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Assessing Ask Us Online
the utility of web post counselling, as reported
                 by service users
November, 2011

© Kids Help Phone




This paper was prepared by Tina
Wilson, Research Analyst and Lila
Knighton, Director, Knowledge
Mobilization.

Thanks to all counsellors and
counselling managers for ensuring
the invitation to participate was sent
out with counsellor’s responses.
Contents


Implementation & Data Collection ...............................................................................................1
   Sample................................................................................................................................................ 1
Results.........................................................................................................................................2
   Demographics .................................................................................................................................... 3
   Relationship with Kids Help Phone ..................................................................................................... 4
   Counselling Issues .............................................................................................................................. 5
   What Young People Find Most Useful About Post Counselling.......................................................... 6
   Which is More Important, the Process of Writing, or Receiving a Response from a Counsellor?...... 8
       The Best Things about Writing Out My Post(s) Are… .................................................................... 8
       The Best Things About Getting Counsellors Response(s) Are…...................................................... 9
   If Ask Us Online Wasn’t Available, Would You Call the Helpline Instead? ....................................... 11
   Sub-Population Trends ..................................................................................................................... 12
   Is There Anything Else You Would Like Us To Know? ....................................................................... 14
Appendix A: Client Age Distribution ........................................................................................... 18
Appendix B: Survey Questions .................................................................................................... 19
Ask Us Online Client Survey


    O
            ver the month of October 2011, clients of Kids Help Phone’s non-synchronous Ask Us Online
            web post counselling service were invited to fill out a survey to help us better understand
            why they find the service helpful. We hoped their responses would help us answer five
    questions:

      1. Overall, what is it about posting to Ask Us Online that young people find most helpful?
      2. Which do young people experience as more helpful, writing out their post or the content of
         the counsellors response?
      3. Are posters a different group of clients than callers?
      4. Would posters use the phone service if the Ask Us Online option no longer existed?
      5. Are there differences in the types of
         issues young people bring to the post
                                                     “We’d love to hear your feedback about our Ask Us
         channel in comparison to the
         phones?                                      Online service. The survey is completely voluntary
                                                      and totally anonymous. Your counsellor will not be
                                                       able to see your responses. If you would like to
                                                     participate, click here to go to the survey. Thanks in
    Implementation & Data                                advance, from all of us at Kids Help Phone.”
    Collection



    C
              ounsellors appended the invitation to participate to the end of web post counselling responses
              published in the month of October. The invitation to participate process began at about 9am
              on October 1st and the survey was closed to further responses at 6:30am on November the 1st.



    Sample
    A combination of convenience1 and volunteer2 sampling was used to gather survey responses. This
    means the findings discussed in this report reflect the responses of the group who chose to
    participate, but may or may not be representative of how all post counselling service clients would
    have responded.




    1
        Post clients responded to in the month of October.
    2
        Data was gathered only from those who self-selected to participate.



1
A total of 1,286 counselling responses were published to the websites in the month of October, 1,122
in English and 164 in French.3 We estimate the survey link was sent out with 75-
80% of English responses (about 870 invitations)4 and about 80% of French           Final number of
                             5                                                      volunteer
responses (128 invitations), for a total estimated 998 invitations. Of this         participants (N=
group, 234 young people volunteered to participate, with 214 English                234)
                                  6
and 20 French survey responses. This means                                          Estimated number
                                                                                    of invitations sent
our response rate is estimated at 23%                                               out (N= 998)
overall; 16% for French and 25% for
English. Our survey completion                                                      Web posts
                                                                                    responded to in
rate – the number of surveys for                                                    October (N=1,286)
which every question was
answered – was 77% (164) for                                                        All post counselling
                                                                                    clients
English respondents and 80% (16)
for French respondents. This is a
very good response rate for this
type of questionnaire, particularly as
no incentive was given to encourage
participation.

Please note that a single web post counselling client could be asked to participate more than once, if
they received more than one response in the month of October. Also, the invitation to participate in
the survey is both visible and clickable to anyone viewing the Ask Us Online forums, so there is the
possibility that the survey was also filled out by people other than those to whom the invitation was
addressed.


