Community evaluation

This page will help programs or interventions with strategies that focus on improving the social inclusion of young people whose parents have a mental illness.

Social inclusion is critical for young people as it fulfils the need to belong and provides opportunities for personal development and identity formation. Children whose parents have a mental illness are at greater risk of social exclusion; such children report more negative school experiences, less participation in recreational activities, and poorer peer relationships. A wide range of macro-level factors also exist to separate families with parental mental illness from the mainstream and continue the cycle of disadvantage.

Programs or interventions dealing with social inclusion and children of parents with a mental illness might focus on:

  • providing them with alternate in-groups to belong to
  • educating them about prejudice and stigma
  • improving their self-identity.

This section outlines some key resources for evaluating social inclusion programs or interventions.

Note: We thank Janelle Levesque for her work in developing this section.

Click the headings to read more.

Social inclusion - the concept

Social inclusion is a key determinant of mental health as it fulfils the human need to belong. A long history of research shows that belonging to a group/s is pivotal to establishing self-identity, self-esteem and resilience, while the social support that accompanies belonging may be critical in coping with life problems.

In a socially-diverse society, inclusion can be hard to establish and maintain as it requires people to value difference and people are often uncomfortable with those who are different to themselves.

This section examines the concept of social inclusion from various theoretical perspectives, defines social inclusion and exclusion, and reviews measures designed to assess social inclusion and exclusion.

Theoretical background

Evolutionary theory suggests that the need to belong is pivotal for optimal human functioning and survival. Human infants are most likely to flourish and reach their full potential if they can establish secure attachments to caregivers. Historically, people living in group and communal settings have been able to survive and reproduce with greater success than people living alone, due to the increased possibility of finding a mate and greater ease of hunting and gathering food within a group setting. Accompanying this evolutionary pressure is the positive emotional elation associated with human relationships (therefore reinforcing the drive to establish relationships), and conversely the negative emotional despair associated with loneliness and exclusion. A lack of social inclusion may lead to feelings of sadness, jealousy, anger, shame, anxiety and resentment. Psychologically, excluded individuals are likely to have lower self-esteem and higher levels of depression and self-loathing.

The concepts of social inclusion and exclusion are embedded within the sociological perspective. Hanvey (2003) acknowledges that social inclusion is a process rather than a static state of being. The Laidlaw Foundation in Canada argues that social inclusion encompasses five essential dimensions:

  1. valued recognition
  2. human development
  3. involvement and engagement
  4. proximity
  5. material wellbeing.

Some sociologists argue that true social inclusion requires the re-evaluation of public policy. It is proposed that inclusive public policy must start with the individual and create a society that includes a meaningful place for all. While this may represent an ideal position, the critical question is 'How does one go about including individuals and groups in a set of structured social relationships responsible for excluding them in the first place?' (Labonte, 2004).

Social exclusion is perpetuated through a range of interacting circumstances such as poverty, unemployment, stigmatisation, racism, attitudes and values. These factors, combined with the social processes of segregation, silencing and institutionalisation, bring about exclusion through the creation of powerless, undervalued vulnerable groups of individuals who experience limited prospects and poor life experiences (Hanvey, 2003). The mentally ill are an exceptionally vulnerable group within our society, facing:

  • barriers to employment
  • lower than average socioeconomic conditions
  • stigmatisation
  • fear and misunderstanding perpetuated by the media's treatment of mental illness.

As young people are tied to the family and its position within society, children whose parents have a mental illness may be at greater risk of exclusion due to their family's circumstances. In addition, their exclusion influences a variety of environmental factors that in turn impact on their future opportunities (Hanvey, 2003), thus creating a situation of potential lifelong exclusion.

From a social-psychological viewpoint, it may be argued that human experience is based upon a framework of relationships with others within which people actively seek inclusion and a sense of belonging. However, by their very nature relationships not only include but must also exclude people through the boundaries that are established to define the relationship (Abrams, Hogg & Marques, 2005). For example, school membership will be determined by age and to some extent location of the family residence, while sporting teams routinely exclude individuals based on their skills and performance.

Research conducted in social psychology settings has shown that social exclusion has a negative affect on both individuals and communities. At an individual level, exclusion may contribute to increased aggression, uncooperative and unhelpful behaviour, self-defeating choices and behaviour patterns, and defensive denial. At a community level, exclusion creates boundaries that lead to conflict, inequality and mistrust (Twenge & Baumeister, 2005, in Abrams et al., 2005).

Social inclusion and exclusion in relation to children requires an examination of the broader groups to which the child belongs, most importantly the family unit. Phipps and Curtis (2001) question whether it is possible for a child to be socially included yet come from a socially-excluded family. This question is particularly pertinent to children whose parents have a mental illness. Theoretically it is possible for a child from a family with parental mental illness to be socially included. However, the degree of inclusion and ease with which this inclusion is established may be different when compared to a child with similar social circumstances but mentally healthy parents.

