Alienated and unsafe: Experiences of the first national UK COVID-19 lockdown for vulnerable young people (aged 11-24 years) as revealed in Web-based therapeutic sessions with mental health professionals.

Background: The COVID-19 pandemic and subsequent lockdowns have disproportionately affected young people, and those who are vulnerable are disadvantaged further. Here, we seek to understand the experiences of vulnerable young people accessing Web-based therapeutic support during the pandemic and early lockdown, as revealed through the observations of mental health professionals. Methods: Four focus groups with 12 professionals from a digital mental health service were conducted to understand the experiences of vulnerable young people during the pandemic lockdown. Workshops with young people with diverse experiences resulted in the co-design of the focus group topic guide and the interpretation and validation of analysis. The experiential inductive-deductive framework of thematic analysis was used to analyse the workshop transcripts. Results: Four main themes and subsequent subthemes were identified: escalation of risk; the experience and consequence of loss; feeling supported and empowered; and feeling separate and isolated. Conclusions: Findings reflect early data that suggest that those with existing vulnerability face an increased risk of poor outcomes through the pandemic and the restrictions of lockdown, but evidence is also provided of positive outcomes from lockdown and its function as a catalyst for change. Results reinforce the need for focused support for vulnerable young people as we emerge from lockdown, and point to supportive and protective factors of relevance to online and offline support provision.

Assessing the need of young people using online counselling services: how useful are standardised measures?

BACKGROUND: Clinical assessments for children and young people entering a mental health service help to identify the prevalence of need within that population, support intervention recommendations, and enable service evaluation. Evidence related to the use of standardised measures in an ever-expanding online environment, for the purpose of identifying need, is limited. METHODS: This study explores the reliability of using a standardised measure to detect clinical need in an online therapeutic environment, and the measures assessed are as follows: Strengths and Difficulties Questionnaire (SDQ), Young Person's CORE (YP-CORE) and the Short Warwick and Edinburgh Wellbeing Scale (SWEMWBS). A deep-dive approach is used to inform practitioner assessment of young people, followed by a Weighted Cohen's Kappa (Κw) to measure the interrater reliability between this and the individuals' self-rated outcome. Composite case studies represent the complexities of presentation among the sample population. RESULTS: The interrater reliability between self-rated and practitioner rated assessment varied between Κw = .222 and Κw = 0.446 depending on the measure. High levels of need and low levels of well-being were found among the sample (YP-CORE Avg. = 26.9, SDQ Avg. = 19.56, SWEMWBS Avg. = 18.1). CONCLUSIONS: The findings demonstrate a fair to moderate reliability when assessing concordance between service users and practitioners, which suggests standardised measures are a reliable indicator of need. Higher levels of need were present than those seen previously in general or face-to-face clinical populations, which suggests using such measures in an online therapeutic environment influences the way in which assessments are responded to.