Results7



P      eople who respond to voluntary feedback surveys typically have stronger than average
       opinions and/or a stake in the topic. This means we need to consider if our respondents are
       representative of all our Ask Us Online clients or if particular sub-populations are over or
under represented. We can estimate this by comparing our participant’s demographic and
issue/topic responses with similar data for all post counselling clients. The greater the similarity (i.e.
same gender, location and issue breakdown between respondents and all post clients) the greater the
confidence we can have that the findings from this exploratory survey also represent the opinions
and experiences of all our web post counselling clients. In addition, attending to overall differences in
who uses our two counselling channels – web and phone – will help us identify if particular sub-

3
  Data source: Flexiforum data, turnEN and turnFR, “Messages Posted by End Users in this Month that made it
to the live site” (N=1,286).
4
 Data source: Estimated by counselling management.
5
  Data source: Estimated by counselling management.
6
  Data source: Total number of SurveyMonkey surveys (both complete and incomplete).
7
  All data is from the month of October, 2011.



                                                                                                              2
populations gravitate more to one service than the other. This comparison is important because it
    draws attention to service accessibility and/or service reach.

    In the charts that follow, “Post-Counsellor” refers to web post counselling session data recorded by
    counsellors in the month of October (N=1,010). “Post-Client” refers to young peoples’ responses to
    our survey (N=234). “Respondent” refers to those clients who filled out our questionnaire. “Phone-
    Counsellor” refers to phone counselling session data recorded by counsellors in the month of October
    (N=2,642).


    Demographics

    Demographic comparisons between our survey respondents and all post users will be briefly touched
    upon here and any differences highlighted.

    Gender: The gender breakdown between those who self-selected to participate in our questionnaire
    and all Ask Us Online clients is fairly similar.

    This said, our phone service receives proportionately more male callers than does our post
    counselling service.8

    Age: The bulk of our respondents were between the ages of 14 and 16. In comparison to all Ask Us
    Online clients, 14 and 16 year olds are slightly over represented in our sample. Overall, those who
    use Ask Us Online tend to be a bit younger than those who use the phone service.

    Official Language: We received 20 French-language survey responses and 214 English. This is roughly
    proportionate to the language breakdown for all post counselling sessions recorded in October.

    Location: The regional distribution of our respondents was quite similar to that of all post counselling
    records completed in the month of October. The only notable differences are that we received
    proportionally more responses from Quebec (roughly 7% more) and proportionally fewer responses
    from Ontario (roughly 7-8% less) than the post counselling record data indicates we received overall.

    Data for urban or rural location is not regularly collected for all counselling contacts which make
    comparisons between our respondents and all post clients especially limited. This said, 72% of young
    people who responded to our questionnaire were located in urban areas (N=169) and 24% in rural
    areas or small towns (N=56). One respondent was from a First Nations community or Métis
    settlement. Of those post counselling records that did contain this data, 78-80% of clients were from
    an urban area. This suggests, very roughly, that our respondents included about 6% more rural
    clients than is the norm for our post service.




    8
     This higher proportion of male callers may have something to do with the number of prank calls the helpline
    receives.



3
Relationship with Kids Help Phone




T     here are a few different ways we can think about our respondents’ relationship with the Ask Us
      Online counselling service: Absolute numbers of new and returning clients; the frequency with
      which respondents contact us; the length or duration of their relationship; and if they use one
or both of our counselling services.

About 80% of our respondents were repeat service users and a little more than 20% stated that this
was their very first time
posting to the Ask Us Online                          New vs. repeat service users
counselling service. As this
                                  100%
chart illustrates, this is a much              250                 172              495
higher proportion of returning     80%
clients than Ask Us Online
                                   60%                                             1,141
receives overall. This said,                                                                                 Repeat
more than half (N=539) of          40%         221                                                           New
October’s post counselling
records did not include data       20%
                                                                   47
about new/repeat status.
                                     0%
                                            Post-Counsellor     Post-Client         Phone-Counsellor


