Part 3 - Case studies


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Reach Out Pro Module - Connecting Our Worlds
Part 3

This document accompanies 'Part 3 - Technology in Practice Tutorial', and provides case studies of how technology can be used in practice with young people.

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Part 3 - Case studies

  1. 1. Case Studies Part 3. Using technology in practice
  2. 2. Part 3. Using technology in Educational Module 1. Using websites to assist with developing rapport In practice Melanie was a 15 year old girl referred to a psychologist working within a youth organisation following a serious suicide attempt. Melanie presented with symptoms of Major Depressive Disorder including low mood, social withdrawal, tearfulness, irritability, and poor sleep. She had failed to engage with several of her previous health professionals and had limited family support. For the first three sessions, Melanie remained mostly silent and with minimal verbal communication with the psychologist at all. Discussions with her parents suggested that Melanie was motivated to attend sessions and wanted to talk during session, but became overwhelmed in discussions about herself and tended to “shut down”. Melanie’s mother reported that Melanie did spend a lot of time on the computer using social networking sites. Armed with this information in the fourth session, her psychologist asked her about these sites and which ones she enjoyed. Although Melanie was not forthcoming with information, she was able to nod in response and agreed to show the psychologist her Facebook page. While both were looking at the page her psychologist was then able to ask questions about the items on the page, and whilst looking at the screen, Melanie was able to answer the questions, thus facilitating a less confronting discussion about aspects of her identity, friendships and difficulties. This paved the way for building rapport and more open communication. Page 2
  3. 3. Part 3. Using technology in Educational Module 2. Using SMS to enhance engagement In practice: The Adelaide SMS project A recent study published in the Journal of Adolescent Health has shown that SMS communications can be effectively used by clinical staff to engage adolescents [1]. The study which examined the content of SMS exchanges between therapists and young people, aimed to identify the extent of inappropriate SMS use. Since its formation in 2000, the Youthlink team has recognised the challenge of maintaining contact with young people within their service. As with many communications, referrals coming through to their service often only included home telephone numbers. Whilst this is often a suitable method of contact for adults, response rates indicated that there was a limited likelihood that young people would either answer or return calls. Based on this observation, it was evident to the team that the use of mobile phones (both SMS and calls) increased the chance of more consistent contact being made. By clinicians providing their mobile phone numbers to young people, and being open to using SMS, therapists at Youthlink were able to organise appointments directly with the young person, instead of through an administration officer. In addition, an SMS message was sent to the young person before they were contacted by the team. This provided the young person with a warning about the pending call and helped to ‘break the ice’, therefore, increasing the chance of the call being responded to. The team initially had concerns about inappropriate SMS use by clients and how they would be best to respond to messages surrounding safety. An audit of messages received from clients indicated that only 2% were deemed as inappropriate. The majority (60.68%) of messages received from clients were classified as being appointment related (eg. time, place, logistics). The study also revealed that the use of SMS between client and therapist provided reassurance for the young person; allowing them to make contact on their terms. This allowed for mutual trust and respect to develop between the therapist and the young person. Such results therefore indicate that the use of mobile phones, particularly SMS, are not only beneficial for making and maintaining contact with young people, but a safe and efficient way to coordinate appointments. “It is the use of SMS in coordinating and negotiating appointments (phone, face to face, home visits etc) that has been of most benefit to the Youthlink team. The real time contact made through SMS gives clients and therapists a chance to build on their relationship outside more formal appointments.” Ann Crago Youthlink Coordinator To read the full interview conducted by Youth Ambassador, Helen Pepper, refer to using-sms-to-support-youth-services.aspx Page 3
