Monitoring digital youth counseling interventions: Understanding the demographic profiles and outcome changes

Blackshaw, E., Sefi, A., Mindel, C., Maher, H., & De Ossorno Garcia, S. (2023). Digital mental health outcome monitoring for a structured text-based youth counselling intervention: Demographic profile and outcome change. Psychology and Psychotherapy: Theory, Research, and Practice.

Summarized by Ariel Ervin 

Notes of Interest:

  • Although the mental health needs of young people are increasing, a quarter of youths with mental health disorders don’t have access to informal support or professional mental health services in England.
  • Considering the advancement of technology and young people’s tendencies to seek assistance about their health online, digital mental health interventions are a promising and more accessible resource for youths.
  • This study evaluated youth demographic profiles via a digital mental health support service and how outcomes shifted throughout the online counseling intervention (involved synchronous text chats with a practitioner) over fifteen months.
  • Single-session digital support was the most popular form of engagement for young people.
  • Findings suggest that many young people who utilized this service had more mental health needs (especially youths with non-binary identities) than young people who used face-to-face services.
  • Most of the users were female. There were equitable access rates among youths of color.
  • The small effect sizes of overall outcome change became moderate when youths engaged with a designated practitioner for seven or more sessions.
  • This journal article underscores the importance of accessible digital mental health services for youths and the potential of single-session therapies.
  • Researchers and practitioners need to expand their understanding of incorporating digital interventions into the broader mental health landscape in the UK and maintain youth engagement in digital mental health services.

Introduction (Reprinted from the Abstract)

Background: Digital mental health interventions comprise a potentially effective and accessible form of support for young people, particularly at times when traditional face-to-face service delivery is reduced, as in the COVID-19 pandemic.

Aims: This study assessed the demographic profile of young people using a digital mental health support service and evaluated outcome change over the course of a structured online counselling intervention (synchronous text-chat sessions with a practitioner).

Materials and Methods: The data were collected from 23,260 young people aged between 10 and 25 years engaging with the intervention between April 2019 and June 2021.

Results: Young people accessing these services had high levels of mental health needs, particularly those identifying with non-binary gender identity. Service users were mostly female, with equitable rates of access for young people from racialised communities. Overall outcome change demonstrated small effect sizes according to the YP-CORE (0.19) and CORE-10 (0.38), which increased to a moderate level when young people remained engaged with a dedicated practitioner for at least seven sessions (0.38, 0.58). Regression analysis illustrated the effect of the number of sessions on outcome change, but this can be also influenced by other variables such as age and gender.

Discussion and Conclusion

Further research is required to explore ways to engage with young people using digital web-based services for a longer period and to collect and analyse single-session outcome data.

Implications (Reprinted from the Discussion)

The current study provides a profile of young people presenting at a digital mental health support service delivering text-based therapy across 15 months, and a systematic evaluation of outcome change for those engaging with an online structured therapeutic intervention via synchronous chat. The findings help us to understand which young people engage with digital mental health interventions and how, and contribute to the growing body of evidence on the effectiveness of digital support for young people.

Users engaging in a structured therapeutic intervention were predominantly female (79%). This is in line with uptake patterns in CYP-IAPT (59.75%; Wolpert et al., 2016), voluntary sector community mental health services (64.6%; Duncan et al., 2020), and secondary school counselling (56.31%; Cooper, 2009), although to a greater extent. It is well-established that men are less likely to seek help for mental health difficulties compared to women (Sagar-Ouriaghli et al., 2019), but these findings suggest that digital mental health services may not constitute an equitable pathway to support for male users, even in the context of reduced male help-seeking. Research should prioritise exploring potential barriers to access for male service users who disengage after registering.

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