Of Today - A Year In Review 2018/2019 - XenZone

Page created by Jared Clarke
 
CONTINUE READING
Of Today - A Year In Review 2018/2019 - XenZone
of Today

A Year In Review 2018/2019
Of Today - A Year In Review 2018/2019 - XenZone
02   KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                    03

                                                   Contents
                                                   Introduction from the CEO           04
                                                   2018 Headline Stats                 06
                                                   Early Intervention and Prevention   10
                                                   Choice                              18
                                                   Outcome Informed, User Led          22
                                                   Autonomy                            28
                                                   Flexibility                         32
                                                   Kooth Face-to-face                  34
                                                   Growth                              36
                                                   Get in Touch                        41
                                                   References                          42
Of Today - A Year In Review 2018/2019 - XenZone
04                                                          KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                                                             05

     Introduction
     from the CEO
                    There is no doubt that the world has moved                                Building a strong evidence-base is vital and    A common question we face is how
                    on since Kooth launched in 2004. Back then                                we are working with many thought leaders        we marry our safety message with the
                    we were at the bleeding edge of innovation,                               in their fields to contribute to this at the    anonymity we offer young people on Kooth.
                    if not a lone voice, then one among just a                                widest scale. You will find more detail on      Often is it the power of anonymity that
                    few shouting the benefits of using digital                                our activities and vision within this report.   allows someone to share their thoughts
                    technology to reach those unlikely or unable                                                                              and experiences. Through this report
                    to access traditional mental health services.                             From experience of delivering public            you will see how our team build trusted
                                                                                              services to young, often vulnerable people,     relationships to help the young person to
                    Today, because of the ground laid by                                      we know that there cannot be a trade-off        a better place; through this process many
                    disruptive thinkers and the brave decisions                               between safety and the drive to do new          will share their identity, but even where
                    made by those seeking to transform                                        things in new ways. Our commitment to           they choose not to, safety is always at the
                    dysfunctional systems from within, digital                                safeguarding is evident in everything we do.    forefront of what we do.
                    mental health services are commonplace.
                    This is apparent by the attention given                                   Our experienced clinical team carefully         I hope you will find the insight in this
                    to digital in the NHS Long Term Plan.                                     monitor issues both at an individual and        report of value. XenZone is a special
                    Which is all good news.                                                   aggregated level. They oversee support          organisation, made up of wonderfully
                                                                                              given, ensuring those at risk receive offers    committed and visionary people with
                    The potential of digital to give more people                              of regular, additional help. They know          shared values and a core purpose of
                    access to great mental health services is                                 when and how to bring in specialist support     helping everyone find their way to
                    why XenZone was established. We have                                      if needed and work in partnership with          better mental health.
                    been at the forefront of this revolution,                                 services in the ‘real world’, always ensuring
                    breaking new ground in the early days and                                 that those accessing our services are at
                    now delivering services at scale to almost                                the heart of all decision-making. Online        Zoë Blake
                    100,000 people last year. From experience                                 mental health workers are professional,         CEO
                    and not out of any disillusionment around                                 experienced and appropriately accredited
                    the potential, we offer a word of caution.                                and receive ongoing training and
                                                                                              supervision. This isn’t to say we don’t see
                    Digital has become common vernacular                                      the value in bringing non-professionals
                    for mental health and healthcare in general,                              into our support infrastructure.
                    with many great examples of innovation                                    Our Ambassador and Peer Supporter
                    delivering new models of care, providing                                  programmes are excellent, and will grow
                    advice, support and treatment. But as a                                   both in scale and impact. There is no
                    category it is all-encompassing, without                                  substitute for those offering support from
                    distinction on the breadth of offer, the                                  lived experience. They too receive clinical
                    clinical model of care or the scale of impact.                            supervision to keep them and those they
                                                                                              support safe.
Of Today - A Year In Review 2018/2019 - XenZone
06                                                                 KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                                             07

2018 Headline Stats

LOGINS                                         98,744       38,580                                                                                     ARTICLES &
                                                            Total counselling                                                                 DISCUSSION FORUMS
                                            Unique young      chat sessions
                                            people logins

                                                                                                                                                             257,764
                                                                                                                                                             Total article views
                                                                                                                         18,815
     638,344                                                                                                         Unique YP
                                                                                                                                         223,417
                                                                                                                     using chat          Total forum views
             Total logins                                                                                       This is live messaging
                                                                                                                    with a counsellor

                         CHAT &
                      MESSAGING

335,698
Total asynchronous
messages sent
                                                                                                                         53,231
Asynchronous messaging involves sending                                                                    Unique YP using
or receiving a message through an ‘inbox’                                                                    asynchronous
style messaging system                                                                                          messaging

                                                                                                                                                             36,654
                                                                                                                                                             Unique YP
                                                                                                                                                             viewing articles
Of Today - A Year In Review 2018/2019 - XenZone
08                                                  KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                         09

GOALS                     Top 5 goal types                                Top 5 presenting issues                                 OTHER

                          1   Getting professional help                   1   Anxiety/stress

         12,313           2 Self help/self care                           2 Self-worth
                                                                                                          72%
        Total number of                                                                                         Out of hours login
         goals moved      3 Emotional exploration                         3 Family relationships
                                                                                                                Counselling is available to
                                                                                                                10pm daily, 365 days a year

