XenZone and University of Manchester unveil research findings on digital mental health support

Digital health specialist XenZone and the University of Manchester have launched a research report, defining the specific ways children and young people are benefitting from digitally-delivered mental health support.

Researchers found young people experience beneficial outcomes resulting from the physical absence of a therapist as well as from being able to explore themselves in a safe, moderated space without the fear of a negative backlash, as is common to other social media platforms.

Researchers used online mental health and wellbeing service for children and young people, Kooth, which sees over 2,200 log-ins every day across the country. Their aim was to identify the characteristics and mechanisms of the service that lead to better mental health and wellbeing.

The findings have been published in a report, “A Positive Virtual Ecosystem: The Theory of Change for Kooth, which include:

  • The physical absence of a therapist allows children and young people to express themselves, focusing exclusively on their situation and their feelings without fear of judgement or dismissal.
  • Kooth’s environment means children and young people feel able to explore themselves with no chance of a negative backlash common to other social media platforms. Calling this Kooth’s ‘Positive Virtual Ecosystem’, researchers observed young people benefitting from the choice available within the service, navigating their way to the right support on any given day, week, month or year, depending on the issue they were trying to manage or how they felt.
  • The therapeutic ‘touch-points’ available was found to be central to the effectiveness of the community, with children and young people able to use digital tools such as mood trackers, access peer support through online forums, read and contribute articles or contact therapists as and when they wished.
  • The anonymity of the service means the young person feels it is safe to open up and can get to the key issues they wish to address quickly.
  • The site’s accessibility means that young people can use it when they need to, going back for more support as required. The young person therefore, is in control of the pace of support, which shifts the power dynamic away from the therapist.
  • Researchers also found that as well as experiencing and benefitting from a ‘therapeutic alliance’ – a constructive relationship – with their counsellor, children and young people on Kooth also felt this alliance with Kooth as a whole service. This is an important mechanism of change. Children and young people choose to use the service and return to it because it is a beneficial and safe space centred around their needs.

Commenting on the new report, “A Positive Virtual Ecosystem: The Theory of Change for Kooth”, Aaron Sefi, XenZone’s research and evaluation director, said: “The culture around assessment and diagnosis in the world of mental health is, in places, reductive, narrow and prescriptive.  People are defined by their symptoms. We have tried to take a more rounded approach with Kooth, which is evident in today’s report. The findings are grounded in the direct experience of children and young people on Kooth and so reflect what it is they get from the service. The outcome measures we will publish next year will also come from our service users rather than being prescribed by practitioners.”

These ‘mechanisms of change’ will be used to inform a new set of outcome measures the organisation is developing and intends to validate. The data collected will be used to make recommendations to the NHS on best practice for evidencing the impact of digital mental health support services in England.

Dr Terry Hanley, senior lecturer at the University of Manchester, who co-authored the report, said: “There is a growing need to define what mental health and wellbeing support looks like today so that we have an accurate understanding of the potential of new approaches and new modes of delivery. It also follows that we need to evolve our understanding of outcome measures so that we avoid using old systems to measure newer, broader services. The ambition of this project, therefore, was to articulate and share the Theory of Change for the Kooth platform; future work will address the outcomes required to evidence this work.”


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