What are practitioners' views of how digital health interventions may play a role in online child sexual abuse service delivery?

Introduction Online child sexual abuse (OCSA) affects considerable numbers of children globally and is associated with a variety of mental health problems. Existing practitioner studies suggest that young people are infrequently asked about online abuse and practitioners have a fragmented understanding of the problems experienced or how they might approach them. There are very few evidence-based interventions that guide clinical assessment or practice. Digital Health Interventions (DHIs) have the potential to be an effective option where children and young people's services are challenged, including accessibility and anonymity. The aim of this study was to explore mental health practitioners' views of how DHIs may play a role in supporting young people who have experienced OCSA, and the role they can play in healthcare delivery. Method In-depth qualitative interviews and one focus group were conducted with 25 child mental health professionals across two sites (Manchester and Edinburgh). Data was analyzed using reflexive thematic analysis. Results Three overarching themes and 9 sub-themes were identified: (1) feeling a little bit lost; (2) seeing potential problems; and (3) knowing what works. Practitioners expressed interest in a DHI to support this client group and saw it as a way of managing waiting lists and complementing existing therapies. They felt that many young people would see this as a preferred medium to in-person therapy, would be empowering, and offers new ways of learning how to stay safe online. However, there were concerns about how much time would be needed by staff to deliver a DHI, anxieties about safety issues in relation to content and data protection, some of which may be unique to this population of young people, and concerns about the absence of a therapeutic relationship with vulnerable children. Discussion Our findings indicated that practitioners were uncertain about working with children subjected to OCSA but were receptive to the possibility of using a DHI to support their practice and to reduce waiting lists. Concerns were expressed about the time needed for staff training and support as well as concerns over patient safety and the lack of evidence about the effectiveness of an unsupported DHI.

Page 1 of 7 Study Title: A qualitative study of professional stakeholders' perceptions about the uptake of a digitally mediated intervention for young people who have experienced online sexual abuse and its integration into existing NHS and e-therapy infrastructure.
Topic guide A for interviews or focus groups.

General Interview Guide
Equipment required: • Participant Information Sheet (in case participant wants to see sheet again) • Consent form (in case participant wants to see consent form again) • Video recording (if interview via video conference) or phone recording equipment (if interview via phone)

Prior to interview:
• Participant Information Sheet -any questions?
• Consent form -explain video/audio recording and limits of confidentiality.

Introduction:
Introduce self, welcome, and thank participant for attending the interview.Ensure that the participant is comfortable.Ensure technology is working.

Consent:
Re-confirm informed consent is still valid, and participant still wishes to take part.

Interview details:
Outline interview procedures and expected length of time for the interview.
Remind the participant that the interview will be video/audio-recorded, that participation is voluntary, that they have the right to withdraw at any point without penalty and offer pauses and breaks.

Confidentiality:
Explain confidentiality -everything the participant says during the interview will remain confidential; however, if the participant discloses anything which suggests risk to self or others, the researcher will need to inform the named healthcare contact.
Explain the purpose of the study and take any questions: "Thanks again for meeting with me today.You are being invited to take part in a research study that aims to understand healthcare professionals' perspectives about what will facilitate the uptake of a digitally-mediated intervention designed to support young people who have experienced online sexual abuse, and its future integration into existing services provided by the NHS and e-therapy providers.OSA involves being asked or persuaded to take part in sexual activities, whether someone is aware or not of what is happening (for example, being coerced into sharing sexual images of oneself, taking part in sexual activities via a webcam or smartphone, having sexual conversations by text, or being groomed, abused and exploited which may then lead to contact abuse) via any device connected to the Internet and across multiple platforms and applications where technology is involved at any stage.During the interview, we will talk about your experiences, views and ideas about working with YP-OSA.In the interview, 'digitally-mediated intervention' refers to any digital tools that can be used to support mental healthcare, including apps, computer programmes, wearables etc.The interview will take approximately 60 minutes to complete.With your permission, the interview will be audio-recorded and then transcribed and anonymised so that we have a record of what has been said.Sometimes we may wish to use quotes that you provide during the interview in publications, but we would always make sure that you would not be identifiable.Do you have any questions at all?"

Seek consent to continue and to audio-record the interview (if applicable).
Inform participant that no personal identifiable data will be recorded and a participant number will be allocated to them.What are your experiences of using a mentalization approach with young people?
Probe: If some experience, what are your views on how such an approach might be used in an online intervention for young people exposed to OCSA? Probe: For the young person?Probe: For professionals?

Experience of adapting face-to-face interventions to an online environment. (Probe a bit, but if none, move on to question 3).
Probe: What happened?3.Understanding of YP-OCSA

Who might benefit from an online intervention
What might get in the way / act as a barrier to the uptake of i-Minds within your organisation?
Probe: Think about this in relation to a YP-OCSA you have worked with.What would help that YP?Is there anything you avoid?Why?9.Probe: For the young person?Probe: For professionals? Probe: For the service?Probe: For the young person?Probe: For professionals? Probe: For the service?15.