                          4 Feeling happier                               4 Friendships

                          5 Emotional regulation                          5 Depression

                                                                                                          95%   Would recommend
                                                                                                                the service to a friend
                                                                                                                (*Of 16,687 responses to
                                                                                                                End of Session Questionnaire)

                                                                                                          19%   Avg. of new
                                                                                                                registrations
                                                                                                                identify as BAME
Of Today - A Year In Review 2018/2019 - XenZone
10                                                                                               KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019   11

     Early Intervention
     and Prevention
          K    ooth is predicated on providing
               easy access to professional help.
          In eliminating all the barriers in the way
                                                         For those choosing a booked or drop-in
                                                         counselling session, we have a large team
                                                         of experienced therapists and emotional
          of support, we enable earlier preventative     wellbeing practitioners on hand. Children
          intervention for children and young people.    and young people present with a huge
                                                         variety of issues and are supported
          Anonymity is an important component            according to need; counsellors are flexible
          of this accessibility. It gives children and   and use therapeutic approaches best
          young people a sense of autonomy and           suited to an individual, often trying and
          control over their support: they can get       combining different approaches to find
          help on their own terms.                       the right path.

          This help can be found in a number             Each practitioner is aware of the critical
          of ways. Some young people choose to           importance of safeguarding. This is
          engage in a one-to-one session with            supported at XenZone through rigorous
          a counsellor, some read and contribute         and ongoing training and via a clinical
          therapeutic content, some use online tools     team who have oversight of vulnerable
          like our mood tracker or online journal        Kooth clients.
          and some take part in moderated
          peer-to-peer forums.
Of Today - A Year In Review 2018/2019 - XenZone
12                                                                                                   KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                                                       13

     Safeguarding is our Priority

                There can be no greater priority than          In 2018 there were 146 safeguarding calls                               Unique Young People Presenting    Our counsellors are prepared for any
                safeguarding children and young people.        made to the out of hours ‘on-call’ manager;                             with these Issues in 2018         number of presenting issues when making
                For this reason we have a dedicated            these calls are made internally by the team                                                               contact with a young person on Kooth.
                safeguarding team which oversees and           and often require outreach to emergency                                 Eating Issues                     From eating disorders, suicidal ideation and
                supports the work of our online and            services or out of hours social services.                                                                 self-harm to depression and bereavement,
                face-to-face counsellors. The team
                carefully assesses the ‘at risk’ nature
                of individuals engaging in one-to-one
                                                               A total of 668 cases were reviewed over the
                                                               year to facilitate supporting young people
                                                               who presented with high safeguarding risk.
                                                                                                                                       867                               they have the support and training they
                                                                                                                                                                         need to help each individual.

                counselling sessions, ensuring that staff      In 2018, following the implementation of                                                                  Sometimes issues presented can be life
                and clients are fully supported. As we         a Child Exploitation intelligence reporting                                                               threatening, which is why safeguarding
                                                                                                                                       Self-Harm
                regularly help vulnerable young people         protocol, in addition to our safeguarding                                                                 is paramount.
                who might be experiencing complex
                mental health difficulties, we work closely
                with organisations such as CAMHS, the
                                                               processes in place, over 20 cases of Child
                                                               Exploitation intelligence were shared with
                                                               local and regional police forces.
                                                                                                                                       3,401                             According to one of our Kooth counsellors:
                                                                                                                                                                        “Often young people need someone to hear them
                police, child protection investigation teams                                                                                                             out and help them discover what other options
                and local authority social care services       All our online workers undergo                                                                            they have. Young people who have come on to
                and safeguarding teams. Clinical and           safeguarding training at induction and
                                                                                                                                       Suicidal Thought                  Kooth and disclosed their plans for suicide have

                                                                                                                                       3,213
                safeguarding reviews occur on a weekly         annually thereafter, adhering closely to                                                                  then gone on to share their details to receive help
                basis to review individual cases, all of       our safeguarding policy and escalation                                                                    or they have committed to a safety contract.”
                which are overseen by the Head                 procedures. We work to the latest
                of Safeguarding.                               safeguarding guidance and are guided                                                                      In other ‘at risk’ situations, such as
                                                               by the Common Assessment Framework                                                                        child sexual exploitation or domestic
                                                               as the basis for case note recording. We                                Depression                        abuse, counsellors work on harm

                                                                                                                                       4,435
                                                               are committed to working with our local                                                                   reduction strategies.
                                                               authority partners and their Safeguarding
                                                               Boards to align safeguarding procedures                                                                  “In these instances we work with young people
                                                               and ensure proper integration. As Kooth                                                                   to find ways they can keep themselves safe,
                                                               is accredited by the BACP, we also abide                                                                  all the while finding appropriate means of
                                                               by its ethical principles and code of                                    Bereavement                      encouraging them to identify themselves to us

                                                                                                                                        1,038
                                                               professional conduct.                                                                                     so we can support them further. Every time a
                                                                                                                                                                         young person enters a chat, we remind them of
                                                                                                                                                                         the contract they have with a Kooth counsellor.
                                                                                                                                                                         This sets out our boundaries of confidentiality
                                                                                                                                                                         and our duty of care to support them if they
                                                                                                                                                                         disclose that they are at risk of harm.”
Of Today - A Year In Review 2018/2019 - XenZone
14                                                                                              KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019   15

      Therapeutic Alliance
      Safety is as much about processes and protocols as it is about the relationship between
      the young person and the counsellor. Therapeutic alliance is the foundation of therapy.
      We measure the strength of the counsellor-client relationship through end of session
      questionnaires. Outcomes from 2018 demonstrate the strength of the therapeutic
      alliance through Kooth.

