What is CaFI?

Family Intervention (FI) is a talking therapy for people diagnosed with schizophrenia and other forms of psychosis.

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.

CaFI pilot study

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.

Read more about the results from the pilot study on the NIHR website.

Current CaFI study

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.

Project aims

The main aim of the CaFI Randomised Control Trial (RCT) is to test CaFI’s effectiveness compared with usual care.

An RCT randomly assigns participants into an experimental group or a control group. In this trial, the experimental group is the intervention we are testing: CaFI therapy. The control group is usual treatment.

The people testing CaFI will be service users of sub-Saharan and Caribbean origin, diagnosed with schizophrenia or other related psychoses (ICD 10 F20-F29) and their families.

We also aim to understand and address the things that make it more or less likely for CaFI to be implemented by services.

Timeline and process

See our timeline for what we want to do in the next four and a half years.

The lead organisation, Greater Manchester Mental Health NHS Foundation Trust (GMMH), opened to recruitment on 6 December 2021.

Other sites also opened to recruit participants in 2021/2022.

In CaFI, service users can take part with a family member or relative. If they do not have a family member or relative, they can choose someone else, such as a friend or care coordinator.

If the service user cannot nominate someone themselves, there are volunteers and peer mentors who they can participate with.

Service users and family units can be referred by clinical teams, or you can get in touch with us directly if you’re interested in taking part in CaFI.

To find out more, please contact our research team.

• Email: CaFI@gmmh.nhs.uk

Recruitment (0-24 months)

The study has a 24-month recruitment period. This includes a 12-month pilot phase to ensure we can recruit people from both Sub-Saharan African and Caribbean backgrounds and keep them in the study.

We aim to recruit 300 families in total across all participating sites. Family units will have a 50/50 chance of receiving either CaFI or usual care.

The family units who receive CaFI will get 10 x 1-hour sessions of ‘talking treatment’, delivered by specially trained therapists.

During the study, we will collect information from study participants at the start, and at 6 and 12 months after people agree to take part.

Follow-up (24-36 months)

We have 12 months to follow up with people who take part to see how they get on.

During this period, researchers will complete interviews and questionnaires to the remainder of study assessments with families.

Close-out (36-42 months)

Once all follow-up assessments have been completed, the information we have collected will be carefully studied to help us write a report on what we found from the study.

We will use different methods to share what we found with service users and their families, members of the public, health professionals, policymakers, and academics.