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This essay aims to identify and critically appraise evidence of whether ‘social intervention’ improve outcome for depression in British Pakistani women. I will analyse whether ‘social intervention’ can lead to improve mental wellbeing, empowerment and individual growth. I will analyse the value emphasis of therapeutic social support in mental health. The context of social work practice in mental health is complex, therefore social work intervention has to have an ethical and value based framework. I will assess the theoretical basis for standardise practice. The statutory changes in Britain to consider the fundamental values position incorporated in recent policies and legislation will be examined.
Define the concept of evidence based practice
Evidence based practice (EBP) according to Sackett (1997) citied in Gray et al (2009: 119) connotes a process of improving professional judgement through the “conscientious and judicious” integration and synthesis of well-researched empirical evidence to evaluate the efficacy and effectiveness of intervention in enhancing service users’ outcomes and how this can be integrated into practice context to improve service delivery and professional accountability (Department of Health Service and Public Safety, 2012) (Gray, Plath, & Webb, 2009) (Sheppard, 2004) (Corby, 2006). It “gives a framework for analysing the situation and generating a number of possible options” (Thompson N., 2000, p. 35). (Mathews & Crawford, 2011) suggested that practitioners must think critically and reflect on research evidence for credibility, completeness and transferability to inform professional judgement as this an implication for policy makers, professionals, communities and service users.
The impetus for EBP within social work is underpinned on the centrality on service users’ best interest to guide practice that is culturally sensitive and of significance to service users within the dynamic context of practice, legislation and social policy (Bolton, 2002). EBP therefore necessitates social workers’ reflexivity of how values, “theoretical assumptions”, policies, past experiences and the context in which practice takes place combine with service users perspective, preferences, and culture to guide and inform practice (Munro, 2002:10). This is to account for the multifaceted personal, cultural and social dimensions of service users (Webber & Nathan, 2010)
Select an aspect of social work
What interest me in this topic is the gap which exist in providing culturally sensitive support to black and ethnic minority group with depression. The evidence available suggest that individual with mental health distress including depression are “the most marginalised and excluded groups in society” (Stepney & Ford, 2001). Additionally, the prevalence of depression in black and minority ethnic (BME) and in particular women from Pakistani background in Britain, underlines the importance of supporting statutory and voluntary initiatives directed towards meeting their needs (Husain, Creed, & Tomenson, 1997) (Gater, et al., 2009). (Miranda, et al., 2003) noted the gap in evidence based for ‘social intervention’.
Drawing on their practice experiences and appropriate evidence
Within the context of community voluntary mental health services, their diverse types of evidence that informs practice and policy and social workers have an ethical obligation in the choice of theories and model of working.
In my practice, a systems approach is emphasised in understanding the interplay and multiplicity of service users’ context. Psychodynamic approach is concerned with how perceptions of needs, stigma and stereotypical assumptions motivate human behaviour including help seeking, disclosure of sensitive information. Past experiences are seen as central in the problems individual experience and used in understanding the dynamics of the helping relationship.
Social learning theory suggests behaviours are influenced by service users’ socio-cultural context. For example help seeking behaviour is influenced and reinforced by stigma and service delivery
Therefore cognitive- behavioural therapy is emphasised by understanding the role perceptions in help seeking. Therefore through interaction, modelling service users’ perception is influenced.
Conflict theory is invaluable in understanding cultural conflicts, stigma and oppression, power imbalance.
As noted in Saleeby (1996) the strength perspective is intrinsic to social work values of service users’ involvement, and respecting individual as having strengths
The feminist perspective takes into account the role of gender and the historical lack of power experienced by women. Collaborative relationship is emphasised between the social worker and service user through equality and empowerment.
Through empirical observation using randomised controlled trial, Gater, et al (2010) investigated the effective of ‘Social intervention’ for British Pakistani women with depression. It sought to explain the ’cause and effect’, to predict and control reality, and to create unambiguous objective ‘truth’ that can be proven or disproved to inform the effectiveness of intervention and policies implementation.
Qualitative data used to understand individuals “social reality” within their socio- cultural context which questions cultural assumptions, discrimination and oppression and the implication and significance in implementation. This can be used to conceptualise service users’ perspective regarding intervention and polices implications, their needs and perceptions about current polices and interventions.