                                                    “The session was
     “I felt listened to”                            useful for me”

      97%              agree                         96%               agree

     “The session covered what                      “I would recommend
      was important to me”                           Kooth to a friend”

      97%              agree                         95%               agree

     “I could work well with
      the practitioner”

      95%              agree
Of Today - A Year In Review 2018/2019 - XenZone
16   KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                                     17

                                                           I think I said this last time but last summer
                                                           it felt like what you’ve done had saved my life
                                                           it got that bad for me. The state of mind I
                                                           was in could have gone one way or another.*

                                                           For years I’ve felt unable to do anything with
                                                           my life. Now, I want to live it. I wouldn’t be
                                                           able to do that without the help of yourself
                                                           and this service. You kept me alive and safe
                                                           when others couldn’t.

                                                           Thank you for last night. You really helped
                                                           me out of a tough and dangerous time and
                                                           situation. It is much appreciated, thank you
                                                           for being the only one to listen.

                                                           *All quotes from young people are anonymous
Of Today - A Year In Review 2018/2019 - XenZone
18                                                                                           KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                                      19

     Choice
         A     s a digital service Kooth has the
               opportunity to offer a variety of
         channels for intervention across the
                                                        Working within the Thrive framework1 it
                                                        has become clear that young people require
                                                        a choice of approach in order to thrive.
                                                                                                                                                   How Young People within Kooth
                                                                                                                                                   fit within the Thrive Quadrants
         platform. In 2018 93.5% of young people
         who used chat chose to ‘drop-in’ rather than
         ‘schedule’ a chat. This indicates that Kooth
         is used on a needs led basis. Additionally

                                                                                                                                                    40%
         Kooth is largely used outside of traditional
                                                                                                                                                             of YP who logged on to Kooth stayed
         working hours with 60% of all online
         forums and articles being viewed outside
                                                                                                                                                             in ‘getting advice’ last year
         working hours.

                                                                                                                                                    54%      of YP who logged into Kooth moved
                                                                                                                                                             into ‘getting help’ last year
                                   Getting                Getting
                                    advice                help

                                           THRIVING
                                                                                                                                                   4.5%      of YP who logged into Kooth moved
                                                                                                                                                             on to ‘getting more help’ last year

                          Getting risk                    Getting
                             support                      more help

                                                                                                                                                    2.5%     of YP who logged into Kooth moved
                                                                                                                                                             on to ‘getting risk support’ last year
20                                                                                          KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                  21

     Mental health is such a complex field that     Professor Mick Cooper offered his thoughts
     choice of treatment would seem an obvious      from a pluralistic therapeutic perspective;
     requirement. But across a field increasingly   Professor Miranda Wolpert was keen to
     focused on quantitative evidence, we were      look closely at need. Dr Terry Hanley made
     concerned therapeutic choice was being         the point that one size does not fit all.
     limited to approaches based on a narrow        And Tim Tod, who works with young
     definition of evidence base.                   people and families in schools, maintained
                                                    that making that first conversation easy for
     We know that choice is imperative to           a young person without the medicalised
     support and that there are ‘A Thousand         language that often goes with it, was
     Ways to Therapy’. In 2018 we launched          important so that they could go forward
     this campaign having consulted with            in whichever direction they chose.
     experts, compiling a powerful repository
     of transcript interviews and videos about      Our clinical lead, Dan Mills-Da’Bell, offered                             This work reflects our philosophy of
     therapeutic approaches and choice.             his direct experience of working with a                                   therapeutic choice being intrinsic to
                                                    boy without the emotional language to                                     what we do and how we do it.
                                                    communicate his feelings. He responded
                                                    incredibly well to drama, play and music                                  As Professor Mick Cooper stated: “Research
                                                    therapy using a variety of therapeutic                                    makes clear that there is no one best ‘therapy’.
                                                    frameworks. XenZone Research and                                          Different clients need different things at
                                                    Evaluation Director Aaron Sefi was keen to                                different points in time. There’s a thousand
                                                    push for innovation in the field of therapy,                              ways to therapy and a democratic culture
                                                    but maintained that spending years building                               honours that diversity.”
                                                    a top-down evidence base would risk
                                                    blocking the availability of such treatments                              This campaign has been the most
                                                    to those who could benefit today.                                         successful campaign run by XenZone
                                                                                                                              to date, achieving significant reach and
                                                                                                                              engagement in a few short months.
                                                                                                                              The ongoing campaign continues to
                                                                                                                              be shared widely and evolve.
22                                                                                               KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                                                               23

