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It has often been reported that young people are at high risk of mental health concerns, more so than at any other time in development over their life span. The situational factors that young people report as impacting their well-being are not addressed as often: specifically, family discord. Kids Helpline, a national service in Australia that provides free counseling online and by telephone to young people in distress, report that family discord and well-being issues are one of the major concerns reported by clients. In order to meet the preferences that young people seek when accessing counseling support, Kids Helpline has designed and trialed a custom-built social network platform for group counseling of young people experiencing family discord that impacts their well-being.
In this exploratory study, we communicate the findings of Phase 1 of an innovative study in user and online counselor experience. This will lead to an iterative design for a world-first, purpose-built social network that will do the following: (1) increase reach and quality of service by utilizing a digital tool of preference for youth to receive peer-to-peer and counselor-to-peer support in a safe online environment and (2) provide the evidence base to document the best practice for online group counseling in a social network environment.
The study utilized a participatory action research design. Young people aged 13-25 years (N=105) with mild-to-moderate depression or anxiety (not high risk) who contacted Kids Helpline were asked if they would like to trial the social networking site (SNS) for peer-to-peer and counselor-to-peer group support. Subjects were grouped into age cohorts of no more than one year above or below their reported age and assigned to groups of no more than 36 participants, in order to create a community of familiarity around age and problems experienced. Each group entered into an 8-week group counseling support program guided by counselors making regular posts and providing topic-specific content for psychoeducation and discussion. Counselors provided a weekly log of events to researchers; at 2-week intervals, subjects provided qualitative and quantitative feedback through open-ended questions and specific psychometric measures.
Qualitative results provided evidence of user support and benefits of the online group counseling environment. Counselors also reported benefits of the modality of therapy delivery. Psychometric scales did not report significance in changes of mood or affect. Counselors and users suggested improvements to the platform to increase user engagement.
Phase 1 provided proof of concept for this mode of online counseling delivery. Users and counselors saw value in the model and innovation of the service. Phase 2 will address platform issues with changes to a new social network platform. Phase 2 will focus more broadly on mental health concerns raised by users and permit inclusion of a clinical population of young people experiencing depression and anxiety.
Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12616000518460; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370381
The demand for Australian online counseling services by young people experiencing family discord and the impact on emotional well-being are substantial and unabating; 8.18% (12,052) and 9.04% (13,322) of the 147,424 contacts recorded by
It is established that the most popular online resource young people are attracted to is social networking [
Kids Helpline is the leading national service in telephone and online counseling in Australia, given that it is the only 24/7 counselor-monitored service (ie, not a peer-to-peer counseling service). Consumers who receive help via the service often wish to revisit in order to receive ongoing counseling support, not just one-time counseling or further referral to other services. Garcia [
This participatory action research (PAR)-designed exploratory study [
A total of 105 participants were recruited from the Kids Helpline telephone and Web-chat counseling service, as well as from their website and social media posts. The participants initially contacted the service to seek help for their concerns and upon counselor interview and assistance for their immediate concerns, they were introduced to the option to join KHL Circles as volunteer participants. The inclusion criteria were as follows: (1) aged 13-25 years and of any gender identity, (2) newly contacting or previously engaged (ie, returning client) with Kids Helpline via one-on-one phone and/or Web counseling, (3) seeking support specifically for issues related to family discord and emotional well-being (eg, at-home psychological abuse, distress, or communication problems with family members), and (4) able to speak English (ie, required under ethical approval for the study, as no translator for other languages could be provided within the counselor-mediated social network). The mean age of participants was 16.2 years (SD 2.9) and the majority were female (86/105, 81.9%). The age, gender, and location breakdowns of participants are presented in
Participant demographics and response count.
Demographic | Participants (N=105), n (%) | |
|
|
|
|
13-15 | 50 (47.6) |
|
16-18 | 36 (34.3) |
|
19-21 | 10 (9.5) |
|
22-24 | 8 (7.6) |
|
25 | 1 (1.0) |
|
|
|
|
Female | 86 (81.9) |
|
Male | 10 (9.5) |
|
Trans or gender diverse | 6 (5.7) |
|
Other | 1 (1.0) |
|
Missing | 2 (1.9) |
|
|
|
|
New South Wales | 32 (30.5) |
|
Victoria | 22 (21.0) |
|
Queensland | 22 (21.0) |
|
South Australia | 4 (3.8) |
|
Tasmania | 1 (1.0) |
|
Western Australia | 1 (1.0) |
|
Australian Capital Territory | 3 (2.9) |
|
Missing | 15 (14.3) |
This exploratory study used a single-group, PAR, mixed-method design [
Volunteer participants who contacted a Kids Helpline phone or Web counselor received immediate one-to-one counseling (ie, standard care model for the service). While in one-to-one counseling, they were asked if they would be interested in joining the study trialing the peer-support social network, KHL Circles. Those who indicated they wanted to join the trial were informed that they may not be able to join one of the Circles in the social network immediately and, if this was the case, they would be asked to wait for the next group to begin. Potential volunteer participants were screened for severe mental health problems (ie, high-level depression and anxiety) or risk of self-harm behaviors before being permitted into the online group-counseling environment. Screening was conducted through counselor interview. Those who were deemed high risk were provided with one-to-one counseling via Kids Helpline’s regular telephone or Web counseling services. Once suitable participants were assigned to a KHL Circle, they completed an entrance survey containing psychometric tests to measure baseline depression, anxiety, self-esteem, and perceived social support.
