Assessment of digital risks in child and adolescent mental health services: A mixed-method, theory-driven study of clinicians’ experiences and perspectives

Abstract

Children and adolescents in the UK spend increasingly more time in the digital world, raising societal fears about digital risks in this age group. Professionals are not always aware of the ever-developing research or guidance available around digital safety. This gap underscores the need to understand current experiences and determinants of digital risk assessment, including clinicians’ views on barriers and facilitators. A mixed-method design was used. Fifty-three clinicians working in child and adolescent mental health services (CAMHS) in South England took part in a survey; of these 12 took part in semi-structured interviews. A psychological model of behavioural change (COM-B: capabilities, opportunities, motivation and behaviour) guided the analyses. Survey data revealed that clinicians showed awareness and concerns for several digital risk issues but there appeared to be gaps in their knowledge and practice. Interview data revealed different factors influencing staff enquiry about digital risks in CAMHS. These included aspects of capabilities (knowledge and skills), opportunities (resources, organisational context and empowerment of youth), and motivations (habit change, emotional experiences, and professional identity/role). Targeting both staff-level and organisation-level barriers to digital risk assessments in CAMHS is crucial. This study informs service improvement to ensure that children and young people safely navigate the digital world.

The experiences of practitioners working with young people exposed to online sexual abuse

“…Reference was made to existing research on OCSA and digital safety, which was shared with caregivers as part of the intervention, but there was a marked lack of confidence in whether practitioners had sufficient expertise in relation to this. Other studies have noted this ( 42 ) and how this lack of confidence influenced the willingness to inquire about digital risk-taking unless there were very specific issues around safeguarding. In these circumstances, the fall back was to use standardized safeguarding approaches.…”

“…Recent research in the UK has noted that within Child and Adolescent Mental Health Services (CAMHS), staff are not always aware of the current research findings associated with OCSA or the guidance available around digital safety ( 42 ). The authors of this research used a mixed-methods design with clinicians working in CAMHS (of which 12 took part in interviews), clinicians expressed awareness of, and concerns around, a number of digital risk issues, but there were gaps in their knowledge and practice.…”

“…There was awareness of OCSA, but the focus was narrow such that people only identified particular types of abuse (such as sharing FPPI) which led to services not exploring wider online risks or their antecedents. As with the UK CAMHS study ( 42 ), assessment tools were generic and tended to omit online risks unless specific safeguarding issues were raised. Furthermore, multi-agency collaboration was problematic as there was an absence of referral pathways and staff had few opportunities for specific training related to online risks.…”

What are practitioners' views of how digital health interventions may play a role in online child sexual abuse service delivery?

“…Further UK research has noted that child and adolescent mental health services (CAMHS) staff are not always aware of the most recent findings about the impact of OCSA or guidance available around digital safety ( 28 , 29 ), with clinicians expressing awareness of, and concerns about, several digital risk issues, but also gaps in their knowledge and practice. Different factors played a role in whether they asked CYP about OCSA, which included lack of confidence in their knowledge and skills, a lack of resources which would facilitate engagement, and their motivation to change their routine ways of practicing.…”

“…While there was an awareness of OCSA, it had a narrow focus with practitioners identifying types of abuse (e.g., online grooming) which led to clinicians not asking CYP questions about wider online risks or their antecedents. As with the UK CAMHS study ( 28 ), generic assessment tools were used, which tended to omit online risks unless specific safeguarding issues were identified. Furthermore, multi-agency collaboration was problematic as there was an absence of referral pathways and staff had few opportunities for specific training related to online risks.…”