     Outcome Informed,
     User Led
         A     primary way of measuring outcomes
               on Kooth is through recording the
         achievement of goals set by young people.
                                                           In 2018 over 12,000 goals were partly or
                                                           fully achieved by over 3,700 young people
                                                           in online counselling and support.
                                                                                                                                   In 2018, all the most common goals were
                                                                                                                                   achieved above and beyond a 3-point
                                                                                                                                   increase benchmark, with Getting further
                                                                                                                                                                                    Goals around Emotional exploration and
                                                                                                                                                                                    Managing low moods also scored a 7-point
                                                                                                                                                                                    average or above. Emotional exploration
         For this we developed CoGS – Counselling                                                                                  help from professionals both in and outside      could be considered the primary activity
         Goals System, to demonstrate the types            There is a general recognition that any                                 the Kooth service as the highest achieved        in counselling; through exploring our
         of goals young people achieve within our          goal moving over 3-points is considered a                               goals. These are important goals; within the     emotional reactions to events and people
         service. Based on the Goal based Outcome          significant movement. In 2018 the average                               service it develops the therapeutic bond or      we can learn so much about ourselves and
         (GBO) Measure that is used extensively            goal movement for all moved goals on                                    alliance to Kooth practitioners, and goals       consider strategies to improve our situation
         in CAMHS, CoGS was researched by the              Kooth was 6.8-points (out of ten).                                      to get help outside the service are crucial to   where necessary.3
         University of Manchester2, validating the                                                                                 ensure digital is embedded within the wider
         types of goals set online.                                                                                                support structure of young people.               Examples of typical goals set for emotional
                                                                                                                                                                                    exploration and managing low moods:
                                                                                                                                   Examples of typical goals set for getting

         The ten most common goal types                                                                                            further help – in service:
                                                                                                                                                                                      •   To identify positives in my

         and their average achievement                                                                                               •   Fill out safety plan and message
                                                                                                                                                                                          behaviour and attitudes

                                                                                                                                         counsellor with it before next session
                                                                                                                                                                                      •   Practice positive self-talk
                                                                                                                                                                                          and deep breathing
                                                                      Count of              Average                                  •   To get the courage to speak to
                                                                                                                                                                                      •   To sit with my feelings until
         Goal                                                         Category            Movement                                       someone in one-to-one chat
                                                                                                                                                                                          they become less intense
         Getting professional help – in service                            1,890                  8.10

         Getting professional help – outside our service                     490                  8.02
                                                                                                                                   Examples of typical goals set for around         Setting and achieving goals like these give
         Emotional exploration                                              1,255                 7.43                             getting further help – outside service:          young people power and autonomy, not
         Managing depression or low mood                                     268                  7.34                                                                              just in Kooth but in their own lives as

         Managing suicidal thoughts                                          281                  7.22
                                                                                                                                     •   Speak to pastoral support about            well. There is increasing evidence to show
                                                                                                                                         getting a safe space in school             setting and achieving goals in themselves
                                                                                                                                                                                    lead to improved mental health.
         Speaking up – communicating better                                  188                  6.80
                                                                                                                                     •   To join support group in local centre
         Family relationships                                                169                  6.78

         Overcoming anxiety                                                  875                  6.63

         Self Help – Skills for life                                         611                  6.58

         Emotional regulation                                                725                  6.53
24                                                                                                      KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                                                                    25

     The Future of Outcomes and Evaluation on Kooth

               When Kooth was created more than 15             Our goal-based outcome (GBO) measure,                                       We are providing support at specific              We have long recognised how important
               years ago, it represented a truly fresh and     Counselling Goals System (CoGS), is a                                       times. This means that often we are there         it is to keep the relationship at the heart
               innovative service. Co-developed with           powerful way of being able to describe                                     ‘in the moment’ for previously undetected          of any ways we develop to capture impacts
               children and young people looking for           what is being achieved in our online service.                               issues, and for early and timely intervention     and evidence. It is this human approach
               mental health support, it signalled a major     In fact, NHS England is currently reviewing                                 for emerging and more complex issues.             to capturing outcomes that is driving our
               shift in the way services were provided.        CoGS with a view to incorporating it                                        Measures that capture the impact of this          development work in evaluating Kooth.
                                                               within the outcome metric for the Mental                                    early intervention are critical but also
               As the service has grown and expanded,          Health Service Data Set (MHSDS)4.                                           extremely complicated to develop.6                This year, thanks to a close steer from our
               we have developed a range of ways to                                                                                                                                          Research Advisory Group, and a partnership
               interpret and demonstrate activity on           But we want to go further. Continuing our                                  None of this takes account of the                  with the University of Manchester and the
               Kooth, focusing on its impacts.                 proud history of innovation, we are going                                  therapeutic work we do beyond the                  Centre for Mental Health, we are working
                                                               beyond the standardised measures used in                                   counselling space where we are enabling            to develop a range of new outcome measures
               Today we continue to capture the rate           face-to-face services to capture outcomes.                                 facilitated peer support and therapeutic           that fit all aspects of the Kooth service model
               and trend of presenting issues, the extent                                                                                 content. There are very few measures for           and its different support channels.
               of the therapeutic alliance experienced by      Taking the counselling element of our service                              this kind of work in face-to-face settings;
               children and young people and the volume        alone, there are so many reasons why standard                              the richness of the ways in which emotional        Using research methods that draw on the
               and progress made against co-created            measures designed to capture reduction of                                  and informational support provided here            practice wisdom of our most experienced
                 therapeutic goals (see page 22). We also      specific symptoms are not sufficient:                                      impacts children and young people requires         clinicians, the wealth of data accrued over
                           value the incredible testimonials                                                                              closer investigation.                              the past 15 years, and, crucially, direct
                                  from young people            We provide children and young                                                                                                 feedback from young people, we are
                                       themselves.             people access to Kooth as and when                                         There is also a wider question of whether          developing co-created measures that will
                                                               the need arises. This immediacy of service,                                the measures currently used in face-to-face        tell us the truest story possible of what is
                                                               and the range of different levels of access –                              services are even applicable in the settings       achievable in online therapeutic support.
                                                               from a single session to intermittent drop-in,                             for which they were designed. The recent
                                                               and from regular sessions with a named                                     King’s Fund report7 highlights: “a risk of         We look forward to sharing some of our
                                                               practitioner to long-term support                                          over-emphasising the tangible, measurable,         early findings in next year’s report.
                                                               for more protracted needs – are all central                                more scientific dimensions of health and care
                                                               to the choice we offer. But are also too                                   at the expense of the less tangible, less easily
                                                               complex a challenge for a single standard                                  measurable humanitarian dimensions of care.”       Aaron Sefi
                                                               outcomes measure.                                                                                                             Research and Evaluation Director
                                                                                                                                          The report goes further in questioning the
                                                               We offer clinical support in a digital                                     need for ‘quality metrics’ of scientifically
                                                               space. All standard measures were built for a                              measurable change, asking whether they
                                                               different environment. We know the digital                                 are in fact impacting negatively on the
                                                               space changes some of the ways children                                    therapeutic relationship.
                                                               and young people receive and experience
                                                               therapeutic support5. We also know this
                                                               autonomy affects how they complete
                                                               forms and questionnaires, especially in the
                                                               immediate ‘nowness’ of the digital world.
26                                                                                     KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                                                                 27

