Factors Related to Perceived Helpfulness in Supporting Highly Distressed Individuals through an Online Support Chat

The Usage of a Chat-Based Help Service for Young People: A Nationwide Descriptive Study

Adolescents with subclinical depression are at high risk of developing mental disorders. Early interventions are effective but expensive. Affordable and accessible mental health services are needed. This multimethod study obtained its sample from the database of the Finnish national chat room service and describes the usage of the service among young people in Finland. All chats between 1.1-31.12.2018 were extracted and analysed using quantitative and qualitative methods. The usage frequency was analysed with descriptive statistics, while the specific content of the chat topics was first categorised with content analysis and then quantified and analysed using descriptive statistics. The association between the demographic characteristics and the usage were analysed. A total of 839 young people used chat room services. The great majority of the chat users were girls, and half were 12-14 years old. The use of the chat room varied in terms of the number of words and the duration of the chat discussions. Based on the chat room topics, young people had complex life situations with psychological distress, difficulties related to their social living environment, or they were involved in risky behaviour. The gender and the age of the users influenced their chat room usage. The results of this study can be used in the development of mental health services for young people.

Effect of helping suicidal people using text messaging: An evaluation of effects and best practices of the Canadian suicide prevention Service's text helpline

BACKGROUND

Empirical research on best practices in suicide prevention text intervention is scarce. We present analyses of exchanges concerning suicide on the Canadian Suicide Prevention Service (CSPS) text helpline.

OBJECTIVE

To describe the users of the CSPS text service, explore the perceived impact of the service, and identify intervention characteristics associated with a greater likelihood of positive or negative effects of the exchanges.

METHODS

We analyzed data from 112 transcripts using quantitative content analysis, counselor assessments of the calls, and responses by callers to pre-call questionnaires.

RESULTS

Counselors infrequently conducted a complete suicide risk assessment, but almost always thoroughly explored resources and discussed possible solutions to callers' problems. An operational action plan was rarely developed. Only one technique, reinforcing a strength or a positive action of the caller, was a significant predictor of positive effects of the call. The number of words exchanged during the intervention was positively correlated with the completeness of explorations of resources and solutions and the development of an action plan.

CONCLUSIONS

High-quality effective interventions can be delivered via text messages. Using reinforcement of strengths and encouraging longer calls is recommended. Intervention effects were comparable to those reported in studies of telephone and chat services.

Lifeline Crisis Chat: Coding form development and findings on chatters' risk status and counselor behaviors

OBJECTIVE

This study aimed to develop a reliable tool for the abstraction of data from crisis chat transcripts; to describe chatters' suicide risk status and selected counselor behaviors; and to examine the relationship of chatters' self-reported pre-chat suicidal thoughts to counselor behaviors and to chatters' disclosures of suicide risk during the chat conversation.

METHODS

Coders used an instrument developed for this study to abstract data from 1034 crisis chats handled by the National Suicide Prevention Lifeline Crisis Chat network in 2015. The relationship of transcript coding data to data from an automated pre-chat survey (PCS) was examined.

RESULTS

Lifeline Crisis Chat serves a young (median age = 21), high-risk population: 84.0% of chats (869/1034) came from chatters endorsing current or recent suicidal thoughts on the PCS. Counselors engaged in rapport-building on 93.3%, problem-solving on 70.1%, and suicide risk assessment on 67.7% of these 869 chats. Counselor risk assessment behavior, and the availability of information on suicide risk in the chat transcript, varied significantly by the chatter's PCS response.

CONCLUSION

Crisis counselors are able to implement keystones of Lifeline's crisis intervention model over the medium of online chat. Additional efforts are needed to ensure that suicide risk is assessed on every chat.

National Suicide Prevention Lifeline crisis chat interventions: Evaluation of chatters' perceptions of effectiveness

OBJECTIVE

As part of the National Suicide Prevention Lifeline's crisis response system, the Lifeline Crisis Chat Network (LCC) answers chats from hundreds of thousands of at-risk individuals yearly. The study's objective was to assess the effectiveness of these online crisis interventions.

