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CaFI

CaFI: Culturally-adapted Family Intervention

A NEW TALKING THERAPY FOR PEOPLE FROM SUB-SAHARAN AFRICAN AND CARIBBEAN BACKGROUNDS WITH EXPERIENCE OF PSYCHOSIS AND THOSE CLOSE TO THEM

 

WHY IS CAFI NEEDED?

In the UK, African-Caribbean people including those of Mixed heritage, are much more likely to be diagnosed with schizophrenia and to be ‘sectioned’ under the Mental Health Act than any other ethnic group.

 

The National Institute for Health and Care Excellence (NICE) highlight an urgent need to improve access to effective care, experiences of services, and outcomes for Black service users.

 

Delayed diagnosis and access to care also creates considerable tension, conflict, and increased burden on service user’s support network (family members, carers, friends, children) which can result in relationship breakdown. Lack of access to family support and social contact is, in turn, associated with service users’ social isolation and increased risk of relapse and readmission to hospital.

 

Getting families to understand service users’ experiences and helping service users to understand how their behaviour affects their families can reduce stress and conflict. Family Intervention (FI) is a type of talking therapy with strong evidence-base of clinical effectiveness for people diagnosed with schizophrenia and other forms of psychosis to support recovery. NICE recommends FI for schizophrenia and related psychoses because it improves self-management and problem solving which, in turn, has the potential to prevent relapse and readmission to hospital.

 

However, people of Sub-Saharan African and Caribbean origin are rarely offered psychological therapies in NHS psychiatric inpatient and community services. When these ‘talking treatments’ are offered, they often do not address people’s needs, experiences, and culture.

 

Whilst people from other ethnic groups may also experience these issues, they disproportionately impact Sub-Saharan African and Caribbean families due to deep-seated fear, mistrust, and avoidance of mental health services.

 

WHO MADE CAFI?

CaFI has been created by Professor Dawn Edge in collaboration with Black service users, their families, community members, mental health advocates, and health professionals for people from African-Caribbean backgrounds diagnosed with psychosis.

In this video, some of the people involved in developing and pilot testing CaFI speak about their experiences of being involved in the research and why it is so important to them

WHAT DOES CAFI AIM TO DO?

The study aims to:

  1. Evaluate CaFI’s clinical and cost-effectiveness in Sub-Saharan African and Caribbean populations compared with usual care.
  2. Determine how to maximise facilitators and overcome barriers to successful implementation.

To achieve the above aims, therapists will work in partnership with families to:

  • Develop more helpful explanations for symptoms or experiences.
  • Facilitate better communication in the family.
  • Develop more effective coping and stress management strategies.
  • Promote recovery and relapse prevention.


WHAT ARE THE BENEFITS OF CAFI?

A research team led by Professor Dawn Edge at The University of Manchester trialled CaFI over a 12-month intervention period, with Caribbean origin service users and their families who were recruited from hospital and community settings across Greater Manchester. The study found that of the 26 family units who commenced CaFI, 24 completed all ten sessions (92% completion rate).

 

Benefits for service users include:

  • Improved understanding of illness and symptoms better mood and less paranoia.
  • Better social functioning – going into work, university, and volunteering.
  • Better communication.

 

Benefits for family members include:

  • Increased understanding of condition.
  • Better engagement and support with service users.

 

Benefits for Healthcare Professionals include:

  • More cultural awareness and understanding of needs of Caribbean people.
  • Using CaFI skills/materials in everyday practice.

 

However, we cannot guarantee that the study will help you personally.

WHAT DOES CAFI THERAPY INVOLVE?

CaFI therapy is a hybrid model consisting of Behavioural Family Therapy (BFT) and Cognitive Behavioural Therapy (CBT).

 

All family units have a 50/50 chance of being randomised to receive 10 one-hour CaFI therapy sessions. CaFI sessions are delivered across a 26-week treatment block can be done in-person or online on the CaFI Digital platform. Service users can also request a loanable Electronic Tablet from the Research Team for their online sessions (IT support available).

 

CaFI is delivered by two therapists: A lead therapist and Co-therapist. Below is a breakdown of what is generally covered in the sessions.

 

Component 1: Engagement and Assessment

  • Understanding the family dynamics and different roles.
  • Building positive relationships and understanding the individual current need.

Component 2: Shared Learning

  • Navigating mental services.
  • Addressing power dynamics in the family and health care services.
  • Challenging stigma.
  • Improving knowledge about schizophrenia and related psychoses.

Component 3: Communication

  • Building on existing communication skills within the family.
  • Empowering participants to express their needs.
  • Engaging with mental health services.
  • Supporting carers and family members in representing the view and needs of service user and themselves.

Component 4: Stress Management and problem solving.

  • Identifying stressful situations.
  • Creating goal-based coping strategies.
  • Promoting positive cycles around thoughts, feelings, and behaviours.

Component 5: Staying Well and Maintaining gains.

  • Recovery-focused approach.
  • Developing long-term plans for maintaining wellbeing.
  • Spotting early warning signs. Delivering

 

NHS TRUSTS CURRENTLY RECRUITING PARTICIPANTS FOR CAFI

 

TAKING PART IN THE CAFI STUDY

We are inviting eligible people from Sub-Saharan African and/or Caribbean heritage who are currently receiving NHS Care from Greater Manchester, the West Midlands, London, and Southampton Mental Health Services to take part in our study to see whether CaFI is effective for Black and Mixed heritage people diagnosed with schizophrenia or psychosis and their families.

 

The National Institute for Health Research (NIHR) has now funded a larger-scale study to see whether CaFI is effective for Sub-Saharan African and/or Caribbean (including Black and Mixed heritage) people aged 14+ diagnosed with schizophrenia or other related psychoses and their families.

 

We are offering CaFI to 202 families of Caribbean and Sub-Saharan African origin across the north-west, Midlands, south-east and London as part of a randomised controlled trial (RCT). We shall compare their results with 202 families who do not receive CaFI to see if CaFI is at least as good as usual care.

 

A RCT randomly assigns participants into an experimental group or a control group. Participants randomised to receive CaFI will receive talking therapy over ten sessions.

OTHER WAYS TO GET INVOLVED

There are lots of other ways to get involved in the CaFI trial, whether you are a service user, family member or community member or other.

 

For example:

  • Working as a therapist on the study.
  • Supporting service users during Therapy as a Family Support Member.
  • Becoming a member of our Research Advisory Group (RAG).
  • Volunteering on the CaFI study to build your research knowledge and skills.

 

We meet with communities regularly by organising events and workshops to give everyone opportunities to learn about CaFI.

These events are opportunities for you to let us know what you think about the project and share any ideas you may have.

If you would like to get involved, please get in touch.

 

I’M INTERESTED IN TAKING PART OR KNOW SOMEONE I THINK MIGHT BE SUITABLE. WHO DO I CONTACT?

Please contact the research team by emailing, cafi@gmmh.nhs.uk
Alternatively, you may contact the Research Management Team, directly on: cafitm@gmmh.nhs.uk

If you would like to find out more information about CaFI and other research around African and Caribbean mental health, please see the links below:

https://sites.manchester.ac.uk/cafi/