All authors have reviewed the final manuscript for submission. 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. Le Boutillier C, Croucher A. The lead author was responsible for screening the titles and abstracts of all document using the agreed inclusion and exclusion criteria. Accessed 23 Nov 2016. Hacking S, Bates P. The inclusion web: a tool for person-centered planning and service evaluation. International Journal for Equity in Health Social Exclusion Cyberball is a computer-based task that in-duces feelings of exclusion, relative to a social inclusion con-trol condition [37]. Med. Of the papers that did set out a clear definition at the outset, it was one from the World Bank that appeared most often [46]. 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. A further four of the tools (4/21) were devised for use with both those attending mental health services and other groups; including members of the general population, people who are migrants and those with traumatic brain injury. 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. As primary healthcare is the point of initial contact the majority of people have with the health system and it includes such a wide variety of components, it can offer help for many health issues. 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Estivill J. Concepts and Strategies for Combating Social Exclusion: An Overview: International Labour Organization. Encouraging the social inclusion and reintegration of people with mental health problems into society has also become an important policy goal internationally [51, 52]. Accessed 15 Sep 2016. : There were no scales or tools found that were developed for the measurement of social exclusion alone. For example, the SIS tool for patients in mental health settings with schizophrenia focuses on the concept of social integration. The tools that are listed have been developed and utilised in a number of different countries, and by researchers from various backgrounds and disciplines. 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. The Netherlands on the European scale 2019. In: Room G, editor. Mathieson J, Popay J, Enoch E, Escorel S, Hernandez M, Johnston H et al. Inclusion Health: Improving Primary Care for Socially Excluded People: Department of Health. Med. Social Inclusion (ISSN: 2183-2803) is a peer-reviewed open access journal which provides academics and policy-makers with a forum to discuss and promote a more socially inclusive society. To see where opinion on poverty and social exclusion stands, two Eurobarometer surveys have been conducted as part of the European Year for Combating Poverty and Social Exclusion. Its results show how both the perception of necessities and the level of poverty have evolved in the last 20 years. 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” [33]. Royal Soc Arts J. Soc Inclusion. 2000;6(3):201–12. Accessed 11 Jul 2017. Social exclusion refers to keeping an individual or group out of social situations. Authors have explained that the social exclusion can contribute to mental illness, but also “improving social inclusion of the individual is an important contributor to recovery” [48, 49]. Pinfold V. ‘Building up safe havens…all around the world’: users’ experiences of living in the community with mental health problems. PubMed  London: Mind; 1999. http://www.siis.net/documentos/Digitalizados/900204_Creating%20Accepting%20Communities.pdf. 2013;47(10):906–19. Primary healthcare has wide population coverage in most countries. Usefulness and Potential (7/22) was concerned with a person feeling able to contribute positively to society and being able to fulfil personal potential. Arch Phys Med Rehabil. Van Brakel WH, Anderson AM, Mutatkar R, Bakirtzief Z, Nicholls PG, Raju M, et al. World Health Organization. A scoping review of the peer-reviewed and grey literature was conducted to examine tools developed since 2000 that measure social exclusion or social inclusion. 1 [39]. 2016;388(10053):1545–602. The impression of an London: Routledge; 2009. 2006;9(10):14–21. This is a veritable explosion of concern. Accessed 25 Apr 2017. The mystery of general practice. Peace R. Social exclusion: a concept in need of definition? Accessed 12 July 2017. Social exclusion is a multidimensional, dynamic concept which emphasises the processes of change through which individuals or groups are excluded from the mainstream of society and their life chances reduced. Abbreviations of names of tools in Tables below are suggested; some have been suggested by the creators of the tools themselves, others have been originally used by previous review authors. Room G. Poverty and social exclusion: the new European agenda for policy and research. Berry HL, Rodgers B, Dear KB. Accessed 10 Dec 2016. POD is a GP, Clinical Fellow in Social Inclusion and a PhD student at the University of Limerick Graduate Entry Medical School. One paper included a definition of social inclusion apparently composed by the authors themselves [47]. There is a need for the development of a tool for measuring social inclusion or social exclusion in primary healthcare settings. 2012; https://doi.org/10.3310/hta16010. Efforts were made to obtain a copy of each of the original tools, and all relevant background literature. 