METHOD

Data from 39,911 pre-chat surveys and 13,130 linked pre- and post-chat surveys completed by LCC chatters from October 2017-June 2018 were analyzed. The relationship of several effectiveness measures with chatter demographics, pre-chat distress, suicidal ideation, and chatters' perceptions of engagement with their counselors was examined using a series of logistic regression analyses.

RESULTS

Chatters were significantly and substantially less distressed at the end of the chat intervention than at the beginning. By the end of the chat, two-thirds of suicidal chatters reported that the chat had been helpful, while just under half reported being less suicidal.

CONCLUSIONS

Our study offers empirical evidence for the Lifeline's online crisis chat services' effectiveness, but also highlights areas for improvement. This is of critical import in light of the recent designation of 988 as the nationwide number for the Lifeline beginning in 2022, which will increase the Lifeline's prominence in providing suicide prevention and mental health crisis interventions in the United States.

Peer-based interventions targeting suicide prevention: A scoping review

Peers of individuals at risk for suicide may be able to play important roles in suicide prevention. The aim of the current study is to conduct a scoping review to characterize the breadth of peer-delivered suicide prevention services and their outcomes to inform future service delivery and research. Articles were selected based on search terms related to peers, suicide, or crisis. After reviews of identified abstracts (N = 2681), selected full-text articles (N = 286), and additional references (N = 62), a total of 84 articles were retained for the final review sample. Types of suicide prevention services delivered by peers included being a gatekeeper, on-demand crisis support, crisis support in acute care settings, and crisis or relapse prevention. Peer relationships employed in suicide prevention services included fellow laypersons; members of the same sociodemographic subgroup (e.g., racial minority), workplace, or institution (e.g., university, correctional facility); and the shared experience of having a mental condition. The majority of published studies were program descriptions or uncontrolled trials, with only three of 84 articles qualifying as randomized controlled trials. Despite a lack of methodological rigor in identified studies, peer support interventions for suicide prevention have been implemented utilizing a diverse range of peer provider types and functions. New and existing peer-delivered suicide prevention services should incorporate more rigorous evaluation methods regarding acceptability and effectiveness.

Going Online: The Affordances of Online Counseling for Families Affected by Alcohol and Other Drug Issues

Online counseling can overcome barriers families face when accessing support services for issues such as a relative's alcohol or other drug use. However, little research has explored how online counseling platforms assist family members to improve their well-being and support their relative. We thematically analyzed 90 transcripts of online counseling sessions with family and friends of people who use alcohol, opioids, and amphetamines in Australia between 2015 and 2016. In our analysis, we drew on the concept of affordances to articulate how online platforms afford or constrain potentially therapeutic encounters with families. We found online counseling enabled families to make first contact, relieve distress, plan appropriate action, improve communication, regain direction, and connect with local services. Sessions were constrained by Internet access, web-chat communication, counselors' focus on referral, and limitations in addressing the wider concerns of families. The findings present opportunities for improving online services for families.

Online support for transgender people: an analysis of forums and social networks

Transgender people face a range of personal and social conflicts that strongly influence their well-being. In many cases, the Internet can become the main resource in terms of finding support. The aim of this study was to understand how transgender people give and receive help online. Between 2013 and 2015, 122 online community conversations were collected on Italian forums and Facebook groups involving transgender people, and online interviews were conducted with 16 users of these communities. A qualitative content analysis was conducted by using the software package, NVivo10. The main categories that emerged were: motivations to join an online community, online help, differences between online and offline interactions, status, conflicts and professional help. Results indicate that participation in online communities often derives from the users' need for help. This help can be given by peers who have had similar experiences, and by professionals who participate in the discussions as moderator. The need to test one's own identity, to compare oneself with others and to share one's personal experiences made online communities at risk of exposing users to invalidation and transphobic messages. Administrators and moderators try to ensure the safety of users, and suggest that they ask for professional help offline and/or online when over-specific medical advice was sought. This study confirms that transgender people might find benefit from an online platform of help and support and might minimise distance problems, increase financial convenience and foster disinhibition.

