Part 1 - Notes

Part 1 -
Technology and
Young People
Connecting Our Worlds
ReachOutPro.com.au Educational Module

Part 1. Technology and Young People

ReachOutPro.com.au Educational Module Part 1 Technology and Young People

Part 1- Technology and
Young People
The following document and corresponding slides aim to provide you with a basic
understanding of how using technology may help your practice. It will also begin
to provide you with strategies to integrate technology into your sessions. Specific
learning goals are;

• An understanding of the benefits associated with using
technologies both to your own professional development and
with young people;

• An understanding of what young people feel might be useful
and why;

• A basic knowledge of current research into the use of
technology with young people and evidence supporting this;

• An understanding of why it’s not essential to be an expert in
technology in order to use it with good effect with young people.

It is also important to note that Part 1 of this module is designed to be utilised
with the other 3 remaining parts. Each section has been developed with the aim
of providing you with an overview of the key aspects of technology, how you can
implement these into practice as well as covering professional considerations.
We recognise that the evidence supporting the use of technology is still emerging
and that there are risks associated with technology use. We therefore advise
reviewing the information about risks and managing your online safety which can
be found in Part 4.

Page 2


The changing face of technology
Within each generation, technological changes become faster and more innovative.
However, this means that it can often seem like once you’ve got your head around
one version of a program, an update appears! Or once you understand one social
networking site, young people move onto another.

As clinicians who work with youth, we are often time poor, resource stretched, and can
at times work with difficult to engage clients. For these reasons, any tools that enable
you to engage more readily with young people are helpful. Whether it be through
assisting in building rapport, assessment tools, monitoring mood or symptoms, or
even psycho-educational – technology can make your job easier for you.

Youth and Technology
For many reasons, young people may engage better with a technology assisted
session, than a traditional face-to-face, medical model consultation. This is likely to be
due to the integration of technology in young people’s lives - a trend that is becoming
increasingly more apparent.

Within Australia;

• 91% of 12-17 year olds indicated that the internet was a ‘highly important’
part of their life [1].

• Over 95% of young Australians use the internet [2].

• The majority of young people spend between 1.1-3.0 hours per day on the
internet [3].

• Online chatting was ranked at the most favoured leisure activity by young
people [1].

- This use dramatically changes the ways in which they interact with
one another, their families and communities.

- The use of technology by young people has been shown to
enhance communication with family, friends and wider networks [4, 5]
and is thought to be key in social inclusion [6].

• Of those online, social media has become the most common activity - with
73% of online Australians using social media in 2010 [7]

In addition to the traditional computer-based internet, increasing prevalence of mobile
technology is also allowing online interactions to occur more frequently and easily.

• In 2010, 95% of Australians had mobile phones

• 10% of people in Australia no longer have landline phones, using mobiles
instead [8].

• Of those Australians that are online, 25.3% are now accessing the internet
using mobile phones [2].

Page 3


The constantly connected generation
This constant connectivity and use of technology has resulted in the current generation
of young people being labelled the ‘constantly connected generation[9]. Understanding
why and how young people use technology is a vital part of this understanding both the
young people themselves, and how to communicate with them. Whilst social networking
sites like Facebook and MySpace receive the most publicity, many young people use
the internet to access information and services that they would not feel comfortable
doing day-to-day. Internet connectivity is now a crucial part of help seeking for many
and is helping to reduce traditional barriers to accessing help.

Recent research has indicated that;

• The internet has been identified as a key source of advice and support by young
people [10], and the proportion of young people accessing support and advice
through the internet has increased from 10.1 per cent in 2002 to 22.5 per cent in
2009 [11].

• When seeking help, 85.9% sought help from friends – which may be initiated
through face-to-face contact, instant messaging or chat, SMS, or via networking
sites. Comparatively, only 11.7% would seek help from community agencies (eg
youth workers) [5].