                                                                                                                         Jake’s story
     Outcomes play an important role in           In 2018 we once again opened the                                      “My passion for mental health grew when I was
     influencing how the service develops but     programme up to those young people                                     diagnosed with a brain tumour at the age of
     they are limited by those who engage with    who wanted to play an active role in                                   11 and sadly lost my sight as a result. I didn’t
     them and the domain in which they are        talking about mental health within their                               want anybody else to be treated the way that
     used. As a person-centred service we value   communities. This cohort of ambassadors                                I was. Throughout my own personal struggles
     engagement with service users to drive       were asked to complete a Kooth training                                with mental health, I was always being told to
     service development. One example             programme, which they helped to create.                               “man up,” and to “grow a pair,” and it was this
     of user involvement is the Kooth                                                                                    experience that made me want to change the
     Ambassador programme which has                                                                                      social stereotype towards males. I had recently
     run for a number of years.                                                                                          learnt that suicide was and still is the biggest
                                                                                                                         killer of young men, and I now realised why.
                                                                                                                         I wanted to make it easier for young men and
                                                                                                                         all young people to come out about their mental
                                                                                                                         health, I wanted to tell them that it’s okay not
                                                                                                                         to be okay.

                                                                                                                         The Kooth Ambassador Programme was a                 This year we have
                                                                                                                         remarkable experience. I felt able to make           also built an online training
                                                                                                                         a difference. I was given the opportunity to speak   portal for Kooth Peer Supporters.
                                                                                                                         at various conferences; I got to speak to over       Enabled by funding awarded by the
                                                                                                                         500 different practitioners at two mental health     Small Business Research Initiative, and
                                                                                                                         events about the transition between children’s       building on our experiences running
                                                                                                                         services and adult services, a subject close to my   the Kooth ambassador programme, we
                                                                                                                         heart. The most important thing that I got from      have co-designed learning modules to
                                                                                                                         the programme was that I wanted to continue          up-skill young people in their delivery of
                                                                                                                         doing this. It finally made me realise that I        peer support. Measuring outcomes, and
                                                                                                                         wanted a job in mental health. I’m honoured          advancing channels for peer support within
                                                                                                                         to have been given this opportunity.”                Kooth are a key focus for the coming year.
28                                                                                        KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                                                                                           29

     Autonomy
         T    he autonomy obtained through
              remaining anonymous on Kooth is a
         big reason for young people to continue
                                                        Registrations of harder
                                                        to reach groups on Kooth
                                                                                                                            Males generally are also harder to reach.
                                                                                                                            This is why our teams have been working
                                                                                                                            with schools to deliver Personal, Social,
                                                                                                                                                                                Reasons for Choosing
                                                                                                                                                                                Online Counselling

