Navarro Pablo, Sheffield Jeanie, Edirippulige Sisira, Bambling Matthew
Kids Helpline, yourtown, Brisbane, Australia.
School of Psychology, University of Queensland, Brisbane, Australia.
JMIR Ment Health. 2020 Jan 29;7(1):e15564. doi: 10.2196/15564.
Population-based studies show that the risk of mental ill health is highest among young people aged 10 to 24 years, who are also the least likely to seek professional treatment because of a number of barriers. Electronic mental (e-mental) health services have been advocated as a method for decreasing these barriers for young people, among which text-based online counseling (TBOC) is a primary intervention used at many youth-oriented services. Although TBOC has shown promising results, its outcome variance is greater in comparison with other electronic interventions and adult user groups.
This pilot study aimed to explore and confirm e-mental health professional's perspectives about various domains and themes related to young service users' (YSUs) motivations for accessing TBOC services and factors related to higher and lower effectiveness on these modalities.
Participants were 9 e-mental health professionals who were interviewed individually and in focus groups using a semistructured interview. Thematic analysis of qualitative themes from interview transcripts was examined across the areas of YSU motivations for access and factors that increase and decrease TBOC effectiveness.
A total of 4 domains and various subthemes were confirmed and identified to be related to YSUs' characteristics, motivations for accessing TBOC, and moderators of service effectiveness: user characteristics (ie, prior negative help-seeking experience, mental health syndrome, limited social support, and perceived social difficulties), selection factors (ie, safety, avoidance motivation, accessibility, and expectation), and factors perceived to increase effectiveness (ie, general therapeutic benefits, positive service-modality factors, and persisting with counseling despite substantial benefit) and decrease effectiveness (ie, negative service-modality factors).
Participants perceived YSUs to have polarized expectations of TBOC effectiveness and be motivated by service accessibility and safety, in response to several help-seeking concerns. Factors increasing TBOC effectiveness were using text-based communication, the online counselor's interpersonal skills and use of self-management and crisis-support strategies, and working with less complex presenting problems or facilitating access to more intensive support. Factors decreasing TBOC effectiveness were working with more complex problems owing to challenges with assessment, the slow pace of text communication, lack of nonverbal conversational cues, and environmental and connectivity issues. Other factors were using ineffective techniques (eg, poor goal setting, focusing, and postcounseling direction) that produced only short-term outcomes, poor timeliness in responding to service requests, rupture in rapport from managing service boundaries, and low YSU readiness and motivation.
基于人群的研究表明，10至24岁的年轻人心理健康问题风险最高，由于多种障碍，他们也是最不可能寻求专业治疗的人群。电子心理健康（e-心理健康）服务被倡导为减少年轻人这些障碍的一种方法，其中基于文本的在线咨询（TBOC）是许多面向青少年服务中使用的主要干预措施。尽管TBOC已显示出有前景的结果，但与其他电子干预措施和成年用户群体相比，其结果差异更大。
这项试点研究旨在探索并确认电子心理健康专业人员对与年轻服务用户（YSUs）使用TBOC服务的动机以及这些方式有效性高低相关的各种领域和主题的看法。
参与者为9名电子心理健康专业人员，采用半结构化访谈对他们进行了单独访谈和焦点小组访谈。对访谈记录中的定性主题进行了主题分析，涉及YSUs使用服务的动机以及提高和降低TBOC有效性的因素等方面。
共确认并确定了4个领域和各种子主题，它们与YSUs的特征、使用TBOC的动机以及服务有效性的调节因素有关：用户特征（即先前负面的求助经历、心理健康综合征、有限的社会支持和感知到的社会困难）、选择因素（即安全性、回避动机、可及性和期望），以及被认为能提高有效性的因素（即一般治疗益处、积极的服务方式因素以及尽管受益显著仍坚持咨询）和降低有效性的因素（即负面的服务方式因素）。
参与者认为YSUs对TBOC有效性的期望两极分化，他们受服务可及性和安全性的激励，以应对一些求助方面的担忧。提高TBOC有效性的因素包括使用基于文本的沟通方式、在线咨询师的人际交往技能以及自我管理和危机支持策略的运用，以及处理不太复杂的呈现问题或促进获得更强化的支持。降低TBOC有效性的因素包括因评估挑战而处理更复杂的问题、文本沟通速度缓慢、缺乏非言语对话线索以及环境和连接问题。其他因素包括使用仅产生短期结果的无效技术（如目标设定不佳、注意力不集中和咨询后指导不当）、对服务请求响应的及时性差、因管理服务界限而导致的融洽关系破裂，以及YSUs准备度和动机低。
