The main aim of this research is to explore the potential benefits, and explore the economic case, for peer support in Kooth. The authors analysed whether participants obtained better outcomes over a 1 month period after having accessed Kooth, whether they attribute changes in part to use of Kooth, and at what cost.

The authors stated this their report that; “From an economic perspective, the Kooth intervention can be considered good “value for money” when used to target those outcomes that were found

to be significant (YP-CORE- reduced psychological distress, SIDAS, reduced suicidal ideation, HOPE - improved hope). This finding is also supported when comparing Kooth with similar interventions aimed at improving mental health in children and adolescents.”

Kooth has produced a conversion of the UK Economic Evaluation model to be applicable to the US Market. The Kooth program has demonstrated success with children and young people and can project significant cost savings, both in terms of medical cost and societal impact.. 

Medical costs could be reduced by an estimated $790.72 per user while society could see an added $18.49 per user in benefits. 

For a population of 1,000 children and young people, 92% are expected to have an emerging mental health need (EMHN) and Kooth expects a 76.5% retention rate. Ultimately 704 are expected to engage with Kooth. The total population projected savings related to medical costs is $556,664 with a potential societal impact of $13,019.

This report utilised data from the first five months of this pioneering pilot demonstrates the value, as well as the need, in having Kooth available as a digital mental health and wellbeing service across whole-school districts in Pennsylvania. Key education-based stakeholders in school districts involved in this pilot program have reiterated the increasing mental health needs of their students, which outstrip the current resource in many of their schools, and alongside leading academics, have shown support for Kooth as a digital platform to provide mental health and wellbeing support to their students. This report provides early evidence around how Kooth can (1) improve access to mental health and wellbeing services, (2) reduce the need for downstream intervention with early help, (3) enable the use of other services, and (4) impact the school system, at a student and organisational level.

The early Kooth Theory of System Change outlines the predicted long-term change as a result of the Kooth whole-school approach to mental health and well-being. The framework describes sequential events within the Kooth service (inputs, activities, outputs, and outcomes) and theorises the potential impacts on wider systems. By providing the Kooth service and enabling mechanisms of change, Kooth can contribute to improved literacy and agency; social, emotional, and mental wellbeing; downstream service access; school and economic outcomes. Therefore, it is theorised that Kooth meaningfully impacts wider systems in Pennsylvania, such as the education, healthcare, government, judicial, and economic systems, leading to positive systemic change.

Using Kooth’s data, this paper explores the impact of the pandemic on service access and presenting concerns and whether differences were observed by sociodemographic characteristics in terms of access (gender, ethnicity and deprivation). 

Activity and contact with digital web-based therapy increased in the first few months of the pandemic. Significant changes were observed in referral routes to the service, unsurprisedly a drop in referrals from educational settings was observed due to school-based lockdowns. 

Changes were observed in presenting concerns for service users before and during the pandemic, reflecting some of the immediate mental health impacts, including a significant increase in risk, abuse, and safeguarding issues for young peole but also mental health concerns, suicidality and, self-harm demonstrating the enhancing vulnerability for young peole during the pandemic.

As the UK’s leading digital mental health service provider, we provided anonymised mental health insights to support the NHS and Local Authorities, Public Health England, policymakers, charities, and businesses since the UK’s first lockdown in March 2020.

This report provides a unique analysis of access, severity and needs during the Covid-19 lockdowns in the UK.

This study examines changes in user engagement with Kooth during the COVID-19 pandemic. The cohort study, based on usage data, included 18,889 users aged 14-25, split into pre-COVID and COVID cohorts. Results show a notable shift in primary engagement clusters, with a greater proportion of users in the COVID cohort engaging primarily with community-based interventions. 

The study identified significant changes in how users engaged with digital mental health services during the COVID-19 pandemic.  While users were generally less engaged during the pandemic, there was a notable increase in users seeking community-based interventions. The findings emphasised that continuous monitoring of user engagement patterns is crucial to develop informed designs and personalised interventions, since patterns within digital mental health services may be susceptible to change in response to external events such as a pandemic.

This paper develops a measure to assess brief therapeutic interventions to be used in a web-based digital therapy setting. No measure before this captured the benefit and/or ‘change’ directly related to these brief sessions. This study included a pre- and post-questionnaire for users to identify what they wanted to get from their session, and how well they thought it was achieved. 

