A cluster randomised controlled trial of a web-based youth mental health service in Australian schools

Abstract

Background: Secondary schools have attempted to address gaps in help-seeking for mental health problems with little success. This trial evaluated the effectiveness of a universal web-based service (Smooth Sailing) for improving help-seeking intentions for mental health problems and other related outcomes among students. Methods: A cluster randomised controlled trial was conducted to evaluate the 12-week outcomes of the Smooth Sailing service among 1841 students from 22 secondary schools in New South Wales, Australia. Assignment was conducted at the school level. The control condition received school-as-usual. The primary outcome was help-seeking intentions for general mental health problems at 12-weeks postbaseline. Secondary outcomes included help-seeking behaviour, anxiety and depressive symptoms, psychological distress, psychological barriers to help-seeking, and mental health literacy. Data were analysed using mixed linear models. This trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12618001539224).Findings: At 12-weeks post-baseline, there was a marginal statistical difference in the relative means of help-seeking intentions (effect size = 0 • 10, 95%CI: -0 • 02-0 • 21) that favoured the intervention condition. Help-seeking from adults declined in both conditions. There was a greater reduction in the number of students who "needed support for their mental health but were not seeking help" in the intervention condition (OR: 2 • 08, 95%CI: 1 • 72-2.27, P < • 0 0 01). No other universal effects were found. Participants found the service easy to use and understand; However, low motivation, time, forgetfulness, and lack of perceived need were barriers to use.Interpretation: Smooth Sailing led to small improvements in help-seeking intentions. Refinements are needed to improve its effectiveness on other mental health outcomes and to increase student uptake and engagement.

Exploring the Potential of a School-Based Online Health and Wellbeing Screening Tool: Young People’s Perspectives

“…Our findings highlight the importance of having a broad range of approaches for the identification of need, to ensure there are options which young people feel confident and comfortable using. Our study adds to the evidence of school-based screening surveys having a high level of acceptability and being perceived as a useful approach for exploring health and wellbeing issues with young people [ 39 , 51 , 52 ]. It highlights the potential of school-based universal health and wellbeing screening with linked follow-up intervention as supporting identification and providing support for young people with unmet health needs [ 20 , 21 , 23 , 31 , 33 , 37 , 38 , 39 , 45 ].…”

“…Our study adds to the evidence of school-based screening surveys having a high level of acceptability and being perceived as a useful approach for exploring health and wellbeing issues with young people [ 39 , 51 , 52 ]. It highlights the potential of school-based universal health and wellbeing screening with linked follow-up intervention as supporting identification and providing support for young people with unmet health needs [ 20 , 21 , 23 , 31 , 33 , 37 , 38 , 39 , 45 ]. Screening models such as the DHC may afford a way of responding to recent calls in the UK to improve mental health support and treatment in schools [ 53 ], and investment to boost mental health support for children and young people to reduce current treatment gaps [ 54 ].…”

“…There is growing evidence that universal school-based health screening offers the potential to help identify and provide support for young people with unmet health needs [ 21 , 31 , 34 , 37 , 38 , 39 ]. There is also growing evidence of the positive perspectives of school-based screening for health needs from parents and professionals [ 33 , 40 , 41 , 42 ], but less exploration of young people’s perspectives of their acceptability.…”

Human-Computer Interaction in Digital Mental Health

“…A platform that integrates standalone e-mental health services with a global network of face-to-face youth mental health services (MOST+) was noted as being reliable, acceptable, and scalable at the pilot evaluation stage [52]. An RCT with Australian secondary schools established a small but positive effect on help-seeking intentions for mental health from a web-based mental health service that integrates screening, with stepped intervention and CBT [53]. Future trials were recommended to determine a threshold for a clinically meaningful significance.…”

“…There are a range of ethical risks related to the security of sensitive data, socio-cultural adaptability, and fitting education and training of medical professionals [81,149,150]. In addition, there should be consideration of quality therapeutic aspects (e.g., the need for empathetic and inclusive care) which makes the digital therapeutic relationship important to delivering effective, efficient, and patient-centered care [151] in a blended [84] hybrid [152,153] or stepped model of care [36,50,53].…”