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The adoption of digital health technologies accelerated during Covid-19, with concerns over the equity of access due to digital exclusion. The aim of this study was to assess whether service access and presenting concerns differed before and during the pandemic. Sociodemographic characteristics (gender, ethnicity, and deprivation level) were examined to identify disparities in service use. To do this we utilised routinely collected service data from a text-based online mental health service for children and young people. A total of 61221 service users consented to sharing their data which represented half of the service population. We used interrupted time-series models to assess whether there was a change in the level and rate of service use during the Covid-19 pandemic (April 2020-April 2021) compared to pre-pandemic trends (June 2019-March 2020) and whether this varied by sociodemographic characteristics. The majority of users identified as female (74%) and White (80%), with an age range between 13 and 20 years of age. There was evidence of a sudden increase (13%) in service access at the start of the pandemic (RR 1.13 95% CI 1.02, 1.25), followed by a reduced rate (from 25% to 21%) of engagement during the pandemic compared to pre-pandemic trends (RR 0.97 95% CI 0.95,0.98). There was a sudden increase in almost all presenting issues apart from physical complaints. There was evidence of a step increase in the number of contacts for Black/African/Caribbean/Black British (38% increase; 95% CI: 1%-90%) and White ethnic groups (14% increase; 95% CI: 2%-27%), sudden increase in service use at the start of the pandemic for the most (58% increase; 95% CI: 1%-247%) and least (47% increase; 95% CI: 6%-204%) deprived areas. During the pandemic, contact rates decreased, and referral sources changed at the start. Findings on access and service activity align with other studies observing reduced service utilization. The lack of differences in deprivation levels and ethnicity at lockdown suggests exploring equity of access to the anonymous service. The study provides unique insights into changes in digital mental health use during Covid-19 in the UK.

Young people are increasingly seeking out web-based support for their mental health and well-being. Peer support forums are popular with this age group, with young individuals valuing the fact that the forums are available 24/7, providing a safe and anonymous space for exploration. Currently, little systematic evaluation of the helpfulness of such forums in providing support has been conducted. This study examined the helpfulness of the support offered within web-based mental health and well-being peer support forums for young people. It specifically investigated the self-reported user ratings of helpfulness reported through the completion of a developing experience measure. The ratings will be used to consider further development of the measure and reflect upon the overall helpfulness of the forums as indicated by the reported scores. The study used routinely collected practice-based outcome data from web-based mental health forums for young people. These forums are hosted by the UK-based web-based therapy and support service, Kooth. A cross-sectional design was used to explore-using a range of inferential statistical measures-the outcomes reported by those accessing the forums using a Peer Online Community Experience Measure (POCEM). To consider the helpfulness in general, 23,443 POCEMs completed in 2020 were used. A second data set of 17,137 completed POCEMs from the same year was used to consider whether various engagement indicators had an impact upon the helpfulness rating. Female users aged between 11 and 16 years predominantly completed the POCEM. This is in keeping with the majority of those using the service. In total, 74.6% (8240/11,045) of the scores on the POCEM indicated that the individuals found the posts helpful. An ANOVA indicated that male users were more likely to report obtaining intrapersonal support, whereas female users obtained interpersonal support. Furthermore, the POCEM scores reflected the internal consistency of the measure and provided an insight into the way that young people made use of the peer support resource; for instance, posts that were rated more helpful were correlated with spending longer time reading them, and the topics discussed varied throughout the day with more mental health issues being discussed later at night. The results seem to demonstrate that, overall, the young people involved in this study found web-based peer support helpful. They indicate that peer support can provide an important strand of care within a supportive mental health ecosystem, particularly during time periods when in-person support is typically closed. However, limitations were noted, suggesting that caution is needed when interpreting the results of this study. Although such services are incredibly well used, they have received little research attention to date. As such, further investigation into what constitutes helpful and unhelpful peer support is needed.

Online digital mental health communities can contribute to users' mental health positively and negatively. Yet the measurement of experience, outcomes and impact mechanisms relating to digital mental health communities is difficult to capture. In this paper we demonstrate the development of an online experience measure for a specific children and young people's community forum inside a digital mental health service. The development of the Peer Online Community Experience Measure (POCEM) is informed by a multi-phased design: (i) item reduction through Estimate-Talk-Estimate modified Delphi methods, (ii) user testing with think-aloud protocols and (iii) a pilot study within the digital service community to explore observational data within the platform. Experts in the field were consulted to help reduce the items in the pool and to check their theoretical coherence. User testing workshops helped to inform the usability appearance, wording, and purpose of the measure. Finally, the pilot results highlight completion rates, differences in scores for age and roles and “relate to others”, as the most frequent domain mechanism of support for this community. Outcomes frequently selected show the importance of certain aspects of the community, such as safety, connection, and non-judgment previously highlighted in the literature. Experience measures like this one could be used as indicators of active therapeutic engagement within the forum community and its content but further research is required to ascertain its acceptability and validity. Multi-phased approaches involving stakeholders and user-centred design activities enhances the development of digitally enabled measurement tools.