In light of the above, it is important to consider research by Major and Eccleston (2005, in Abrams et al., 2005) who examined the coping mechanisms that may be used to address stigma-based social exclusion. They found that the impact of stigma-based exclusion could be reduced if the individual was able to:

  • improve their relational desirability by reducing the stigma (ie distancing themselves from the stigmatised group, concealing the stigma, overcompensating in relationships)
  • seek alternative sources of inclusion (ie creating relationships with those in similar situations, therefore increasing opportunity for self-expression, social support and the development of a collective identity)
  • attribute their exclusion to the prejudices of others rather than personal characteristics.

Such findings are especially important for programs or interventions which may be able to contribute to developing and improving appropriate coping skills, thus helping to reduce the social exclusion experienced by this group of young people. However, interventions that focus on individuals are unable to address the broader social factors that contributed to the creation of social exclusion in the first place. To address the foundations of social inclusion or exclusion, interventions must involve political action and interagency collaboration to target broad systemic factors that contribute to inequality and discrimination.Definition of social inclusion and related concepts.

Definition of social inclusion and related concepts

Social inclusion may be defined as 'the nature and number of a person's social networks, social ties, their participation and connectedness in community life and their access to basic human entitlements' (Davies et al., 2007, p. 215). An alternate definition by Sen (2000) proposes that inclusion is achieved when the society enables all members (children included) to participate meaningfully, experience equality, engage in social experiences and achieve wellbeing.

Social inclusion in childhood is the combination of participation in school and social activities, accompanied by belonging to social networks (Davies et al., 2007).

While social inclusion is related to connectedness, it is a much broader view of involvement with others and includes how such connections contribute to group membership, identity and socially-equitable access to resources.

Social exclusion encompasses factors that limit the individual's ability to participate in the economic, social, cultural and political life of a culture, accompanied by alienation from mainstream society (Phipps & Curtis, 2001). This definition of social exclusion is largely based on adult exclusion from society and it can certainly be argued that adults with a mental illness are a marginalised group at high risk of social exclusion, and that therefore their children are at increased risk of social exclusion. Phipps and Curtis argue that from a child's perspective social exclusion encompasses five dimensions:

  1. lack of success at school
  2. general ill health
  3. inability to participate in peer activities
  4. poor relations with peers
  5. lack of participation in organised recreational activities.

Stigma is present where groups in society are marginalised, subject to systematic devaluation, and excluded from social domains. Stigmatisation occurs when a person is thought to possess 'an attribute, or characteristic, that conveys a social identity that is devalued in a particular social context' (Crocker, Major & Steele, 1998, p. 505).

Measures of social inclusion and exclusion

Several scales may be useful in assessing various aspects of social inclusion and exclusion.

Aspects of the concept of social inclusion may also be measured within the connectedness scales.  

Social Inclusion Scale

The Social Inclusion Scale aims to assess the level of perceived social inclusion, specifically examining an individual's perceived inclusion after participation in an intervention for people with a mental illness.

The scale was developed for use with adults and therefore, in its current form, is unlikely to be suitable for use with children.

Structure of the measure

The scale contains 22 items which are rated on a 4-point Likert scale assessing frequency (ranging from 'not at all' to 'all the time'). The scale consists of three subscales:

  1. social isolation
  2. social relations
  3. social acceptance.

Construct validity

The Social Inclusion Scale has demonstrated positive correlations with empowerment and mental health functioning measures.

Reliability

Overall, the reliability coefficient for the entire Social Inclusion Scale is 0.85. Each subscale also reports a reliability at or above the 0.70 level of acceptability (social isolation = 0.76; social relations = 0.76; social acceptance = 0.70).

Evaluation and/or research that has used this measure

The Social Inclusion Scale is new and therefore has not been used extensively in research. The items were developed through a literature review and existing UK and European surveys on the topic.

Availability of the scale

The measure is included in the article detailing its development:Secker, J., Hacking, S., Kent, L., Shenton, J. & Spandler, H. (2009). Development of a measure of social inclusion for arts and mental health project participants. Journal of Mental Health, 18, 65-72.

Social Provisions Scale

The Social Provisions Scale is designed to examine various aspects of social relationships and the contribution of these relationships to social support. The scale was developed for use on adults and would need to be assessed and revised for its suitability with young people.

Structure of the measure

The Social Provisions Scale contains 24 items and is divided into six subscales (four items in each). The subscale areas are:

  1. Attachment
  2. Social integration
  3. Reassurance of worth
  4. Reliable alliance
  5. Guidance
  6. Opportunity for nurturance.

The scale assesses both the presence and absence of each type of support. Respondents indicate their level of agreement with each statement using a 4-point Likert scale. Total score and subscale scores are available, with higher scores indicating higher levels of perceived support.

Construct validity

The Social Provisions Scale subscales have demonstrated the expected relationships with other measures of social relationships, social networks, and satisfaction with relationships.
The subscales are also able to distinguish between types of relationships (eg higher levels of attachment are reported in romantic relationships compared to other forms of relationships in college students).

Reliability

Internal consistency ratings in various studies are reported to be greater than 0.60. A shorter version of the scale using two items per subscale reports less than satisfactory reliability with alphas ranging from 0.33 to 0.56. Test-retest reliability ranges from 0.37-0.66.