This paper provided a new measure, as well as helped young people  generalise their thoughts and feelings into achievable goals. it helped focus the chat and provided a framework 

This paper focuses on testing the validity of the previously created SWAN-OM measure (see below). More specifically, it measured concurrent validity against other frequently used outcome and experience measures, at a web-based service. 

Findings show that the SWAN-OM demonstrates good concurrent validity with common measures of outcome and experience.

This study outlines the development of a measure for single session wants and needs in adults using contemporary machine learning methods and textual data analysis of transcript data from Qwell's counselling sessions. The study solicited feedback from clinical experts and Qwell service users  to refine the measure. 

The aim of the study is to provide insights into the wants and needs of users and improve mental health support. The study focuses on developing outcome measures in the context of 'single sessions' and refining automated methods through collaboration with clinicians and individuals with lived experience.

The aim of the study is to provide insights into the wants and needs of users and improve mental health support. The study focuses on developing outcome measures in the context of 'single sessions' and refining automated methods through collaboration with clinicians and individuals with lived experience.

This paper assessed changes in the wellbeing and mental health of Kooth users over one month, specifically focussing on the platform’s community features. Young people completed a survey when they first accessed Kooth and again one month later. In addition, a few qualitative interviews were completed to explore perceptions of the Kooth community. 

The findings suggest improvements across psychological distress, suicidal ideation, loneliness and more. This was similar for users who utilised only the community features of Kooth, as well as those who engaged with counsellors

The aim of the study is to provide insights into the wants and needs of users and improve mental health support. The study focuses on developing outcome measures in the context of 'single sessions' and refining automated methods through collaboration with clinicians and individuals with lived experience.

In this paper we demonstrate the development of an online experience measure for a specific children and young people's community forum inside a digital mental health service. The development of the Peer Online Community Experience Measure (POCEM) is informed by a multi-phased design.

Findings showed that Young People who participated in the community as writers found it more helpful than those who consume the community as viewers. young service users( 10 - 14 years ) have a more positive experience within the community. Outcomes frequently selected show the importance of certain aspects of the community, such as safety, connection, and non-judgment previously highlighted in the literature.

Kooth created the POCEM (Peer Online Community Experience Measure) to explore experiences with online content. This study provides novel insight into how children and young people interact with the POCEM measure.

The results appear to demonstrate that overall, the young people found web-based peer support helpful. They indicate that peer support can provide an important strand of care within a supportive mental health ecosystem, particularly during time periods when in-person support is typically closed.

Individuals suggested the forums were supportive environments where they felt able to interact to share helpful advice and ask questions, making them feel less alone and more connected to others.

Analysis indicated that forums do not replace the role of a counsellor, but they provide a valuable place for young people to gain additional, lower level support requirements.

The aim of the research was to gain an understanding of how young people use an online forum on Kooth for emotional and mental health issues. There was an investigation into what young people discuss and how they seek support on the forum and how the young service users responded to posts to gain an understanding of how young people provided each other with peer-to-peer support.

Online forums provide young people with both informational and emotional support around a wide array of topics. Informational/emotional support can be seen as either directive or non-directive.

This paper identified patterns of goal-based outcome (GBO) engagement in digital therapy for adults. Goals were examined for level of progress on goal, pattern of engagement with self-set vs. collaboratively-set goals and the influence of key presenting issues on goal progress. 

Results showed that goals set collaboratively with a practitioner were successfully achieved more than those set independently, as well as those with a practitioner-recorded presenting issue. 

These insights suggest that goals are useful for monitoring therapeutic progress with adults within the digital context.

Utilising data from Kooth, this paper examined how university students use web-based therapy, specifically focusing on goal setting. The results suggest better engagement with goals from younger individuals (18–22). Additionally, males were less likely to set goals and less likely to move towards achieving them , whereas females showed increased movement and achievement.

Most young people made significant movement towards their collaboratively agreed goals in Kooth, which is a good indication that the service is helping to address important areas of change. 

The findings indicated that those who report improvements in goals may engage with services more. The high proportion of ‘getting help’ goals may be attributable to the online setting, which young people may use as a first point of contact for help seeking, to gather information to access further support.

This project explored the types of goals that young people want to achieve from online services. The challenges and opportunities that online counsellors have experienced when working with these goals were also explored. 

The findings suggest that three different types of goals were typically identified by young people: 

1) intra-personal goals

2) interpersonal goals

3) goals on self-relating to others

Literature suggests young people from ethnic minority backgrounds face barriers in accessing mental health support due to discrimination and stigma and so this study aims to explore how young people from ethnic minority backgrounds interact with online counselling. 

