Introduction and where to start?

Introduction  

It’s a fine balance between being pragmatic and living within the required security and privacy governance, our own limits of competence and our ethical frameworks. - ACTO, 2020

This toolkit pulls together best practice learning on how to support young people’s mental health and wellbeing remotely in a safe and accessible way. While organisations have been forced to adapt rapidly during a time of international upheaval and uncertainty, it is clear from Youth Access members that the lockdown has brought opportunities, too, and many of the practices adopted during the crisis will be continued beyond social distancing.  

This toolkit isn’t designed to teach you what you already know, but it is hoped its contents will be able to support your organisation with remote working wherever you’re at. You don’t have to read it all the way through: each section can be used by itself, or in conjunction with others – so choose those that are most relevant to your organisation. It’s perhaps most important to note that, as with face-to-face support, there is no one-size-fits-all model of remote working with young people.  

Please note: ‘Remote’ support in this toolkit refers to anything that is not carried out in-person, and typically takes place online or via telephone. Much of the guidance applies to multiple forms of remote working; when advice applies to only certain tools, this is specified. We use the terms ‘therapy’, ‘support’ and ‘practice’ interchangeably, to encompass the full spectrum of mental health and wellbeing support offered to young people. However, it is acknowledged that YIACS provide a wide range of interventions that fall under alternative definitions. 


 Where to start?

“I have found that, for staff, and for young people and families, the contact with one another and knowing our service is still there and still available has been the most important thing...The other developments in how we can offer our service during this time have followed from that, but the connectedness is the first thing that needs to be in place.”  - Kirsty Drysdale, Primary Care Wellbeing Practitioner Team Lead, YPAS

Youth Access’ Going Digital, written in 2017, provides important learning to support members to work ethically and safely. It suggests that individuals and services seeking to incorporate remote therapy into their practice begin with a three-point checklist, which we have updated here to include present-day considerations 

1.Consider possible risks   

Supporting young people remotely brings a unique set of risks, which need to be considered carefully before and whilst incorporating this into your practice. We have listed some of these here, and will cover how to safeguard against these risks in detail later in the toolkit.

  • The Disinhibition Effect: Practitioners don’t have the same control during remote sessions, and the fact of being physically separated can encourage feelings of fantasy and unreality for the young person involved. Being online creates a sense of anonymity, which can lead individuals to act with less restraint than in face-to-face sessions. They may end up sharing and disclosing more early in the therapeutic relationship.  
  • The Black hole effect: You may experience a young person disappearing from the screen suddenly, which could be down to several factors, including accidental ones like a loss of internet connection. Whatever the case, young people need to be made aware from the offset how you will respond to them disappearing from the session without warning and how you will deal with disclosures and safeguarding issues. 
  • Difficulty in spotting safeguarding concerns: Supporting young people via video call, telephone or other non-face-to-face means makes it harder for practitioners to notice changes in a young person’s physical appearance or behaviour and to spot safeguarding concerns.  
  • Lack of confidentiality: Some young people aren’t able to be supported confidentially due to a lack of private space in their home, difficult or dangerous home environments, or family members / housemates who don’t know they’re receiving support. It may also be difficult for a young person to discuss their concerns freely if their home circumstances are part of the problem.  
  • Remote support presents too many barriers: Others may be unwilling to access remote support because speaking on the phone or via video increases their anxiety. Youth Access members have also raised concerns about reaching young people who have limited use of English, difficulties with language in general or Special Educational Needs and Disabilities (SEND).
  • Limited access to technology: Many young people have little or no access to the means by which to receive support remotely and important consideration needs to be given to young people who don’t have internet connection or access to devices, and for whom data and phone credit costs are prohibitive.  
  • Concern that remote support is inferior: Some young people may be unwilling to receive support online or over the phone because they fear it will be ineffective, or less effective, than face-to-face support.  

2. Are you up to date with the relevant regulations and legislation? 

Consider which regulations and legislation apply to remote therapy and what your organisation’s current practice is in these areas. These will depend to an extent on what support you offer, but we have included two that are universally applicable below.

Ethical framework for remote support

Though it presents unique challenges, the ethical principles and values for online work are no different than for face-to-face. As such, the BACP advises practitioners to use its good practice Fact Sheet in conjunction with, not instead of, its Ethical Framework for the Counselling Professions. These two documents are a good place to start when thinking about bringing remote support into your practice.

If you or your organisation are part of a different regulatory body, it is advisable to seek out their guidance for remote practice, too.

In addition, the Association of Counselling and Therapy Online (ACTO) is a vital source of information and support on how to deliver ethical online therapy and has a dedicated live document for remote working during the coronavirus pandemic.

GDPR

This is a crucial consideration for any organisation working remotely with young people, so that young people’s data are being protected, to support safeguarding processes and ensure you are operating within the law. The ICO has an easy-to-read guide on this, and you can read more on GDPR compliance in relation to coronavirus in this toolkit’s section on digital security and privacy.

3.Develop relevant policies and integrate into your existing face-to-face service   

Introducing remote support to your service will require a process of review and an update of your organisational policies – something that has been highlighted by Youth Access members since the lockdown. Some areas to consider include:   

  • Online safety policy statement and agreement
  • Referral and waiting list policies and procedures
  • Data protection policy   
  • Confidentiality policy   
  • Online service risk policy   
  • Therapeutic agreement   
  • Out of service hours / out of area risk management policy

Key resources

Next section: Which online tools should we use?