Online counselling is increasingly being used as an alternative to face-to-face student counselling. Using an exploratory mixed methods design, this project investigates the practice by examining the types of therapeutic goals that 11 to 25 year olds identify online in routine practice. These goals are then compared to goals identified in equivalent school and community-based counselling services. 1,137 online goals (expressed by 504 young people) and 221 face-to-face goals (expressed by 220 young people) were analysed for key themes using grounded theory techniques. This analysis identified three core categories (1) Intrapersonal Goals, (2) Interpersonal Goals, and (3) Intrapersonal Goals directly related to others. Further statistical analysis of these themes indicated that online and face-to-face services appear to be being used in different ways by students. These differences are discussed alongside the implications for professionals working in educational settings.

Background Web-based counseling and support has become increasingly commonplace for children and young people (CYP). Currently, there is limited research that focuses on the mechanisms of change within complex telepsychology platforms, a factor that makes designing and implementing outcome measures challenging. Objective This project aims to articulate a theory of change (ToC) for Kooth, a web-based therapy and support platform for CYP. Methods A collaborative qualitative research design involving professional staff, academic partners, and young people was used to develop the ToC. The following three major reflective phases were engaged: a scoping workshop involving professional staff and academic partners, a series of explorative projects were completed to inform the development of the ToC, and the draft ToC was reviewed for coherence by key stakeholders (young people, online professionals, and service managers). Results A collaboratively developed ToC was presented. This was divided into the conditions that lead to individuals wanting to access web-based therapy and support (eg, individuals wanting support there and then or quickly), the mode of service delivery (eg, skilled and experienced professionals able to build empathetic relationships with CYP), and the observed and reported changes that occur as a consequence of using the service (eg, individuals being better able to manage current and future situations). Conclusions Developing the ToC helps to shed light on how web-based therapy and support services aid the mental health and well-being of CYP. Furthermore, it helps to understand the development of positive virtual ecosystems and can be used to devise evaluative tools for CYP telepsychology providers.

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As mental health services for young people develop, the need for evaluation and audit to justify expenditure follows suit. Counselling is being provided in more and more schools and community settings across the country, and there is an increasing focus on evidence-based funding. Practice-based evidence has an important role to play in fulfilling this requirement, and there are calls for a single outcome measure to be utilised across services. The emerging frontier of online support is receiving steadily greater attention, but as yet it has had little attention with regards to its effectiveness. An existing routine evaluation and outcome measure (Young Person's Clinical Outcome Measures in Routine Evaluation) was incorporated within other routine evaluation systems within an online support service for young people (Kooth). The findings have been examined, with a view to recommending most suitable evaluation tools for this medium. Initial data suggest that the online service, when compared with equivalent face-to-face data, attracts a wide range of needs and levels of distress, with a high proportion of complex needs presented. Such findings may also reflect the complex nature of the support needs for the client group in question. Capturing appropriately rich data using a range of qualitative and quantitative measures that account for the complex online environment and client group needs to be carefully considered.

This chapter explores goal-oriented practice across therapies: cognitive behaviour therapy (CBT), psychoanalytic psychotherapy, psychoanalytic child psychotherapy, interpersonal psychotherapy (IPT), humanistic and existential therapies, systemic family therapy, and online therapy. Each section gives an overview of the approach and sets out ways that goals are conceptualized, negotiated, and embedded. Examples are given to illustrate how goals are used. Differences are found across these approaches in the methods used to negotiate goals, and the extent that these are made explicit and embedded in the work. Greater similarities are found in the use of goals in CBT and IPT, compared with the less directive modalities of humanistic, psychodynamic, and systemic psychotherapies. Differences are also found within modalities (e.g. psychoanalytic psychotherapy for adults versus psychoanalytic child psychotherapy). However, the chapter demonstrates the many similarities in the use of goals as a common factor across these different therapeutic approaches.

Aims: Counsellors are becoming commonplace within the support structures of secondary schools. To date, research findings from practice-based outcome studies suggest this is a positive move. There are, however, numerous limitations to this work, and this project aims to develop this existing body of literature. Method: Nine 13Á15 year olds attending counselling in six school-based services participated in the project Á one individual withdrew. A standardised self-report questionnaire (YP-CORE) was collected at four intervals: (1) the point of referral; (2) the onset of counselling; (3) the completion of counselling; and, (4) a two-month follow-up. The change indicated in each of these phases is examined and reported here. Additionally, YP-CORE was completed during each session. Findings: The YP-CORE indicates an improvement in the well-being of this small sample, while waiting for and attending therapy. Further examination of sessionby-session data also highlights how pre-and post-outcome data should not necessarily be viewed as linear in nature. Discussion: This is a small-scale investigation and further work is needed in this area. It does, however, raise a number of issues regarding the complexity inherent in conducting outcome research that warrant further investigation.

Self-harm is a prevalent issue amongst young people, yet it is thought around 40% will never seek professional help due to stigma surrounding it. It is generally a way of coping with emotional distress and can have a range of triggers which are highly heterogeneous to the individual. In a move towards enhancing the accessibility of personalized interventions for selfharm, we undertook a three-stage study. We first conducted interviews with 4 counsellors in self-harm to understand how they clinically respond to self-harm triggers. We then ran a survey with 37 young people, to explore perceptions of mobile sensing, and current and future uses for smartphone-based interventions. Finally, we ran a workshop with 11 young people to further explore how a context-aware self-management application might be used to support them. We contribute an in-depth understanding of how triggers for self-harm might be identified and subsequently predicted and prevented using mobile-sensing technology.

published a report stating over 100,000 young people had been in contact with NHS mental health services in the UK across two months in 2016. Such figures provide a strong argument for the need for good mental health provision for young people. Young people's mental health has been at the forefront of UK government initiatives with the aim to improve access to and availability of mental health services (Care Quality Commission,