Evaluation and/or research that has used this measure

The scale has been used in a variety of studies and has consistently demonstrated its reliability. As a measure of social inclusion or exclusion the scale only examines relationships with others and therefore potentially overlooks key elements of inclusion and exclusion.

Availability of the scale

The measure is available for download at: Cutrona, C. E. & Russell, D. (1987). Social Provisions Scale.

Social Inclusion Interview Schedule (SIIS)

The SIIS is based on the view that social networks represent a system of nested relationships varying in the degree of closeness and support. The closest relationships are family, followed by friends and community-based sources (eg workplaces, leisure contacts, religious groups, school staff).

As the SIIS is based on the actual relationships within the young person's life, you will need to prepare and be familiar with the participant in order to use this measure.

Structure of the measure

The interview involves questions that examine both close relationships and the places the children attend.

Evaluation and/or research that has used this measure

The SIIS was developed for use with children with learning disabilities, so may be an effective tool for assessing social inclusion in very young children or children with limited language ability.

Availability of the scale

For further information about the SIIS contact the developer Raghu Raghavan, email: R.Raghaven@bradford.ac.uk.

Interview development and pilot study results are detailed in the article:

Pawson, N., Raghaven, R. & Small, N. (2005). Social inclusion, social networks and ethnicity: the development of the social inclusion interview schedule for young people with learning disabilities. British Journal of Learning Disabilities, 33, 15-22.

Phipps and Curtis Exclusion Measure

This measure examines social exclusion based on information obtained from parents about their children on the dimensions of health, school success, ability to engage in activities, peer relationships, and engagement in recreational activities.

Structure of the measure

The Phipps and Curtis Exclusion Measure contains five items that ask a single question in relation to each dimension of social exclusion in children. Two versions of the items relating to peer interaction and engagement in activities are presented, one for 6-9 year olds and one for 10-13 year olds.

Evaluation and/or research that has used this measure

Little information about the measure is available and the publication detailing its use does not provides information about its psychometric properties. It is included in this review because it was designed to examine the dimensions of social exclusion specific to children and young adolescents.
The measure also possesses high face validity and therefore has potential as a suitable measure for use with parents to ascertain their perceived level of exclusion of their children.

Availability of the scale

The measure is included in the following paper: Phipps, S. & Curtis, L. (2001). The social exclusion of children in North America, Canadian Council on Social Development (see Appendix 1 pages 35-36).

Programs or interventions

As far as is known at the time of writing, no programs or interventions exist that have an explicit aim of increasing social inclusion. However, most programs implicitly aspire to increase the ability of parents and families to participate in all aspects of society.

Key readings

Abrams, D., Hogg, M. A. & Marques, J. M. (2005). The social psychology of inclusion and exclusion. New York: Psychology Press.

Hanvey, L. (2003). Social inclusion research in Canada: children and youth. Canadian Council on Social Development.

Laidlaw Foundation. (2001). Working Paper Series on Social Inclusion. The Laidlaw Foundation website provides a variety of papers on social inclusion and exclusion, including several articles on children and youth, available for free download.

VicHealth. (2005). Social inclusion as a determinant of mental health and wellbeing: Social inclusion is a key priority of The Victorian Health Promotion Foundation. This fact sheet includes Australian statistics.

Other references

Crocker, J., Major, B. & Steele, C. (1998). Social stigma. In Gilbert, D., Fiske, S. T. & Lindzey, G. (Eds.), The Handbook of Social Psychology (4th ed., Vol. 2, pp. 504-53). New York: McGraw Hill.

Davies, B., Davis, E., Cook, K. & Waters, E. (2007). Getting the complete picture: combining parental and child data to identify the barriers to social inclusion for children living in low socioeconomic areas. Child: Care, Health and Development, 34, 2, March, 214-22.

Labonte, R. (2004). Social inclusion/exclusion: dancing the dialectic. Health Promotion International, 19, 1, March, 115-21.

Major, B. & Eccleston, C. P. (2005). Stigma and social exclusion. In Abrams, D., Hogg, M. A. & Marques, J. M. The social psychology of inclusion and exclusion (pp. 63-88). New York: Psychology Press.

Pawson, N., Raghaven, R. & Small, N. (2005). Social inclusion, social networks and ethnicity: the development of the social inclusion interview schedule for young people with learning disabilities. British Journal of Learning Disabilities, 33, 15-22.

Phipps, S. & Curtis, L. (2001). The social exclusion of children in North America. Canadian Council on Social Development.

Secker, J., Hacking, S., Kent, L., Shenton, J. & Spandler, H. (2009). Development of a measure of social inclusion for arts and mental health project participants. Journal of Mental Health, 18, 65-72.

Sen, A. K. (2000). Social exclusion: concept, application, and scrutiny. Social Development Papers No. 1, Office of Environment and Social Development Asian Development Bank, June.

Twenge, J. M. & Baumeister, R. F. (2005). Social exclusion increases aggression and self-defeating behavior while reducing intelligent thought and prosocial behavior. In Abrams, D., Hogg, M. A. & Marques, J. M. The social psychology of inclusion and exclusion (pp. 27-46). New York: Psychology Press.