United Nations Department of economic and Social Affairs. Beyond the threshold: the measurement and analysis of social exclusion. The domains these tools cover are also very similar to the domains covered by those tools explicitly stating that they are measures of social inclusion. PubMed POD summarised all data found and presented it to KE and DOD for comment and feedback. Pinfold V. ‘Building up safe havens…all around the world’: users’ experiences of living in the community with mental health problems. Dorer G, Harries P, Marston L. Measuring social inclusion: a staff survey of mental health service users’ participation in community occupations. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. A review of social inclusion measures. Observatory on National Policies to Combat Social Exclusion: Second Annual Report: Commission of the European Communities Directorate General Employment, Social Affairs and Industrial Relations. In: Hills J, Le Grand J, Piachaud D, editors. Poverty, social exclusion, and minorities. Primary healthcare services, such as general practice, work to alleviate many of the causes and ill effects of social exclusion on a daily basis – primary healthcare professionals understand that to cure or attempt to resolve the health problems of many of their vulnerable patients, they often need to find solutions to the exclusionary processes being experienced by those patients, as well as dealing with the actual medical issues. (Ed. PubMed Coombs T, Reed C, Rosen A. Waiting list-controlled evaluation of a participatory arts course for people experiencing mental health problems. CAS A Vision for Change: Report of the Expert Group on Mental Health Policy: Government of Ireland. Environ Urban. 2006;9(10):14–21. In: Room G, editor. Outcome, recovery and return to work in severe mental illnesses. The number of tools that have been created since the year 2000 is striking. A scale generated by Bude and Lantermann was used to assess social exclusion. Aust N Z J Psychiatry. Davis FA, Burns J. Social exclusion, which is a phenomenon that covers To find publications related to these research questions we searched electronic databases, reference lists and key websites for both peer-reviewed papers and grey literature. 2016;126(2):657–72. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Many international bodies, such as the World Bank and the International Labour Organization, have also adopted the concept of social exclusion for use in their spheres of influence [10,11,12]. ... or the rich people who lock themselves away at the other end of the social scale? For example, ‘housing’ is only mentioned in 10/22. In 1995, Dr. Iona Heath wrote that general practitioners (GPs) often develop a deep understanding of the lives of their patients, and that GPs “see, every day, how society functions in a way which systematically undermines the health of its most vulnerable members” . The Social Inclusion Scale (SIS) has three subscales measuring social isolation, relations and acceptance. Ginzler JA, Monroe-DeVita M. Downtown Emergency Service Center’s Vulnerability Assessment Tool for individuals coping with chronic homelessness: A psychometric analysis: The University of Washington. Kelly R. Social Inclusion Policy Community & Enterprise Directorate Clare County Council. Vulnerability Assessment Tool for Determining Eligibility and Allocating Services and Housing for Homeless Adults. The authors declare that they have no competing interests. Accessed 13 June 2017. 2014;7(1):30–41. Psychiatr Bull. Disabil Rehabil. The basis for this goal is the idea that an individual with mental illness who receives appropriate and timely treatment will eventually become more engaged and included in society, making it more likely that they will be able to re-enter the workforce and contribute. Borkhataria C. Social exclusion that leads to ‘fake news’ conspiracy theories could be the secret of Donald Trump's success. Perceived social exclusion was measured using a scale developed by Bude and Lantermann. Arch Phys Med Rehabil. 2008. http://www1.paho.org/hq/dmdocuments/2010/PHC_The_World_Health_Report-2008.pdf. The specific websites that were searched included those of the United Nations Development Programme, the World Bank and the WHO. 3/21 resulted in the development of a visual map of the social inclusion status of the person in question (HOS, MHRS, Inclusion Web [IW]). Efforts were made to obtain a copy of each of the original tools, and all relevant background literature. One paper included a definition of social inclusion apparently composed by the authors themselves . Groups that are commonly mentioned in the context of social exclusion and health include people who experience homelessness, people who are problem drug users, people who engage in sex work, Gypsies and Travellers and people with disabilities [27, 28]. The background papers reported in Additional file 1 highlight that the work associated with these tools has been published in a wide variety of research areas including journals relating to psychiatry, general mental health, occupational therapy, disability, rehabilitation, development, homelessness and social inclusion itself. 