Scoping Report: Using behavioural science to increase access to and use of mental health self-help tools for young people

UNPITCHD was commissioned by the LGA and a consortium of 11 North East England local authorities to develop an intervention to increase access to, and use of, mental health self-help tools for children and young people aged 10-15 who may be experiencing low mood and/or anxiety for the first time.

The 11 local authorities included in the project are: Durham, Gateshead, Hartlepool, Middlesbrough/Redcar and Cleveland (South Tees), Newcastle, Northumberland, North Tyneside, South Tyneside, Stockton-on-Tees, and Sunderland.

 

The purpose of this scoping report is to provide an overview of the insights collected to date, outline the landscape of potential interventions that arose out of the behavioural opportunities the consortium identified and summarise the final intervention.

The original challenge description (per the councils’ common bid)

• The impact of the Covid-19 pandemic on mental health for Children and Young People (CYP) has been huge, with the Mental Health of Children and Young People in England survey (2020) found 16% (1 in 6) of children aged 5 to 16 years to have a probable mental health disorder, an increase from 1 in 9 in 2017
• Evidence suggests that some children and young people, especially those with certain characteristics, such as those who are disadvantaged economically, females, and those with pre-existing mental health needs, have experienced greater negative impacts on their mental health and wellbeing.
• Improving mental health outcomes for children and young people is aligned to priorities for all 11 of the local authorities in the North East, who aim to promote good mental health for children and young people and improve access by reducing demand on specialist services

The chosen challenge statement for all 11 councils:

Improve access to and use of mental health self-help and resilience tools for young people aged 10-15 who may be experiencing low mood and/or anxiety for the first time.

Insights gathering phase overview:

1. Insights gathering activities
2. Literature review
3. Consortium meetings
4. Insights gathering outcomes

Insights gathering activities conducted by the PMs of each council and UNPITCHD were articulated in 3 sub-phases: Conduct, Capture, and Distil.

i. Conduct: Conducting insights gathering activities, such as:

• Interviews with children and young people, parents, and adults who work with CYP
• Creating and disseminating a survey to CYP
• Other insights activities (i.e. downloading and immersing themselves in existing mental health tools)

ii. Capture: Capturing observation, notes, and quotes in the excel insights collection template

• Using excel template to record observations and behavioural insights
• Designating insights using the COM-B framework

iii. Distil: Distil insights into ‘behavioural opportunities’

• Recording results of the capture phase in ‘behavioural opportunity templates’
• Consortium-level synthesis of insights

Insights Gathering: overview in numbers of the sample sizes:

• Qualitative sample sizes:
  • 16 children and young people
  • six parents
  • 29 adults who work with young people
• Quantitative sample size: 233 survey respondents (10-15 year olds.)

The UNPITCHD team conducted a thorough literature review, comprised of:

• Reports and grey literature collected from PMs around the consortium
• Peer reviewed literature such as journal articles
• Reports from mental health organisations such as Kooth

The literature review examined several themes within mental health, potential target groups, the work of existing organisations in the space as well as previous interventions with CYP mental health.

This phase consisted of three monthly consortium meetings:

1. Insights gathering planning
2. COM-B training and how to analyse behavioural insights
3. Collective analysis debrief and storytelling

We identified six overarching barriers to access for self-help tools following the analysis of our insights.

1. Lack of awareness of self-help tools: “CYP just don’t know self-help tools exist”
2. Lack of perceived relevance: “CYP don’t think self-help tools are for them”
3. Perceived effortfulness to engage: “Using self-help tools feels like too much work”
4. Leveraging the right messengers: “CYP listen to their friends and trusted authorities when it comes to mental health issues”
5. No triggers: “There are no reminders to use tools”
6. Self-help tools are not accessible to everyone: “Once they are made aware of their existence, CYP need the means to use them”

Key elements of ideation of intervention ideas and feasibility:

1. Potential intervention ideas
2. Criteria for a successful intervention

During our ideation consortium meeting, the group came up with over 50 intervention ideas using the insights gathered (as articulated in section II.). Through thematic analysis of the original 50 ideas, the group identified 5 potential communications campaign intervention ideas to address the behaviours and attitudes we observed in our insights gathering:

1. Above the line communications campaign
2. Social Media Campaign
3. In-context communications
4. Communications Products
5. Co-creation with children and young people in schools

Those five key communication campaigns formed our short-list of options for an intervention.

