Black Lives Matter: CORC's statement of support - one year on
In June of last year, CORC made a statement in support of Black Lives Matter, prompted by the events surrounding the murder of George Floyd, setting out our commitment to contribute to and inform conversations on racism and inequalities in the child and youth mental health sector, and identifying some specific areas we would work on. One year on, we want to reflect back with CORC members on what has emerged from this work, and how it is progressing.
Given the focus in our work on the use of standardised measurement tools which can be prone to systematic biases, we undertook to understand more about how racial bias might operate in mental health outcome measures. Those commonly used in the UK have often been developed based on the expected behaviours and attitudes of Western, White children and young people, and validated in studies where participants were predominantly White. The team looked into what the peer-reviewed research could tell us, taking as a point of focus two of the most widely-used and widely-researched measures – the SDQ and RCADs – and looking at whether studies could demonstrate that these showed ‘measurement invariance’ (i.e. measure a trait in the same way) across different ethnic groups. In our blog sharing findings from this review, we reported mixed findings, noting that the number of studies exploring the relationship between outcome measures and ethnicity or culture remain relatively small, and that more work is needed to understand where and how measures can be used to make meaningful comparisons across different contexts and ethnicities.
We used our November 2020 Member Forum to discuss the implications of this with CORC members, inviting practitioners to share experiences of using outcome measures with children, young people and families from different ethnicities and cultures. Practitioners raised as issues the accessibility of the language used in questionnaires, and situations where some of the constructs they ask about do not translate well or feel meaningful in some other cultures or contexts.
Thinking about what lessons could be drawn from their experience, we would emphasise how important it is: for there to be interaction between a child or young person and their practitioner about using the questionnaire (e.g. to explain words and draw out meanings); for services to involve service users when selecting measures; and to always use outcome data as one piece of information alongside other types of information about what service users are experiencing. At an overarching level, a key message we want to communicate through CORC is that services should be aware of the potential for questionnaires to be responded to differently depending on culture and ethnicity, and to be thoughtful about how this might play out among the populations that they serve. While research is thin as to exactly how this impacts different people, in different contexts and for different measures, we are working to update the measures pages on our website to incorporate insights available from existing studies.
Another key area for us was to take stock of the current state of research about youth mental health and racism, and to consider how our own data and research strategy could contribute to the better understanding and addressing of racial inequalities in experiences of mental health and mental health support. With colleagues at the Evidence Based Practice Unit we hosted a roundtable where we invited a range of organisations to share with us their views on this question. Some points that were really brought home for us from this conversation, were the emphasis on researching ‘with’ – how crucial the genuine and thorough-going involvement of research participants is in non-discriminatory research; the need to draw on methodological approaches that allow for complex experiential information to be considered alongside larger-scale quantitative data; and a challenge to researchers around their responsibilities in following through to ensure research is used and has impact. Emerging from this, we are currently co-leading a new research network, Crucial Conversations on Youth Mental Health and Racism. The network is supported by Emerging Minds and aims to bring together young people, community organisations, researchers and policymakers to foster and support research that improves understanding in this area, and to create change for young people. We aim to foster collaborations between those working in this area and create spaces for different groups to share what they are doing.
A key area for our own research has been whether the measurement tools that we use adequately reflect the diversity of lived experience in relation to mental health and wellbeing, and how we can develop tools and research that better reflect individual and cultural diversity, prioritising what is important to young people. To this end we will be conducting a set of discussions over the coming months and we invite young people and parents/carers from Black and minoritized ethnic groups to share their views on how we can make research more inclusive, from setting the right questions, to sharing findings as well as how the research is conducted and what measurement tools are used.
We also committed to thinking about how the data we already hold – the outcome and experience information of approximately 400,000 children and young people, collected through the routine interactions of CORC member organisations and shared with CORC for research purposes - could illuminate issues of racism in youth mental health. We grapple with issues inherent in large datasets, in particular the way that sparse or partial data can prevent clear conclusions being drawn using quantitative statistical techniques. We also need to reflect on the ways ethnicity and race are recorded in our datasets, and how this itself may create bias in research findings.
However, we have been exercising our commitment to applying the lens of racism and inequalities to our ongoing research enquiries into CORC data. For example a recently published paper exploring the circumstances around case closure found that compared to White British young people, Black or Black British young people, mixed-race young people, and those from other White backgrounds were more likely to have case closure due to non-mutual agreement than case closure due to mutual agreement (see the free access full paper). Another recent study using CORC data found that Black children and young people, and those who did not provide information about their ethnicity, were more likely to attend services for a single session only (full paper). We will be continuing with this work: most immediately, we have recently merged the datasets we hold, and are now planning analysis to look at any relationships between ethnicity and outcome improvement rates and reasons for ending treatment for the children and young people whose information is captured in this dataset.
We are excited at CORC that in the coming months we will be moving into the Anna Freud Centre: our commitment to our anti-racist work will not be lessening. As well as continued opportunities for close collaboration with colleagues in the Evidence Based Practice Unit in relation to equity, diversity and anti-racism, we will be engaging with the Anna Freud Centre wider work on equalities and diversity. We will continue to share our progress and findings with the CORC membership and Network through our newsletter, website and Twitter feed, and inviting colleagues to reflect on what emerges, and to discuss with us the next steps and further actions these prompt.