Currently submitted to: JMIR Mental Health
Date Submitted: Jul 22, 2019
Open Peer Review Period: Jul 23, 2019 - Sep 17, 2019
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Exploring Mental Health Professionals’ perspectives of Text-Based Online Counselling effectiveness with Young People: Mixed Methods Pilot Study
Population-based studies show that the risk of mental ill health is highest among young people aged 10-24 years, who are also the least likely to seek professional treatment due to a number of barriers. Electronic-mental (e-mental) health services have been advocated as a method for decreasing these barriers for young people, among which, Text-Based Online Counselling (TBOC) is a primary intervention used at many youth-oriented services. Yet, while TBOC has shown promising results, its outcome variance is greater in comparison to other e-interventions and adult user groups.
This pilot study aimed to explore and confirm e-Mental Health professional’s perspectives about various domains and themes related to Young Service Users’ (YSUs) motivations for accessing TBOC services; as well as factors related to higher and lower effectiveness on these modalities.
Participants were nine e-Mental Health professionals that were interviewed in focus groups using a semi-structured interview. Thematic analysis of qualitative themes from interview transcripts were examined across the areas of: YSU motivations for access; and factors that increase and decrease TBOC effectiveness.
Four domains, and various sub/themes, were confirmed and identified to be related to YSUs’ characteristics, motivations for accessing TBOC, and moderators of service effectiveness: user characteristics (i.e., prior negative help-seeking experience, mental health syndrome, perceived low social support, perceived social difficulties); selection factors (i.e., safety, avoidance motivation, accessibility, expectation); and factors perceived to increase effectiveness (i.e. general therapeutic benefits, positive service-modality factors, persisting with counselling despite substantial benefit) and decrease effectiveness (i.e., negative service- modality factors).
Participants perceived YSUs to have polarized expectations of TBOC effectiveness and be motivated by service accessibility and safety, in response to several help-seeking concerns. Factors increasing TBOC effectiveness were using text-based communication; the online counsellor’s interpersonal skills and use of self-management and crisis-support strategies; and working with less complex presenting problems or facilitating access to more intensive support. Factors decreasing TBOC effectiveness were working with more complex problems owing to challenges with assessment, the slow pace of text-communication, lack of non-verbal conversational cues, and environmental and connectivity issues. Other factors were using ineffective techniques (eg, poor goal-setting, focusing, postcounselling direction) that produced only short-term outcomes, poor timeliness in responding to service requests, rupture in rapport from managing service boundaries, and low YSU readiness and motivation.
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