We used the APEASE criteria to help us identify the best intervention amongst the five potential options.

APEASE criteria:

• Acceptability: acceptable to potential partners (I.e. Kooth, communications teams in councils)
• Practicality: the intervention is practically possible
• Effectiveness: potential for high impact
• Affordability: not too resource intensive and within council budgets
• Side-effects: low chance for unintended negative consequences
• Equity: intervention addresses issues of equity

In addition to the APEASE criteria, the UNPITCHD team suggested four additional measures:

• Pathway to data: how will we get data to measure our effect?
• Measurability: can the intervention be measured to demonstrate success?
• Replicability: can other local authorities replicate this work easily and take on our learnings?
• Joy factor: is there energy for this intervention?

Using the criteria above, the consortium identified the chosen intervention.

Our intervention will consist of testing three to five co-created behavioural messages on social media with 13-15 year olds, to understand which behavioural principle(s) are most effective for driving awareness of and engagement with self-help tools.

The intervention will be a randomised control trial in 11 North East England councils over 5 weeks in January and February 2023.

We will co-create the communications with CYP in the North East in a session in December.

We will test our 3-5 behaviourally informed, co-created comms against a control communication to assess impact on uptake. The adverts will be linked to Kooth to anchor to a real self-help tool.

The roll out of the intervention (under the scope of this project) will take place in three stages:

1. Co-creation with three to five CYP from the North East of England
   1. A co-creation session will take place on zoom with CYP recruited by the PMs, in order to create three to five communications informed by our ‘five behavioural pathways’
2. Test three to five messages on social media with our 13-15-year-old audience
3. Identify winning message
   1. The social media campaign will enable us to measure which message is driving the most:
      1. Curiosity for self-help tools
      2. Adoption of the self-help tools
   2. Our report will include recommendations on how to roll-out future comms that will relay the winning message

To remedy some limitations of the interventions (namely digital exclusion, the impossibility to ‘target 10-13 year olds on social media) and to make the most of our findings, the individual councils will be encouraged to take the project into a Phase 2.

All councils will be able to take forward the learnings of the project to develop and distribute physical and in-context comms using the winning message (with more confidence that the investment will yield adoption).

Examples of locations include poster boards in community centres, flyers, in school buses, and on the back of toilet doors.

Phase 2. is optional for the PMs, beyond the scope of the contracted work with the LGA and UNPITCHD.

On Instagram, we will use ad tools and metrics to both target our audience (13-15 year olds in the North East) as well as measure the relative performance of each ad (click-through ratio) and click through cost.

Via Kooth, we will measure the number of site visits and new joiners.

Kooth Collaboration

Following talks with Kooth, they are happy to collaborate with us. In discussion with Kooth, we agreed:

• The social media intervention co-created by the mental health champions in each of the councils will link and advertise Kooth’s services
• UNPITCHD will send our collected insights to date, including the potential intervention ideas and will continue to share the insights gathered as part of the intervention (for example, invite Kooth to observe our co-creation session with children and young people)
• In exchange, Kooth will provide the data necessary to assess the impact of the intervention on the traffic and uptake of its services in the regions targeted over the duration of the pilot (approximately 5 weeks). Kooth will also suspend additional digital campaigns in the region during that period so that we may isolate the effect of the intervention.

Next steps for trial launch

1. Trial planning: Data collection and measurement
   1. Data extraction and evaluation methods will need to be put in place, via Instagram ad insights and an additional Kooth extraction.
2. Co-creation of communications materials session with CYP:
   1. PMs will recruit 3-5 CYP from around the consortium to participate, UNPITCHD will create the stimulus comms, prepare and run the session in early December.
3. Instagram set-up: Setting up the right targeting tools and metrics for a successful comms campaign
4. Collection of data and data analysis

Timeline of next milestones

• Launch planning consortium meeting Dec 7th
• Co-creation session with CYP: early December
• Finalising intervention materials: December to early January
• Intervention running: Mid January to February
• Final report writing: Feb-March

Full list of works consulted