Predictors of psychological improvement on non-professional suicide message boards: content analysis

BACKGROUND

Suicide message boards have been at the core of debates about negative influences of the Internet on suicidality. Nothing is currently known about communication styles that may help users to psychologically improve in these settings.

METHOD

In all, 1182 archival threads with 20 499 individual postings from seven non-professional suicide message boards supporting an 'against-suicide', 'neutral' or 'pro-suicide' attitude were randomly selected and subject to content analysis. Initial needs of primary posters (i.e. individual who open a thread), their psychological improvement by the end of the thread, their responses received and indicators of suicidality were coded. Differences between 'pro-suicide', 'neutral' and 'against suicide' boards, and correlations between primary posters and respondents in terms of suicidality were assessed. Logistic regression was used to test associations with psychological improvement.

RESULTS

'Pro-suicide' boards (n = 4) differed from 'neutral' (n = 1) and 'against-suicide' (n = 2) boards in terms of communicated contents. Indicators of suicidality correlated moderately to strongly between primary posters and respondents on 'pro-suicide' message boards, but less on other boards. Several communicative strategies were associated with psychological improvement in primary posters, including the provision of constructive advice [adjusted odds ratio (aOR) 4.10, 95% confidence interval (CI) 2.40-7.03], active listening (aOR 1.60, 95% CI 1.12-2.27), sympathy towards the poster (aOR 2.22, 95% CI 1.68-2.95) and provision of alternatives to suicide (aOR 2.30, 95% CI 1.67-3.18).

CONCLUSIONS

Respondents resemble primary posters with regard to suicidality in 'pro-suicide' boards, which may hinder psychological improvement. Still, opportunities to intervene in these settings using simple communication techniques exist and need to be taken and evaluated.

Suicide prevention via the Internet: a descriptive review

BACKGROUND

While concerns abound regarding the impact of the Internet on suicidal behaviors, its role as a medium for suicide prevention remains underexplored.

AIMS

The study examines what is currently known about the operation and effectiveness of Internet programs for suicide and self-harm prevention that are run by professionals.

METHOD

Systematic searches of scholarly databases and suicide-related academic journals yielded 15 studies that presented online prevention strategies.

RESULTS

No professional programs with a sole focus on nonsuicidal self-harm were identified, thus all studies reviewed focused on suicide prevention. Studies were predominantly descriptive and summarized the nature of the strategy and the target audience. There was no formal evaluation of program effectiveness in preventing suicide. Studies either presented strategies that supported individuals at risk of suicide (n = 8), supported professionals working with those at risk (n = 6), or attempted to improve website quality (n = 1).

CONCLUSION

Although the Internet increasingly serves as an important medium for suicidal individuals, and there is concern about websites that both promote and encourage suicidal activity, there is lack of published evidence about online prevention strategies. More attention is needed in the development and evaluation of such preventative approaches.

Defining the Role of the Online Therapeutic Facilitator: Principles and Guidelines Developed for Couplelinks, an Online Support Program for Couples Affected by Breast Cancer