Findings from this study reveal school-based services are the most popular source of referral for all young people; however, a higher number of young people from Asian and Black ethnicities reached out through informal sources such as Google as opposed to health professionals such as GPs. From the data, young people who identified as Indian, Chinese and African present to online counselling at a lower level of distress compared to their White British counterparts, contradictory to findings investigating measures of need in face-to-face settings.

It is important to provide access routes for individuals from different ethnic and cultural backgrounds who are less likely to access through Kooth’s traditional referral routes, such as via schools.

Focus groups with professionals from Kooth were conducted to understand the experiences of vulnerable youth during the pandemic lockdowns in the UK. Four main themes were identified: 1) escalation of risk; 2) the experience and consequence of loss; 3) feeling supported and empowered; and 4) feeling separate and isolated.

Findings suggest that those with existing vulnerability, for example having experienced adverse childhood trauma, face an increased risk of poor outcomes through the pandemic and restrictions of lockdown. There needs to be acknowledgement that, as life returns to ‘normal’, vulnerable young people are not being met with the support they need at the time they need it, particularly for those who feel alienated.

The findings highlight the importance of the consistency and availability of care during periods of uncertainty and restricted face-to-face care access, with digital provision being well suited to provide consistent support. We recognise the critical role that schools play, not only in the early identification of risk and provision of mental health support but also in providing access to a safe and predictable space and respite away from an abusive or precarious environment, or where young people may experience alienation within the family home.

This report explores how providing a digital mental health support service - Kooth for Adults (Qwell) - for free, with flexible access and anonymity can help adults dealing with stressful life events, and contribute to their personal growth. A survey was released across the service, and four interviews were conducted with Qwell users who had experienced stressful events.

Headlines from  the report were; 

->84% said it was important that they were in charge of their own mental health journey and 90% said it was important that they were supported in accepting that their problems and emotions are real and valid. 

-> Adults in ’absolute poverty’ experienced significantly more Stressful Life Events and these had a significantly higher negative impact on their lives and wellbeing. 

->Anonymity on Qwell reduces inhibitions and promotes disclosure talking about mental health.

Results indicate that Qwell, as a digital service, was well-placed to support individuals who experience stressful life events. Financial hardship, as well as experiencing absolute poverty was a major contributor to the impact of stressful life events on an individual's mental health and wellbeing, as well as likelihood to seek support.

This reiterates the importance of free access, and raises questions on how a counselling service can support the financial hardship experienced by people struggling with a stressful life event in both the short-term and in the long-term.

Online forums provide young people with both informational and emotional support around a wide array of topics. Informational/emotional support can be seen as either directive or non-directive.

This report is a snapshot view of how parents interact with online therapeutic support, including an insight into their needs and their wants from a digital mental health platform. 

Headlines from the report showed; 

->67% of parents accessed Kooth for support with their own mental health and 71% of parents who use Kooth for parenting support want to discuss challenges with their child’s mental health or behaviour.

->Increased goal setting was associated with improvements in routine outcome measure scores, with the largest association to improved GAD-7 scores measuring generalised anxiety. 

->63% of parents aged 20-30 years want to experience reduced isolation from using Kooth, compared to 20% aged 50+ years. 

->No-one in the <£20,000 income bracket is likely to seek face-to-face counselling as an alternative to Kooth, compared to 67% of those in the £50,000-75,000 bracket.

Whether using Kooth for support with their own needs or for help related to parenting, parents want reliable information from professionals or their peers, to support them in making informed choices within their lives. Using a digital platform to get these needs met not only helps to reduce some of the barriers that adults face as a result of social inequalities, but also enables autonomy and independence in how the individual engages with support.

The present study aims to explore the experience of online, anonymous, text-based services provided by Kooth, an online MH platform, to YP previously at risk of suicide during the COVID-19 pandemic. 

Results discuss three superordinate themes: a safe space to share; control; and need for connection. Thematic results highlight the desire for anonymity and control of therapeutic conversations due to concerns regarding confidentiality, and the perceived consequences of seeking help. Participants were successfully able to build connections through chats with online MH support staff. Themes suggest that anonymous, online services can overcome access barriers and enable YP to share and process their experiences.

