1. The Acceptability of Internet-based Interventions for Children, Youth and Young Adults: A Review A. Struthers, S. Winters, Evaluation Platform

2. Objectives Rationale for the review Methods Findings Discussion and conclusion

3. Rationale

4. Barriers to treatment 10 - 20% of youth have a mental illness, but only 20% receive services. Barriers: Stigma, embarrassment, poor mental health literacy, geography and a preference for self-reliance. E-mental health may help to overcome some of these barriers. (Canadian Mental Health Association 2013; Gulliver,A. 2010; Christensen,H. 2011; Griffiths,K.M. 2007; Christensen,H. 2010).

5. Research Question How acceptable are e-mental health services for children, youth and young adults to providers and clients (including parents)? Part of a CIHR- funded study entitled “The availability, effectiveness, cost-effectiveness, acceptability and equity of e-mental health services for children and youth”.

6. What is acceptability? “The extent to which consumers of a treatment … view the treatment as reasonable, justified, fair, and palatable” We explored five dimensions: 1.satisfaction; 2.client expectations; 3.uptake; 4.adherence; and 5.client/provider experiences (Kazdin,A.E. 2000)

7. Methods Searched published and grey literature Abstracts screened by the research team Quality of relevant papers was assessed using: – The Quality Assessment Tool for Quantitative Studies – The Critical Appraisal Skills Programme Tool for Qualitative Research. Findings were synthesized within the framework of the five dimensions of acceptability (5468 Thomas,B.H. 2004; 5469 CASP)

8. Results

9. Study Selection

10. Studies included for Acceptability: 24 – eating disorders (8) – depression (7) – anxiety (5) – obsessive compulsive disorder (1). – General (3)

11. Expectations, satisfaction, uptake, and adherence Client expectations: in general, participants had positive expectations of treatment (3 studies) Satisfaction: moderate to high (7 studies) Uptake: participants who agreed to participate and started the intervention ranged from 62.6 - 100% (7 studies) Adherence: participants completing intervention ranged from 29.4% to 87.5% (8 studies)

12. Client and provider experiences 6 studies in total Therapeutic relationship: participants were able to be open and share emotions and experiences; providers thought therapeutic relationships could be developed online(3 studies) Clients appreciated human support elements, anonymity, privacy, accessibility and convenience, but worried about access from public place (3 studies) A small number of participants felt services were too impersonal (2 studies)

13. Perceived benefits of e-mental health Improved body image and eating patterns; Improved general functioning and wellbeing; Development of coping skills; Development of self-understanding and self- responsibility; Increased knowledge; Increased confidence.

14. Discussion Limitations: selection bias in satisfaction ratings, low quality qualitative studies, many intervention types Efficacy: Findings from systematic review Future study: Factors that affect adherence, high quality qualitative studies to explore client experience, innovative study designs to account for drop-out, integration into existing systems

15. Conclusion E-mental health appears to be an acceptable intervention option in child, adolescent and young adult mental health

16. Questions?

17. Acknowledgements Funding: Canadian Institutes of Health Research (Grant No. KA1-119794) Co-authors: C. Charette, S. Bayyavarapu Bapuji, X. Ye, M. Raynard, C. Metge, S. Kreindler, J. Lemaire, M. Synyshyn, K. Sutherland