• The headspace National Youth and Parent Community Survey (2008) assessed
young people’s Internet use in Australia and the perception of usefulness of online
mental health services. Within this survey, 76.9% of young people reported using
the internet to connect with other young people. Of those in the 18-25 year old
group, 33.9% reported using it to seek information about a mental health problem[3].

• The recent ReachOut.com National Survey 2010 has shown that in tough times,
more than 65% of young people would be likely or very likely to seek help on
ReachOut.com or other websites whereas 52% would be likely or very unlikely to
talk to a professional such as a GP or counsellor [12].

Page 4


The argument for technology
Within the field of medical management and healthcare, there is increasing interest
being paid to Health 2.0. Such a model encourages the health care professional and
patient to engage with technology in the form of information sharing and monitoring.
This is likely to enhance access to patient information but also facilitate meeting
clinician needs through the use of streamlined educational delivery and access.

The improvements in technology have not only benefitted and empowered health
care professionals. Young people want to access mental health support in a manner
that suits them, in the time and place that it will be most beneficial [13]. However,
the majority do not seek help through mental health services [14]. As therapeutic
relationship is thought to be one of the best predictors of outcome with young people
[15, 16], engaging them in a way in which they relate to and understand, such as
using technology, may help to facilitate outcomes [17].

There are many advantages to using technology with young people. These include,
but are not limited to;

• The internet is not restricted by geographical, psychological or physical barriers
and can reach those that would otherwise be difficult to reach [18-20].

• The effectiveness of online therapy can be a beneficial adjunct to standard
therapy [21-24] or as a brief intervention [18], particularly in areas of limited resources,
such as in youth mental health [25, 26].

• Using the internet can result in the young person feeling empowered and more
in control [3]. It allows them to be ‘able to dip their toe in or out’ and moderate the
intensity and duration of contact – particularly around sensitive topics [14, 27].

• Technology also spans the digital divide and may help marginalised young people
gain access to services [11].

• Embracing technology many help to overcome generation awkwardness or
barriers such as shyness or lack of confidence in communication

- Emails for example, have been shown to increase the directness in help-
seeking and the reporting of physical complaints by adolescents to
healthcare professionals [28].

• Failing to recognise and link the young person to online networks leaves a crucial
area of support ignored.

- The internet has been shown to be important in building the support networks
of young people [29].

- Additionally, the research indicates that young people may more accurately
represent their perception of their personality online [30, 31]. Therefore providing
an alternative data source during assessment.

In addition to these factors, the role of health care professionals in guiding young
people through these sites has also been recognised. Recently, a study of youth
workers indicated that 90% of respondents believed that youth workers had an
important role in helping youth navigate technology [32].

Page 5


Using technology with young people
Regardless of the individual clinicians’ experience, there is no doubt that the idea of
using technology in clinical practice is daunting and raises a number of challenges.
In fact, despite the increased awareness of need, only 35% of youth workers felt
equipped with the knowledge to assist young people navigate the internet [33].
Technological change is so rapid and many of us have never been exposed to social
networking, ipods, the internet, mobile phones or computers while we were at school
or university. Even if you were exposed to computers in your mental health training
there is a good chance you’ve not received any training or exposure to how computers
can be used to enhance your work with young people and support mental health
outcomes.

Upgrades to available technologies happen regularly, and in many cases faster than
most can keep up, however the general foundation for use never changes, it just
gets easier based on user needs. Similarly to keeping up to date on current research
outcomes by following journal articles, keeping up with technology requires regular
but not extreme effort and can easily become part of regular practice. Once a basic
understanding is developed, often general principles can be applied across programs
and settings.

The good news is that in order to gain the benefits from using technology in sessions,
you don’t have to be a technological expert. What a young person would find useful
will vary for each individual. The essential consensus in interviews with young people
suggests having an open dialogue with the young person, taking an interest in their
needs and knowledge and having a variety of options and suggestions is ideal.