  4. 4. Part 3. Using technology in Educational Module 3. Fun ways to provide psycho education In practice As a clinician I enjoy working with young people – particularly those that present with complex problems, or those that are difficult to engage. Many of the clients I work with have been sent to our service by the school, their parents, or their doctor – and have not really come along because they “want to see a psychologist”. Often problems are down played during the initial few sessions, and at times, not even disclosed. Often I find that online sites can really help with building the relationship. This often starts with sharing clips and media that we both like, and then exploring sites like tumblr or Facebook. More often than not there are posts on these sites that give hints towards other difficulties that can be explored further. When there are other difficulties, sites like are great. You can browse through the sites with the young person; allowing them to navigate towards the areas that they are interested in. Sometimes they go immediately to the problem area, or ignore it completely, but more often than not they will go back to it another time (usually outside of session). These websites are often great to help young people communicate with their parents or friends about their difficulties. Downloadable information sheets, links posted on Facebook, and the sharing of other people’s experiences means that they can use other ways to communicate what’s going on. It can also help to normalise the experience, and more importantly the process of help seeking and therapy. Sometimes it’s even helped mum and dad understand a bit better too about what’s going on. Where possible I chose sites that are multidimensional – that combine information, forums and activities to hold their interest for longer. These resources are invaluable and add so much to the sessions. Page 4
  5. 5. Part 3. Using technology in Educational Module 4. Treating mild to moderate anxiety and depression In practice Stephen was a 16 year old boy living in an intact family in Western Sydney. He had been referred to a youth counselling service by his school counsellor who noticed a deterioration in his mood following a relationship break-up. Stephen had not connected well with his school counsellor and was reluctant to discuss personal issues with others. At initial assessment, Stephen was found to be suffering some symptoms of mild to moderate depressive illness and although he did not meet full criteria he was certainly at risk. Due to staff constraints at the youth service Stephen was placed in a waiting list and could expect to be seen in approximately four weeks. The health professional providing this assessment provided links to both e-couch and moodgym and encouraged him to have a look at these in the meantime. She followed up with weekly phone calls to check on his progress. When Stephen attended his first appointment with his assigned youth health worker he appeared brighter and described an improvement in his mood, he continued to be reluctant to discuss personal issues with his worker but could relate to concepts linking his thinking to self-esteem and mood and was able to benefit from individual work. Page 5
  6. 6. Part 3. Using technology in Educational Module 5. Assisting with monitoring of mental state In practice Whilst not everyone is technology savvy (clinicians and patients alike), you can utilise mood diaries that are sent to the patient electronically rather than in paper format. I use this regularly in practice because once you have sent the diary once, the young person then has a copy of that can be used many times. The young person then emails me the diary on the day of the session. This means it’s waiting when they arrive, I have a chance to review it, there’s no chance of it getting lost (or the dog eating it), and it also means that mum or dad, or their friends, won’t find it lying around and read it. Electronic copies also make it easier to upload notes to our practice software which means I can track mood over time easily. Alternatively, if the young person is really technology savvy and has an iPhone, I often use the Moody Me app with them. Although they’re often a bit sceptical about keeping a diary on their phone, the ability to upload photos is often quite appealing and they take to it with zeal. By the time they come to the next session they have loads of mood ratings and a rich source of information about their triggers. Since using these technologies, I’ve found that it’s really important to set the scene with the young person about what you are getting them to do, and why. This is really important if you want them to use the tool and to use it properly. A clear rationale and setting expectations of frequency of use is important for everyone to get the benefits. Page 6
  7. 7. Part 3. Using technology in Educational Module 6. Encouraging community engagement and connection In practice The Community Forums. The real value of the online forums is helping the young person to feel they are not alone. So many young people feel that they are the only one experiencing what they are feeling. The forums offer a safe place where young person can express how they feel which they can’t necessarily do with their friends or family. They might post “I have been feeling down lately and am thinking about seeing a counsellor”. In posting such a comment they receive validation from their peers on the legitimacy of how they are feeling and encouragement to take action and seek help. A common theme often emerging from the forums is around help seeking. Through peer support and expressing their fears, many young people go on to seek professional help. Young people will use the forums for a period of time or to address a particular concern and will often return when they feel down and are looking for further support. Community Forums Coordinator, April 2011 “to the RO community, thank you thank you thank you! you guys are always here. you let me grow in