         returning to the service, giving them                                                                              Health and Economic (PSHE) sessions                 In 2017, the Education Policy Institute
         incredible freedom to express themselves.                                                                          to young men to encourage more                      wrote an independent report about online
                                                               19%
         It is cited as the main reason young people                                                                        communication around mental                         counselling using data from Kooth. The value
         choose online counselling.5                                                                                        and emotional wellbeing.                            of anonymity for autonomy emerged through
                                                                                                                                                                                the survey, asking young people to select their
         This anonymity also gives young people a                                                                           According to Tim, a Kooth worker in                 top 3 reasons for using online counselling:
                                                                                   10%
         sense of control and autonomy that may                                                                             London who supports young males as
         not be there is other aspects of their life.                                                                       well as other groups such as young people           I want to discuss my issues without my parents or anyone else knowing
         Inviting co-produced content does the                                                                              within the Jewish community and                       51%
         same, encouraging young people to share                                                                            young carers:
         their feelings and own the service. It paves                                                                                                                           I like being anonymous
                                                                                                                                                                                  45%
         the way for peer support and identification                                                                       “The truth is, while there has undoubtedly been
         with others, as well as involving young                                                                            a shift in attitude, there is still a patriarchal
                                                                                                                                                                                I like not having to talk to someone in person
         people in the continued development of                                                                             culture of the alpha male needing to take
                                                        Average number      General Kooth-                                                                                        41%
         the platform.                                                                                                      responsibility for their family and present
                                                        of 2018 Kooth       aged population
                                                                                                                            outwardly as hard or strong. This is most           I feel I can express myself more clearly
                                                        registrations who   identifying
         The consequences of this accessibility and                                                                         prevalent in low income or disadvantaged              40%
                                                        identify as BAME    as BAME in
         autonomy are that Kooth holds an appeal                                                                            households where young people are more
                                                                            commissioned                                                                                        I am more comfortable online
         for typically hard-to-reach groups, some                                                                           likely to have faced hardship and would in
                                                                            areas5                                                                                                26%
         of which tend to be the most vulnerable.                                                                           fact benefit from a service like Kooth.”
         The service sees comparably high rates of
                                                                                                                                                                                I don’t have to wait for an appointment
         Black and Minority Ethnic young people,                                                                           “Going into schools to work directly with these
                                                                                                                                                                                  24%
         for example:                                          4.4%
                                                                                                                            groups of people provides a space for young
                                                                                                                            males to listen, generate their own thoughts        I can talk about whatever I like
                                                                                  0.2%
                                                                                                                            about emotional wellbeing, and leave knowing          23%
                                                                                                                            that Kooth is available for them to use in
                                                                                                                            privacy, outside of school hours. It’s important    I can get help whenever and wherever I need it
                                                                                                                            to recognise that Kooth is not there so that          20%
                                                        2018 Kooth          Average number of                               young people don’t need to seek help from
                                                        registrations who   those recorded in                                                                                   I feel safer
                                                                                                                            trusted adults or services, but it can be a
                                                        identify with       CAMHS as having                                                                                       16%
                                                                                                                            gateway to shifting help-seeking attitudes and
                                                        nonconforming       ‘other’ gender5                                 supporting young people in building wider           Other
                                                        Gender (Agender                                                     support networks where needed.”                       7%
                                                        or Gender fluid)
                                                                                                                                                                                I don’t know where/how to find face-to-face services
                                                                                                                                                                                  7%

                                                                                                                                                                                *Each young person selected up to 3 reasons
30   KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                                     31

                                                           I love how this conversation is easier to
                                                           have behind a computer screen than it
                                                           would be with a person I could see.

                                                           Also I would like to thank the Kooth team
                                                           for creating a safe place for people like me
                                                           to come to this place maybe after school
                                                           or during the day to express their feelings,
                                                           give advice or vent about their day or problems
                                                           to try and get solutions. So thank you!

                                                           I just wanna say thank you for the support
                                                           and help you give to people like me.

                                                           I’ve got lots of help from LGBT+ groups on
                                                           here, I finally feel like I can be who I wanna
                                                           be and not feel like I have to hide anymore.

                                                           … Thank you lot so so so much for
                                                           helping me be who I am!!!
32                                                                                               KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                                 33

     Flexibility
           F   lexibility within Kooth refers to the
               options available to young people, such
           as how they engage with the counselling
                                                          13-15 year old females use proportionately
                                                          more synchronous chat-based counselling
                                                          than any other user demographic on
                                                                                                                                                       I also like that with Kooth you can come
                                                                                                                                                       and join in at a time that is convenient to
           team, what time they choose to log on,         Kooth, though they do so for a shorter                                                       you – especially as it’s open until 10pm!!
           whether they write article posts or just       amount of time than their older peers.
           view them.                                     The most popular mode of interaction
                                                          with Kooth for this demographic is the
           13-15 year old females are the highest         asynchronous messaging; messages which
           demographic on Kooth, making up 35%            can be composed and sent in their own
           of all users. To demonstrate the choices       time at any time of the day. They are                                                        I love the article bit because people
           available to young people we have zoomed       particularly active in the peer support and
           in on this cohort of Kooth users to            self-help domains of Kooth, with 40% of                                                      are so brave and you can relate to
           understand how they used Kooth in 2018.        this cohort regularly viewing co-produced                                                    their posts and write your own.
                                                          articles, in comparison to 32% of their
           To contextualise the reasons for these         male counterparts. Though they are active
           young people to seek support on Kooth          users of forums, it is those who identify as
           we can turn to the presenting issues of this   agender or genderfluid across all age groups
           cohort. Compared with the previous four        who are the most avid forum users.
           years, 2018 saw the highest prevalence
                                                                                                                                                       I really enjoyed last night live forum,
           of self-harm as a presenting issue in          The flexibility offered through Kooth
           this age group, replacing ‘confidence’         is further demonstrated by usage of the                                                      despite it being so hard it was so
           issues which reduced in presentation           platform out-of-hours. In 2018, 13-15 year                                                   lovely to support everyone and get
           frequency compared to previous years.          old females predominantly used Kooth
           Friendship, self-worth and anxiety have        between the hours of 18:00pm and 21:00pm
                                                                                                                                                       advice from everyone.
           been consistently prevalent issues for this    every day of the week. This is similar
           demographic over the past 5 years.             across all age groups, however logins spike
                                                          over lunch time for those who identify as
                                                          genderfluid or agender.
34                                                                                                   KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                               35

