Project details

Summary

What is the study about? 

CaFI therapy is a hybrid model consisting of behavioural family therapy and cognitive behavioural therapy. It is delivered by two therapists: a lead therapist and another who will assist them, known as the co-therapist.

The therapy is recommended by the National Institute for Health & Care Excellence (NICE). However, people of Sub-Saharan African and Caribbean origin are rarely offered talking therapies in NHS psychiatric services.

People in this group who are diagnosed with psychosis, including those who identify as Black British or Mixed heritage, have worse access to mental health care, treatment, and outcomes than White British people in the UK.

What are you trying to find out?

A research team led by Professor Dawn Edge at The University of Manchester has pilot-tested a specific FI called Culturally-adapted Family Intervention (CaFI) with Caribbean families.

CaFI was designed together with service users, their families, community members, and health professionals for people from African-Caribbean backgrounds diagnosed with psychosis.

The people who tried CaFI had positive things to say. Service users and their families said it helped them better cope with the illness, and everyone said they would recommend CaFI to others. However, only 26 families tried CaFI in the pilot, meaning the study was too small to know if the therapy really works.

The National Institute for Health Research (NIHR) has now funded a larger-scale study to see whether CaFI is effective for Black and Mixed heritage people diagnosed with schizophrenia or psychosis and their families.

We are offering CaFI to 150 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 150 families who do not receive CaFI to see if CaFI is at least as good as usual care.

What does taking part involve?

This study is no longer looking for new participants but is still ongoing.

In our study, all family units randomised to receive CaFI therapy will receive 10 one-hour sessions. These are delivered face-to-face/in person, or via CaFI:Digital. This is an online platform that we have developed to increase patient choice and flexibility.

If family units opt to receive CaFI:Digital, the therapy sessions will be delivered via Microsoft Teams. Participants can also request the loan of an iPad for their online therapy session.

A breakdown of what is generally covered in the sessions is below.

Component 1: Engagement and Assessment (Sessions 1 and 2)

• Understanding the family dynamics and different roles.
• Tailoring CaFI to meet individual needs.
• Building positive relationships.

Component 2: Shared Learning (Sessions 3 and 4)

• 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 (Sessions 5 and 6)

• 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 (Sessions 7 and 8)

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

Component 5: Staying Well and Maintaining gains (Sessions 9 and 10)

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

Why is it important?

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.

Delayed diagnosis and access to care also creates considerable tension, conflict, and increased burden on service users’ support networks (family members, carers, friends, children).

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 that the National Institute for Health and Care Excellence (NICE) recommends for schizophrenia and related psychoses. This is 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.

How can I find out more?

You can find out more information about this study by visiting the CaFI project website here.

This study is no longer looking for new participants but is still ongoing. 

However, if you have questions for the research team, click the button below to email the research team:

Email the research team