The problem solving model focuses on understanding service users in their context and working in partnership.
In a cross sectional study, prevalence of depression amongst women of Pakistani origin was twice as high compare to white European women (Gater, et al., 2009).
(Campbell & McLean, 2002) suggested that social capital resources is embedded in within social networks and improve recovery. An alternative explanatory framework for the prevalence of depression in Pakistani women in mental health statistics has been the social constructive perspective. This perspective encompasses help seeking behaviour.
There are some evidenced based interventions that have been proven to help people recovery from depression. The randomized control trial study by (Harris, Brown, & Robinson, Befriending as an intervention for chronic depression among women in an inner city: Randomised control trail, 1999) found that befriending schemes are beneficial in improving recovery.
This is to counter the criticisms of ‘institutional racism’ and cultural assumptions in the delivery of mental health services to black and ethnic minority groups (Gould, 2010). Phillip Rack (1982) cited in (Gould, 2010): 40 proposed a “Culturally attuned approach that used insight”
This intervention is central to social work values of respecting and valuing uniqueness and diversity and recognising and building strengths. Social intervention involves aspects of partnership and include and emphasis on the impact of environmental pressures on individuals and therefore can be invaluable in anti-discriminatory work with service users in “offering empowerment and dealing with structural oppression” (Ahmad B. , 1990, p. 51). He also noted the importance of importance of qualitative research in exploring these issues (Ahmad W. , 1995). This social intervention included specific target groups. It uses an approach that included education and/or direct contact with people who are depressed.
Social intervention provides social workers with a “structural appreciation of the nature of social problems” (Gould, 2010, p. 60)
(Harris, 2010) social support and depression
Reconnection of hope through therapeutic encounter
Psychosocial and cognitive therapies have now been included in clinical practice guidelines. However, there remain considerable problems with black and ethnic minority accessing these services.
Research has shown a consistent relationship between mental illness and indicators of social disadvantages (Fryers, Melzer, & Jenkins, 2003). Thus, development of strategies to support help seeking and treatment is needed.
(Mathews & Crawford, 2011)
(Orme & Shemmings, 2010)
(Gask, Aseem, Waquas, & Waheed, 2011) qualitative thematic analysis (social isolation) family conflict, social cultural factors, psychosocial factors
Identify what can be learned from the evidence
In Gater,et al (2010) Social intervention for British Pakistani women with depression: randomised controlled trial, Participants’ social functioning and depression were signi¬cantly improved. Given the prevalence of depression (Gater, et al., 2009) in this group and the under-representation amongst people able to access supportive services, this presents an important development.
In relation to improving participants’ engagement qualitative studies have found the debilitating effect of stigma as a signi¬cant barrier for accessing support (Livingston & Boyd, 2010) (Mak, Poon, Pun, & Cheung, 2007). Stigma is understood as the interplay of individuals’ social identity and socio-cultural dynamics in which individuals with mental health are discriminated against and socially excluded due to stereotypical assumption (Lam, 2008). This ¬nding is consistent with the evidence regarding social support interventions in (Harris, A stress-vunerability model of mental health disorder: implications for practice, 2010). However, there is a gap of how stigma associated with mental illness can be reduced.
The study was of high research quality, which indicates a reduced risk of biasness and confounding. A major limitation of this study is heterogeneity amongst the sample, that only 123 participants and increase in social functioning is limited to only 3 months. Therefore, the medium to long-term effects of social intervention within this group remain largely unknown. Another research gap is the absence of a dynamic medication adherence related studies aimed at this group, which have been identi¬ed as important for achieving adherence and better outcome for depression (Miranda, et al., 2003).
Addressing the resistance from family members around issue of confidentiality and stigma amongst this population may be best accomplished through culturally appropriate communication strategies that facilities warm and empathy and social capital. In contrast, the research suggests that social intervention although it improves depression in the short run will not achieve meaningful improvements in the long run without antidepressant.
(Department of Health, 2007) emphasises partnership working, respect for diversity, strengths and aspirations and service users centred. Its focus on effectiveness, accountability and personal development are congruent with the principles of evidence based practice.