     Kooth Face-to-face
         I  n all areas where Kooth is commissioned,
            we provide a joined up model of care,
          building close relationships with local
                                                          Kooth face-to-face services differ
                                                          depending on the needs of the area,
                                                          and include targeted support for the
                                                                                                                                       A 2018 snapshot of Kooth Face-to-face

          face-to-face services, including the local      reduction of CAMHS waiting lists, as
          CAMHS providers.                                well as specific therapeutic approaches
                                                          such as Interpersonal Psychotherapy for
          In seven of our commissioned areas             Adolescents. Where appropriate young
          Kooth delivers a blended service which         people are encouraged to use Kooth
          combines a Kooth online contract with a        online whilst waiting for a face-to-face

                                                                                                                                                     14,215
          face-to-face counselling service. Our face-    intervention, to use the self-help and
          to-face services are operated and managed      peer-support during an intervention,                                                                                               5,692
          locally, being delivered by qualified          or as part of sustaining their process
          counsellors, associate counsellors and         after a face-to-face intervention.                                                        Total number of             Unique young people
          counsellors-in-training.                                                                                                                sessions delivered           who received a Kooth
                                                         As with all Kooth services, safeguarding                                                                               face-to-face session
          As with Kooth online, choice and flexibility   young people is our priority. In face-to-face
          are paramount operational values. There is     services this is possible to achieve ‘in the
          flexibility around the type of intervention,   moment’ with young people, and through
          with some areas offering group work            our established relationships with local
          focusing on techniques such as Dialectical     safeguarding boards, or safeguarding
          Behaviour Therapy or on specific issues        leads in schools.
          such as self-harm. We endeavour to
          provide ease of access through the chosen
          locations of our counselling teams, who
          often see young people in schools, as well
                                                         “I love working in the North-West managing a                                  Top presenting issues
                                                          team of 17 Counsellors, made up of face-to-face,
          as offering flexible hours for those who        online and blended workers, who see over 120
          wish to attend outside of school hours.         young people a week for face-to-face counselling.                            1    Anxiety/Stress
                                                          Recently I have seen value in working to the
                                                          Thrive model providing joint appointments
                                                          through the community hubs with our CAMHS                                    2 Family Relationships
                                                          partners and providing support in schools,
                                                          colleges and community centres.”
                                                                                                                                       3 Anger
                                                          Lisa Cary,
                                                          Kooth Area Manager

                                                                                                                                       4 Confidence

                                                                                                                                       5 Self-worth
36                                                                                             KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                                                                        37

     Growth
         X     enZone’s clinical model has been
               developed over many years, in
         response to what our young people
                                                       Supported by a dedicated clinical, research
                                                       and technology leadership team means we
                                                       are well placed to combine the best clinical
                                                                                                                                 Who are the online team?
                                                                                                                                 The Kooth Senior Practitioner                     The Kooth Counsellor
         tell us they want. The changing nature        and digital approaches to meet the ever
         in presenting issues is an interesting        changing needs and wants of our                                           Through line management of the 70-strong           Kooth counsellors are autonomous
         barometer of the mental health of children    young population.                                                         online team, Kooth senior practitioners            and empowered in their role to provide
         and young people; it’s critical that we are                                                                             encourage personal development and                 counselling in line with their skill set and
         aware of what they are managing and to        2018 saw a 21% staff increase within                                      support to deliver the service. What this          expertise, whether this is wholly person-
         ensure we are offering consistent support     the online team of senior practitioners,                                  looks like in practice is assurance of policy      centred, cognitive behavioural therapy
         in the best way we can.                       counsellors, emotional wellbeing                                          adherence, dissemination of good practice,         focused, through transactional analysis,
                                                       practitioners (EWPs) and the content                                      running informative surgeries focused              or other integrative approaches.
         Choice has always been at the heart of our    and community team.                                                       on the issues affecting young people,
         therapeutic philosophy; we aim to see ‘the                                                                              and supporting staff in more complex               The support counsellors on Kooth get is
         whole person’ as opposed to just seeing the                                                                             presentations or cases.                            quite unique, with access to a community
         difficulties or presenting ‘symptoms’ and                                                                                                                                  of more than 70 other online workers
         are strong advocates for an integrative                                                                                                                                    who can and do offer support alongside
         model, working alongside other agencies                                                                                “It’s a real luxury to truly empower a young        regular supervision.
         as appropriate.                                                                                                         person because they are choosing to be there
                                                                                                                                 rather than being coerced to sit in a room with
                                                                                                                                 someone. It’s their world, it does completely     “More than anything for me, online counselling
                                                                                                                                 belong to them.”                                   is about developing a relationship. A huge
                                                                                                                                                                                    number of our young people will say ‘I can’t tell
                                                                                                                                 Jo Gilbert,                                        the school counsellor that, I can’t tell mum that’.
                                                                                                                                 Senior Practitioner                                For them there’s a safety, a freedom, in
                                                                                                                                                                                    being able to tell someone is who making no
                                                                                                                                                                                    judgement. For the young person it can be a
                                                                                                                                                                                    very powerful experience.”

