Digital Strategy

Thematic Session: Using New Technology to Protect ChildrenChild Helpline International PDRCVietnam November 2013Digital Strategy, new Research into young people’s experience of text counselling & new developments and opportunitiesAmber DaviesYouthlineNew Zealandamber@youthline.co.nz

Digital Strategy • Defines the purpose and aims for the organisation • Guides the direction of the work • Links international and national strategy/rights/commitments to ground the work in best practice and international standards • Analysis of opportunities and threats (SWOT) • Analysis of current digital footprint • Analysis of environmental factors impacting the organisation (PEST)

Youthline’s Digital Health Promotion and Early Intervention Strategy The Ottawa Charter defines health promotion as ‘the process of enabling people to increase control over, and to improve, their health’ Youthline recognises that health promotion strategies and community development processes need to reflect the needs of the local community, and must involve the community in all aspects of decision making and planning, allowing people in the community to develop skills and gain knowledge whilst creating a sense of responsibility for their futures (working with people, not on them).

Youthline’s current digital footprint

Key Threats • High or increasing cost of delivering online services • Not capturing your audience or being outdated • Competition from other services nationally and internationally

$800,000 per year to run national helpline and all supporting infrastructure (telcos, IT, training, staff)!$160,000 per year phone bill only!

Partnership • In a highly competitive international digital world we need strong partnerships to maximize resources and reach the maximum number of children and young people

Young people’s experience of mobile phone text counselling: Balancing connection and control Kerry Gibson & Claire Cartwright The University of Auckland New Zealand 2013 (soon to be published)

Context: Youthline Text Counselling • Started 2004 • Free from 2007 • Originally used as a portal to phone counselling – to first step to gain access and comfort for young people • Young people wanted to keep texting! • Person-centred strengths-based approach • ‘Let them lead the way’ • No limit on number of texts or length of conversation • Policy and practice based evidence to support system (Risk management and Care a protection policy, Managed care policy -covers long term crisis and complex and serious mental health concerns, Misuse of the helpline policy – covers verbal and sexual abuse, testing the service and overloading the service)

Study design and sample • Qualitative approach to explore young people’s experience in text counselling • 21 young people aged 15-18 years old • 16 young women • 4 young men • 1 self described ‘gender fluid’ • High number of minority groups and migrants (considering sample size) • Only 33% dominant ethnicity

Findings and Themes: • The privacy of text messaging is highly valued by young people • Particularly as parents don’t need to know • Participants explained a sense of risk with parental involvement, particularly in relation to their sense of autonomy – parental involvement seen as intrusive and potentially controlling

Text messaging seen as posing less risk of adults actively intervening in young people’s lives • Young people fear being removed from family • Sense there is less chance of active intervention over text • Young people feel safe to reveal information about their difficulties

Young people valued feeling in control of the process • Being able to take their own time to reply rather than feeling on the spot over phone or face to face • Feeling like they could manage and control their responses, that face to face they would be subject to pressure from counsellors to talk • Able to close down the process when they wanted

Anonymity and decreased likelihood of being judged valued • Decreased fear of being judged over text • Counsellors valued for being outside of their social circle lessening concerns of judgement of past behaviour

There when they need it • Young people highly valued the flexibility of text counselling to integrate into their lives when they needed it • Can text wherever and whenever, even when others are around • In the moment important, rather than retrospective like face to face counselling

It’s the young people’s way of talking • Young people mostly found it comfortable to text • Described text as easier than face to face • Writing down their problems had therapeutic benefits for some, including catharsis and self reflection

Feel connected to the person behind the text • Imagining and conceptualising the text counsellor as someone familiar to them, ‘like’ their boyfriend or friends, or someone they needed at the time (gender or age wise) • Feeling of comfort and trust in the counsellor

Feel a sense of constancy of connection with counsellors and the organisation as whole • Participants’ described the experience as feeling like a constant friendship • Sense of relationship countered sense of isolation and loneliness

A few not so good things • One participant spoke about the difficulty of emotional connection through text • Shift between different counsellors uncomfortable for some participants • Some participants found it distressing when there were delays in text responses • One participant who had disclosed suicidal thoughts over text and the counsellor had suggested they call in adult resources to support resulted in her not wanting to bring up suicidality again (however continued to use service)

Summary • Needs of relational connection and autonomy and control key for participants (this mirrors research into youth counselling in general settings • This research suggests that text counselling may provide greater opportunities than face to face counselling for the young person to protect their autonomy (Ottawa charter health promotion = ‘the process of enabling people to increase control over, and to improve, their health’) • Young people experience text counselling as a less risky and judgement free space in which to confide their problems

New developments and opportunities Inspireme Reach Out! Rise Up!

