1. Introduction to theoretical framework and justification for the research including clinical significance and contribution to knowledge: This section needs to draw on both the empirical and theoretical literature in order to justify why this study will make a contribution to psychological research and clinical practice. It should also make brief reference to NHS Values. Use additional pages as necessary. (Maximum of 650 words). The following questions need to be addressed: (1) What are the underlying theories or theoretical perspective(s) guiding your research? (2) Provide brief details about the key empirical studies you are drawing from, (3) What is the rationale for the study and (4) What are the relevant NHS values this project is proposed to take into consideration?

The National Institute for Health and Care Excellence (NICE) has been issuing evidence-based guidance on mental health and behavioural problems for the National Health Service (NHS) since 2002. The notion of evidence-based practice (EBP) has been the subject of vigorous controversy in the field of mental health (Tanenbaum, 2005), with many authors arguing the flaws in research methods used by NICE to build their evidence base. Marzillier and Hall (2009), for example state that NICE’s reliance on randomised control trials (RCTs), with minimal value placed on meta-analytic studies limits the applicability of the guidelines to the messy reality of clinical practice.

In addition to this, despite the apparent success of NICE, there is also evidence that the level of implementation of NICE guidelines is low (Prytys, Garety, Jolley, Onwumere & Craig, 2011). Traditionally this has been attributed to clinicians’ knowledge, beliefs and external factors (Cabana et al., 1999). A number of psychological theories have been utilised in the area of guideline implementation, with the theory of planned behaviour ([TPB] Ajzen, 1985) being one of the most common. TPB proposes that intention to perform a behaviour is influenced by an individual’s beliefs, subjective norms and perceived behaviour control. Psychological theories focusing on behaviour change have also been utilised to encourage implementation of guidelines e.g. self-efficacy (Bandura, 1986) and preparedness to change (Prochaska & DiClemente, 1986).

It also presents concerns for clinical psychology as a profession. Marzillier and Hall (2009) suggest that CBT’s prominence in the profession of clinical psychology may be blurring the boundaries between CBT and the science as a profession, reducing the range and versatility of clinical psychology. Lloyd (2009) points out that CPs are trained not in one particular therapy, but to deploy high level competencies to adapt and apply knowledge to novel and complex situations. Unless CPs articulate their unique contribution to the field, questions will arise as to why commissioners should invest in CPs rather than lower cost professions, and why clinical psychology training should not become CBT training.

There are also significant implications and risk for service users who are different to the people in the RCTs used to evidence the guidelines. This may particularly be the case when applying the guidelines to work with black and minority ethnic (BME) communities. For instance, there is a dominance of CBT within the guidelines but the difficulties of culturally adapting CBT have been widely documented. Naeem, Gobbi, Ayub, and Kingdon (2009) found that Pakistani students viewed CBT as incompatible with their social, personal and religious values. Their beliefs of living by collectivist community and familial rules were in conflict with the Western, individualistic concepts underlying CBT. This is important because BME service users already have poorer experience and outcome of psychotherapy than the majority white population, as well as significant inequality in access to psychological therapies (Department of Health [DoH], 2003). A recent national survey (Crawford et al., 2016) explored patient experience of the negative effects of psychological treatment. Among those reporting adverse effects from psychotherapy, a high proportion were from ethnic minority and LGBT groups. Worryingly, this suggests that minority groups who are already hard to reach, may be at a higher risk of negative experiences from psychotherapy when they do access services.

This raises questions about the relevance, effectiveness, and accessibility of NICE guidelines and its recommended treatments for people from minority backgrounds. The NHS value of ‘everyone counts’ emphasises our responsibility to ensure NHS resources are distributed fairly to those most in need and that nobody should be disadvantaged. It is therefore important that further research is conducted to elicit CPs’ beliefs about and use of NICE guidelines when working with people from minority communities to help explore the underlying processes that influence CPs to practice in ways that may compromise quality of care and may prevent their skills from being recognised.

How do clinical psychologists navigate between NICE guidelines and the flexible adaptation and application of knowledge when making judgements about how best to work with people from ethnic minority backgrounds?

a.     What are clinical psychologists’ beliefs about NICE guidelines and how do they describe the processes involved in deciding how to use them when working with people from ethnic minority communities?

b.     How do clinical psychologists choose which theoretical resources/skills to draw on at any particular point when working with people from ethnic minority communities?

c.      How do clinical psychologists describe their work in different contexts/for different audiences (e.g. managers and commissioners) and why?

d.     Under what conditions are the guidelines perceived/acted upon by clinical psychologists as guidelines and when are they perceived/acted upon as prescriptive?