This research aims to better understand the challenges and needs of moderators and digital counsellors. Moderation can be defined as the ‘governance mechanisms that structure participation in a community to facilitate cooperation and prevent abuse’. Moderators and digital counsellors need both intellectual and social capital, as they require both specialised subject knowledge and the ability to navigate online support in effective ways. Through this case study, the authors intend to contribute to the development of responsible AI tools that are fit for purpose and better understand the challenges. If AI is delivered in a responsible way, with safeguards in place as part of a wider and evidenced governance framework, coupled with opportunities for stakeholder trust to be built via mechanisms such as co-design, then it can potentially empower moderators and lead the field of digital community moderation into an exciting future.

Self-harm is a prevalent issue amongst young people, yet it is thought around 40% will never seek professional help due to stigma surrounding it. It is generally a way of coping with emotional distress and can have a range of triggers. This paper explores perceptions of mobile sensing, and current and future uses for smartphone-based interventions. This paper also contributes to the understanding of how triggers for self-harm might be identified and subsequently predicted and prevented using mobile-sensing technology.

This report provides an outcome-based framework based on the theory of change methodology for Kooth adult services. This research explores the different pathways of engagement in the platform through a collaborative multimethod approach using qualitative and quantitative data to inform the intended impacts, outcomes, mechanisms and inputs of the service.

The defining features to date of Kooth for adults are described as a positive virtual ecosystem, humanistic, anonymous and accessible, used by people in need of mental health support. It provides an integrative view of the service as an ecosystem with shared impacts across self-directed, reactive, structured and ongoing pathways of engagement.

This paper signals the beginning of an important, ground-breaking journey to define the role and the impact of Kooth. We have explored, mapped and categorised activity within the service with a specific goal in mind: to define our Theory of Change. This describes the Kooth experience and the many routes in and out of the service, each reliant on our understanding of an individual’s unique building blocks for wellness. 

The Theory of Change (ToC) is not a clinical model and nor does it seek to be. It is not there to show how we can address specific standalone symptoms. Instead it is a characterisation of the broad, person-centred, holistic work Kooth does every day. It is also the foundation for a future set of mental health outcome measures, which will represent each child or young person’s journey.

This report provides a timely look at Kooth, bridging insights from young people, from professionals who signpost or refer to Kooth, and from the routinely collected data from the service as a whole. The integration between commissioned, digital services alongside on-the-ground services is now more important than ever, and this report highlights Kooth’s mechanisms to enhance reach and engagement from young people and professionals.

There is strong evidence that service users highly value the ability to be autonomous and make choices in their mental health journey on Kooth, whilst, importantly, remaining anonymous. Removing barriers to support is critical to improving early access and prevention of mental health deterioration. Kooth has multiple mechanisms and features that can support a diverse set of users accessing the service and is seen as a digital front door for many due to no thresholds, referrals or waiting lists. Service users reported that Kooth helped them feel heard and listened to, and there were strong indicators that service users promoted the platform to their peers. Both service users and professionals outside of Kooth highly value the out-of-hours support as well as the ability to access the platform without a referral and no waiting lists to have a chat with a professional.

This study explores the reliability of using a standardised measure to detect clinical need in an online therapeutic environment, focusing on three specific measures. A deep-dive approach is used to inform practitioner assessment of young people, validating it along with the individuals’ self-rated outcome.

The findings demonstrate a fair to moderate reliability when assessing concordance between service users and practitioners, which suggests standardised measures are a reliable indicator of need. Higher levels of need were present than those seen previously in general or face-to-face clinical populations, which suggests using such measures in an online therapeutic environment influences the way in which assessments are responded to.

The aim of this research is to contribute to the knowledge base of young people's motivation to complete voluntary standardised mental health assessment measures and how the accuracy of the information derived may be improved.

The findings demonstrate the need for transparency online, to instil trust in those completing standardised mental health assessment measures. This may be implemented through co-designed visual materials which contribute to the young people's understanding of how the data collected through assessment will be used and what the response of the service will be following assessment.

There has been a growth of services delivering online therapy to young people and this study identifies the factors that young people find helpful and unhelpful in chats that were synchronous text-based therapy (STBT), and the processes by which these factors may be of value. Young people, aged between 14 and 18, were interviewed synchronously online. All participants had a minimum of four chat sessions. Data were analysed thematically.

Four main domains of helpful and unhelpful factors were identified: 1) anonymity, 2) access, 3) communication, and 4) control. Control was a particularly important element for young people and was an underlying aspect across all themes.