• While young people don’t require clinicians to be experts on using technology,
they appreciate openness to exploring their opinion and flexibility of practice.
Each young person who presents to you may find different things helpful to them.
Consequently, we encourage an active dialogue with the young person regarding
the use of technology.

• Let them be the expert and let them guide you as to what would be preferable.
Having a basic understanding of what types of technologies you might use in
clinical practice, along with a good sense of clinically appropriate boundaries and
safety is recommended, but the rest can be negotiated with the individual you are
working with.

• Young people describe an appreciation of being listened to and being
acknowledged as the experts in their own lives, given technology is often such a
big part of those lives, we encourage you to take the same approach.

• Websites such as Beacon (http://www.beacon.anu.edu.au/) can also offer support
and guidance about the strength of evidence of an intervention [34].

Page 6


“Be open to using technology in your practice. We young people
live in a world of technology, so we know our stuff. If you are unsure
about how to use something, let us know, because we would be more
than happy to help you understand it. Especially if we know that it is
going to be used in supporting other young people. We like to help as
it gives us a voice in our treatment plans. If you want to know more
about mobiles, let us talk to you about them. If you want to understand
how to surf the net for places that we young people hang at, give us
this knowledge so we can inform you. Be open with us, and we will be
open with you.” Becks 2010

“Technology plays such a huge role in the lives of young people - and
I don’t think it’s about the health care professional even being a pro at
using technology because it’s constantly changing. I used to help my
counsellors learn chat lingo and it made me feel like I had something
to offer and communicated to me that they were interested in my world
(not just my problems).” Meke 2010

Technology, risks and professional
boundaries
Whilst technology has many benefits, it also has its draw backs too. Issues around
boundaries and appropriateness of communications can be blurred and so good
judgement needs to be exercised. Part 4 – Safety and Professional Issues provides
more details about ethical boundaries and safe use of technology to help guide you
through this.

Despite the challenges of negotiating technology use, we believe and the literature
supports, that when using technology with young people, the benefits far outweigh the
risks.

Access to technology
Frustratingly, we recognise that many professionals who work with young people don’t
have access to the technology that would enable them to engage readily with some of
the aforementioned sites. We understand that this can be limiting but is something that
needs to be addressed if organisations and institutions want to engage young people
in new and innovative ways.

The one page rational document attached below presents key statistics and
references as a resource for professionals who are wishing to negotiate within their
organisations for improved access to technology for the purpose of working with
young people [link to Rationale document].

Page 7


What’s next
The following three parts to this Module will help you to negotiate the technology path.
Part 2 will introduce you to common programs, tools and sites that young people are
using, or that you may like to use in your practice. Whereas Part 3 is more of a ‘how
to guide’ which will assist you in using technology or initiating conversations with
young people about technology.

Click here to proceed to Part 2 – Learning the Language of Technology

For further information on the information presented in Part 1 refer to the reference list
below.

Part 1 Reference List
1. Australian Communications and Media Authority, Australia in the Digital
Economy R.J. Xavier, Editor. 2008, Australian Communications and Media
Authority: Canberra.

2. Ewing, S., J. Thomas, and J. Schiessl, CCI Digital Futures Report: The
Internet in Australia. 2008, ARC Centre of Excellence for Creative Industries
and Innovation Institute for Social Research, Swinburne University
of Technology: Melbourne: Australia. .

3. Burns, J.M., et al., The internet as a setting for mental health service
utilisation by young people. Med J Aust, 2010. 192(11 Suppl): p. S22-6.

4. Grinter, R.E. and M. Eldridge, Wan2tlk? : Everyday text messaging, in
Proceedings of ACM Conference on Human Factors in Computing System
(CHI 2003). 2003: Fort Lauderdale, Florida, USA.

5. Grinter, R.E. and L. Palen, Instant Messaging in teenage life. , in ACM
Conference on Computer Supported Cooperative 2002, NY: ACM Press. p.
21-30.

6. Wyn, J., et al., Young people, wellbeing and communication technologies.
2005, Victorian Health Promotion Foundation: Melbourne.

