Datasheet1_What are practitioners' views of how digital health interventions may play a role in online child sexual abuse service delivery?.pdf

IntroductionOnline 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.
MethodIn-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.
ResultsThree 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.
DiscussionOur 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.

引言 在线儿童性虐待（Online Child Sexual Abuse，OCSA）在全球范围内影响大量儿童，并与多种精神健康问题相关联。现有针对从业者的研究显示，青少年极少被问及在线虐待相关问题，且从业者对受害群体所经历的问题及应对方式缺乏系统全面的认知。目前鲜有能够指导临床评估与实操的循证干预方案。数字健康干预（Digital Health Interventions，DHIs）在儿童青少年服务面临可及性、匿名性等挑战的场景下，有望成为有效的解决方案。本研究旨在探究精神健康从业者对数字健康干预如何辅助受害于OCSA的青少年，以及其在医疗服务交付中可发挥的作用的看法。
方法 本研究在曼彻斯特与爱丁堡两个研究站点开展，对25名儿童精神健康专业人员进行了深入质性访谈与1次焦点小组讨论。数据采用反思性主题分析法进行编码与分析。
结果 本研究共提炼出3个核心主题与9个子主题：（1）些许迷茫无措；（2）察觉潜在风险与问题；（3）明晰有效实践路径。从业者对用于辅助该受害群体的数字健康干预工具表现出浓厚兴趣，认为其可作为缓解候诊积压、补充现有治疗手段的有效途径。他们认为，多数青少年会将此类工具视作优于线下诊疗的媒介，能够赋能青少年，并为其学习如何在网络空间保障自身安全提供全新路径。然而，从业者也存在诸多顾虑：一是工作人员部署此类数字健康干预所需投入的时长；二是对内容合规与数据保护相关安全问题的担忧，其中部分问题或为该青少年群体所独有；三是担忧无法与脆弱儿童建立治疗联结。
讨论 本研究结果显示，从业者在应对遭受OCSA的儿童时仍存在不确定性，但对采用数字健康干预辅助临床实践、缓解候诊积压的可能性持开放态度。从业者同时表达了诸多顾虑：包括工作人员开展相关干预所需的培训与支持时长、服务对象的安全问题，以及缺乏针对无配套支持的数字健康干预有效性的相关证据。