Thursday, 23 July 2020

Does Teletherapy Work?

From a blog by 
Scott D. Miller, Ph.D.

Director, International Center for Clinical Excellence

"So, what does the research indicate?
Drum roll please …
no difference in outcome for adults, adolescents and children being treated for the most common concerns addressed in psychotherapy (e.g., depression, anxiety, trauma, eating problems, substance abuse).  What’s more, online services are associated with greater utilization of and less dropout from mental health care.squeeze head

That said, challenges are evident.  For most clinicians and clients, teletherapy is an entirely new enterprise requiring a period of learning and adjustment.  Critically, the sensory input clinicians rely upon to make clinical judgments is also restricted — all the more reason to make “Feedback-Informed Treatment (FIT) a routine part of the services you provide.  Even if you’re regularly seeking feedback from clients using standardized measures like the Outcome and Session Rating Scales, doing so virtually will be new for most."

Link to blog

Tuesday, 14 July 2020

UKSIC partner with ITU to release new Child Online Protection guidelines

UKSIC partner with ITU to release new Child Online Protection guidelines

"UKSIC, along with industry partners SWGfL and IWF have helped to release the new ITU (International Telecommunication Union) Child Online Protection guidelines for 2020 to raise awareness of online safety across the world."

UKSIC Director David Wright, SWGfL, and the IWF have helped guide and inform some of these resources along with 80 other leading online safety and child protection organisations from across the world.  

The guidelines have been running since 2009, yet with the internet evolving so much through the years, the need for online safety awareness has become much more important. Children and young people have access to more resourceful things online than ever before. The internet plays a huge part in many young people’s lives and can provide many opportunities for education and fun. Socialising, sharing content and expressing opinions has never been more easy, yet challenges around online safety are still very much a part of the discussion.

Specially aimed at children, parents and educators, industry and policy-makers, the guidelines are meant to act as a framework, which can be adapted and used in a way that is consistent with national or local customs and laws.


There are three different age groups available within the guidelines. Each helps young people learn how to manage risks online whilst showing how to engage with the internet effectively. Included is:

  • Online with Sango – a storybook for children under 9 years’ old
  • Work with Sango – a workbook for children age 9-12 and 
  • The Net rules challenge – a social media campaign related to this website for young people age 13-18 years

"In Conversation… Assistant Professor Dr. Dienke Bos on Neuroimaging"


"In this podcast Assistant Professor Dr. Dienke Bos discusses neuroscience, and in particular neuroimaging. The interview looks at the typical development of behavioural control and how this is represented naturally, magnetic resonance imaging to monitor brain changes in relation to childhood development, and where the evidence is that early intervention can slow or reverse damage."

"Dr. Bos also talks about her research on longitudinal studies, how social emotional processing evolves from adolescence into early adulthood, and what’s in the pipeline for her work."


Monday, 13 July 2020

" Diving into COVID survey data, part 1"

Excerpt from Blog by Adam Peel, Research and Learning Manager at the National Youth Agency. 

"What’s next?
The data shows a lot of uncertainty for young people, and that the uncertainty itself may have an impact on their mental health. For example:
How much will return to ‘normal’? What does ‘the new normal’ mean? 
How will schooling change and will grades and university places be affected?
Will graduation and employment be significantly impacted, and what will the financial impacts be?"

"As the route out of lockdown emerges, we should be better able to understand the longer-term changes in young people’s mental health, including against existing annual surveys, and to be able to attribute these to the different concerns via the numerous longitudinal surveys that are underway."

"However, the surveys already highlight some important insights in how to support children and young people’s mental wellbeing during the pandemic: 

  • Taking an ‘age-sensitive’ path that responds to the needs and concerns of specific age groups
  • Signposting children and young people to regular, trust-worthy and clear sources of news and  information
  • Supporting children and young people to help out, support others and be involved in their local community efforts
  • Promoting opportunities for children and young people to spend time outside 
  • Reaching out to young people with self-reported or known mental health needs to offer them specific support 
  • Celebrating and recognising where children and young people say they are coping and finding ways to manage stress and boredom"

Friday, 10 July 2020

"Remote mental health interventions work – but not as a replacement for face-to-face support"

9th July 2020

Crucial thoughts from Youth Access in light of a recent rapid review - The need for evidence and informed decision making is discussed.
The following excerpts identify the need for appropriate training and why this is important.

"It's crucial that practitioners traditionally trained in face-to-face work are supported to transition to remote working, in particular those who are newly qualified practitioners, were furloughed or have had limited to no experience of providing sessions remotely during lockdown. As we emerge out of crisis response and look to reflection and recovery, we must take the opportunity to ensure those providing remote support are able to take the time to receive training to continue their work safely and accessibly. Such training, at a minimum, should cover consent, risk management and safeguarding, privacy and confidentiality as they relate to remote interventions, as well as ethical and legal considerations required for this work. It should also cover the impact that remote work can have on communication and power dynamics between the young person and practitioner, and how to adapt to these new challenges."

