FI be acceptable to patients, families, and health professionals?

Duration of the project

36 Months (commencing May 2013)

Funding body


Members of the project

Name Role
Dr Dawn Edge Principal investigator
Professor Kathryn Abel Co-investigator
Dr John Baker Co-investigator
Mrs Daisy Barratt Principal Collaborator
Professor Christine Barrowclough Co-investigator
Dr Katherine Berry Co-investigator
Prof Dinesh Bhugra Co-investigator
Mr Patrick Cahoon Co-investigator
Dr Sarah Cotterill Co-investigator
Miss Amy Degnan Research assistant
Dr Richard Drake Co-investigator
Rev Paul Grey Co-investigator
Dr Mark Harrison Co-investigator
Professor Shôn Lewis Co-investigator
Prof Nicholas Tarrier Co-investigator