1. Health and Mental Health in Social Work Conference, Quebec, May 26th 2004 Online information, advice and counselling for young people; NSPCC service evaluation Julia Waldman University of Southampton University of Southampton

2. Context: In December 2001 the NSPCC launched the UK’s first online child protection support service called There4me.com, including the provision of real time online discussion with adult advisers In December 2001 the NSPCC launched the UK’s first online child protection support service called There4me.com, including the provision of real time online discussion with adult advisers Service uses qualified and trainee social work staff Service uses qualified and trainee social work staff Provides information, advice, support and counselling to 12-16 year olds anonymously via a website Provides information, advice, support and counselling to 12-16 year olds anonymously via a website Regional launches but the nature of internet searches and public access means that increasingly young people from all over UK and abroad can use the site Regional launches but the nature of internet searches and public access means that increasingly young people from all over UK and abroad can use the site

3. brief description of the service and its web- based components brief description of the service and its web- based components some of the key findings related to the emotional and mental health needs of young people and discuss their implications some of the key findings related to the emotional and mental health needs of young people and discuss their implications comment upon the known characteristics of service users and what the study says about those who use and appear not to use the service comment upon the known characteristics of service users and what the study says about those who use and appear not to use the service finally some conclusions and comments on further research questions raised by the study finally some conclusions and comments on further research questions raised by the study

4. There4me – places protection of users and content authenticity first Web elements

5. Young people and the internet in the UK Between 1998 and April 2003 the proportion of households in the UK with internet access rose from 9% to 47% (source National Statistics online 8/7/03) Between 1998 and April 2003 the proportion of households in the UK with internet access rose from 9% to 47% (source National Statistics online 8/7/03) levels of internet access still relate very strongly to income and region (source ONS, Family Expenditure Survey, 2000) levels of internet access still relate very strongly to income and region (source ONS, Family Expenditure Survey, 2000) the presence of children in the household significantly boosts the likelihood of internet access (sic) the presence of children in the household significantly boosts the likelihood of internet access (sic) 75% of users who gave feedback (n=709) said they were accessing the site from a pc at home 75% of users who gave feedback (n=709) said they were accessing the site from a pc at home This evidence has implications for accessibility to services to some vulnerable young people

6. An independent evaluation of the service was completed in spring 2004. An independent evaluation of the service was completed in spring 2004. This paper focuses upon the findings of the evaluation, paying close attention to the role of the service in supporting the emotional and mental health needs of the young people who access the service. This paper focuses upon the findings of the evaluation, paying close attention to the role of the service in supporting the emotional and mental health needs of the young people who access the service. The evaluation provides a timely opportunity to explore the ways in which new technologies offer opportunities for the development of professional practice with vulnerable young people who might not access other forms of community and statutory services. The evaluation provides a timely opportunity to explore the ways in which new technologies offer opportunities for the development of professional practice with vulnerable young people who might not access other forms of community and statutory services. Timely not only because new technologies require researchers and practitioners to respond to new questions related to e-practice, e-methods and ethics but also because on March 30th 2004 the first ever UK Inquiry into deliberate self-harm among young people was launched (Mental Health Foundation, accessed 23/3/04). Timely not only because new technologies require researchers and practitioners to respond to new questions related to e-practice, e-methods and ethics but also because on March 30th 2004 the first ever UK Inquiry into deliberate self-harm among young people was launched (Mental Health Foundation, accessed 23/3/04).

7. I think there4me has got rid of some of my stresses and strains. If anything ever goes wrong I use the forum to talk to other people my age. I think talking to a computer is a lot easier than talking to a person. I don't know why. I think it might be the feeling that a computer won't g off and skit you behind your back. I know the advisers won't but if I talk to friends they might. I could talk to an adviser but they don't know me, and are not friends with me, but I use my computer a lot, so in some ways it is my friend. When I have talked to advisers they have helped me as best they can. Sometimes, they have solved my problem, other times they haven't but have give me knowledge about where to go, or who to talk to.

8. Does the service deliver what its aims to provide? sub questions are: What patterns of use are there for the service? What is the quality and range of information available, including its presentation on the site? How does the service balance its role in relation to child protection and support with that of broader information provider? What are users perceptions of the advice, information and support received? In essence three key methods were adopted: Descriptive statistical analysis of There4me numerical monitoring data from web and system databases Content analysis of text-based material generated within the site on the Message Board and from 1-2-1 archives Online consultation with young people using There4me.com via questionnaires and an open text format proforma A big question hanging over the data collection that is irresolvable was that the evaluators had not way of knowing from whom the data came.