Development of psychological interventions delivered via the Internet is a rapidly growing field with the potential to make vital services more accessible. However, there is a corresponding need for careful examination of factors that contribute to effectiveness of Internet-delivered interventions, especially given the observed high dropout rates relative to traditional in-person (IP) interventions. Research has found that the involvement of an online therapist in a Web-based intervention reduces treatment dropout. However, the role of such online therapists is seldom well articulated and varies considerably across programs making it difficult to discern processes that are important for online therapist involvement.In this paper, we introduce the concept of "therapeutic facilitation" to describe the role of the online therapist that was developed and further refined in the context of a Web-based, asynchronous psychosocial intervention for couples affected by breast cancer called Couplelinks. Couplelinks is structured into 6 dyadic learning modules designed to be completed on a weekly basis in consultation with a facilitator through regular, asynchronous, online text-based communication.Principles of therapeutic facilitation derived from a combination of theory underlying the intervention and pilot-testing of the first iteration of the program are described. Case examples to illustrate these principles as well as commonly encountered challenges to online facilitation are presented. Guidelines and principles for therapeutic facilitation hold relevance for professionally delivered online programs more broadly, beyond interventions for couples and cancer.

Adolescent's preferred modes of delivery for mental health services

BACKGROUND

Mental health interventions for young people are increasingly being delivered online. This is occurring due to an assumption that young people prefer online interventions because they address some of the well-established help-seeking barriers.

METHOD

A self-report questionnaire investigating preferences for mental health care delivery was administered to a nonclinical sample of 231 young people aged 15-19.

RESULTS

The strongest help-seeking intention in response to a scenario describing symptoms of depression was for face-to-face services, followed by not seeking help at all. Only 16% expressed a preference for online treatment.

CONCLUSION

The assumption that a majority of young people will prefer online delivery of mental health treatment was not supported, although boys showed a stronger relative preference for online modes.

Evaluation of the Dutch AIDS STI information helpline: differential outcomes of telephone versus online counseling

OBJECTIVE

Health information helplines have an important function in health education, prevention and counseling. Information and help services are increasingly provided online. This study focuses on the differences and similarities between online help services and telephone services.

METHODS

The telephone service of the Dutch AIDS STI helpline was compared to its e-mail equivalent. After consulting the helpline service, both callers and e-mailers (N(tot) = 455) were asked to participate in a survey that evaluated their background characteristics, contacting reasons, and satisfaction with the specific service and information received. The survey also included questions regarding the advice received from the helpline. A follow-up measure 4 weeks after the baseline survey evaluated to what extent clients acted upon the advice.

RESULTS

The study shows that both services are positively evaluated and are equally persuasive in their counseling. Differences between callers and e-mailers were found regarding background characteristics, content of the consultation, satisfaction, and the advice received.

CONCLUSION

It can be concluded that online health information services are an important addition to, but not a replacement for, the traditional telephone helplines.

PRACTICE IMPLICATIONS

In order to provide an optimal health service to a wide public, both online and telephone counseling should be offered.

Volunteer and user evaluation of the National Sexual Assault Online Hotline

PURPOSE

The National Sexual Assault Online Hotline (NSAOH) is a new model for delivery of rape and sexual assault crisis services through a secure, confidential chat-based online hotline. This paper presents a program evaluation drawn from volunteer counselor and user perceptions and experiences during the second year of operation of the NSAOH.

METHOD

Outcome data are presented from 731 session evaluations submitted by 94 volunteers and session evaluations from 4609 user sessions collected between June 1, 2008 and May 30, 2009. Evaluation includes ratings of usefulness, topics discussed, length of sessions, services provided, and session difficulties.

RESULTS

The results indicate that the model is viable and useful, and the majority of volunteers and users are satisfied. Volunteer knowledge and skills are strongly associated with satisfaction with the hotline. Nevertheless, one-fifth of volunteers rate their session as not useful and users rate 8.2% of volunteers low in knowledge and skills.

DISCUSSION

NSAOH is reaching many who have not previously sought services or did not resolve issues through other means. Findings suggest the importance of preparing volunteers in both crisis intervention and a wide variety of long-term issues related to sexual assault. Recommendations for program development, evaluation, and further research are presented.