2014;119(1):121–37. : For example, the SCOPE-C was developed by adapting the SCOPE tool from the UK for the language and cultural context of people in Hong Kong. The Social Exclusion Unit: Office of the Deputy Prime Minister. Social development: Sector results profile. 2001;16:17–36. Fourteen of the tools described their aim was to measure social inclusion, and one (the EPQ) indicated it was meant for the measurement of both social inclusion and exclusion. The widespread adoption of the term has been met with scepticism by others who have been critical of the move from focusing mainly on low levels of income as the primary cause of disadvantage; saying that now much of the blame for being socially excluded rests with the individual themselves, conveniently shifting the focus away from those with power and influence in society [14,15,16]. It has not been all smooth sailing, though. 2nd ed. Social inclusion - a framework for evaluation. Completion of the majority (20/21) of the tools involved self-reported questionnaires or interviews of patients by staff of researchers. POD conducted early scoping searches, returning to KE and DOD at intervals for advice. 2000;6(3):201–12. The strengths of this scoping review include the fact that a wide range of databases and grey literature sources were searched by the authors. Accessed 01 Oct 2016. Paris: Editions du Seuil; 1974. Articles within this special edition explore social exclusion from a range of perspectives, with an emphasis on the needs of people who experience mental health problems. These were Row 1: “social incl*” OR “social excl*” OR “social marginal*”, Row 2: health* and Row 3: measure* OR frame* OR index OR indic* OR monitor* OR scale OR tool OR instrument. Additional file 1 provides details on the background literature linked to each of the 22 tools described in Table 1. Med. This scale has been partially validated with arts and mental health project users, demonstrating good internal consistency. We measured relative deprivation via a modified Yitzhaki Index, social exclusion using a four-point Likert scale, and QOL using the Kessler Psychological Distress Short Scale, the Satisfaction with Life Scale, and a subscale of the 36-item Short-Form Health Survey. There are many definitions of social exclusion but generally it describes the state of disadvantage faced by particular groups who are felt to be removed from mainstream society, and who cannot fully participate in normal life . This also overlaps with the argument from some authors that health should be considered a human right and that a rights framework should be used to set appropriate standards and allocate responsibility for the improvement of the health status of certain groups in society . Bull World Health Organ. In: Taket A, Crisp BR, Nevill A, Lamaro G, Graham M, Barter-Godfrey S, editors. Social inclusion and mental health. Accessed 24 May 2017. Accessed 01 Mar 2016. London: Palgrave MacMillan; 2000. Social anthropologists argue that exclusion is a process and that identifying and measuring it risks essentialising statistical categories into groups. 2002;14(1):41–51. Accessed 10 Jan 2017. Bearing these factors in mind, we are seeking to discover if the degree of social exclusion a person is experiencing – in all its complexity and with the ambiguity associated with the terminology – could be an appropriate measure for use in primary healthcare settings. Others felt that this ‘new’ concept could also be seen as more acceptable politically and less stigmatising for those people who are actually affected by it [10, 14]. These tools vary in the number of items they include, how scores are allocated and in how they are administered. Int J Soc Res Methodol. Poverty and Social Exclusion in the WHO European Region: Briefing on policy issues produced through the WHO/European Commission equity project: World Health Organization Regional Office for Europe. Furthermore and in contrast to the subjective outcome measures, the more objective number of important people in regular contact was also used as outcome variable. Accessed 23 Nov 2016. What is surprising, however, is that many tools omit domains that would seem to be important for any measure of social inclusion or social exclusion to cover. 2014;43(2):354–64. Health Technol Assess. It makes sense that the two domains most frequently found in the 22 individual tools displayed in Table 2 are Social Networks and Community; these are referred to in 22/22 and 17/22 respectively. Ment Health Rev J. There are several definitions of both social inclusion and social exclusion in use and they differ greatly in scope. 2008. http://www.outcomesstar.org.uk/wp-content/uploads/Q_Outcomes-Star-Impact-and-good-practice.pdf. It is likely that the lack of agreement on definitions and the domains that should be included for measurement are factors. The researchers conducted qualitative studies on the meaning of social inclusion in that country and then altered the domains and questions asked as part of the tool accordingly. This may have been because the SEKN team only discussed the measurement of exclusion at global, regional and country level; there was no analysis of individual level measurement. Taket A, Crisp BR, Nevill A, Lamaro G, Graham M, Barter-Godfrey S. Introduction. 