9. Out of 3362 letters posted to Sam over a 24-month period from December 2001 to November 2003 the most frequently occurring topics among letters replied to concerned Relationships (18%), Sex (15%) and Emotions (11%). An analysis of the letters falling into this category over the data collection period showed that 15 appeared to fit into other pre-determined categories. The remaining letters were concerned with issues such as suicidal feelings, eating issues or disorders, depression, self-harm, bereavement, concerns with appearance and worries over reputation, many of which are concerns that feature notably in other parts of the site. Out of 3362 letters posted to Sam over a 24-month period from December 2001 to November 2003 the most frequently occurring topics among letters replied to concerned Relationships (18%), Sex (15%) and Emotions (11%). An analysis of the letters falling into this category over the data collection period showed that 15 appeared to fit into other pre-determined categories. The remaining letters were concerned with issues such as suicidal feelings, eating issues or disorders, depression, self-harm, bereavement, concerns with appearance and worries over reputation, many of which are concerns that feature notably in other parts of the site. Moving on to the Message Board, the peer-to-peer module, the evidence shows that this is a dynamic, busy and popular part of the site. The number and range of messages submitted each month are broad. The most popular topics for messages, Relationships, Sex and Abuse, are similar to those in Ask Sam. Moving on to the Message Board, the peer-to-peer module, the evidence shows that this is a dynamic, busy and popular part of the site. The number and range of messages submitted each month are broad. The most popular topics for messages, Relationships, Sex and Abuse, are similar to those in Ask Sam. A more in depth look at the letters shows a trend to be somewhat concerned about; the extent to which young people who self harm and are experiencing various degrees of mental distress and stress use the site to talk about their cutting and other self harming activities with their peers. Once again because the categories are open to interpretation and not comprehensive counting the prevalence of certain subjects is hampered and a true picture may remain somewhat hidden. The content analysis of message content showed that self-harming letters had equal highest mean number of responses and often quite long. Simply reading about some of series of exchanges about self-harming activities, as a neutral observer is somewhat disturbing A more in depth look at the letters shows a trend to be somewhat concerned about; the extent to which young people who self harm and are experiencing various degrees of mental distress and stress use the site to talk about their cutting and other self harming activities with their peers. Once again because the categories are open to interpretation and not comprehensive counting the prevalence of certain subjects is hampered and a true picture may remain somewhat hidden. The content analysis of message content showed that self-harming letters had equal highest mean number of responses and often quite long. Simply reading about some of series of exchanges about self-harming activities, as a neutral observer is somewhat disturbing

10. 121 A review of subjects covered for a year period was undertaken, with which to develop a sampling framework for a content analysis. During the year reviewed, the most used, but in many ways least specific, category was Information. The next highest grouping was Relationships (both peer and family), which accounted for 20% of contacts. The next highest grouping was for Abuse (sexual, physical, emotional and neglect) at 19%, with sexual abuse being particularly high at 13%. These ratios are similar to the queries in the Message Board, however advisers can only code each conversation in one topic even though many relate to several. Bullying and emotional problems are both relatively high. The figure for self-harm as a single topic is again quite high at 7% of all contacts. These figures show that 1-2-1 is being used by the majority of young people for talking about concerns that are the core of NSPCC objectives, which is a key finding.

11. Summary of Issues The service has provided a valuable outlet for young people to access professional support in a confidential manner The Message Board provides a very positive representation of young people that confounds some of the more negative representations of young people’s use of the internet for ‘chat’ and the discourses which focus upon the dangers of the internet, rather than its positive potential. However as a barometer for young people’s concerns the picture is mixed. Normal adolescent interests in music, difficulties with relationships and parents are mixed up with a more disturbing sense of emotional and mental distress, with often manifests itself in self-abuse. A wider issue of concern is the extent to which young people present mental health issues in 121 conversations with talk about self-harming (generally or cutting online), suicidal thoughts, depression and feelings of worthlessness Often the incidence of mental health topics are ‘hidden’ within other topics that the database systems cannot detect. Only a more in-depth mining strategy brings out the prevalence of, for example self-harming and depression, amongst other topics.

12. Recent UK research has shown that girls are more likely to self-harm than boys and overall one in ten young people self-harm in the UK, with the peak age for starting being thirteen years (Health Development Agency, 2001; BBC news, 2004; MHF, 2004; Samaritans, 2003). There4me seems to have tapped into this group of young people and faces a number of challenges in managing its own responses and how these needs of young people may change the nature of the service offered. Further information NSPCC site www.there4me.com www.there4me.com Our website with study information www.sws.soton.ac.uk/t4mstudy email jw@socsci.soton.ac.uk jw@socsci.soton.ac.uk