Developing good practice indicators to assist mental health practitioners to converse with young people about their online activities and impact on mental health: a two-panel mixed-methods Delphi study

Abstract

Background Online activity has been linked to poor mental health in children and young people, particularly those with existing vulnerability who may inadvertently or otherwise access harmful content. It is suggested health and social care practitioners should address online activity during mental health consultations, but guidance about acceptable or effective ways to do this is lacking. This study sought to derive good practice guidance to support mental health practitioners to engage young people in conversations about their online activities and impact on mental health. Methods A mixed-methods Delphi (consensus) study was conducted with a panel of mental health practitioners (n = 21) and a panel of young people (n = 22). Practitioners worked with children or young adults in the UK, mostly in statutory services (80.9%), in varied clinical roles, with 2 – 30 years of experience and most were female (87.5%). Young people were mostly female (77.3%), 13—22 years old, reported varied mental health diagnoses and had sought help from services. Across 3 rounds, panellists completed questionnaires which involved rating agreement with statements and answering open-ended questions. Iterative analysis informed subsequent questionnaire content. The percentage of participants rating their level of agreement with each statement was calculated. The threshold for inclusion as a good practice indicator (GPI) was 75% across both panels. Thematic analysis was used for free-text data. Results Twenty-seven GPIs emerged covering ‘who’ (which young people) should be asked about online activities, ‘when’, ‘what’ should be discussed, and with what ‘outcome’. Panels agreed conversations should be initiated with all young people from first meeting and regularly thereafter, with ‘red flags’ indicating a conversation may be pertinent. Core topics were identified with additional areas for patients presenting with disordered eating or self-harm. Panels emphasised conversations should be fluid, normalised, and encourage reflection and self-awareness. Conclusions Mental health practitioners could empower young people to exercise agency in relation to online safety and capitalise on positive features. Findings also identify training needs for practitioners. Further research should explore real-world application of the GPIs and transferability to underrepresented groups within our panels, such as males and younger children. Ethnicity and deprivation were not recorded.

Digital Technology Use and Mental Health Consultations: Survey of the Views and Experiences of Clinicians and Young People

“…To address the need for guidance, a recent study by our group [ 26 ] used the Delphi format to investigate good practice indicators for discussions about digital technology use between young people and clinical professionals. This study highlighted the need for discussions to move beyond information gathering to take the form of a deeper conversation with a focus on encouraging individuals to reflect on the meanings and impact of their behavior on the web.…”

“…The actual prevalence may in fact be lower. It is also possible that the discussion of digital technology has increased since our data were collected, although evidence from our ongoing work does not support this [ 26 ]. Further limitations are the lack of ethnic diversity in the sample of young people; most individuals responding to the survey were White British, although the study did include a large number of individuals with a high proportion of those who identified as LGB+ and with prior experience of mental health issues.…”

Mental Health Practitioners’ and Young People’s Experiences of Talking About Social Media During Mental Health Consultations: Qualitative Focus Group and Interview Study

“…Young people in our study expressed a willingness to learn safer ways to navigate the web-based world and explore why they engage in harmful web-based behavior; however, they seldom initiated or shared their experiences with practitioners out of fear of being judged. Opportunities for meaningful and constructive conversations are being missed, but this could be resolved with increased guidance for practitioners on how to approach and support young people’s safer use of social media and digital technology [ 21 , 27 ]. A degree of knowledge exchange between young people and practitioners will be essential, and both groups expressed a desire for any training or guidance to be co-designed between practitioners and young people.…”

Recommendations for digital sharing of notes with adolescents in mental health care: a Delphi study

“…The World Health Organization has proposed that recommendations should be based on formal consensus methods such as the Delphi method (14). Over the last decade, such recommendations have been made in related areas, for example guidance on supporting the self-management and transition to adult healthcare for adolescents with chronic somatic diseases (11)(12)(13), and communicating with young people in mental health care about their online behaviour (15). Such recommendations for healthcare professionals typically include providing adolescents and young people with information about the speci c topic/treatment program early on, as well as relevant topics to cover when informing (11)(12)(13)15).…”

“…Over the last decade, such recommendations have been made in related areas, for example guidance on supporting the self-management and transition to adult healthcare for adolescents with chronic somatic diseases (11)(12)(13), and communicating with young people in mental health care about their online behaviour (15). Such recommendations for healthcare professionals typically include providing adolescents and young people with information about the speci c topic/treatment program early on, as well as relevant topics to cover when informing (11)(12)(13)15). While these recommendations often are either created based on or evaluated by members of medical societies and associations, the views of diverse staff members working in the speci c eld are not always included.…”