Peer counseling in an online chat service: a content analysis of social support

In a recently launched one-on-one chat service for young people with psychosocial problems, young peer volunteers (ages 16-23) have a leading role in the conversations, comparable to the role of counselors in web-based and telephone-based child help-line services. A content analysis of the chat conversations showed that the contribution of the peer counselors in the confidential chat sessions satisfied the various quality criteria of the service. Moreover, the peer counselors offered the young people who visited the site varied types of social support. The variety of types of social support appeared a stronger predictor of the quality ratings than the length of the conversation or the quantity (instead of variety) of social support, which emphasizes the importance of multidimensional social support in online conversations.

Intervening via chat: an opportunity for adolescents' mental health promotion?

Mental health problems are highly prevalent among adolescents, but a majority of adolescents is reluctant to seek help at mental health services because of shame and lack of anonymity. Intervening via chat (i.e. offering online support) could be a solution to remove these barriers and to reach adolescents. The dimensions of the RE-AIM model (reach, efficacy, adoption, implementation and maintenance) served as a guiding principle for discussing the potential of offering online support via chat. It appeared that the use of chat may be an appropriate way to reach adolescents and may have a positive impact on outcome measures related to mental health. Additional efforts are needed to stimulate adoption at the individual level (target group, intermediaries) and the organizational level. Future research needs to focus on the dissemination of chat-based interventions, differences between online peer support and online professional support, and the content of conversations via chat about mental health problems.

Facilitating online support groups for cancer patients: the learning experience of psycho-oncology clinicians

OBJECTIVE

Counsellor familiarity and engagement with technology-mediated communication represents an important factor in the ability to implement support programs to cancer patients. This study describes the experiences of a cohort of expert psycho-oncology counsellors who learned to facilitate online support groups (OSGs) and identifies the important elements of their learning experience that led to their engagement. PROCEDURE AND METHOD: Six psycho-oncology counsellors were trained to facilitate OSGs and later facilitated OSGs in their own practice context. They subsequently reflected on and discussed their experiences with OSGs over time: in a panel discussion within 6 months of training, and in two focus groups. A participatory method was used to describe and interpret key elements of the learning process.

RESULTS AND DISCUSSION

Three themes of the counsellors' learning experience emerged: immersion in experiential learning, perceptions of clinical value and benefit, and overcoming challenges with adapted skills. Counsellors described components of their experiential learning: co-facilitating online cancer support groups with an expert, debriefing online, and participating in an online peer supervision group, as critical to their becoming engaged. Despite initial challenges, the counsellors learned new skills, and adapted known clinical skills, to the text-only environment.

CONCLUSION

With appropriate training and practice over time, counsellors familiar with delivering face-to-face support groups to cancer patients became skilled and engaged in leading OSG's for cancer patients. Learning to facilitate OSGs shifted practice by significantly expanding the scope of services they were able to provide their patients and has implications for expanding access to support services.

Description and psychometric evaluation of the Youth Counseling Impact Scale

The present article describes and evaluates the Youth Counseling Impact Scale (YCIS; L. Bickman et al., 2007), a recently developed therapeutic process measure that assesses youths' perceptions of the impact individual mental health counseling sessions have on their thoughts, feelings, and behaviors. This measure is intended for frequent use in the mental health treatment of youths aged 11-18. It provides a general Impact score as well as two subscale scores: Insight and Change. Five hundred youths receiving mental health services participated in this investigation. Classical test theory, item response theory, confirmatory factor nalysis, and analyses of the relationship of the YCIS with other scales were used to evaluate the research questions. The results suggest that, overall, the YCIS is a well-functioning scale with good psychometric properties. The proposed model for 1 primary general factor of impact and 2 secondary factors (Insight and Change) fit the data well. Specific weaknesses of the scale are discussed, and possible improvements are suggested.

Children's experiences with chat support and telephone support

BACKGROUND

In line with the wider trend of offering support via the Internet, many counseling and referral services for children have introduced online chat, often in addition to a traditional telephone service.

METHODS

A comparative study was conducted between the telephone service and the confidential one-on-one online chat service of the Dutch Kindertelefoon. The design included a concise pretest and a posttest (n = 902). The study also comprised a follow-up test (n = 213), which included the Strengths and Difficulties Questionnaire.