While 80% of respondents were returning clients, the majority (51%) had only started using our
service in the last year, with 31% of all respondents contacting us in the last three months. The
majority of our respondents had submitted between
                                                                  When did you first post to Ask Us
one and five posts (N=137) to the service. The highest
                                                                                  Online?
number had submitted 2-5 posts (N=90), and the
second highest (N=47) were first time posters.
                                                                                                Last 3 months
                                                                     14%
If we cluster numbers of responses, we see that the                                             3-12 months
                                                                               31%
majority of our respondents (63%) were also “new”              17%                              1 year ago
service users in that they had submitted five or fewer
                                                                                                2 years ago
posts.                                                              18%       20%
                                                                                                3+ years ago

At the same time, our respondents also contain a sub-
group of longer term clients (2+ years, N= 53 or 32%)                  Contact frequency
and very regular service users (11-21+ posts, N=46 or
21%). Overall, while our sample includes more
                                                                                           New users (1-5
returning clients than is average for the service as a                                     posts)
whole, newer service user and those that have only               21%
posted a few times are also well represented.                                              Repeat service
                                                              16%                          users (6-10 posts)
                                                                               63%
                                                                                           Regular service
                                                                                           users (11-21+
                                                                                           posts)
                                                                                                                      4
Counselling Issues




    C
            omparing what our respondents’ write about when posting to Ask Us Online to what our
            counsellors document for all post counselling clients also helps us understand if our survey
            participants are representative of all web counselling clients. However, it is important to note
            that counsellors and clients will assess and label issues differently. For example, a counsellor
    might note a substance misuse issue. The client may not identify this in our survey, either because it
    is not a presenting issue for them at the time of posting, or they do not identify any issues with their
    use more generally. With this major caveat in mind, this chart compares our respondents’ answers
    with the both the post and phone counselling records completed by counsellors in the month of
    October:
                                      Counselling topics, by data source

                               Phone-Counsellor     Post-Counsellor    Post-Client


        Information about laws or rights

             Substance use or addictions

    Sexual orientation or gender identity

                 Becoming independent

                Physical or sexual health

                       Violence or abuse

                                 Bullying

                              Self-injury

               Suicide and related issues

                                  School

                    Family relationships

                     Friend relationships

             Mental or emotional health

                                            0%    5%       10%        15%       20%       25%       30%




5
Clients who chose to participate in our survey told us they write to counsellors about proportionately
more school, suicide, self-injury and independence related concerns. They were less likely to identify
their concerns as related to mental or emotional health, or about friend or family relationships.

Counsellors recognize more friend and more health issues in their work with posters to Ask Us Online.
Counsellors also identify more family issues, and a few more bullying, legal, and violence and abuse
issues in work with phone clients.



What Young People Find Most Useful About Post Counselling



W
            e asked post clients to tell us the reasons why the Ask Us Online counselling service was a
            good option for them; they could pick as many responses as applied to them as well as
            enter their own response in an essay box (N=217).




          What is it about posting to Ask Us Online that makes it a good option
                                         for you?
 I think posting is more anonymous/confidential than
                   calling the help line                               70

             Writing out my problems helps me think
                                                                             92

     I like seeing the counsellor’s response in writing
                                                                                  111

     I don't have enough privacy to talk on the phone
                                                                                    117

           I find it easier to express myself in writing
                                                                                        126

  I feel too nervous or uncomfortable to call the help
                          line                                                                  163




                                                                                                          6
The majority of respondents told us that they feel too nervous or uncomfortable to call (75%) and
     that they find it easier to express themselves in writing (58%).

       •“I'm scared to talk to someone about this.”
       •“i stutter :/ so i like being able to write it out rather than try to talk with the person on the phone”
       •“When I talk on the phone I cry uncontrolably about my situation”



     This was followed by privacy issues (54%) and then by a preference for seeing the counsellors’
     response in writing (51%).

       •“Im not aloud to us the phone :(“
       •“I don't have a cellphone, but I have a personal computer.”
       •“I can look back on the replies from the counselors if I still need to”
       •“it helps to be able to go over the response a few times”


     Many also stated that writing out their problems helps them think (51%).




     A smaller but still sizable number also perceive web post counselling to be more anonymous and
     confidential than the phone service (32%).



     Of the 17 free-text responses we received, three offered a critique of our phone counselling service
     as a reason for choosing Ask Us Online.

       •“I tried calling once and the person wasn't that nice”



    Another way to look at responses to this question is to divide the questions and answers into two
    categories – those related to access (things like ease of expression, comfort level, privacy and
    perceptions of anonymity and confidentiality)
                                                               Access vs. therapeutic benefit
    and those that relate more to therapeutic
    benefit (things like finding writing helpful and
    being able to review the counsellors’
                                                                                           Access (easier, less
    response in writing). Results suggest the                                              discomfort, privacy,
    majority of those who responded to our              30%                                anon. & conf)
    survey use Ask Us Online for reasons
    related to accessibility.
                                                                                                     Therapeutic benefit
                                                                                                     (like writing,
                                                                                   70%               reviewing the
                                                                                                     counsellors
                                                                                                     response)

7
Which is More Important, the Process of Writing, or Receiving a Response
from a Counsellor?
The Best Things about Writing Out My Post(s) Are…
We asked young people, “thinking about your experience with posting in general (not just your last
post), please rank the following in order of importance (with 1 being most important to you and 5
being the least important to you). The best things about WRITING out my post(s) are:” and gave five
options (below). We expected to see a clear ranking of options, but instead found considerable
dispersion, with a loose trend becoming evident as high count responses were clustered together.
This is illustrated in the following table (N=182):

                                              1st          2nd        3rd         4th                 5th         Response
                                              choice       choice     choice      choice              choice      count
Knowing that someone who cares will                                                                                  N=143
know about my situation                               34        32          34              21            22
The chance to express myself/ tell my                                                                               N=135
story                                                 33        35          25              15            27
Writing helps me to sort out my                                                                                     N=133
feelings                                              23        36          30              27            17
Writing helps me figure out what to                                                                                 N=151
do next with my situation                             22        28          36              40            25
Sharing my story on a public site helps                                                                             N=156
me to feel like I’m not alone                         35        16          24              31            50

As another way of looking at the responses to this question, the next chart contrasts the combined
number of first and second choices with the combined forth and last choices. Looking at the data this
way, we can see that in terms of numbers, each possible response was important to a sizable number
of clients but not important to another sizable number:


          The best things about writing out my post(s) are... choice 1+2 & choice
                                      4+5 combined:
                                            1st &2nd       4th &5th

 Writing helps me figure out what to do next with                                 50
                   my situation                                                                  65

          Writing helps me to sort out my feelings                                          59
                                                                             44

       The chance to express myself/ tell my story                                                68
                                                                            42
Knowing that someone who cares will know about                                                   66
                   my situation                                             43
 Sharing my story on a public site helps me to feel                               51
                like I’m not alone                                                                           81

                                                      0    10   20     30    40        50        60     70     80    90
                                                                             Number



                                                                                                                             8
Next, we asked young people to tell how helpful they find the process of writing out their post(s)
    overall. 73% of respondents told us that writing was helpful to them (scale points 1-3 falls on the
    “helpful” side of the neutral midpoint on
    our scale). 25% told us they find writing    On a scale of 1 to 7, where 1 is very helpful and 7 is not at
    to Ask Us Online “very helpful.”             all helpful, in general, how helpful do you find WRITING out
                                                   your post(s)?
    Overall, the majority of our respondents
    find the process of writing out their
    response very helpful, but the reasons          Not at all                                           Very
    for this vary from person to person.            helpful                                             helpful
                                                                 1    2    3    4    5        6   7
    Respondents’ rankings show a
    tendency to value “the chance to                    In general, how helpful do you find WRITING
    express myself,” “knowing that some                               out your post(s)?
    who cares will know about my
                                                                 1%   3%
    situation,” and “writing helps me sort
    out my feelings” more highly.                                                                 1 - Very helpful
                                                                 9%
                                                                               25%                2