All volunteer participant members of KHL Circles were asked to use pseudonyms in order to protect their identities from each other. The counselor facilitating the group was the only group member aware of their true identities. Participants were instructed not to reveal any identifying information during the trial, including any identifying photos or images. Those recruited were asked to give electronic consent if they were 16 years of age or older, or consent and optional assent from a parent or guardian if 15 years of age or under. Participants were also asked to read the Kids Helpline policy and agree that during their time in KHL Circles, if they choose to start their own social network support group on a non-Kids Helpline service (eg, Facebook), that Kids Helpline would not be liable for the safety and running of those groups.
Participants completed a baseline survey in the week prior to joining their Circle containing psychometric tests measuring levels of depression, anxiety, self-esteem, and perceived peer support. Participants were also asked to complete a
The research protocol was approved by The University of Sydney Human Research Ethics Committee (HREC) (Project #2016/132) and registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12616000518460).
KHL Circles was developed by a team of researchers, psychologists, and programmers following consultation and beta testing with young Kids Helpline clients and using PAR design principles [
As part of the baseline survey, participants put forward their pseudonym, which was reviewed by the site administrator to ensure that it did not reveal their identity. In the days leading up to week 1, the site administrator assigned participants to their Circles and emailed them unique log-in details. Participants were asked to log in to the site prior to the week 1 commencement date to complete their profiles (ie, gender, hobbies, and likes) and to choose a profile picture from a suite of
The main menu bar of the site presented six tools:
Topics: the default view, which showed a list of the all discussion posts and threads posted to date, with the most recent at the top of the page.
Recent activities: allowed participants to quickly access topics they had contributed to.
Your profile: participants could update their profile information here.
Messages: participants could send and receive a private message to or from a Kids Helpline counselor but not to or from other participants.
Contact KHL: a link to the Kids Helpline phone and Web-chat counseling service.
Sign out.
For each Circle, Kids Helpline Counselors posted three new
Kids Helpline Circles (KHL Circles) mobile phone interface design.
The safety protocol of KHL Circles is based upon the existing safety protocols of the Kids Helpline phone and Web counseling service, which includes policies for mandatory reporting. Monitoring of KHL Circles by Kids Helpline counselors was done 24/7 and was combined with having access to contact details via particpants’ Kids Helpline files; this allowed any potential risks to the safety or mental health of participants to be addressed proactively by contacting the participant directly via email or via the private messaging function of KHL Circles, encouraging them to contact the Kids Helpline phone counseling service.
KHL Circles was hosted on Kids Helpline’s private server, using a URL secured with HTTP over Secure Socket Layer (SSL); HTTP Secure (HTTPS) conformed to industry best practice as defined by the Open Web Application Security Project [
The following psychometric tests were included as part of each survey (ie, the baseline survey;
The baseline survey asked participants what they hoped to gain from KHL Circles (open response). Each check-in survey and the final survey asked participants whether they felt that KHL Circles had helped them feel supported in coping with their problems (yes/no) and, if so, what made them want to return to communicate with their Circle (open response). The final survey also asked participants to indicate how helpful they found KHL Circles (4-point scale), if they would return to KHL Circles for any future issues (yes/no), and what sorts of issues they would be comfortable discussing in KHL Circles (from a list of nine options or specify
Safety was assessed using the following a priori indicators: (1) any instances of adverse events, (2) any instances of breaching guidelines of use, and (3) qualitative feedback from participants.
As recorded in the baseline survey, most participants were female (86/105, 81.9%) and aged between 13 and 15 years (43/105, 41.0%). A total of 105 participants responded to the baseline survey; however, over the course of the study, the number of participants who completed the
Participant demographics and response count.