1983;21(6):234–9. The most common domain seen was Social Networks (referred to in some way in all 22 tools); which included all aspects of interaction with family members and friends, and feeling accepted by them. The World Bank. More recently, some authors such as Adam and Potvin have taken the work of the SEKN and adapted it to focus more on individual level social exclusion . 2004. http://webarchive.nationalarchives.gov.uk/+/http:/www.cabinetoffice.gov.uk/media/cabinetoffice/social_exclusion_task_force/assets/publications_1997_to_2006/seu_leaflet.pdf. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the global burden of disease study 2015. The creators of four other tools (SCOPE-C, CMSI, LCQ and MHRS) also explained that their particular measure was based on an existing tool. All purchases are final and non-refundable once documents have been purchased and downloaded. Developing the Social Exclusion Scale for the Persons with Disabilities (SESPD): Validity and Reliability Study Yunus Bucuka* Abstract: There are various problems in the field of disability. Department of Health. We focused on those measurement tools developed for use with individual patients in healthcare settings. Any difficulties with search process arising were discussed with KE at regular intervals. Disabil Rehabil. Stickley T, Shaw R. Evaluating social inclusion. In this study, social exclusion is measured accurately and on a large, cross-national scale, by using social network data from 731 classrooms in England, Germany, and Sweden (CILS4EU data). Social exclusion is often mentioned as one of the social determinants of health. 2012;59(5):501–7. Community Ment Health J. Behav. Finally, the SEKN authors reported that social exclusion was too complex a subject to be adequately assessed by quantitative methods alone, declaring that “exclusionary processes can only be adequately ‘represented’ through both quantitative and qualitative data – through both indicators and stories” . 2011;15(2):78–87. Social exclusion is multidimensional, and can encompass a lack of access to employment, legal redress and markets; a lack of political voice; and poor social relationships. Twenty-two measurement tools were included in the final scoping review. Br J Gen Pract. London: Nuffield Provincial Hospitals Trust; 1995. Indicators of Social Exclusion and Inclusion: A Critical and Comparative Analysis of the Literature: Institute of Population Health University of Ottawa. Primary healthcare has wide population coverage in most countries. One such example is the Poverty and Social Exclusion Survey of Britain ... A 6-item scale for overall, emotional, and social loneliness: Conﬁrmatory tests on … 1 . Yanicki SM, Kushner KE, Reutter L. Social inclusion/exclusion as matters of social (in)justice: a call for nursing action. The broader view of disadvantage, which social exclusion policy now addresses, is typically directed at whole communities in While there are many tools that have been developed for measuring these concepts in healthcare settings, these do not have a primary healthcare focus. In addition, the fact that there are over thirty different domains mentioned across the 22 tools we investigated highlights the fact that work in this area is hampered by the lack of a consensus definition and agreement on the domains that should be accounted for in any measure. World Health Organization. To determine the exclusion of adolescents in social relations, the Social Exclusion Scale … World Health Organization Regional Office for Europe. 2006. http://www.hse.ie/eng/services/publications/Mentalhealth/Mental_Health_-_A_Vision_for_Change.pdf. Therefore gay people are in fact likely to experience greater economic deprivation and social exclusion in some circumstances precisely because of their sexual orientation. Having located the background literature naming each tool, attempts were made to contact the authors of each tool by email. Social exclusion, global poverty, and scales of (in)justice : rethinking law and poverty in a globalizing world. If that same person with the pneumonia is a person who injects drugs and who is rough sleeping, then the GPs advice and management may be different. DOD is Senior Lecturer in Social and Preventive Medicine at the National University of Ireland Galway School of Medicine and Director of Public Health at Health Service Executive West. Social exclusion is a concept that has been widely debated in recent years; a particular focus of the discussion has been its significance in relation to health. Poverty in Europe. The tools that are listed have been developed and utilised in a number of different countries, and by researchers from various backgrounds and disciplines. This may then lead to the presumption that if you measure social inclusion, you have assessed both social inclusion and social exclusion status. Social exclusion is an interactive process between multiple people, yet previous research has focused almost solely on the negative impacts on targets. Room G. Poverty and social exclusion: the new European agenda for policy and research. Heath I. 2009. http://www.uwcnvi.ca/web_documents/cfp_hps_hf_appendix_b_-_sample_assessment_tool.pdf. J Psychiatr Ment Health Nurs. What we know. Br J Occup Ther. Lloyd C, King R, Moore L. Subjective and objective indicators of recovery in severe mental illness: a cross-sectional study. But results are already starting to come through. Social Exclusion Unit (SEU) Office of the Deputy Prime Minister. Three (3/21) of the tools had both a long and short version of the tool developed; the SCOPE, the Australian Community Participation Questionnaire (ACPQ) and the Participation Scale (PS). Improving Access to Health Care for Gypsies and Travellers, Homeless People and Sex Workers: Royal College of General Practitioners Clinical Innovation and Research Centre. 