RESUMO
BACKGROUND: The internet has become a place of increased risk of abuse, including sexual abuse, for young people (YP). One potential risk factor to online abuse and exploitation is the ability to mentalise. We developed the i-Minds app, a mentalisation-based digital health intervention (DHI) for YP who have experienced technology assisted sexual abuse (TASA), which we tested in a clinical feasibility trial. Nested within the trial was a qualitative implementation study with clinicians who referred to the trial. OBJECTIVE: To explore the barriers and enablers to the future integration of i-Minds into clinical practice. PARTICIPANTS AND SETTING: Twelve HCPs were recruited from across two trial recruitment sites (Manchester and Edinburgh). METHODS: Semi-structured interviews were informed by Normalisation Process Theory (NPT). Framework analysis was used; transcripts were coded deductively to NPT constructs. RESULTS: Practitioners were positive about the need for, and added value of, the i-Minds app over existing interventions, including other DHIs. While they felt confident with the app, concerns remained around the safety of using the app without practitioner support. i-Minds promoted changes in practitioners' work and impacted online behaviour of YP. There was an identified need for further training and organisational support. CONCLUSIONS: Practitioners are aware of TASA but have limited knowledge, skills and tools to work with TASA in clinical practice with YP. There is a need for awareness raising and education about TASA and DHI. i-Minds offers a theory-informed DHI for working with YP exposed to TASA that is acceptable to practitioners and YP.
RESUMO
BACKGROUND: There is growing evidence that Technology Assisted Sexual Abuse (TASA) represents a serious problem for large numbers of children. To date, there are very few evidence-based interventions available to young people (YP) after they have been exposed to this form of abuse, and access to support services remains a challenge. Digital tools such as smartphones have the potential to increase access to mental health support and may provide an opportunity for YP to both manage their distress and reduce the possibility of further victimization. The current study explores the acceptability of a digital health intervention (DHI; the i-Minds app) which is a theory-driven, co-produced, mentalization-based DHI designed for YP aged 12-18 who have experienced TASA. METHODS: Semi-structured interviews were conducted with 15 YP recruited through Child and Adolescent Mental Health Services, a Sexual Assault Referral Centre and an e-therapy provider who had access to the i-Minds app as part of a feasibility clinical trial. Interviews focused on the acceptability and usability of i-Minds and were coded to themes based on the Acceptability of Healthcare Interventions framework. RESULTS: All participants found the i-Minds app acceptable. Many aspects of the app were seen as enjoyable and useful in helping YP understand their abuse, manage feelings, and change behavior. The app was seen as usable and easy to navigate, but for some participants the level of text was problematic and aspects of the content was, at times, emotionally distressing at times. CONCLUSIONS: The i-Minds app is useful in the management of TASA and helping change some risk-related vulnerabilities. The app was designed, developed and evaluated with YP who had experienced TASA and this may account for the high levels of acceptability seen. TRIAL REGISTRATION: The trial was registered on the ISRCTN registry on the 12/04/2022 as i-Minds: a digital intervention for young people exposed to online sexual abuse (ISRCTN43130832).
Assuntos
Saúde Digital , Serviços de Saúde Mental , Adolescente , Criança , Humanos , Saúde Mental , SmartphoneRESUMO
BACKGROUND: Young people with refugee or asylum-seeker status (R/AS) often present with complex mental health needs, in the context of traumatic life experiences. Generic mental health services in the United Kingdom (UK) may be ill-equipped to manage the unique experiences of these young people. Culturally adapted interventions (CAI) could provide a culturally sensitive approach to mental health support for refugee children experiencing difficult symptoms. A systematic review was conducted to determine the different types of cultural adaptation in the included studies, and to determine the efficacy of CAIs in comparison to generic treatment. METHODS: Systematic searches of eleven databases were completed in December 2020. Any psychosocial interventions conducted in the United Kingdom aimed at providing mental health support for refugee young people and families were included. This was to ensure the potential inclusion of all studies regardless of their adherence to the traditional framework of assessment and intervention in high-income countries, for example randomised control trials. RESULTS: Eleven studies of varying methodology, participant group, intervention type and outcome measures were included in this review. Studies used a variety of cultural adaptations including surface-level and deep-level adaptations. Studies showed some support for the use of CAIs with young people with R/AS, with varying degrees of symptom reduction. It was not possible to compare the effectiveness of CAIs against 'treatment-as-usual', nor to determine the effectiveness of different CAI components. CONCLUSIONS: Whilst there is evidence for the use of CAIs with R/AS young people, the heterogeneity between studies limits the generalisability of these results. The available research is not sufficient to provide conclusive evidence of the use of CAIs over 'treatment-as-usual'. Research and clinical implications are highlighted. Future research could examine the most effective components of CAIs and aim to increase the evidence base of interventions for young people and families with R/AS.