                                                                                                                                                                                    Rachael Pickett,
                                                                                                                                                                                    Counsellor
38                                                                                                  KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                                                            39

     The Kooth Emotional                                The Kooth Content                                                             Technology Vision for Growth                     The vision for Kooth to develop new, user
     Wellbeing Practitioner (EWP)                       and Community Team                                                            and Development of Kooth                         centric models of care backed by evidence
                                                                                                                                                                                       will be enabled through the use of data
      EWPs have a varied role on Kooth; they            The content and community team run live                                       Technology has always been a critical enabler
                                                                                                                                                                                       and experimentation contributing to
      offer support through chats and messages,         forums three nights a week, and moderate                                      to Kooth, empowering it to provide young
                                                                                                                                                                                       an evidence base of efficacy. XenZone’s
      and safeguard journals written by young           all content written by young people before                                    people with a unique support platform they
                                                                                                                                                                                       world-class engineering team is rapidly
      people as well as daily management of             it is published on Kooth (if it adheres to                                    can access safely, remotely, and anonymously.
                                                                                                                                                                                       growing to support the needs of children
      the chat queue.                                   community guidelines).                                                        Technology has never been viewed as a
                                                                                                                                                                                       and young people; made up of engineers
                                                                                                                                      substitute for skilled clinical workers but as
                                                                                                                                                                                       with a thorough understanding of user
     The experiences and skills of an EWP               They sit between counsellors and young                                        a critical enabling tool for delivering high
                                                                                                                                                                                       behaviour and a deep commitment to the
     contribute to the diversity in the multi-          people, facilitating the growth, safety and                                   quality choice of care.
                                                                                                                                                                                       safeguarding and well-being of service
     disciplinary online team. EWPs tend to             health of the community. The live forums are
                                                                                                                                                                                       users and providers.
     come from backgrounds working with                 a discussion space for a whole range of topics                                The engineering team at XenZone is
     children and young people in different             from sex education to religious holidays.                                     continuously seeking to improve the
     capacities, such as youth work, social                                                                                           quality of care operations. Our approach
     work, schools, pupil referral units, and            Identifying risk within individuals who                                      to quality is two-fold, focusing on the
     young offender institutions.                        post any content is a significant part of the                                efficiency of the service, and increasing
                                                         community engagement team’s role who                                         the models of intervention available to
                                                         are on hand to engage with individuals and                                   children and young people. Through 2019
     “When I told people I was going to [work at]        signpost them to channels within Kooth,                                      and beyond, this will be achieved through
      Kooth there were a few sceptics ‘how can online    or crisis support where necessary.                                           working closely with young people as
      work support people when you don’t know who                                                                                     well as XenZone’s clinical, content and
      they are?’. I have found anonymity doesn’t                                                                                      user engagement teams. Identified
      impact the number of people we can help and       “Kooth has that holistic approach of counselling                              pain points and opportunities
      the level of help we give. People on Kooth make    support and peer support. The fact it’s online                               for improving outcomes for
      claims like they want to ‘save lives’ and from     means they’re in control of it, they can login                               young people will drive the
      where I’m sitting it’s definitely achievable.”     when they want to. They can be a slightly                                    developments of Kooth.
                                                         different person: you can be more confident
      James Tyler,                                       than you might be in a big group in real life.
      EWP                                                It’s a service that’s mouldable to your needs.”

                                                         Helen Rhodes,
                                                         Editorial and Content Lead
40                                                  KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019                                                 41

           Map of
           commissioned areas*                                                                            Get in Touch
                                                                                                          Contact Details

                                                                                                          If you would like to find out more about
                                                                                                          anything in this report, or about Kooth
                                                                                                          in general you can contact us at:
                                                                                                          contact@xenzone.com

                                                                                                          If you are a young person who uses Kooth
                                                                                                          and would like to give us feedback, you can
                                                                                                          leave anonymous feedback by logging into
                                                                                                          Kooth and heading to the feedback page.

                                                                                  LONDON

                                  ENGLAND & WALES

*Accurate data as of April 2019
42                                                                                           KO OT H O F TO D AY   A YE AR IN RE VIEW 2018/ 2019   43

     References
          1. Wolpert, M., Harris, R., Hodges, S.,     4. Wolpert, M. (2018). The Context
             Fuggle, P., James, R., & Wiener, A.         for our recent Outcome Measures
             et al. (2015). THRIVE Elaborated.           Survey: The new children and young
             Press CAMHS.                                people’s mental health outcome metric.
                                                         Presentation.
          2. Hanley, T., Ersahin, Z., Sefi, A.,
             & Hebron, J. (2017). ‘Comparing Online   5. Frith, E. (2017). Online Mental Health
             and Face-to-Face Student Counselling:       Support for Young People. London:
             What Therapeutic Goals Are Identified       Education Policy Institute. Retrieved
             and What Are the Implications for           from: https://xenzone.com/wp-content/
             Educational Providers?’, Journal of         uploads/2018/11/Online_Mental_
             Psychologists and Counsellors in            Health.pdf
             Schools, 27(1), 37-54. https://doi.
             org/10.1017/jgc.2016.20                  6. Early Intervention Foundation
                                                         (2018). Realising the Potential of
          3. Edbrooke-Childs, J., Jacob, J., Law,        Early Intervention. [online] London.
             D., Deighton, J., & Wolpert, MR.            Available at: https://www.eif.org.uk/
             (2015) ‘Interpreting standardized           report/realising-the-potential-of-early-
             and idiographic outcome measures            intervention
             in CAMHS: What does change mean
             and how does it relate to functioning    7. Collins, B. (2019). Outcomes for Mental
             and experience?’ Child and Adolescent       Health Services: What Really Matters?.
             Mental Health, 20 (3), 142- 148.            [online] The Kings Fund. Available at:
             https://doi.org/10.1111/camh.12107          https://www.kingsfund.org.uk/sites/
                                                         default/files/2019-03/outcomes-mental-
                                                         health-services_0.pdf
You can also read