Implementation of the enhanced moderated online social therapy (MOST) model within a national youth e-mental health service (eheadspace): The MOST+ project

Enhanced MOST (Moderated Online Social Therapy), called MOST+ MOST+ adopts a strengths-based approach through which users are guided and prompted to identify, discuss and exercise key personal strengths within the online social environment and in real life, to foster positive mood, enhance social connectedness and self-efficacy, and build resilience. This approach is based on the positive psychology model which proposes that psychosocial interventions should aim to build strengths, meaning and purpose as well as relieve symptoms. Materials A self-report registration survey will be completed, primarily consisting of items administered within the registration for standard eheadspace services. Additional items screen for immediate clinical risk, request details for an emergency contact, and assess key secondary study outcomes. All participants will have access to the MOST+ platform, called Generation. Participants are presented with a welcome letter and a video tutorial at first login after registering. Generation includes 1) user-directed strength-based activities; 2) short comics designed to guide and teach the user; 3) clinician-delivered webchat; and 4) moderated peer-to-peer social networking. Follow-up survey includes various questionnaires (see ‘Outcomes’ section of registration). Training of Generation moderators will utilise a training manual written specifically for this study. Procedures Approximately 250 young people will be progressively recruited to the intervention via a link on the eheadspace homepage over the first 4 weeks of an 8-week pilot. The link will be active only when MOST+ clinicians are available (4pm to midnight AEDST). A brief screen will determine eligibility. Eligible young people will be presented with details of the study procedures, and consent form. Those who screen as ineligible for MOST+ will be redirected to the eheadspace homepage. Consenting, eligible young people will be administered an online registration survey (approx. 10 minutes) prior to study enrolment. Participants will be granted partial access (i.e., access to evidence based therapy content and clinician delivered web-chat) following registration. Full access (social networking) will be enabled once telephone contact is made to confirm age (16-25 years) and conduct induction. If i) participants indicate acute clinical risk (ie. risk of self-harm) or ii) participation in social networking is likely to interfere with management of symptoms or harm to others, full access will not be enabled until further assessment. Young people who are excluded from social networking will have access to all other features of MOST+, in addition to any additional referred services. MOST+ clinicians will operate according to the eheadspace clinical governance framework. The clinician delivered web-chat with screened high risk MOST+ users will focus on risk assessment and management, with referral to additional services where possible and appropriate. Following implementation of the appropriate clinical response, eligibility for the social networking component of MOST+ will be determined based on the treating clinician’s assessment of ongoing safety and treatment needs. Generation enrolment periods will be managed via an automated process. At 5 days post intervention enrolment, all participants will receive an SMS reminder to log on to MOST+ and renew their account within two days, if they wish. Participants who choose to log in and renew their account will be granted an additional week of access. This weekly opt-in process will be repeated until the participant chooses not to renew their account, or until the end of the pilot. If a participant chooses not to renew their account within two days of receiving their reminder SMS, their profile will be automatically deactivated. User profiles and social network contributions will be hidden at account deactivation. Participants will have a 4-day grace period to reactivate their account and restore their profile information. All other user activity, including social network comments, will not be reinstated. Follow-up assessments will be conducted online and via telephone approximately 4 days after a users’ account has deactivated. Participants will first receive an SMS link to their online follow-up survey followed by a phone call from the study RA to conduct the semi-structured feedback interview. Those participants who have not yet completed their online follow-up survey at the time of successful RA contact will be asked to complete this over the telephone. It is anticipated follow-up will take approx. 20 minutes. Participants who maintain active enrolment across the study intervention period will complete follow-up assessments as soon as possible following conclusion of the pilot. In order to understand the likely real world usage levels of this intervention, the number of users will not be capped. Therefore, it is difficult to predict the total duration of follow-up. Who Peer moderators will be trained and supported young people with a recent lived experience of mental ill health. They will be active members of the MOST+ social network to provide guidance and emotional peer-to-peer support, and foster hope and empowerment. All clinicians working within the Generation platform will be eheadspace clinicians, who are allied health professionals and have specialist training and experience in the delivery of e-mental health support to young people in distress. Modes of delivery Participants can log into the online Generation platform at any time. Through a link on Generation, participants can initiate text-based interactive web chat with a clinician if there is a clinician available. Where Generation is available to young people living within Australia, wherever internet access is possible. eheadspace clinicians will be based at the eheadspace operation centre in Melbourne. When & how much Participants will be given initial access to the MOST+ intervention for one week, with the option to extend their access on a weekly basis across the study intervention period. Thus, enrolment in the intervention will range from a minimum of one week to a maximum of eight weeks. Participants will be able to reactivate an expired account at any time during the study intervention period, and this will be treated as a second episode of care. Tailoring Super users and clinicians are encouraged to personalise communication to suit the needs and circumstances of each participant. Assessment of adherence Usage of the online system will be monitored across the study intervention period. Generation clinicians and Super Users will provide guidance and encourage user directed engagement with MOST+ therapy content.