Online help for adolescents with mental health problems: experiment of the implementation and effectevaluation at the preventive Youth Health Care

Relatively many (19-28%) of adolescents suffer from a variety of mental health
problems. These problems can cause suffering and an impairment of functioning.
Further it is known that mental health problems of adolescents can continue
into adulthood and hamper functioning in daily life. These problems can lead to
an increased use of healthcare services, resulting in higher associated costs.
It is therefore important to prevent, or treat on time, mental health problems
of adolescents. It is also known that a majority of adolescents with mental
health problems do not receive professional help, because for many of them it
is difficult (high threshhold) to seek and find professional help. Obviously
the current healthcare organisations (in preventive and primary care, like the
preventive Youth Health Care and general practitioner) are insufficiently able
to reach adolescents with mental health problems. Therefore we look as the
preventive Youth Health Care (YHC) for better possiblities to reach this target
group. To offer (anonymous) help or support through the Internet (by e-mail or
chat sessions, what we call online help) is a favourable option. Our recently
performed research confirms that adolescents show a strong need for help
through the Internet.

The primary objective of this study is to modernize the practice of the
preventive YHC by adding online help for adolescents with mental health
problems as an innovative method of working, additional to the *care as usual*.
The test implementation and effects of this online help, in comparison with the
*care as usual* by the YHC, will be studied. With the results of the study it
can be assessed if online help could get an additional place in offering help
by the YHC for adolescents with mental health problems. The ultimate goal is to
reach more adolescents with mental health problems and to offer them help.

The secundary goal of this study is to gain insight into the facilitating and
obstructing factors of the experiment of implementing online help (process
evaluation), with the different concerned people (adolescents and YHC workers).

There will be a selection of enough (300) adolescents *at risk*, attending the
secondary year of some secondary schools in the Southeastern part of the
Netherlands, through the *Triage* of the preventive health assesments of the
*care as usual* performed by the YHC-team. The condition for inclusion of this
study is that adolescents have a high total summed score (12 or higher) of the
SDQ questionnaire. Through stratification of the randomisation there will be an
equal distribution of the adolescents over the different levels of education
(lower vocational education to higher general secondary education) in both the
intervention as the control group. These adolescents will be at random
classified in an intervention (online offer)- and a controlgroup (care as
usual). These numbers make it also possible to look specific at the level of
education if the intervention effect is equal for all the different levels of
education (diversity).

The process evaluation will be a qualitative study, where:
1. The participating adolescents of the online study will receive a
prestructured digital questionnaire.
2. The YHC workers will be interviewed in a focusgroup after they performed the
online intervention.

The selected adolescents from the *Triage* receive at random intervention 1
(online intervention) or 2 (care as usual intervention):
1. Online (information, e-mail and chat) help from the preventive Youth Health
Care physician or nurse, with a total of maximum 3 (follow-up) contacts, over a
period of maximal 3 months, or:
2. Care as usual face-to-face contact help from the preventive Youth Health
Care physician or nurse, also with a total of maximum 3 (follow-up) contacts,
over a period of maximal 3 months

The burden and risks for the particpants of this study are minimal. All
participants (as well as in the study-, as in the control group) receive the
same intervention, and this intervention is also the same as the "care as
usual" of the preventive Youth Health Care. The difference between the 2
interventions is the way how the intervention is offered to both groups: the
control group through a face-to-face-contact and the study group
through an online (Internet) contact.
The burden and risks for the participating adolescents who are asked to fill in
a digital questionniare, and for the YHC workers who are interviewed will be
minimal.