7. AC Nielsen. Nine Million Australians now interacting via social networking
sites. 2010 [cited 2011 4th April, 2011]; Available from: http://www.nielsen-
online.com/pr/social_media_report-mar10.pdf.

8. The Australian Communications and Media Authority, Communications
Report 2008-09. 2010, ACMA: Melbourne.

9. Clark, L.S., The constant contact generation: exploring teen friendship
networks online
New York, in Girl Wide Web, S. Mazzarella and Peter Lang, Editors. 2005. p.
203–221.

10. Gould, M.S., et al., Seeking help from the internet during adolescence. J Am
Acad Child Adolesc Psychiatry, 2002. 41(10): p. 1182-9.

11. Mission Australia, National Survey of Young Australians 2009: Key &
emerging issues. 2010, Mission Australia: Sydney.

12. Metcalf, A., J. Stephens-Reicher, and P. Collins, ReachOut.com National
Survey 2010. 2010.

Page 8


13. Blanchard, M., Navigating the Digital Disconnect: Understanding the use of
information communication technologies by the youth health workforce
to improve young people’s mental health and wellbeing. , in Orygen
Youth Health Research Centre, Centre for Youth Mental Health.
2011, University of Melbourne Melbourne

14. Burns, J.M., L.A. Durkin, and J. Nicholas, Mental health of young people in
the United States: what role can the internet play in reducing stigma and
promoting help seeking? J Adolesc Health, 2009. 45(1): p. 95-7.

15. Barrett, M.S., et al., Early Withdrawal from Mental Health Treatment:
Implications for Psychotherapy Practice. Psychotherapy, 2008. 45(2): p. 247-
267.

16. Castonguay, L.G. and L.E. Beutler, Principles of therapeutic change: a task
force on participants, relationships, and techniques factors. J Clin Psychol,
2006. 62(6): p. 631-8.

17. Choudhury, B.C.C.M.S., et al., Alliance, technology, and outcome in the
treatment of anxious youth Cognitive and Behavioral Practice, 2004. 11(1): p.
44-55.

18. Tait, R.J. and H. Christensen, Internet-based interventions for young people
with problematic substance use: a systematic review. Med J Aust, 2010.
192(11 Suppl): p. S15-21.

19. Leach, L.S., et al., Websites as a mode of delivering mental health
information: perceptions from the Australian public. Soc Psychiatry Psychiatr
Epidemiol, 2007. 42(2): p. 167-72.

20. Christensen, H. and K. Griffiths, The Internet and mental health literacy. Aust
N Z J Psychiatry, 2000. 34(6): p. 975-9.

21. Calear, A.L. and H. Christensen, Review of internet-based prevention and
treatment programs for anxiety and depression in children and adolescents.
Med J Aust, 2010. 192(11 Suppl): p. S12-4.

22. van Straten, A., et al., Stepped care for depression in primary care: what
should be offered and how? Med J Aust, 2010. 192(11 Suppl): p. S36-9.

23. Perini, S., N. Titov, and G. Andrews, Clinician-assisted Internet-based
treatment is effective for depression: randomized controlled trial. Aust N Z J
Psychiatry, 2009. 43(6): p. 571-8.

24. Hickie, I.B., et al., Practitioner-supported delivery of internet-based cognitive
behaviour therapy: evaluation of the feasibility of conducting a cluster
randomised trial. Med J Aust, 2010. 192(11 Suppl): p. S31-5.

25. Eassau, C.A., Frequency and patterns of mental health services utilization
among adolescents with anxiety and depressive disorders. Depression and
Anxiety, 2005. 22: p. 130-137.

26. Olfson, M., M.J. Gameroff, and S.C. Marcus, Outpatient treatment of child
and adolescent depression in the United States. Archives of General
Psychiatry, 2003. 60: p. 1236-1242.