2013. http://www.worldbank.org/en/results/2013/04/14/social-development-results-profile. There were no scales or tools found that were developed for the measurement of social exclusion alone. Dunn S. Creating Accepting Communities: Report of the Mind Inquiry Into Social Exclusion and Mental Health Problems. Royal Soc Arts J. Accessed 15 Jan 2017. Popay and colleagues reported that the definitions used to explain the concept of social exclusion generally fell into two broad categories: those that documented the many things that a person or group could be excluded from and those definitions that sought to explain a broader “relational” approach that looked more closely at the mechanisms and societal imbalances that led to and perpetuated social exclusion [8, 21]. The work of the SEKN could have offered some clarity on questions relating to the concept of social exclusion, and yet there is little mention of the report in the background literature of the tools that were published after 2008. 2010. http://www.un.org/esa/socdev/publications/measuring-social-inclusion.pdf. Int J Soc Psychiatry. Two (2/21) tools developed for use in homeless service settings were described as having been developed to meet the specific needs of people there in a ‘bottom-up’ process involving staff and service users. Authors therefore argue that it is not enough to examine these issues individually, and that the links between them must be explored. Several reports and papers tabulate and compare the various definitions [11, 14, 43]. Room described many of the recurring ideas seen across various definitions when he stated that social exclusion was ultimately a “multidimensional, dynamic and relational concept” [14, 62, 63]. At some point, we've all felt ostracized at work, by our partner, or even snubbed by friends. This scoping review offers a comprehensive description of existing work on the measurement at the individual level in healthcare settings of social exclusion and social inclusion. model is an important one in the evolution of the concept of social exclusion; though the individualised solutions it brings with it are only some of the strategies needed to combat social exclusion on a wider scale. This statement highlighted possible confusion around the many factors that may lead to social exclusion, compared with those that may have resulted from it. Three, seven-point items are used to measure how much a person believes that GOD supports and... read more », Using four, seven-point items, the scale measures the degree to which a person believes that GOD... read more », One’s belief that he/she has value because of the love that comes from GOD is measured... read more ». Search Now. Life Day. For this review, final inclusion and exclusion criteria were developed as the searching and exploration of the resulting papers took place . 2010;44(3):258–66. Both tools were developed as part of large-scale commissioned research projects: with the SCOPE tool resulting from work on a Health Technology Assessment carried out for the UK’s National Institute for Health Research, and the LCQ being developed by the Australian Mental Health Outcomes and Classification Network for their Government Mental Health Information Strategy Standing Committee. The lead author was responsible for screening the titles and abstracts of all document using the agreed inclusion and exclusion criteria. Social exclusion is conceived as a multidimensional concept. In: Lymbery M, Butler S, editors. McColl MA, Davies D, Carlson P, Johnston J, Minnes P. The community integration measure: development and preliminary validation. The impact of psychosis on social inclusion and associated factors. Stellenbosch Law Review, 22 (3), pp 452–462 Items: 12 / … 2012; https://doi.org/10.3310/hta16010. SOCIAL EXCLUSION: CONCEPT, APPLICATION, AND SCRUTINY 5 This will obviously include Asia, since the paper is being written for use in the Asian Development Bank. For example, the SIS tool for patients in mental health settings with schizophrenia focuses on the concept of social integration. 2nd ed. Rate the degree to which you agree or disagree with each statement using the following scale (1 = Strongly Disagree and 6 = Strongly Agree). Sayce L. Social inclusion and mental health. The concept of “social exclusion” has become more prominent in discussions across many disciplines over the last number of decades. Huxley P, Evans S, Munroe M, Webber M, Burchardt T, Knapp M et al. Scoping reviews do not typically involve detailed critical appraisal of the included work, thereby allowing a variety of both peer-reviewed and grey literature to be included. Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. The SEKN report was critical of the approach taken by many researchers and policy makers who had discussed social exclusion as a state, rather than focussing on the exclusionary processes that led to and perpetuated that vulnerable state . The majority of these tools were developed for measuring these concepts in mental health settings, and it is not clear why this field predominates. 