LIFT – BAME project

ContactHarjit Arranch, Project Lead
Telephone01793 836836
Emailharjit.arranch@nhs.net
Website https://lift.awp.nhs.uk/
AddressOld Town Surgery, Curie Avenue, Swindon, Wiltshire, SN1 4GN

This project aims to increase the proportion of black and asian minority ethnic (BAME) groups who access LIFT Psychology’s services in Swindon, Wiltshire, Bath and North East Somerset.

This has involved running psycho-educational courses (managing pain, managing diabetes, promoting wellbeing, etc.) for people from a minority ethnic background.

Background
Recent analyses of our access rates have shown that ethnic minorities are under-represented in our service. In our attempts to provide an inclusive service for the Swindon/Wiltshire population, we acknowledged the importance of assessing the support needs of hard to reach populations, as well as overcoming barriers to providing this support. A small team worked towards this goal as part of the BAME project.

Through this work, we have developed links within the local community. Linking with the Harbour project has highlighted the unmet support needs of asylum seekers, some of which are thought to be suffering from PTSD. The transitory status of this population posed ethical challenges to providing psychological intervention. Current policy is to prohibit re-experiencing interventions, in case this work cannot be completed and the individual’s mental health subsequently deteriorates.

The change introduced and how this was done
LIFT Psychology began running psycho-educational courses specifically designed for people from minority ethnic backgrounds. It was done by adapting existing psycho-educational materials for BAME populations. Our hope is that these projects will become a part of our regular annual schedule of courses. We also design a Wellbeing Workshop targeted at asylum seekers, which included grounding techniques.

Resources required
Two assistant practitioners were assigned to the project, with one practitioner leading the project. In terms of staffing, this has meant these two assistants setting aside time in their working week for the requirements of the project and liaising regularly with the practitioner/ BAME project lead.

Impact
We have refined and adapted our existing materials to make them suitable for BAME groups, complete with a Promoting Wellbeing manual and handouts. This means that anyone, not just those involved directly with the project can facilitate this course.

To date we have facilitated a ‘Managing Diabetes course’, ‘Managing Long-term pain’, two ‘Promoting Wellbeing courses’ and a ‘Wellbeing Workshop’ (aimed at asylum seekers). The outcomes and evaluations have mainly been subjective and anecdotal. Feedback from those who have participated in our BAME courses has been uniformly positive, with participants reporting that they found the courses helpful. Participants appeared appreciative of the support offered and our contact from the harbour project fed back that the workshops were well received.

Challenges and how these were overcome

Homogeneity of group: A key issue we have had is non-BAME participants choosing to book themselves onto a course designed for BAME participants. This has often resulted in a splitting in the group, with non-BAME participants moving through the material quicker than the BAME participants due to their language ability. There has also been a tendency for non-BAME participants to “hijack” the groups to a certain extent, meaning that the BAME participants possibly got less benefit from the courses than they could have. We have resolved this by encouraging non-BAME participants to book onto more suitable courses.

Low attendance: In terms of advertising, we initially found it difficult to reach BAME communities using our conventional advertising routes. To address this, we approached services within Swindon that work with BAME populations and compiled a BAME contact list of people/organisations that we could disseminate flyers/information about our courses to. Where appropriate we have also changed the wording on our promotional flyers in an attempt to reduce any stigma associated with attending such a group.

High attrition (more relevant to work with asylum seekers):
Due to the unpredictable schedules of this client group, we have decided that it may be more appropriate and convenient to provide a one-day workshop. This is to help ensure that participants receive all of the material in the course.

Language barrier: To overcome the language barrier, we adapted material to be more interactive and have adapted the hand-outs to be more visual. We also informed the group that we were happy to try and re-explain things if they let us know what they did not understand. We allocated time to check understanding and for other members of the group to translate information if necessary.

Assessment: Language barriers have also presented a significant barrier to the completion of our minimum data set questionnaires. We have addressed this both by seeking out questionnaires in widely spoken languages and providing assistance with filling in questionnaires.

Facilitation style: We found that moving away from a didactic style of facilitation to be key in fostering a supportive environment in which people felt comfortable to ask questions / check understanding.

Plan for sustaining and spreading
We learnt a lot from our reflections of the above work and have considered making further changes to future support interventions.

Our future plans include holding a wellbeing course every quarter. We also plan to meet with the lead health ambassador to facilitate greater involvement of their service in this project and to continue building our links with local services. We are keen to continue exploring different advertising channels.

We are also currently planning a one day wellbeing workshop for asylum seekers which will be followed by a focus group. The focus group hopes to explore the participants experiences of attending the group and their reflections on the material covered.

We attend meetings with the Wiltshire LIFT Psychology BAME team to share our reflections and experiences of providing these groups. We see no reason why our approach could not be replicated elsewhere, as it has largely involved liaising with existing services and using widely available mental health promotion materials.

What has been learned
We have learned that mental health issues carry stigma in many minority ethnic groups. One way to address this is in the way courses are advertised. We chose to market our BAME courses as “Promoting Wellbeing” courses to highlight the health and wellbeing component, rather than the managing mental distress component.

Many areas have existing services for BAME populations and organisations aimed at promoting advocacy for these populations. Though these can often be quite dispersed and uncoordinated, they can provide a fertile source for advertising and raising awareness within these populations.

We have also learned that long term health conditions, such as diabetes, are relatively prevalent in some BAME populations. In light of this, we initially began offering long-term conditions/health management courses as a way in to these communities.

In facilitating these groups, we found the normal practice of completing the minimum data set at each session prohibitively time consuming. In future, we plan to complete these measures pre and post intervention by going through the questions as a group. We hypothesise this will stop participants becoming overwhelmed with the requirement of regularly filling in questionnaires.