A. Research participants: The following need to be addressed: numbers of participants, sampling strategy and inclusion/exclusion criteria. If using a quantitative methodology, state how you arrived at power calculations for each hypothesis:

The research participants will be CPs who have worked with BME communities, specifically, with South Asian service users. According to the 2011 census, BME populations make up 14 % of the population in England and Wales and this has increased from 6% following the 1991 census (Office for National Statistics [ONS], 2012). The area of interest for this research is on how CPs work with BME service users in general rather than in the differences between different groups, therefore only one BME group will be focussed on. The South Asian (Indian, Pakistani and Bangladeshi) community will be explored as they are the largest BME population, accounting for approximately 8% of the overall population (ONS, 2012) and with higher percentages within the London area. It is thought that this will help with meeting recruitment numbers for the study.

Similar qualitative MRPs have recruited about 11 participants (Court, 2014). The sample size of 11 is typical for a qualitative study of this kind, due to the depth of analysis (Adler & Adler, 2012). However, this was still described to be a relatively small sample size. Therefore, the recruitment aim for this MRP will be about 15 – 20, taking into consideration the resources and time frame available given that it is an MRP and that recruitment will be from an already small sample group. Initially a purposive sampling method will be used across NHS sites within the London area, with focus on sites known to have higher rates of South Asian service users. Interviews will be taking place either at the participant’s work site or a mutually agreed site if outside of working hours. To help ensure that CPs participating in this MRP come from varying backgrounds and with a variety of views/opinions about the research topic, a pre-interview questionnaire will be administered to aid theoretical sampling. Information such as professional banding, years since qualification and specialist area may be collected at this point as well as the current position that the participant holds regarding the guidelines e.g. how helpful do they view them, how knowledgeable do they feel about them and how much they apply them in current clinical practice.

B. Type of data analysis proposed and rationale:

Grounded Theory (Glaser & Strauss, 1967) will be the proposed method of data analysis. Although Court, Cooke and Scrivener (2016) used Grounded Theory to explore clinical psychologists’ general beliefs about and use of NICE guidelines, this was a small, exploratory study. At the time of developing this proposal, no studies have been found that examined these in relation to particular groups such as people from BME communities. For this reason, an inductive approach will be attempted, whereby theory will be drawn from data as opposed to applying existing theory to the data. This study will utilise Charmaz’s (2006) social constructivist approach which acknowledges the role of both researcher and participants in co-constructing data.

C. Instruments, measures, interviews: Please list the names of all psychometric questionnaires and provide information about the validity and reliability of each. Please also link them to the relevant hypotheses (e.g. a, b, etc.). If you are developing an interview schedule include the interview areas (e.g. death of a child, changes in marriage, birth of a child, etc.) along with sample questions. IMPORTANT: You should also attach actual questionnaires where possible, and interview schedule as an appendix (outside of word count).

Sample consent form (see Appendix 1) and sample interview schedule (Appendix 2). Both of these have been adapted from Court (2014) as there are key areas of interest that overlap because this proposal is a follow up to his study.

___consult in design of project         _X_ help with dissemination of results

___ help with recruitment                   ___ reviewed and commented on interview/questionnaires

____other: (please state) Date you have or plan to consult service user(s):

Currently this research project will focus on clinical psychologists working with the South Asian community. However, if recruitment becomes difficult, the criteria will be loosened to include clinical psychologists who have worked with any ethnic minority group.

Budget items: (please provide relevant details under the following 4 sections as relevant)                        

1. Questionnaires and psychometric tests (list by name, number needed and cost):

2. Software (name and cost):

3. Participant travel costs (up to £10pp) (list anticipated number of participants and cost): Anticipated number of participants is 15. Potential maximum cost will be £150 if all participants have to travel to me, however this is very unlikely

4. Postage (only posted from the Centre):

5. Other:

[The department will fund up to £300.00 for the above items]

Sub-Total £150

+ overhead £1500.00

Total Cost of this Project: £1650

The amount listed here is the total cost of completing this research project. The added £1500 covers university costs such as the library, computers, supervision, etc. For NHS ethics applications this amount should be added to the IRAS Ethics form (if you are using NHS ethics review) in the requested area. Approval of this proposal does not constitute approval of your budget. Please note budget guidelines on Blackboard.