2009;18(1):65–72. 2006;28(4):193–203. The databases accessed included Academic Search Complete, CINAHL, EconLit, Medline, Social Sciences Full Text, Web of Science, EMBASE and Psyc-INFO. Oxford: Oxford University Press; 2005. p. 196–223. 2010. http://webarchive.nationalarchives.gov.uk/20130124054057/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_114365.pdf. It involves the lack or denial of resources, rights, goods and services, and the inability to participate in the normal relationships and activities, available to the majority of people in a society, whether in economic, social, cultural or political arenas. Impact and Good Practice: Triangle Consulting. Some authors did not definitively choose any one definition and instead listed a number of existing ones, while others combined elements of various definitions in an effort to provide clarity [41, 44, 45]. Of the papers that did set out a clear definition at the outset, it was one from the World Bank that appeared most often . The advent of commissioning [where local health trusts in England and Wales plan and purchase services locally based on evidence of need] as a method of planning and funding community health services there has seen a focus on developing the case for service provision to groups traditionally described as socially excluded. The World Bank. Data generated or analysed during this study are included in this published article, and in its Additional file. The majority of these had been specifically developed for the measurement of social inclusion or social exclusion, but a small number were created for the measurement of other closely aligned concepts. Google Scholar. 2017;10(3):229–37. It starts to develop ways of measuring social exclusion, and also includes measures that are compatible with international the European Social Inclusion Strategy, the Australian Social Inclusion Board). (Philip & Shucksmith 1999. Cite this article. Survey on Social Inclusion: Theory and Policy: Oxford University Institute for Global Economic Development. 2004. http://www.who.int/mental_health/evidence/MH_Promotion_Book.pdf. This report and the subsequent 2010 WHO Europe report reinforced the significance of the role that health systems and primary healthcare have in addressing social exclusion and improving the health status of populations . Omtzigt DJ. Accessed 01 Apr 2017. When reviewing the administration of the tools, the number of items or questions included in each tool varied; with 121 questions asked in the long version of the SCOPE too, compared to four questions in the measure of Multidimensional Social Inclusion (MSI). Depressive symptoms were measured by a 15-item Chinese version Geriatric Depression Scale. Social exclusion is something that can happen to anyone. Social Exclusion Unit (SEU) Office of the Deputy Prime Minister. 2009;72(12):520–30. 1992. http://aei.pitt.edu/34932/1/A1082.pdf. While the definitions of social inclusion and social exclusion themselves are unclear, the fact that authors and policy makers also use other similar, but equally ill-defined, terms in discussion of these complex concepts may add to the confusion around the issue. The mystery of general practice. 2013;133(1):28–35. eradicate poverty and social exclusion, as well as a commitment to these goals within societies. Primary Care: Now More Than Ever: World Health Organization Press. This continuum results in health inequities. - 188.8.131.52. Accessed 10 Dec 2016. Social exclusion was represented by income adequacy, social relations, civic participation, and housing condition. Oxford: Wiley-Blackwell; 1998. However, social exclusion can also occur in the online world as cyberostracism (Williams et al., 2000). The majority of these tools were designed for use in mental health settings. 2011. http://www.rrasp-phirn.ca/images/stories/docs/workingpaperseries/wps_dec11_report_final-.pdf. Chan K, Huxley PJ, Chiu MY-L, Evans S, Ma Y. Accessed 12 July 2017. Social exclusion and anti-poverty policy: a debate. Basingstoke: Palgrave Macmillan; 2004. p. 107–32. Photo description: Food bank in Den Bosch, providing relief to 646 clients. Social determinants of health. For the results, we focused on measurement tools looking at social inclusion or social exclusion at the individual patient level, and their supporting publications. 2001. http://apps.who.int/classifications/icfbrowser/. Ment Health Rev J. Behav. Having somewhere secure to live tends to be considered a fundamental need to be dealt with before more complex issues such as health problems can be addressed. Ramon S, Griffiths CA, Nieminen I, Pedersen M, Dawson I. For instance, both online and in-person experiences of ostracism affect people in the same way (Filipkowski & Smyth, 2012). Popay J. The mental health recovery star. It is an important resource for both our students and our researchers as well. , Bennett F, Nazroo J, Rispel L. Understanding and tackling social exclusion Organization Regional for! Included three rows of search terms to be included for measurement are factors validation! 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