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. This project aims to articulate a theory of change (ToC) for Kooth, a web-based therapy and support platform for CYP. 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). 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). 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.

Purpose Literature suggests young people (YP) from ethnic minority backgrounds face barriers in accessing mental health support due to discrimination and stigma and so this study aims to explore how YP from ethnic minority backgrounds interact with online counselling. Design/methodology/approach The study used secondary data provided by Kooth, a digital mental health service for YP, for users who accessed the service from September 2020 to 2021 (N = 118,556). The users measure of need (YP-CORE) was assessed upon sign up to the service, and they also chose the ethnicity and background they felt best represented by. The study hypothesised the following: H1. There would be a significant difference between ethnic group of YP and source of referral; H2. There would be a significant difference in ethnic group of YP and YP-CORE score. Findings The one-way ANOVA and chi-squared analyses demonstrated a significant difference for both hypotheses indicating a significant association between source of referral and ethnicity, and a significant difference in measure of need when comparing YP who self-identified as White to those who self-identified as Asian. Originality/value Findings reveal school-based services are the most popular source of referral for all YP; however, a higher number of YP from Asian and Black ethnicities reached out through informal sources such as Google as opposed to health professionals such as GPs. From the data, YP who identified as Indian, Chinese and African present to online counselling at a lower level of distress compared to their White British counterparts, contradictory to findings investigating measure of need in face-to-face settings.

Online counselling is increasingly being used as an alternative to face-to-face student counselling. Using an exploratory mixed methods design, this project investigated the practice by examining the types of therapeutic goals that 11- to 25-year-olds identify online in routine practice. These goals were 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 used in different ways by students. These differences are discussed alongside the implications for professionals working in educational settings.

As has already been described in Chapter 6, this book takes the stance that there are a multitude of therapeutic responses to the issues that young people bring to therapy. This chapter attempts to take this a step further by providing a glimpse into some of the possibilities that we have encountered within our therapeutic work with this age group. In doing so, we begin by recapping the position of a pluralistic counselling psychology and reflecting upon how this can become even more complex when considering the client group in question. Following this, we provide an overview of the types of goals that young people may have when they enter into therapy, therapeutic tasks undertaken and methods that counsellors often use. Alongside these we also provide reflective activities with a view to getting you, the reader, to enter into a more personal engagement with the topics being discussed. Finally, we present three composite case studies, which aim to clarify what therapeutic work with young people may be like and illustrate the interaction of therapeutic goals, tasks and methods.

Adolescent counselling psychology services come in many shapes and sizes. This chapter provides an overview of some of the major settings in which such services can be found and the major considerations related to them. In turn, the different settings include Child and Adolescent Mental Health Services (CAMHS), school-based counselling services, counselling in the community and online and telephone counselling. Each of these sections has been written by an individual, or individuals, working at the leading edge of such development and aims to highlight some of the key factors related to such ways of working. As is noted at the end of the chapter, these sections will hopefully provide a useful resource for considering therapeutic practice in these different settings.

This chapter aims to provide a transparent basis for what follows within this text. It begins by placing the profession of counselling psychology within context, specifically aiming to address how it is viewed by the editors of this text, and to define some of its parameters within this work. In doing so, the discipline of counselling psychology is reflected upon within both UK and international perspectives, its core values are introduced and it is contrasted with allied/related professions. Following on from this, we move to introduce therapeutic work with young people. This section begins by introducing the arena of adolescent mental health care, placing it within a current political context in the UK, and introduces the complex concept of adolescence. It then goes on to introduce briefly the youth counselling movement and outlines some of the important nuances which are developed throughout this text.

Within this chapter we begin to reflect upon the research related to therapeutic practice with young people. We start by introducing the literature regarding therapeutic outcomes with this client group before moving on to consider the therapeutic alliance within the relationship between counsellor and young person. This initial section culminates in a discussion about what young people themselves want from therapy. In the second section of this chapter we then consider how research findings can be harnessed into research-informed practice. Specifically we reflect upon the way in which research may be used by practitioners, before moving on to consider a pluralistic framework, emphasising the collaborative nature of therapy and the use of practice-based evidence.