"If not supported correctly, staff can become one of the main barriers to adoption of remote modes of support. Our research has found that staff often felt that remote support was not aligned with their professional values, role and responsibilities, and can require staff to re-think their ways of working and identity. In addition, there is some evidence that staff can remain resistant to providing remote support in services that had adopted it, even when it was working well and was popular amongst young people. In these cases, training around the strengths of remote support, and the experiences of young people may be helpful, as well as training around how to increase engagement among young people. This should also be included in undergraduate and entry-level training for mental health practitioners. "

"There is lots to do, but we mustn’t waste this key moment to learn from the lessons of lockdown, confront the challenges presented by remote working and capture the innovations necessitated by the crisis. This new period of transition presents a unique opportunity to build a mental health system that blends remote and face-to-face support, meets young people’s human rights, and is accessible to all. The research community must be at the forefront of this."

Link to full blog

Thursday, 9 July 2020

"Remote mental health interventions for young people A rapid review of the evidence"

 - Dr Karen James, Youth Access July 2020

A valuable, "rapid review" from Youth Access supporting the value of access to online therapy for young people.
This review has limitations - acknowledged in the review itself- as it was carried out in response to COVID-19.

Aim - 
"Our aim was to summarise current evidence of the impact and implementation of remote interventions to support young people’s mental health. Remote interventions include any form of support that is not delivered in person (e.g. telephone or video calls, online chat messaging or forums, text messages or emails). To make sure we were generating knowledge that was most useful for our member organisations we only included remote support that was delivered by a counsellor, or other practitioner, meaning this review does not cover app-based or computerized interventions"

Conclusions - 
"There were very few robust evaluations of remote support,however those included in our review suggest it can lead to improvements in young people’s mental health and wellbeing.
There were examples of how these interventions can allow services to work flexibly and adapt their ways of communication to fit the needs of the young person. In this sense remote interventions, when offered alongside face to-face support, can help to build a service that is truly young person-centred.

However our findings suggest that using remote options as a replacement for face-to-face support (as was necessary during the Covid-19 pandemic) is problematic. Remote interventions were typically described as ‘brief’, meaning sessions were largely focused on providing space for the young person to tell their story and practitioners often did not have time to identify action plans or goals. 

It may be useful for services to consider how their approach could be adapted to provide the most impact over a small number of sessions. Some training around how practitioners can increase engagement might also be useful. Remote support requires staff to re-think their ways of working and identity. This may be less of an issue following the pandemic, however, could still be a challenge for newly qualified practitioners, or those who were furloughed. 

There was also evidence that staff can remain resistant to providing remote support in services that had adopted these approaches, even when they worked well and were popular amongst young people. In these cases training around the strengths of remote support, and the experiences of young people may be helpful. This should also be included in undergraduate and entry level training for mental health practitioners."

My personal thoughts on these conclusions is that these findings might have been different had these practitioners had training in working remotely to provide the information and experience required that allows for a trusting and safe online therapeutic relationship. 

Link to rapid review

Tuesday, 7 July 2020

"Suicide awareness materials: do they help people with suicidal ideation?"

"The ‘Werther effect’ suggests that a spike in deaths by suicide is often observed when a death by suicide (often that of a celebrity) is widely publicised (WHO, 2017). A report on Suicide Prevention by WHO (2017) proposed explanations including social learning and modelling, wherein the death is inadvertently glamorised through the photos of the deceased or the language used to describe the event alongside with the associated circumstances. It is suggested that vulnerable individuals may identify with the deceased and have an increase likelihood of engaging in a similar act. The capability to engage in suicidal behaviours is particularly increased when information about the method of suicide is reported.

On the other hand, a “Papageno effect” is also proposed wherein coverage of effective coping mechanisms highlighting alternative paths (e.g. stories of hope and recovery) may have a protective effect against death by suicide.

Niederkrotenthaler and Till (2019) develop a strong rationale for their research. Whilst the Werther effect has been more marked amongst those with prior suicidal thoughts and behaviours, the Papageno effect has only been studied across the general population, as opposed to focusing on those who are vulnerable. Individuals with suicidal ideation would be the primary focus for suicide prevention initiatives, therefore there is a need to examine the phenomenon within this group.

The authors also note the need to study possible effects of who the intervention is delivered by, e.g. a person with lived experience of suicidality vs. a mental health professional. They suggest that interventions delivered by individuals with lived experience may resonate more closely with these vulnerable individuals. This resonates with current evidence around the values of peer-assisted interventions for those with depression, with some suggesting that the involvement of professionals may compromise efficacy (APA, 2018, Bellamy, Schmutte & Davidson, 2017, Bryan & Arkowitz, 2015, Fuhr et al., 2014).

Overall, they conclude that this is the first study to assess whether these educative messages actually serve to reduce suicide risk among those who are already at risk for suicidal behaviour. Secondly, their research is the first to consider the potential influences dependant on who delivers the message."
Link to full article