Questionnaire | Participants (N=105), n (%) |
Baseline survey | 105 (100) |
Week 2 survey | 48 (45.7) |
Week 4 survey | 12 (11.4) |
Week 6 survey | 13 (12.4) |
Final survey (week 8) | 8 (7.6) |
A simple content analysis of responses to the qualitative questions was conducted. Each response was read and assigned an open code that summarized the key idea in their initial response [
As part of the baseline survey, participants were asked, “What do you hope to gain from joining Kids Help Line Circles?” Content analysis of the 105 participant responses to this question produced six categories: (1)
As part of the
The final survey also asked participants, “Do you feel that being a member of the KHL Social Network 'Circles' has helped you feel supported in coping with your problems?” to which there were 5 responses, 3 (60%) of which were
As part of the final survey, participants were asked questions about their experiences using KHL Circles. Of the 8 participants who responded to the final survey, 5 (63%) provided responses to the user experience questions. The topics participants felt most comfortable discussing were peer relationships (3/5, 60%), family relationships (3/5, 60%), depression (3,/5 60%), and anxiety (3/5, 60%). Other responses included well-being, motivation, sexuality, romantic relationships, gender and identity, and image. When asked, “What did you find the most helpful aspect of KHL Circles?” responses included “connecting with people who understood my concerns” and “learning a lot about the topic discussed.” The only unhelpful aspect identified was “focusing on just the topic” (ie, family discord). When asked about what they thought the most important features of a social media peer-support service were, the most common response was
In addition to the questionnaires completed by participants, the counselor facilitators submitted weekly summaries to report on participant activity and user experiences. In each Circle, activity was highest in week 1, with 207 posts or comments and 532
The most frequent comments made about the experience using the platform were about the navigation challenges. These included clunky scrolling mechanics, inability to resize images, manual linking of images and videos, and inability to archive posts for better flow. Frequent mention was also made about the need to include an automated time stamp to orient users about when posts were made.
Simple technical issues raised by participants involved issues uploading images and videos and the changing of passwords, which were guided or corrected by the counselors directly. Issues that needed immediate attention included counselors not being able to see groups due to log-in or log-out errors and an inability to directly message participants via Elgg, unless participants had directly messaged them first. One participant also suggested to counselors that mobile app notifications were needed, which was a function that was unfortunately not available within the Elgg platform.
An intention of this exploratory study was to conduct repeated-measures quantitative analyses of the psychometric tests administered to participants; however, due to the drop-off in response rates between the baseline survey (105/105, 100%) and final survey (8/105, 7.6%), data quality was too low to conduct meaningful analysis.
This exploratory, mixed-methods, PAR study aimed to assess the user experience and potential benefits of a purpose-built social networking platform, KHL Circles, for online group counseling of young people experiencing family discord. Results showed that the main benefit participants hoped to gain from KHL Circles prior to joining was engaging with others with similar lived experiences. This was the most common theme identified in relation to engaging with others for support. Other themes identified included gaining new information and positive self-outcomes. While low response numbers precluded any significant findings from the psychometric measures used in the study, the majority of participants reported that the overall experience of being a member of KHL Circles helped them in being supported in coping with their problems with family discord. Of those who reported that the service did not help them, it was found that comorbid problems not specific to family discord may have been a factor (eg, school bullying, romantic relationship problems, and specific mental health concerns). While the response rate to the final survey was very low, the majority of those who did remain engaged through the full 8 weeks reported they would continue to use the purpose-built social network if it was made available, which qualitative responses indicated was largely due to obtaining a sense of community about a specific issue they all shared.
As reported by the counselor facilitators of KHL Circles, the least helpful aspect of KHL Circles was reported to be the Elgg platform itself, given that it was not easy to navigate or find threaded responses for counselor engagement with each group. Many users reported that the platform would have been more engaging if it was like existing, popular social networks that they were familiar with (eg, Facebook) and provided a better quality of standard tools (eg, emojis, games, and better mobile phone operability).
While providing proof of concept for the KHL Circle model, results from this study are limited by low retention rates across the 8-week cycle of each group. User experience feedback should, therefore, be interpreted with caution as it only reflects the experiences of participants who completed the entire 8-week cycle. Completion rates of all psychometric surveys were poor beyond initial baseline collection (see
The recruitment for this study was restricted to those with mild-to-moderate levels of depression, anxiety, or stress, in order to abide by the strict ethics protocol provided for this exploratory research. As such, through careful ethical consideration of online safety of minors, this study may have inadvertently denied access to those who are in significant need of such an innovation to aid their distress around family discord and provide relatable online community support and expert counselor facilitation. Phase 2 will seek the inclusion of all young people who wish to access the KHL Circles service, given that Kids Helpline’s services already attract a high level of distressed young people that would not fit the category of mild-to-moderate levels of depression and anxiety.
Of importance to note was the very high rate of female participants in this study. While not unusual to see more females than males engage in seeking help [
From a technical perspective, the Elgg platform was reported by users and counselors to be too rigid to use in comparison to popular platforms such as Facebook. Given this, at the conclusion of the Phase 1 study, the researchers sourced a new platform called HumHub [
Social network uptake and sustained use by young people, not only for leisure but for community support or nonexpert counseling and advice-seeking, has been documented over many years [
As determined by Ridout and Campbell’s [
Australian New Zealand Clinical Trials Registry
Future Generation Investment Fund
Human Research Ethics Committee
HTTP Secure
Kids Helpline Circles
participatory action research
social networking site
Secure Socket Layer
This research and development initiative was funded generously by a philanthropic contribution from the Future Generation Investment Fund (FGX) scheme; funding allowed for the development of KHL Circles and its initial evaluation phase [
None declared.