A digital intervention to improve mental health and interpersonal resilience for young people who have experienced online sexual abuse: the i-Minds non-randomised feasibility clinical trial and nested qualitative study.

Background: No evidence-based support for young people who have experienced technology-assisted sexual abuse exists. The project's aims were to develop a digital intervention that improves mentalisation (the ability to understand the minds of oneself and others that underlies behaviour) to reduce the risk for revictimisation and future harm and improve young people's resilience.

Objectives: To co-design a mentalisation-based digital intervention; determine its feasibility, acceptability, safety and usability; and determine how to best integrate this into practice.

Methods: A mixed-methods, non-randomised study in young people aged 12-18 years exposed to technology-assisted sexual abuse across two United Kingdom sites. We adapted an existing mentalisation-based therapy manual and co-designed a digital health intervention (app) using participatory methods. Recommendations from our pre-trial qualitative work with healthcare professionals supporting young people with technology-assisted sexual abuse and lived experience consultation informed app development and trial procedures. The primary outcome was the feasibility and acceptability of delivering the digital intervention measured against relevant fields of the Consolidated Standards of Reporting Trials statement for feasibility studies. Intervention safety was reported against an adverse events procedure. Usability was guided by the framework for analysing and measuring usage and engagement data in digital interventions. Acceptability was examined using qualitative methods. The planned sample size of the feasibility clinical trial was 60 young people.

Results: Between May 2022 and March 2023, 147 young people were screened for eligibility for the feasibility clinical trial; 72 referrals were made and 43 young people were allocated to receive the intervention. We found that it was possible to recruit and retain participants to this trial. Quantitative and qualitative data showed that the i-Minds app was safe, acceptable and associated with promising signals of efficacy on valuable outcomes post treatment, including technology-assisted-sexual-abuse-related post-traumatic symptoms, resilience, internalising symptoms and reflective functioning. Most participants accessed or completed app modules. User feedback indicated that participants had a positive experience using the app, positively increasing their knowledge/understanding of their own mental health and their motivation to address their mental health difficulties. Practitioners identified the barriers to implementing i-Minds into routine practice as not being involved in its design at the outset, possible impact on workload and whether digital health interventions might replace routine care. Facilitators included the distinct nature and specificity of the i-Minds app for the target group and its ability to support young people on service waiting lists.

Limitations: There was limited ethnic diversity in the samples, reflecting potential selection bias at the referral point. Sexual orientation is not reported in the trial. The trial lacked randomisation and a control group, limiting interpretation of post-treatment improvements.

Conclusions: A mentalisation-based digital intervention is feasible, acceptable and safe. A larger-scale evaluation appears warranted. Further service improvements are required for routine assessment and support for young people experiencing technology-assisted sexual abuse.

Future work: Further questions could be explored, including evaluating training materials for online harms, developing guidelines assessing for and responding to online harms, validated measures to assess for online harms, understanding further where digital health interventions fit along the clinical care pathway, recruiting a more diverse sample, and further differentiating the forms of online harms and their consequences.

Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR131848.