Title: i-Minds: A digital intervention to improve mental health and interpersonal resilience for young people who have experienced online sexual abuse - a non-randomised feasibility study with a mixed-methods design
Funder: Department of Health and Social Care

Abstract: Sexual abuse involves forcing someone to take part in sexual activities, whether someone is aware or not of what is happening. Online sexual abuse (OSA) takes place on the Internet. OSA of young people (YP) has increased; it has become an important priority for health and social care services. OSA can have serious effects on YP’s development and mental health. YP can report this abuse to government agencies and social media companies, but there is little tried and tested support for helpful treatments. Previous research has shown that a therapy called Mentalisation Based Therapy for YP can be useful. This therapy involves helping YP understand their own and other people’s behaviour by making sense of thoughts, feelings and intentions. Research is needed to find out whether this therapy, delivered in a digital format, is helpful for OSA experiences. The NHS urgently needs an accessible intervention to improve the wellbeing of YP who have experienced OSA (YP-OSA) and that could protect them from future harm._x000D_ _x000D_ The aim of this project is to work with YP, parents/caregivers and relevant agencies to develop and test a digital intervention to improve the well-being of YP-OSA. We want to create an intervention that: i) YP find easy to use; ii) has a positive effect on mental health and well-being and helps them to stay safe on the Internet; and iii) could be used in the context of NHS services that already support YP (e.g. Child and Adolescent Mental Health Services, CAMHS) and services that provide online support to YP. _x000D_ _x000D_ The project will involve two phases lasting 27 months, and will be conducted in England and Scotland. From the start, we will set up two advisory panels, one consisting of YP-OSA and the other consisting of parents/caregivers and professionals. These groups will be regularly consulted throughout the project to make sure that the work we produce together is relevant and meaningful._x000D_ _x000D_ In the first phase (12 months), in partnership with our advisory panels, we will develop the digital resource by adapting material we used for face-to-face therapy with YP supported by CAMHS in our past research. We will also work with a team of digital experts to build the software we will use to deliver the intervention. We will test and refine the digital intervention with YP-OSA and stakeholders to make sure it is ready to be used. We will also interview 20 professionals to understand the best way of offering the digital intervention to YP-OSA supported by the NHS in the second phase of the research. _x000D_ _x000D_ In the second phase of the project (15 months), we will ask 60 YP-OSA to take part in a research trial. They will access and use the digital intervention we have developed. This allows us to test whether YP actually use the intervention, whether they like using it and if it is safe to use. They will also be asked to complete questionnaires about their well-being at different time points in the study to monitor whether the intervention was helpful. In addition, we will interview: i) 20 YP who took part in the trial to find out what they liked/did not like about the intervention, what improvements we can make; and ii) 30 professionals to understand how the intervention could be used in existing NHS CAMHS._x000D_ _x000D_ We will share findings with as many people as possible, including YP themselves, parents/caregivers, mental health services, police, schools and education services, industry and voluntary sector organisations, and the general public.

Lay abstract: There is no evidence-based support offered to young people who have experienced online sexual abuse (YP-OSA). NICE (2017) has recognised as a research priority the identification of effective interventions for improving the wellbeing of YP-OSA and preventing further harm. Interventions aimed at improving mentalisation (the ability to understand the mental states of oneself and others) are increasingly applied to treat young people with varied clinical issues. YP-OSA are reluctant to seek in-person support and are generally comfortable receiving support online. A digital intervention aimed at improving mentalisation in YP-OSA may reduce risk for re-victimisation and future harm and make young people more resilient and able to manage distress that might result from OSA experiences. _x000D_ _x000D_ AIMS_x000D_ There are three objectives: 1) develop a mentalisation-based digital intervention that is co-produced with YP-OSA; 2) determine the feasibility, acceptability and usability of the digital intervention; and 3) determine how to best integrate the digital intervention into routine care pathways. _x000D_ _x000D_ METHODS_x000D_ Two workstreams will be delivered over 27 months across 2 sites (Manchester/Edinburgh). In workstream 1 (Months 1-12) we will develop the content and structure of the intervention with input from YP-OSA and stakeholders. Content will be adapted from a mentalisation intervention shown to be acceptable to young people supported by Child and Adolescent Mental Health Services (CAMHS) in our previous research. We will design, develop and test the digital platform using participatory design principles and agile development framework. We will conduct interviews with 20 professional stakeholders to explore views about maximising intervention uptake. In workstream 2 (Months 13-27), we will conduct a mixed-methods non-randomised study to determine the feasibility, acceptability and usability of the intervention. We will conduct interviews with YP-OSA who use the digital platform to assess their impressions of the intervention and identify areas for improvement. Informed by NPT, we will examine barriers and enablers relevant to the future integration of the intervention into existing care pathways, including traditional clinic-based NHS services and NHS e-therapy providers._x000D_ _x000D_ PPI_x000D_ We will build on our existing partnerships with YP-OSA, parents/caregivers and relevant agencies. Regular consultations with YP-OSA and other stakeholders will ensure our work is relevant and meaningful. Project workstreams will be informed by bespoke advisory groups comprising YP-OSA, their parents/caregivers, and practitioners/professionals from a range of statutory and third sector organisations. Our PPI consultations have already indicated that a digital intervention for YP-OSA is welcomed and needed. _x000D_ _x000D_ ANTICIPATED IMPACT AND DISSEMINATION_x000D_ We will develop an evidence-based intervention that can be embedded in existing services to support YP-OSA. We will ensure digital outputs can be scaled-up to provide an accessible intervention. Our confirmed stakeholder partnerships, including law enforcement (NCA-CEOP), industry (Facebook), third sector (Marie Collins Foundation), NHS CAMHS services, and e-therapy providers (Kooth) will ensure outputs meet the intended beneficiaries. Our wide-reaching dissemination strategy, supported by our partners and track-record of world-leading research, will ensure maximum impact, longevity, and integration of outputs into existing infrastructure.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH