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Find out how ReachOut.com establishes boundaries of responsibility, and the differences between managing risk in anonymous forums, and proactively managing risk on Facebook. The case study also includes information on escalation, and on responding to disclosures about suicidal ideation.

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Internal procedures for the monitoring of ReachOut.com’s online spaces ensure that high risk comments are escalated within a maximum of 24 hours, with more rapid response times within business hours.

About ReachOut.com's duty of care online

The online youth mental health service ReachOut.com manages communities of young people in a variety of online spaces, including online discussion forums and social media.

ReachOut.com provides online fact sheets and personal stories that help young people identify emerging mental health difficulties, recognize symptoms and relate to the experiences of other young people. Practical information is provided through the site on how to develop appropriate self-help strategies and how to connect with professional support services when required. Online forums and social media discussions provide a safe, moderated space for young people to ask questions, discuss difficulties and learn from and support each other.

The provision of ReachOut.com’s online service is based on the acknowledgement that young people are increasingly seeking mental health information and support online, and from online communities. The best way to ensure young people are getting the right information and connecting with the right online communities is to provide these services online, in a safe, supportive and structured environment.

Boundaries of service responsibility

In all online places that ReachOut.com engages young people, guidelines are stated outlining the extent of what services are/are not provided. These guidelines are developed with young people and align with the ReachOut.com duty of care policy - ensuring they are both comprehensive and easy to understand.

Guidelines clearly state the appropriate use and intent of the site on which they are located – defining the different kind of activities that are appropriate. For example, on ReachOut.com’s Facebook page, guidelines state that the page is a space to talk about the mental health and wellbeing of young people, and that it is not a place to get one-on-one help, counseling or crisis support. Guidelines in the ReachOut Forums are different, stating that they are a space for peer support and positive discussion of issues related to mental health and wellbeing. In this space, the guidelines clearly specify that young people should not give medical advice to others, but to share instead what has worked for them. In addition, the guidelines specify what is considered acceptable and unacceptable in the space and address both behaviour and language.

In addition to a clear statement regarding the boundaries of the ReachOut.com service, the contact details of appropriate crisis support and counseling services, as well as emergency services, are prominent across the ReachOut.com website.

Managing risk in anonymous forums

Anonymity provides young people with the safety and security to open up and discuss issues they are facing, often in circumstances where they would not otherwise get help. On the ReachOut.com website, risk is managed via three strategies - through technical, self-moderation and staff moderation.

Technical

  • Users must sign in with a member account if they wish to write or submit a comment or forum post.
  • Personal information is not disclosed to the public via membership accounts.
  • Software automatically detects a broad range of ”alert words or phrases” and sends a notification to staff, highlighting potentially inappropriate or harmful posts.

Self moderation

  • All users must adhere to community guidelines, which establish appropriate/inappropriate behavior and the limitations of the services provided by ReachOut.com.
  • Young people can report inappropriate or risky content to moderators by clicking on the report button.

Staff moderation

  • Trained peer moderators monitor the community and facilitate community discussion, hiding or reporting risky or inappropriate content in accordance with the forum guidelines.
  • Staff moderators respond to distressed young people and difficult content.
  • Discussions of sensitive issues or more serious mental health problems are facilitated by youth workers and mental health professionals.
  • If a young person posts information that indicates an intent to suicide or cause harm to themselves or others, or raises child protection issues, staff follow set escalation procedures.

In order to avoid contributing to stigma by appearing to silence the voices of young people reaching out for help, staff moderate only when essential and where it is considered the content may cause harm to the young person or others.

Managing risk on Facebook

Discussions facilitated on Facebook are different to those held in the ReachOut Forums. Due to the more public, less anonymous nature of these spaces discussions are kept to lighter, less sensitive topics and focus on mental health promotion, wellbeing and resilience.

  • Content and discussions on the ReachOut.com Facebook profile encourage young people to share skills and strategies that help them build on strengths and deal with everyday issues such as stress, relationships and bullying.
  • Guidelines explicitly state that posts will be removed if they contain harmful or inappropriate advice, detailed discussions of self-harm or suicide etc.
  • It is clearly noted that ReachOut.com does not provide one-on-one advice or support, and the guidelines provide clear information on alternative services.
  • Young people are directed to the ReachOut Forums or professional support services when they post or discuss more sensitive topics.
  • Users are encouraged to utilize the Facebook reporting functionality for posts (other than on the ReachOut.com page) which discuss suicide.
  • In the event a young person discloses to ReachOut.com information that suggests intent to harm themselves or others, the issue is escalated in accordance with the ReachOut.com duty of care policies.

Escalation process

When a young person is at risk of harm or discloses potentially serious information, there is a clear and defined escalation process that must be followed.

  • On first sight, moderators respond and provide referrals to appropriate crisis support services such as Lifeline or Kids Helpline.
  • Moderators hide the post if necessary, and report the situation to the Online Community Coordinator.
  • If the situation is serious and involves suicide, self-harm, serious mental health concerns, or child protection issues, it is escalated to the Support Group, a small working group comprised of staff who are appropriately skilled to implement and monitor ReachOut.com’s duty of care framework.
  • The Support Group consults and identifies an appropriate response to the post.
  • In exceptional situations the Support Group escalates the issue to the CEO or the Clinical Advisory Board, comprised of experts in child and adolescent mental health, for assistance and/or response.

Internal procedures for the monitoring of ReachOut.com’s online spaces ensure that high risk comments are escalated within a maximum of 24 hours, with more rapid response times within business hours.

Responding to disclosures about suicide

If a young person discloses that they are experiencing suicidal ideation or engaging in suicidal behavior, a risk assessment is conducted by the Support Group to determine the severity of the situation. This risk assessment includes reviewing historical content provided by the young person to identify the presence of risks such as a well-developed suicide plan, access to means of suicide, history of suicidal ideation and behaviour, as well as protective factors such as strong support networks and coping mechanisms. On the basis of this risk assessment, a decision is made about whether or not to contact emergency services. This decision is also informed by the amount of identifying information that can be gathered including IP address and email address. ReachOut.com has an established a relationship with NSW Police which allows for simple and direct reporting of the situation.

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