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.

Addressing Technology‐Assisted Child Sexual Abuse During an Initial Clinical Assessment: A modified Delphi Study

“…This included findings that practitioners were uncertain about the different types of TA‐CSA and how to best manage risk and safeguarding related to TA‐CSA. For example, practitioners mentioned that removing access to technology may not be the best approach for managing risk (Lau‐Zhu, Anderson, and Lister 2023). Content analysis of the retrieved studies also revealed the barriers that young people experience when disclosing TA‐CSA, such as how young people are often holding onto shame, guilt and fear, which can impact disclosure (Katz 2013; von Weiler, Haardt‐Becker, and Schulte 2010).…”

Addressing Technology‐Assisted Child Sexual Abuse During an Initial Clinical Assessment: A modified Delphi Study

“…This included findings that practitioners were uncertain about the different types of TA‐CSA and how to best manage risk and safeguarding related to TA‐CSA. For example, practitioners mentioned that removing access to technology may not be the best approach for managing risk (Lau‐Zhu, Anderson, and Lister 2023). Content analysis of the retrieved studies also revealed the barriers that young people experience when disclosing TA‐CSA, such as how young people are often holding onto shame, guilt and fear, which can impact disclosure (Katz 2013; von Weiler, Haardt‐Becker, and Schulte 2010).…”

A Scoping Review of Children, Empowerment and Smartphone Technology Regarding Social Construction Theory with the Aim of Increasing Self-Direction in Democracies

“…The articles and their full titles as they appear in Table 1 are as follows: Disability Rights and Robotics [72], Prosthetic Performances: Artistic Strategies, and Tactics for Everyday Life [73], Privacy in a Pandemic: An Examination of the United States' Response to Covid-19 Analyzing Privacy Rights Afforded to Children Under International Law [74], Children and Online Privacy Protection: Empowerment from Cognitive Defense Strategies [75], Digital hyperconnectivity and the self [76], Unseen potential: photovoice methods in hazard and disaster science [77], Left to their own devices? A mixed methods study exploring the impacts of smartphone use on children's outdoor experiences [78], The promises and challenges of clinical AI in community paediatric medicine [79], Assessment of digital risks in child and adolescent mental health services: A mixed-method, theory-driven study of clinicians' experiences and perspectives [80], What has been done to improve learning for intellectual disability? An umbrella review of published meta-analyses and systematic reviews [81], Adolescents' experiences of a theory-based behavioural intervention for improved oral hygiene: A qualitative interview study [82], Iranian nongovernmental organizations' initiatives in COVID-19 pandemic [83], Considerations in pediatric intervention research: Lessons learned from two pediatric pilot studies [84], The effectiveness of web-based mobile health interventions in paediatric outpatient surgery: A systematic review and meta-analysis of randomized controlled trials [85], Developing web-based health guidance for coaches and parents in child athletics (track and field) [86], Controlled trial of an mHealth intervention to promote healthy behaviours in adolescence (TeenPower): Effectiveness analysis [87], Acceptability and Utility of an Open-Access, Online Single-Session Intervention Platform for Adolescent Mental Health [88], Safety.Net: A Pilot Study on a Multi-Risk Internet Prevention Program [89], Effectiveness of mobile health-based self-management application for posttransplant cares: A systematic review [90], Development and feasibility testing of the Comfort Ability Program for sickle cell pain: A patient-informed, video-based pain management intervention for adolescents with sickle cell disease [91], Technological Ecological Momentary Assessment Tools to Study Type 1 Diabetes in Youth: Viewpoint of Methodologies [92], "It's like a safe haven fantasy world": Online fandom communities and the identity development activities of sexual and...…”

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.…”

Addressing Technology‐Assisted Child Sexual Abuse During an Initial Clinical Assessment: A modified Delphi Study

“…This included findings that practitioners were uncertain about the different types of TA‐CSA and how to best manage risk and safeguarding related to TA‐CSA. For example, practitioners mentioned that removing access to technology may not be the best approach for managing risk (Lau‐Zhu, Anderson, and Lister 2023). Content analysis of the retrieved studies also revealed the barriers that young people experience when disclosing TA‐CSA, such as how young people are often holding onto shame, guilt and fear, which can impact disclosure (Katz 2013; von Weiler, Haardt‐Becker, and Schulte 2010).…”

A Scoping Review of Children, Empowerment and Smartphone Technology Regarding Social Construction Theory with the Aim of Increasing Self-Direction in Democracies

