Interview with Southern Adelaide Child and Adolescent
Mental Health Service (CAMHS) Research Manager Gareth Furber, and
Youthlink Coordinator Ann Crago.
"Technology doesn't have to be hugely complex! If you can be on
the same page as your client, you are more likely to get
engagement" says Youthlink Coordinator, Ann Crago.
Gareth Furber, Ann Crago and colleagues recently conducted
research into "How Adolescents Use SMS (Short Message Service) to
Micro-Coordinate Contact With Youth Mental Health Outreach
Services". Published in the Journal of Adolescent Health, the
research paper formally demonstrates an "audit [of] the content of
SMS exchanges between therapists and clients and investigate[s] the
extent of inappropriate SMS use" (Furber et. al 2010).
Since its formation in 2000, the Youthlink team has recognised
the difficulty of maintaining contact with young people.
Interviewed for ReachOut Pro, Crago commented that referrals coming
through to their service only included home telephone numbers and
this limited the likelihood that young people would either answer
or return calls. It was clear to the team that the use of
mobile phones (both SMS and calls) increased the chance of more
consistent contact being made.
It is the use of SMS in coordinating and negotiating
appointments (phone, face to face, home visits etc) that has been
of most benefit to the Youthlink team. The real time contact made
through SMS gives clients and therapists a chance to build on their
relationship outside more formal appointments. Crago said that by
giving out their mobile phone numbers and being open to using SMS,
therapists on her team were able to organise appointments directly
with the young person, instead of through an administration
officer. This empowers the young person as it gives them a sense of
ownership over the negotiation of the consultation and appointment
time.
Crago said that another way she and her team have used SMS has
been to send the young person a message before calling them, in
order to give them time to digest the fact that a therapist will be
calling them, and hence prepare for that call. She says this helps
to 'break the ice' for the young person, and also gives them a
chance to reply to this initial contact if they need to.
Thus, it became clear to the Youthlink team that the use of
mobile phones, particularly SMS, was not only a beneficial practice
for making and maintaining contact with their young clients, but a
safe and efficient way to coordinate appointments.
So, is SMS safe and appropriate? Furber said that the primary
concern and objective of the research program was that of safety;
to assess the occurrence of 'red alert' messages. By auditing all
messages sent to and from the Youthlink team in a specific 7 month
period, the service was then able to analyse the de-identified
content and form a list of the purposes for which SMS was used.
Furber et. al (2010) state that "of the 80 conversations, only 5
contained messages that were classified as inappropriate… 6
messages in total, namely 2% of those received from clients".
These results directly challenge the common concerns that by
providing young people with their mobile phone numbers, therapists
would be subject to inappropriate content and levels of SMS
contact.
The secondary objective of the program was to classify what the
messages to and from the Youthlink therapists actually contained..
The majority (60.68%) of messages received from clients were
classified as being appointment related (eg. time, place,
logistics), thus formally confirming that the real time interaction
of SMS, being largely focused around appointment
organisation. The study also revealed that the use of SMS
between client and therapist provided reassurance for the
young person, making contact on their terms' thus allowing for a
relationship of mutual trust and respect to develop between the
therapist and young person.
Countering the advantages of SMS, Furber and Crago outlined the
few difficulties that the team encountered; added pressure on the
therapists as the messages are not fielded by administration, not
being able to respond straight away to messages involving
inappropriate content (eg. self harm), and young people
occasionally taking advantage of the flexibility SMS provides in
making direct contact with their therapists. It is also important
to be aware that not all young people consider themselves to be
'tech savvy' and may not benefit as much as others from SMS use.
However, Crago says that she and her team are continually making
changes to the way things are done, adding technologies and
practices along the way, to provide more safe and appropriate
therapy options.
Furber and Crago both agree that this research study confirms
that SMS is a valuable asset to supporting face to face therapy
with young people; "if we can be where they are, we are far more
likely to engage them".