2008. http://www.outcomesstar.org.uk/wp-content/uploads/Q_Outcomes-Star-Impact-and-good-practice.pdf. Inclusion Health Evidence Pack: Cabinet Office Social Exclusion Task Force and Department of Health. The World Bank. 2013. http://documents.worldbank.org/curated/en/114561468154469371/pdf/814780PUB0Incl00Box379838B00PUBLIC0.pdf. Results: Of the 415 subjects, 246(59.3%) were males and 169(40.8%) females. The impact of psychosis on social inclusion and associated factors. Significantly, none of the 22 individual tools discovered were specifically developed or used in general primary healthcare settings. But results are already starting to come through. Chan K, Evans S, Chiu MY-L, Huxley PJ, Ng Y-L. Patrick O’Donnell. These tools vary in the number of items they include, how scores are allocated and in how they are administered. Photo description: Food bank in Den Bosch, providing relief to 646 clients. Popay J. 2010;44(3):258–66. The domain of Leisure, Cultural & Religious (14/22) was concerned with regularly taking part in these types of activities. Basingstoke: Palgrave Macmillan; 2004. p. 107–32. Accessed 01 May 2017. 2016; https://doi.org/10.1093/heapro/daw005. 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. Wolfensberger W. Social role valorization: a proposed new term for the principle of normalization. 2016;3(2):171–8. Poverty risk, social exclusion, severe financial constraints in the Netherlands and other EU countries in 2017. Davey S, Gordon S. Definitions of social inclusion and social exclusion: the invisibility of mental illness and the social conditions of participation. Impact and Good Practice: Triangle Consulting. Accessed 11 Mar 2017. Mental Health Action Plan 2013–2020: World Health Organization. 2016;52(8):1113–7. The development and properties of the support needs questionnaire. Davis FA, Burns J. How much a person has experienced the feeling of being isolated and ostracized is measured with three, seven-point items. Social inclusion: origins, concepts and key themes: Australian Institute of Family Studies. 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 [32]. 1st ed. There are a number of concepts very closely aligned with social inclusion and exclusion that were measured by seven of the 22 tools described. Social Exclusion. The searches carried out were limited to papers in English, and those published since the year 2000. The now disbanded Combat Poverty Agency defined social inclusion as “a series of positive actions to achieve equality of access to goods and services, to assist all individuals participate in their community and society, to encourage the contribution of all persons to social and cultural life and to be aware of, and to challenge all forms of discrimination”, clearly putting an onus on the government to be proactive in this regard [18]. 2016;62(2):133–40. Gruskin S, Ferguson L. Using indicators to determine the contribution of human rights to public health efforts. 2016;126(2):657–72. Accessed 14 Oct 2016. Behav. Globalization and social exclusion in cities: framing the debate with lessons from Africa and Asia. Secker J, Hacking S, Kent L, Shenton J, Spandler H. Development of a measure of social inclusion for arts and mental health project participants. Existing measures of success in primary healthcare interventions with marginalised patients are generally limited to the traditional disease mortality and morbidity outcomes; but there is the possibility that these do not capture the essence of life and health as a socially-excluded person. Atkinson AB, Marlier E. Analysing and Measuring Social Inclusion in a Global Context: United Nations Department of Economic and Social Affairs. 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. Levitas R, Pantazis C, Fahmy E, Gordon D, Lloyd E, Patsios D. The Multi-Dimensional Analysis of Social Exclusion: Department of Sociology and School for Social Policy & Institute for Public Affairs University of Bristol. 165-172). 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. Sustainable development goal 3: ensure healthy lives and promote well-being for all at all ages. Soc Inclusion. Accessed 14 Jul 2016. The majority (15/21) of the tools were developed and used with patients attending mental health services of some kind. 17. Open Med. ‘Social exclusion is a complex and multi-dimensional process. Accessed 14 Feb 2017. The empiric and grey literature searches were carried out as detailed above. the European Social Inclusion Strategy, the Australian Social Inclusion Board). It is notable that none of the tools stated that its aim was to measure only social exclusion. Coombs T, Reed C, Rosen A. The majority of the individual level tools detailed in Table 1 result in quantitative scores or some other measure of social inclusion or social exclusion, and only two tools collected qualitative answers. For example, a GP may see and treat a person with community-acquired pneumonia using antibiotics and advise when to return if symptoms worsen. 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. 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. Accessed 20 Aug 2017. 