RESULTS

Children experienced a higher sense of well-being and a reduced severity of their problems after consulting the Kindertelefoon. The results were slightly more favorable for the chat service than for the telephone service. The follow-up survey showed that many of the children who contact the Kindertelefoon suffer from relatively severe emotional problems.

CONCLUSIONS

Both the telephone and the web-based support improved the children's well-being and decreased their perceived burden of problem. The results of this study underline the need for closer cooperation between child helplines and mental health and child welfare services.

Motivational interviewing in internet groups: a pilot study for weight loss

Motivational interviewing is a technique for developing and maintaining motivation. This pilot study examined the feasibility and acceptability of motivational interviewing in online weight-loss treatment groups. Twenty women participated in the 8-week minimal contact intervention, received weekly e-mailed lessons, and were randomized to two online groups using motivational interviewing, either with or without a discussion of values. Acceptability of format and content was measured following the second online group. Self-reported weight and motivation were measured at baseline and 8 weeks. Qualitative analysis of group transcripts examined self-motivational statements uttered by participants during online groups. Eighty-four percent of participants reported willingness to participate again and were comfortable with the discussion topics. The average number of self-motivational statements uttered by participants did not differ by group (P=0.85) and was correlated with an increase in autonomous motivation during the 8 weeks (r=0.58, P=0.05). Higher autonomous motivation at follow-up was associated with greater weight loss (r=0.51, P<0.05). This study suggests that motivational interviewing techniques are acceptable and may be useful for targeting and maintaining motivation in online weight-loss groups.

Providing online support for young people with mental health difficulties: challenges and opportunities explored

Despite its growing popularity there is a paucity of information exploring the potential of the Internet to build a trusted community that helps reduce stigma, facilitates help-seeking and aids in the prevention or helps in the management of mental health difficulties for young people. Unsupervised online forums or chat rooms hold potential dangers for young people including the possibility of attracting adults who may take advantage of vulnerable adolescents. Contagion with members organizing suicide pacts, or describing suicidal or self-harming intentions and methods and young people ruminating about feeling depressed are also potential risks. This paper describes the development and conceptual underpinnings of the Reach Out! Online Community Forum, a moderated bulletin board, developed in consultation with, and facilitated by young people aged 16-25. The Forum, although facilitated by young people, is supported and monitored by trained moderators. Anecdotal evidence collected via unsolicited feedback from young people using the Forum suggests that it is a positive, unique and helpful online experience although little is known about the impact on stigma reduction and help seeking in the offline world. Given the proliferation of unsupervised forums and chat rooms there is a need for further research to determine the effectiveness or potential dangers of online forums in mental health prevention and early intervention work.

The internet and suicide: A double-edged tool

Many physicians are unaware of the power of the internet. In an era of an empowered public and patients, the internet may be a more powerful determinant of health-seeking behaviour than medical opinion. In the same way, it may provide more information for self-harm than was ever available to the public domain in the past. The internet is effective across cultural and geographical boundaries. In addition to reporting and romanticising suicide, it has a significant impact in assisting and promoting suicide. It provides services and information ranging from general information to online orders of prescription drugs or other poisons that bypass government regulations and custom controls. This bridges the gaps of locality and accessibility, which previously formed a natural divide in selecting the means of suicide. In addition to these negative effects, there is a vast potential to harness these properties to a beneficial effect. The wide acceptance of the internet makes it a powerful tool for recognition of the at-risk individual, for preventing suicide and supporting survivors, with chat rooms taking the place of telephone help lines. In an information age, it is vital for physicians to use all available means of informing and empowering the public and patients. The internet also has a role in training, providing accessible self-help sites for suicidal persons and web-based prevention services, all of which remain sadly under-utilised. The challenge to physicians of the 21st century is to harvest the internet in a beneficial manner.