27. Burns, J., et al., Reach Out! Innovation in service delivery. Med J Aust, 2007.
187(7 Suppl): p. S31-4.

28. Harvey, K., et al., Health communication and adolescents: what do their
emails tell us? Family Practice, 2008. 25(4): p. 304-311.

29. Stanton-Salazar, R. and S. Spina, Adolescent Peer Networks as a Context
for Social and Emotional Support. Youth and Society, 2005. 36(4): p. 379-
417.

Page 9


30. Larsen, M.C. Understanding Social Networking: On Young People’s
Construction and Co-construction of Identity Online. 2007 [cited 2011, April
4th, 2011]; Available from: http://citeseerx.ist.psu.edu/viewdoc/download?doi
=10.1.1.168.3872&rep=rep1&type=pdf.

31. Stern, S., Producing Sites, Exploring Identities: Youth Online Authorship,
in Youth, Identity, and Digital Media, D. Buckingham, Editor. 2008,
Massachusetts Institute of Technology: Boston. p. 95-117.

32. Davies, T. and P. Cranston. Youth Work and Social Networking. 2008 [cited
2011 April 1st, 2011]; Available from: http://www.gallomanor.com/files/GFSR.
pdf.

33. Davies, T. and C. P., Youth Work and Social Networking: Interim Report.
2008, The National Youth Agency.

34. Christensen, H., et al., Beacon: a web portal to high-quality mental health
websites for use by health professionals and the public. Med J Aust, 2010.
192(11 Suppl): p. S40-4.

Page 10


Additional references for the use
of technology for the engagement,
prevention and treatment of mental and
physical health problems.
Atun, R. and S. Sittampalam. A review of the characteristics and benefits of SMS in
deliverying healthcare. The Role of Mobile Phones in Increasing Accessibility and
Efficiency in Healthcare Report. Vodafone, 2006.

Griffiths, K. Farrer, L., & Christensen, H. Clickety-click: e-mental health train on track.
Australiasan Psychiatry, 2007, 15(2), 100-108.

Griffiths K. M., & Christensen, H. Internet-based mental health programs: A powerful
tool in the rural medical kit. The Australian Journal of Rural Health, 2007, 15(2), 81-87.

Fjeldsoe, B.S., Marshall A.L., and Miller Y.D., Behavior change interventions delivered
by mobile telephone short-message service. American Journal of Preventive
Medicine, 2009, 36(2), 165-73.

Menon-Johansson AS, McNaught F, Mandalia S, Sullivan AK. Texting decreases the
time to treatment for genital Chlamydia trachomatis infection. Sexually Transmitted
Infections, 2006, 82, 49 –51.

Pal, B., The doctor will text you now; is there a role for the mobile telephone in
health care? British Medical Journal, 2003, 326, 607.

Petrie, K.J., et al. A Text Message Program Designed to Modify Patients’ Illness and
Treatment Beliefs Improves Adherence to Asthma Preventer Medication. European
Journal of Health Psychology, 2010, in press.

Pijnenborg, G.H.M., Withaar, F.K., Brouwer, W.H., Timmerman, M.E., van den Bosch,
R.J. and Evans, J.J. The efficacy of SMS text messages to compensate for the
effects of cognitive impairments in schizophrenia. British Journal of Clinical
Psychology, 2010, 49(2), 259-274.

Rice, R. and Katz, J. Comparing internet and mobile phone usage: potential, pitfalls
and policy. American Journal of Preventative Medicine, 2003, 27, 597-623.

Ritterband L M, Thorndike F P, Cox D J, Kovatchev, Gonder Frederick L A. A behaviour
change model for internet interventions. Annals of Behavioral Medicine, 2009, 38(1),
18-27.

Wantland, D. J., Portillo, C. J., Holzemer, W. L., Slaughter, R., & McGhee, E, M. The
effectiveness of web-based vs non-web-based interventions: A meta-analysis of
behavioural change outcomes. Journal Medical Internet Research, 2004, 10;6(4),e-40.

Page 11

Part 1 - Notes

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Part 1 - Notes