2017. http://www.dailymail.co.uk/sciencetech/article-4243214/Donald-Trump-supporters-felt-socially-excluded.html#ixzz4p9xopA4E. Health Technol Assess. The Other category was utilised for domains that arose only once or twice when analysing the tools; including themes as diverse as political engagement, hopefulness and offending. The databases accessed included Academic Search Complete, CINAHL, EconLit, Medline, Social Sciences Full Text, Web of Science, EMBASE and Psyc-INFO. Health Promot Int. Oxford: Wiley-Blackwell; 1998. Researchers agree that social exclusion serves a specific function for those who employ it, an… POD drafted manuscript for publication that was commented on by KE and DOD. Twenty-two measurement tools were included in the final scoping review. The outputs of the tools varied substantially: 13/21 reported some form of a score of social exclusion or social inclusion. Another reason the SEKN work may not feature is that the SEKN authors stated “inclusion in some measures of a variety of health indicators as a component of or risk factor for social exclusion, rather than an outcome of the experience, all make it difficult to ‘measure’ the impact of social exclusion in health outcomes”. - 40.68.127.93. For the exclusion criteria documents such as conference abstracts and book reviews, publications not relating primarily to social exclusion or social inclusion and its measurement in relation to health and publications reporting on biological or physiological responses to exclusion were omitted. 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. 2012;59(5):501–7. The concept of “social exclusion” has become more prominent in discussions across many disciplines over the last number of decades. 2012. Social Exclusion Cyberball is a computer-based task that in-duces feelings of exclusion, relative to a social inclusion con-trol condition [37]. be grounded in a human rights approach to health and the values and principles of primary health care”, and highlighted the need to include “communities experiencing poverty and social exclusion in the design, implementation, monitoring and evaluation of policy and practice” [26]. 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 [58]. It consists of four items (ranging from 1 = “strongly agree” to 4 = “strongly disagree”): “I am worried to be left behind”, “I feel like I do not really belong to society”, “I feel that I am left out”, and “I feel excluded from society”. 2006. https://ces.fas.harvard.edu/uploads/files/Working-Papers-Archives/CES_WP135.pdf. This may demonstrate that health policies and health system interventions aimed at marginalised and socially excluded groups have tangible benefits. J Ment Health. eradicate poverty and social exclusion, as well as a commitment to these goals within societies. The measurement of social inclusion status and its changes over time in patients who are engaging with treatment for mental health problems are seen as tangible outcomes in mental health clinical settings; they are considered useful alongside the more traditional measures of symptom control. This scale has been partially validated with arts and mental health project users, demonstrating good internal consistency. This continuum results in health inequities. However, social exclusion can also occur in the online world as cyberostracism (Williams et al., 2000). The overwhelming majority of the scales can be used without permission but citations of the original sources or some previous users are expected when reports, papers, or articles are written that refer to the measures. One possible reason for this is recognition of the immense, and increasing, economic and social burden of mental ill health worldwide [53,54,55]. The Guardian. This SDG mentions the effective management of conditions such as HIV and substance abuse and the introduction of universal health coverage among other targets. From these documents, 22 tools or measures for the assessment of individual-level social inclusion or social exclusion, or the measurement of very closely related concepts, were identified and charted in Table 1. A Vision for Change: Report of the Expert Group on Mental Health Policy: Government of Ireland. SE is associated with socioeconomic inequalities in health, and its measurement in routine public health monitoring is considered key to designing effective health policies. 2013. http://www.rcgp.org.uk/news/2013/december/~/media/Files/Policy/A-Z-policy/RCGP-Social-Inclusion-Commissioning-Guide.ashx. It would appear, therefore, that there is scope to develop a measurement tool for this purpose, or to modify an existing tool that covers most or all of the domains felt to be important in the context of primary healthcare. 2010. http://webarchive.nationalarchives.gov.uk/+/http:/www.cabinetoffice.gov.uk/media/346574/inclusion-health-evidencepack.pdf. Completion of the majority (20/21) of the tools involved self-reported questionnaires or interviews of patients by staff of researchers. Ment Health Pract. A sample of the definitions of social exclusion and social inclusion referenced in the background papers for each of the twenty-two tools is also included in Tables 3 and 4. 