àSpecify particular ethical issues pertinent to the proposed research: what are the possible risks for participants; describe how you will obtain consent; describe steps that will be taken to protect the confidentiality of the participants during the study including a) paper-based data, b) data kept in electronic format). Consider NHS values in relation to the ethical issues arising from your research.

A potential risk is that the discussions in the interviews could lead to some participants feeling that they are being criticised, or that it is being implied that they should be using NICE guidelines more or less then they currently are, leading to distress. My position of neutrality will be communicated from the earliest possible contact through providing an information sheet (see Appendix 3), which will emphasise that the research is not aimed at criticising or assessing participants’ practice. Should participants feel distressed or have queries, concerns or complaints, they will be invited to let me know at any point before, during or after the interviews and will be provided with contact details for myself, the lead supervisors and the Research Director of the Clinical Psychology Programme at Canterbury Christ Church University. Participants will be fully informed of the nature of the research as well as research aims before seeking informed consent. They will be advised that taking part is optional, and that they have the right to withdraw during the interview should they wish.

There may also be issues relating to confidentiality given that recruitment of participants will be from a relatively small group, many of whom may know or know of each other. All information obtained will be anonymised such that participants may not be identifiable e.g. use of gender neutral names for participants and aggregated demographics information. Any information gathered will be held on an encrypted memory stick and stored on password protected computers during the course of the project. Any audio recordings of interviews will be transcribed and anonymised. Only the transcribed and anonymised scripts will be stored on a password protected CD and stored in line with the university protocol as described at the beginning of this section. All audio recordings of interviews will be deleted following transcription or final analysis.

Will you be submitting your findings to a journal? YES If not, please be prepared to explain this at the review meeting. Journal name:

Will you feed back your findings to participants? YES If not, you will need to explain this at review; not required to feedback but we need to understand why that will not occur.

A review of the literature on the birth experience and the short term impact on the mother and child relationship

The birth of a child is a time of transition for a woman, which can increase her susceptibility and contribute to the beginning or worsening of mental health conditions. A mother’s stress and sadness may grow after the birth of a child, and the mother’s deteriorated emotional condition is connected to the mother’s sentiments about the kid and the mother-child bond.

The purpose of this study is to examine the link between mother-child contact, maternal emotional state, and mothers’ sentiments for their children.

a)     Theme 1: Mother – child relationship

b)     Theme 2: The child’s attachment to the mother

c)     Theme 3: The psychological state of the mother after childbirth

Literature review based research study

I feel that because I have picked a research project based on a literature review, I will be able to gain fresh or different ideas that I would not have thought of otherwise. Furthermore, I believe it will help me to see what strategies others have used and identify strengths and faults in these methods that may be applied to improve my research study. It also gives me confidence when I find other people’s interest in the scientific field.

·       Ainsworth, M. S. (1979). Infant–mother attachment. American psychologist, 34(10), 932.

·       Bowlby, J. (1969). Attachment. Attachment and loss: Vol. 1. Loss. New York: Basic Books.

·       Brake, E., Berle, D., Reilly, N. M., & Austin, M. P. (2020). The relationship between emotion dysregulation and postnatal attachment in women admitted to a mother baby unit. Australian Journal of Psychology, 72(3), 283-292.

·       Gibson, J., McKenzie‐McHarg, K., Shakespeare, J., Price, J., & Gray, R. (2009). A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatrica Scandinavica, 119(5), 350-364.

·      Harlow, H. E. (1958). The nature of love. The American Psychologist, 13(2), 673–685.

·      Madigan, S., Wade, M., Plamondon, A., & amp; Jenkins, J. (2015). Maternal abuse history, postpartum depression, and parenting: links with preschoolers’internalizing problems. Infant Mental Health Journal, 36(2), 146-155.

·      Uvnas-Moberg, K., Handlin, L., & Petersson, M. (2015). Self-soothing behaviors with particular reference to oxytocin release induced by non-noxious sensory stimulation. Frontiers in Psychology, 5, Article 1529.

·      Weisberg DS, Zosh JM, Hirsh-Pasek K, Golinkoff RM. Talking it up: Play, language development, and the role of adult support. American Journal of Play. 2013;6:39–54.