“…The articles and their full titles as they appear in Table 1 are as follows: Disability Rights and Robotics [72], Prosthetic Performances: Artistic Strategies, and Tactics for Everyday Life [73], Privacy in a Pandemic: An Examination of the United States' Response to Covid-19 Analyzing Privacy Rights Afforded to Children Under International Law [74], Children and Online Privacy Protection: Empowerment from Cognitive Defense Strategies [75], Digital hyperconnectivity and the self [76], Unseen potential: photovoice methods in hazard and disaster science [77], Left to their own devices? A mixed methods study exploring the impacts of smartphone use on children's outdoor experiences [78], The promises and challenges of clinical AI in community paediatric medicine [79], Assessment of digital risks in child and adolescent mental health services: A mixed-method, theory-driven study of clinicians' experiences and perspectives [80], What has been done to improve learning for intellectual disability? An umbrella review of published meta-analyses and systematic reviews [81], Adolescents' experiences of a theory-based behavioural intervention for improved oral hygiene: A qualitative interview study [82], Iranian nongovernmental organizations' initiatives in COVID-19 pandemic [83], Considerations in pediatric intervention research: Lessons learned from two pediatric pilot studies [84], The effectiveness of web-based mobile health interventions in paediatric outpatient surgery: A systematic review and meta-analysis of randomized controlled trials [85], Developing web-based health guidance for coaches and parents in child athletics (track and field) [86], Controlled trial of an mHealth intervention to promote healthy behaviours in adolescence (TeenPower): Effectiveness analysis [87], Acceptability and Utility of an Open-Access, Online Single-Session Intervention Platform for Adolescent Mental Health [88], Safety.Net: A Pilot Study on a Multi-Risk Internet Prevention Program [89], Effectiveness of mobile health-based self-management application for posttransplant cares: A systematic review [90], Development and feasibility testing of the Comfort Ability Program for sickle cell pain: A patient-informed, video-based pain management intervention for adolescents with sickle cell disease [91], Technological Ecological Momentary Assessment Tools to Study Type 1 Diabetes in Youth: Viewpoint of Methodologies [92], "It's like a safe haven fantasy world": Online fandom communities and the identity development activities of sexual and...…”

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.…”

Addressing Technology‐Assisted Child Sexual Abuse During an Initial Clinical Assessment: A modified Delphi Study

“…This included findings that practitioners were uncertain about the different types of TA‐CSA and how to best manage risk and safeguarding related to TA‐CSA. For example, practitioners mentioned that removing access to technology may not be the best approach for managing risk (Lau‐Zhu, Anderson, and Lister 2023). Content analysis of the retrieved studies also revealed the barriers that young people experience when disclosing TA‐CSA, such as how young people are often holding onto shame, guilt and fear, which can impact disclosure (Katz 2013; von Weiler, Haardt‐Becker, and Schulte 2010).…”

A Scoping Review of Children, Empowerment and Smartphone Technology Regarding Social Construction Theory with the Aim of Increasing Self-Direction in Democracies

“…The articles and their full titles as they appear in Table 1 are as follows: Disability Rights and Robotics [72], Prosthetic Performances: Artistic Strategies, and Tactics for Everyday Life [73], Privacy in a Pandemic: An Examination of the United States' Response to Covid-19 Analyzing Privacy Rights Afforded to Children Under International Law [74], Children and Online Privacy Protection: Empowerment from Cognitive Defense Strategies [75], Digital hyperconnectivity and the self [76], Unseen potential: photovoice methods in hazard and disaster science [77], Left to their own devices? A mixed methods study exploring the impacts of smartphone use on children's outdoor experiences [78], The promises and challenges of clinical AI in community paediatric medicine [79], Assessment of digital risks in child and adolescent mental health services: A mixed-method, theory-driven study of clinicians' experiences and perspectives [80], What has been done to improve learning for intellectual disability? An umbrella review of published meta-analyses and systematic reviews [81], Adolescents' experiences of a theory-based behavioural intervention for improved oral hygiene: A qualitative interview study [82], Iranian nongovernmental organizations' initiatives in COVID-19 pandemic [83], Considerations in pediatric intervention research: Lessons learned from two pediatric pilot studies [84], The effectiveness of web-based mobile health interventions in paediatric outpatient surgery: A systematic review and meta-analysis of randomized controlled trials [85], Developing web-based health guidance for coaches and parents in child athletics (track and field) [86], Controlled trial of an mHealth intervention to promote healthy behaviours in adolescence (TeenPower): Effectiveness analysis [87], Acceptability and Utility of an Open-Access, Online Single-Session Intervention Platform for Adolescent Mental Health [88], Safety.Net: A Pilot Study on a Multi-Risk Internet Prevention Program [89], Effectiveness of mobile health-based self-management application for posttransplant cares: A systematic review [90], Development and feasibility testing of the Comfort Ability Program for sickle cell pain: A patient-informed, video-based pain management intervention for adolescents with sickle cell disease [91], Technological Ecological Momentary Assessment Tools to Study Type 1 Diabetes in Youth: Viewpoint of Methodologies [92], "It's like a safe haven fantasy world": Online fandom communities and the identity development activities of sexual and...…”

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.…”