背景:自杀是年轻人可预防死亡的主要原因之一,年轻人交流自杀的方式已经发展到包括基于网络的披露和寻求帮助。迄今为止,心理健康干预服务,无论是在网上还是亲自,都是在传统模式下构思的,如果年轻人(或他们的家人)在痛苦时积极寻求支持,则会提供支持。另一方面,主动外联是一种创新的干预方法,已被证明在其他医疗保健领域是有效的。LiveforTomorrow聊天是在Instagram上发布的,由辅导员组成,他们伸出援手,为发布表明痛苦或自杀的内容的年轻人提供简短的以人为本的干预。
目的:我们的目的是探讨咨询师如何让年轻人参与主动数字干预,以及在这种情况下如何进行风险评估。
方法:我们使用Braun和Clarke的反身主题分析的6步方法,分析了辅导员与13-25岁年轻人之间的35份对话记录。这些笔录包括咨询干预和后续聊天,旨在收集有关咨询干预的反馈。
结果:总共出现了7个主题:使用微技能促进对话,建立信心和能力来应对变化,在接近关于自杀或自我伤害的对话时寻求许可,按照结构化方法进行关于自杀的对话,提供保密保证,对自杀经历的验证,并使用有关自杀的对话来识别干预措施。辅导员能够将关于自杀的咨询微技能和结构化提问转化为数字环境。特别是,在数字背景下,辅导员会使用年轻人的帖子和表情符号来进一步对话并建立融洽的关系。
结论:这些发现强调了辅导员倾听的重要性,同情,验证,并赋予年轻人权力,所有这些技能都可以转移到数字文本咨询干预中。辅导员使用结构化的方法来理解许可寻求中的自杀性,正在验证,以保密的方式识别对年轻人的干预。这些做法使对话超越了传统的风险评估做法,成为有关自杀的有意义的对话。超越传统的风险评估实践,进入有关自杀的对话,可以验证年轻人的经验以及对干预和支持的探索,这些干预和支持是有意义的,并且被认为对年轻人有帮助。这项研究强调了基于数字聊天的主动干预的好处,这是一种与经历心理困扰和自杀的年轻人接触的新颖方法。此外,这项研究证明了将心理健康干预和支持转移到年轻人目前正在披露痛苦和积极干预的媒介的可行性和益处。
BACKGROUND: Suicide is one of the leading causes of preventable death in young people, and the way young people are communicating suicidality has evolved to include web-based disclosures and help-seeking. To date, mental health intervention services, both on the web and in person, have been conceived in the traditional model, whereby support is provided if a young person (or their family) actively seeks out that support when distressed. On the other hand,
proactive outreach is an innovative approach to intervention that has been shown to be effective in other areas of health care. Live for Tomorrow chat was delivered on Instagram and comprised of counselors who reach out to provide brief person-centered intervention to young people who post content indicating distress or suicidality.
OBJECTIVE: Our aim was to explore how counselors engaged young people in a
proactive digital intervention and how risk assessment was conducted in this context.
METHODS: We analyzed 35 transcripts of conversations between counselors and young people aged 13-25 years using the 6-step approach of Braun and Clarke\'s reflexive thematic analysis. These transcripts included a counseling intervention and a follow-up chat that was aimed at collecting feedback about the counseling intervention.
RESULTS: A total of 7 themes emerged: using microskills to facilitate conversations, building confidence and capacity to cope with change, seeking permission when approaching conversations about suicidality or self-harm, conversations about suicidality following a structured approach, providing assurances of confidentiality, validation of the experience of suicidality, and using conversations about suicidality to identify interventions. Counselors were able to translate counseling microskills and structured questioning regarding suicidality into a digital context. In particular, in the digital context, counselors would use the young person\'s post and emojis to further conversations and build rapport.
CONCLUSIONS: The findings highlight the importance of the counselor\'s role to listen, empathize, validate, and empower young people and that all these skills can be transferred to a digital text counseling intervention. Counselors used a structured approach to understanding suicidality in a permission-seeking, validating, and confidential manner to identify interventions with the young person. These practices allowed the conversation to move beyond traditional risk assessment practices to meaningful conversations about suicidality. Moving beyond traditional risk assessment practices and into conversations about suicidality allowed for the validation of the young person\'s experience and exploration of interventions and support that made sense and were seen to be helpful to the young person. This study highlighted the benefits of a
proactive digital chat-based intervention, which is a novel approach to engaging with young people experiencing psychological distress and suicidality. Furthermore, this research demonstrates the feasibility and benefit of moving mental health intervention and support to a medium where young people are currently disclosing distress and intervening proactively.