Text“Inspireme” • Trial following a suicide cluster in Auckland • Young people receive an inspirational quote in a text message each day for 30 days if they text the key word ‘inspireme’ • Quotes chosen by young people through youth advisory • Over 250 young people signed up in the first 3 months *with little promotion -posters

Some feedback from young people • “Th txts were gr8! V inspirational & positive. I forwarded them on to 4 young people in my life who appreciatd them as they goin thru tough times. Tk u v much. :)” • “I love the inspire me messages! They all really inspired me and helped me everyday! Am i able to get it again please?”

Reach Out! Rise Up! Youthline Text Package Pilot Background: • Depression and anxiety consistently in top 5 presenting issues at Youthline via phone, txt and face to face services • Popularity and accessibility of text medium • Research shows the vast majority of young people in New Zealand do not get therapy or treatment for mental health concerns • 82% of NZ high school students spend some time texting each day (Youth ‘07)

Barriers to young people seeking help • Not identifying that one is depressed (Coe, 2009; Zachrisson, et al., 2006) • Not considering that help is available or that it would be useful (Vanheusden et al., 2009) • Feeling too embarrassed or ashamed to seek help (Collins, Winefield, Ward, & Turnbull, 2009) • Not wanting to use mental health care or therapy (Christensen, Leach, Barney, Mackinnon, & Griffiths, 2006; Collins, et al., 2009; Rickwood, Deane, & Wilson, 2007;Wright, Jorm, Harris, & McGorry, 2007) • Depression and psychological distress 'help negating' among young people (Wilson, 2010, Wilson, Rickwood, & Deane, 2007) • Actual and perceived costs of services • Inconvenient location • Professionals failing to carry out consultation that support clients to disclose sensitive issues • Professionals failing to recognise depression and other mental health concerns.

Young people’s preferences for seeking help (Youthline, 2011) • Support via people they know • Self-help • Internet based information • Support that is offered to everyone (so they don’t look different or need to ask for help)

Good evidence for e-therapies and self help • ‘There is good evidence to suggest that various CT programmes (mainly computerized CBT programmes) are effective for the treatment of mild to moderate depression and anxiety among adults and these also appear to be effective for adolescents. Currently evidence suggests that CT’s are more effective where they are offered with some personal encouragement, support or reminders, although this may not require a high level of mental health training and may require only a few minutes per week.’ (Fleming, 2012, p. 4)

Reach Out! Rise Up! Study Aims • The primary aim of this study is to determine whether a 10 week programme of text messages increases positive outcomes on the PHQ-9 and GAD-7 internationally validated depression and anxiety scales. • The secondary aim is to determine whether having a designated phone call supporter calling the young people once a week alongside the text messages increases positive outcomes over text messages alone.

Study design • 40 young people who come through Youthline presenting with mild to moderate anxiety and/or depression will be offered the option of the text programme pilot along with Youthline’s other services normally offered e.g. face to face counselling, helpline services, youth services. • Young people who consent to participating in the pilot will receive text messages for ten weeks including three groups of text messages per week: • Monday 4pm: Psycho-educational message (to give young people a better understanding of their symptoms and help them to gain a sense of perspective on what they are experiencing) • Tuesday 4pm: Weekly challenge (to give them practical and achievable challenges each week based on Cognitive Behavioural Therapy principles for improving their feelings) • Friday 4pm: Inspirational message (to keep them motivated and to learn from the wisdom of others) • PHQ-9 and GAD-7 comparison pre and post • Evaluation of young people’s experience and satisfaction

Texts based on CBT, Mindfulness and goal setting Weekly themes: • Getting to know your moods • Self care basics and breathing • Thinking mistakes and small victories • Balancing thoughts • Avoidance and suppression • Building resilience: Living life and expression • Coping strategies: Self care and mindfulness • Envisioning the future: Goal setting and locus of control • Envisaging the future: Breaking down goals • Wrapping things up

Results to come!! Thank you for listening! Questions and conversations during the conference welcome!

Digital Strategy