Consensus Derived Client Outcomes and Clinician Actions for Youth Online Chat Mental Health Services: A Delphi Study

Sonia Curll¹Kelly Mazzer^1,2*Sabina Albrecht²Skye Barbic^3,4Amanda Fitzgerald⁵Kairi Kõlves⁶Nic Telford²Nickolai Titov⁷Debra Rickwood^1,2

• ¹University of Canberra Faculty of Health, Canberra, Australia
• ²headspace National Youth Mental Health Foundation Ltd, Melbourne, Australia
• ³The University of British Columbia, Vancouver, Canada
• ⁴Foundry, Vancouver, Canada
• ⁵University College Dublin, Dublin, Ireland
• ⁶Griffith University, Brisbane, Australia
• ⁷Macquarie University, Sydney, Australia

Introduction: Online chat services have increased mental health care access for young people (12-25 years), yet their effectiveness remains unclear. This is partly due to a lack of consensus about primary client outcomes and clinician actions facilitating positive service outcomes. This study sought to identify (a) outcomes most important for young people accessing mental health support via online chat, and (b) clinician actions most relevant to achieving these outcomes. Method: A comprehensive list of potential outcomes and actions was developed through literature review and consultation with youth online chat service providers. A three-round Delphi study was conducted with three panels of youth, researchers, and clinicians (n=100; 84% retention rate), primarily from Australia and Ireland. Consensus was reached if ≥ 75% of participants within at least two panels rated an outcome/action as very important or essential. Results: Eleven client outcomes reached consensus: Feeling heard and validated; Reduced distress; Increased help-seeker capacity; Feeling safe; Optimism and hope; Connection with clinician and service; Feeling better; Reduced hopelessness; Reduced overwhelm; Increased coping; and Goals, answers and direction. Fifteen clinician actions reached consensus: Manage risk; Respect diversity; Validation; Welcoming environment; Active listening; Manage distress; Compassion; Checking in; Give choice; Youth friendly; Set expectations and focus; Provide resources; Holistic approach; Highlight strengths; and Problem-solving. Conclusions: The identified client outcomes and clinician actions offer preliminary guidance for monitoring and evaluating youth online chat support. Future research should test and refine these domains within service contexts to inform robust measurement tool development for evaluating youth online chat services.