Challenges to digital therapeutic care exist, mainly how to develop and maintain a supportive, collaborative therapeutic relationship, built upon mutual trust and respect; intrinsic values of relationships that are often implied through complex non-verbal cues. Challenges identified were; learning experience of translating existing therapeutic skills to online working, rapidly building therapeutic relationships, managing risk in the online therapeutic relationship, and techniques for maintaining a digital therapeutic relationship.

It was seen here that online practitioners are eager to learn how to adapt to online delivery, although platform-specific training is limited. The study provides novel insights into the flexibility and adjustments therapists can make to improve online interventions and delivery through the development and maintenance of positive therapeutic relationships. Recommendations are also made in relation to platform-specific training, communicative adaptations, risk management and practitioner support. Clinical staff from Kooth informed these recommendations to evidence best practise to support practitioners moving from physical to digital therapy provision.

This study assesses the relative merits of acceptability, applicability and appropriateness of assessment measures online for children and young people. Acceptability was determined by whether users elected to complete the measure, applicability by whether they understood the questions, and appropriateness by their experience of completing the measure. 

Focusing on three specific measures, the findings suggest a high level of acceptability of all three measures in an online setting,  indicating that any of these measures would be acceptable in an online setting.

An existing routine evaluation and outcome measure (Young Person’s Clinical Outcome Measures in Routine Evaluation - YP CORE) was incorporated within other routine evaluation systems within Kooth. 

Initial data suggests that young people who seek out online counselling and support have a significantly higher level of distress than those within face-to-face services.

This study examines the therapeutic alliance when counselling services are offered online to young people. Three subcategories were identified:

(1) initial engagement,

(2) developing rapport, and

(3) establishing control.

The themes elicited are all relevant to the matching process and viewed as a chronological process similar to face-to-face counselling. However, unlike face-to-face work, specific nuances related to the online work arise that counsellors should be mindful of, including the rationale behind each individual's choice to approach services online, their own computer-mediated communication skills, technical hurdles, and the perceived ‘power’ of the counsellor.

 This study focused upon the development of online counselling services for young people in the UK. It used online forums to host an asynchronous focus group with the intention of bringing together the views of a small sample of counsellors and counsellors in training regarding the subject matter. The focus group lasted a one-month period and initiated 10 threads of discussion and received 41 message postings. These dialogues were analysed using a Grounded Theory approach. Findings suggested that although there is a great potential for offering therapy in this medium, services need to be appropriately regulated and good practice promoted.

Young people (mainly 15-17 years) using an online counselling, support and advice website were asked about their preferences for online versus face-to-face discussion of suicidal feelings. Thematic analysis of results (n = 24) yielded a main theme of ‘anonymity’ with sub-themes of ‘safety and freedom’, ‘confidentiality’ and 'control’. Issues of safeguarding distressed young people who have chosen to remain anonymous are raised.

Artificial intelligence (AI) is increasingly utilised to scale digital mental health services. To do this safely and effectively responsible innovation is the only option. This study explores the applicability of the Alan Turing Institute (ATI) AI ethics and safety guide in developing a safeguarding assistance tool for Kooth, the UK’s leading digital mental healthcare platform

Applying the framework enables structured and transparent development of AI for digital mental health services. The SUM values guide ethical reflection, while the FAST track principles ensure fairness, accountability, sustainability, and transparency. Challenges include need for data for bias monitoring and mitigation. The study demonstrates the framework's usefulness in AI development for digital mental health services. Integration of an AI ethics council and further measurement of user circumstances to enhance bias mitigation are suggested to build on the framework, contributing to the advancement of evidence-based digital mental healthcare delivery.

This article addresses the general ethical issues of accessing online personal data for research purposes. The authors discuss the practical aspects of online research with a specific case study that illustrates the ethical challenges encountered when accessing data from Kooth, an online youth web-counselling service. It presents solutions that aim to protect young DMH service users as well as the DMH providers and researchers mining such data. Special consideration is given to service users’ expectations of what their data might be used for, as well as their perceptions of whether the data they post is public, private or open. We provide recommendations for planning and designing online research that includes vulnerable young people as research participants in an ethical manner. We emphasise the distinction between public, private and open data, which is crucial to comprehend the ethical challenges in accessing DMH data. Among our key recommendations, we foreground the need to consider a collaborative approach with the DMH providers while respecting service users’ control over personal data, and we propose the implementation of digital solutions embedded within the platform for explicit opt-out/opt-in recruitment strategies and ‘read more’ options.