(Slade, 2009) noted that personal recovery is a challenging and contested concept within the domain of empirical evidence. The multi facet level of mental illness is evident in the definition of mental health, the impact of treatment and the social consequences. However, (Resnick, Fontana, Lehman, & RA, 2005) highlighted that “empowerment, hope and optimism, knowledge and life satisfaction” outcome that are central to the recovery model allows the prevalence of recovery to be investigated empirically. (Gould, 2010)
As stated in (Gater, et al., 2009), an epidemiology of depression that accounts for social support and social difficulties is critical. Social context of depression
Nonetheless, depression is associated with important negative consequences, such as social exclusion, low self-esteem.
Social exclusion according to (Hills, LeGrand, & Piachaud, 2004)should be conceptualise in the context of the personal, cultural and structural dimension and highlighted lack of social interaction as a form of social exclusion.
Attuned to cultural beliefs and norms
Social and inclusive practice have been developed and reinforced by the Capabilities for Inclusive Practice (Department of Health , 2007) report: working in partnership, respecting diversity.
Assessment requires service users’ participation and access to information to make informed choice. This model of assessment has to be cultural sensitive and proactive in nature.
Although social support is frequently referred to as beneficial in relation to depression, there has been little attempt to specify what this means and to evaluate the effectiveness of interventions to reduce isolation.
(Tew, 2004) Partnership working is crucial in adopting a social model of intervention. Culturally sensitive practice.
(Gater, Waheed, Husain, Tomenson, Aseem, & Creed, 2010)
(Webber W. , 2011)
Research indicates that (Oakley, Strange, Toroyan, Wiggins, Roberts, & Stephenson, 2003)
Mental health is practice within a context of multi-disciplinary collaboration to integrate the bio-psychosocial model of practice. The implementation of EBP within this context has to account for the theoretical assumptions that underpin this area of practice. This involves training and supervision. Research by (Huxley, et al., 2005) indicated stress of workers as accounting for their lack of implementing EBP.
— noted that another reason for EBP not been implemented is due to stereotypical assumptions that black and ethnic minorities prefer informal support than support from professional.
One barrier to effective assessment and intervention for depression epidemiology
Another barrier is the reluctance of ethnic minority group to share their emotional symptoms due to family pressure and perceive stigma. To overcome these barriers, —social intervention that accounts for social capital is crucial.
EBP therefore requires practice that is needs not resources leads if services are to be provided that are of sound professional judgement.
Perceptions about depression and stigma have been empirically supported in experimental, cross-sectional and longitudinal studies to worsen depression and affect interpersonal outcome and social support (Thomsen, 2006).
Analysis and reflective process of data collection, the transparencies about the relational nature of the research, and the ways which service users perspective are constructed through a respectful partnership and reflexivity of how our values, theoretical assumptions, policies, past experiences and the context in which practice takes place.
Trust and openness in research relationship a reciprocal process
“right- based” analytical approach (Department of Health, 2008) ethical and critical engage that with respectful uncertainties that reflect on the process of engagement and analysis
Mutual and sincere collaboration, over time
Using multiple data sources to account for publication biasness and multiple perspectives and ways of knowing
Acknowledgement of complexities of realities
Use of reflexivity – focus on contexts of and relationships between researcher and researched as shaping the creation of knowledge. Ethical consideration in knowledge
(Gask, Aseem, Waquas, & Waheed, 2011) understanding how symptoms are expressed and perceive. Understanding emotional expressiveness within cultural context.
In conclusion, social intervention has highlighted strategies that have demonstrated some success for improving help seeking.
Given the complexities and multi facet dimension of individual experiences and the context in which needs occurs, it is imperative that the uniqueness of individual is taken into account within the paradigm of culturally competent practice (Dalrymple and Burke, 2006). In addition, Social Work practice draws on theoretical knowledge from social sciences, which are usually Eurocentric, it is essential, that Social Work practice integrate knowledge from best evidence for it to meet it ethical obligation to counter oppressive and discriminatory practice (Thompson N. , 2003) (Webber W. , 2011).
(Thompson N. 2003)
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