my own space. you’ve made me so much stronger. thank you for commenting on my little vents (thank you t_p, you have no idea how happy it makes me to hear that you like my writing), and for giving me a space where I feel safe and supported.” “there are so many times when I am freaking out and feeling totally down, and just coming here and chilling out, and seeing how you’ve all been going, it just makes me feel so much more connected, and just so much better.” The forums host a weekly live discussion which covers more serious topics such as cyber safety and help seeking in a solution focused way. These sessions are held every Monday for two hours and are peer facilitated but held under ReachOut staff supervision. For a full list of topics please see: In addition to the peer lead conversations, the forums host a monthly live discussion on a serious topic that is facilitated by a mental health professional. The topics of the mental health professional facilitated forums can be viewed here: forumdisplay.php?5-Infobus-and-features-guests. The forums also provide a space for discussing practical tools and activities for increasing wellbeing with a positive psychology focus. You can find these topics at: here: http:// Some recommended sites include: ReachOut .com is an Australian based website designed to support young people who are struggling to cope. The site contains information sections, stories from other young people, and online forums. The Low Down The Low Down is a New Zealand based website designed to support young people going through a difficult time. The site contains information, a quiz, shared media and a place to ask questions and get support. Something Fishy Something Fishy is pro-recovery eating disorder website. The site is dedicated to raising awareness and providing support to people with Eating Disorders as well as supporting their loved ones. The site contains psycho-education, a game and an online forum. Page 7
  8. 8. Part 3. Using technology in Educational Module 7. Enhancing wellness and relapse prevention In practice With so much information out there, and the relative ease of access, the young people are going to seek information; particularly if you don’t direct them. Clinically, there are many websites that offer lots of support and/or information for patients that can help guide them post-service discharge. When I work with eating disorder clients I often introduce them to the site in the second to last session. The site has lots of information about recovery from eating disorders, an online game, and a moderated forum that patients can get support from. I think this is so important given the pro-ana sites that are available. By educating the young people I work with about which sites are good and directing them to these, it can help to keep them focussed in the right direction. My patients tend to like it, and I frame it as “now that you are in recovery you can join this ‘recovery’ community”. We go through the site together and I follow-up their use of it in the final session. When writing their discharge plan we include accessing the site if they want to check information, and also that the YP can contact me via email if they have any further questions or need support. This contact doesn’t have to be problem related either – they can email me just to let me know that they are doing well. It keeps the doorway open for communication and access should the need arise in the future. Page 8
  9. 9. Part 3. Using technology in Educational Module 8. Using social media for health promotion Using social networking in practice - Stealth Mission uses social media as a key way to connect to young people in spaces where the young people are. In doing so, our aim is to raise awareness and reduce stigma around mental health, particularly in those who may not yet be seeking help. The Stealth Campaign was a competition run entirely through the Facebook page. Through a specially designed application on our Facebook page, young people were able to enter the competition to win a Mac Computer and digital camera. They needed to order promotional material and then upload a photo to the Facebook page that showed a creative and unusual place that they had placed a sticker, postcard or badge in their local community. Those photos were then voted on by the Facebook community. The campaign was a huge success, with 170 photos entered and 3,258 votes cast. The winning photo collected 648 individual votes. It also proved a particularly good way to engage young males, with 52% of those entering the competition being male - a significant statistic given how difficult it is to engage young males around mental health issues. In addition to the high engagement with males, 25% of people who went to the collateral form ordered the stealth kit (the average conversion rate for this kind of campaign is usually between 2 and 6% so this highlighted how successful this form of media was). The reach of the media was not just limited to those involved in the competition either. A minimum of 27,950 people saw the Stealth Campaign in their newsfeed shared by friends – with the number probably being closer to 83,850 as anecdotal evidence suggests young people’s average number of friends is three times that of site average. This highlights the extensive reach and value of social media as a tool for promoting health, access to services and engaging young people. Page 9