2011;15(2):78–87. In: Hills J, Le Grand J, Piachaud D, editors. POD, KE and DOD conceived the basic idea for the research. Accessed 05 Aug 2017. Int J Soc Psychiatry. These tools cover a wide variety of domains, perhaps highlighting the differing views of researchers and practitioners on what exactly is meant by the terms social exclusion and social inclusion. Nancy Fraser. Social Exclusion and the EU’s Social Inclusion Agenda: Paper Prepared for the EU8 Social Inclusion Study The World Bank. Indexing: Web of Science (Social … Thus, several tools for the measurement of social exclusion or social inclusion status in health care settings have been developed. Clear instructions should be provided to participants so that they respond with respect to a particular time period. The domains covered by these tools varied widely and some of the tools were quite narrow in the areas of focus. : Downtown Emergency Service Center (DESC). Definitions of social exclusion can be broadly categorised: some address the problems associated with exclusion [59, 60], others detail what aspects of life people are excluded from [61], and others mention the various levels on which exclusion is seen to operate [8]. Development of the Living in the Community (LCQ) measure of social inclusion for use in mental health Final report: Australian Mental Health Outcomes and Classification Network (AMHOCN). References to important issues such as Stigma and knowledge of Rights and Freedoms are even less frequently seen in the tools included, being included in only 4/22 and 3/22 respectively. Department of Health and Children. Article  2007. http://siteresources.worldbank.org/INTECONEVAL/Resources/SocialExclusionReviewDraft.pdf. : critically assessing the rise of the homelessness outcomes star. Room G, Berghman J, Bouget D, Cabrero G, Hansen F, Hartmann-Hirsch C et al. It is unclear why social exclusion is a less frequently used term in this context: it may be related to variations in the language used around the concepts of social inclusion and social exclusion, or the perception that social exclusion is more difficult to measure when compared with social inclusion. 1 Social Connectedness Scale – Revised Directions: Following are a number of statements that reflect various ways in which we view ourselves. While limited access to social resources is often assumed to be of significance for educational success, it has rarely been measured explicitly. 2007;10(3):185–221. A review of the definitions of both social inclusion and social exclusion also revealed the variations among the explanations of these complex concepts. PubMed  Social exclusion (SE) refers to the inability of certain groups or individuals to fully participate in society. All tools retrieved were compared in tables, and the specific domains that were included in each measure were tabulated. These terms could be considered more optimistic and acceptable than the negative terms often used to explain the concept of social exclusion. Waiting list-controlled evaluation of a participatory arts course for people experiencing mental health problems. The literature on social exclusion is, obviously, not for the abstemious. Accessed 2 Nov 2016. Understanding social exclusion. 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. Br J Psychiatry. Accessed 01 Oct 2016. Poverty, social exclusion, and minorities. Shaw and colleagues went further to explain that the term social exclusion can also encompass people “who may be stigmatized and marginalized, such as people with HIV/AIDS, who might not be considered in traditional analyses of economic deprivation” [7]. Gore C, Figueiredo JB, editors. It’s as simple – and as complicated – as that” [17]. The World Bank. The final SEKN report summarised that “social exclusion processes result in a continuum of inclusion/exclusion characterized by inequalities in; access to resources (means that can be used to meet human needs), capabilities (the relative power people have to utilize the resources available to them) and rights. Soc Policy J N Z. A 2010 World Health Organization (WHO) report on poverty and social exclusion stated that these two factors were the “driving forces of health inequities for millions of people across the 53 Member States of the European Region” [26]. Aust N Z J Psychiatry. Participants were assigned through block randomization to either a social exclusion or inclusion Int.J. Accessed 01 Apr 2017. 2001;5(2):18–23. Social determinants of health. Waghorn G, Chant D, King R. Classifying socially-valued role functioning among community residents with psychiatric disorders. There is apparently no measurement tool intended specifically for use in primary healthcare settings for the measurement and monitoring of changes in social inclusion or social exclusion status. Accessed 10 Jan 2017. Graduate Entry Medical School, University of Limerick, Limerick, Ireland, School of Medicine, Clinical Science Institute, National University of Ireland, Room 342, Galway, Ireland, You can also search for this author in Huxley P, Evans S, Madge S, Webber M, Burchardt T, McDaid D, et al. Social exclusion is something that can happen to anyone. In: Beck W, Van der Maesen L, editors. Social Exclusion How much a person has experienced the feeling of being isolated and ostracized is measured with three, seven-point items. Int J Soc Psychiatry. Development and preliminary validation of a measure of social inclusion for use in people with mental health problems: the SInQUE. Piachaud D, Bennett F, Nazroo J, Popay J. Rights and Freedoms (3/22) looked at freedom to express oneself and being aware of personal rights. The government of the United Kingdom (UK) had also championed the idea of focusing on exclusion, establishing a specific Social Exclusion Unit (SEU) in 1997, which became part of the Office of the Deputy Prime Minister to drive this agenda across government departments and policymaking activity [3, 8, 9]. Context: United Nations Department of health conducted early scoping searches, returning to KE and DOD at for... Within societies, Marlier E. Analysing and measuring social inclusion—a key outcome in global mental health position social! 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