                                                        14%                                       3
    The Best Things About Getting                                                          4
    Counsellors Response(s) Are….
                                                                                           5
    Similarly, we asked young people,
                                                        19%                                6
    “thinking about your experience with                                 29%
    posting in general (not just your last                                                 7 - Not at all helpful
    post), please rank the following in
    order of importance (with 1 being most
    important to you and 5 being the least important to you). The best things about getting the
    counsellor’s RESPONSE to my post(s) are:” and gave them an additional five options. Compared to the
    “best things about writing” question, we can see somewhat clearer trends as to which aspects of
    counsellor’s responses our participants consider to be more and less important. Out of the number
    who ranked the options, 57% chose “getting a supportive response from someone who cares” as
    most important and “getting a referral” as least important (65%):

                                                         1st   2nd    3rd    4th                     5th Response
                                                     choice choice choice choice                  choice Count
     Getting a supportive response from
     someone who cares                                    55          27       24        20           18             144
     Getting practical tips or suggestions                25          36       38        29            8             136
     Reading the counsellor's response helps
     me figure out what to do next with my
     situation                                            27          41       28        34           25             155
     Getting information about my situation
     or concern                                           26          32       35        36           12             141
     Getting a referral (i.e. information about
     a service in my community)                           22          15       15        24           73             149


9
The following chart, representing the respondents’ first and second choice combined and their fourth
and fifth choice combined, reinforces this trend.


                The best things about getting the counsellors' response to my post(s)...
                                 choice 1+2 and choice 4+5 combined:
                                                   1st & 2nd      4th & 5th

     Getting a supportive response from someone who                                           82
                            cares                                        38
      Reading the counsellor's response helps me figure                                  68
           out what to do next with my situation                                   59

                     Getting practical tips or suggestions                          61
                                                                         37

     Getting information about my situation or concern                             58
                                                                              48
    Getting a referral (i.e. information about a service in              37
                        my community)                                                                97

                                                              0     20        40        60      80        100    120
                                                                                   Number


When we asked young people to rate, on a scale of one to seven, how helpful they find responses
from counsellors, more than 80% of respondents indicated that they find them helpful. 29% rated
counselling responses “very
helpful.”                             In general, how helpful do you find counsellor's
                                                              RESPONSES to your posts(s)?
                                                          6% 3%                               1 - Very helpful
                                                     3%


O
          ne of the questions
                                                                              2
          we hoped to better               8%            29%                  3
          understand was if
the process of writing was                                                    4
                                          22%
more, less or equally                                                         5
important to getting a                                29%                     6
response from a counsellor.                                                   7 - Not at all helpful
If writing was clearly more
important, than our
counsellor moderated Express Yourself forum might be a reasonable substitute for our Ask Us Online
counselling service.9



9
 Clients can submit posts to either Ask Us Online, where they will receive a counsellor’s response, or Express
Yourself, where counsellors review the submission before it goes live on the website, but do not provide a
response.



                                                                                                                       10
Looking at the ratings of how helpful writing and getting a response are side-by-side shows that while
     both are rated as helpful, counsellor’s work is rated as more helpful by most participants.


                         Comparing user reported helpfulness for 'writing' & 'getting a
                                                counsellor's response'

                         In general, how helpful do you find WRITING out your post(s)?
                         In general, how helpful do you find counsellor's RESPONSES to your post(s)?
      60

      50                     53       53
                    50
      40     45                                     44

      30                                   34

      20                                                  25

      10                                                                16
                                                                   12
                                                                                 4       3       9       5       6
       0
              1 - Very            2             3              4             5               6         7 - Not at all
              helpful                                                                                     helpful




     If Ask Us Online Wasn’t Available, Would You Call the Helpline Instead?




     A
              n additional important area to explore was whether limiting or discontinuing the Ask Us
              Online counselling service would result in Kids Help Phone cutting service to a group of young
              people who would not seek out support from our other services. To this end, we asked our
     respondents which Kids Help Phone
     counselling services they use. A                      How do you usually get in contact with
     significant majority were dedicated Ask                          Kids Help Phone?
     Us Online service users; they do not use
     the phone service. 19% of our                            3% 1%
     respondents mostly post but sometimes                                                 Post to the Ask Us
     phone. Only 4% use the phone service                                                  Online forums
                                                            19%
     more than they post.                                                                  Mostly post but
                                                                                                     sometimes phone
                                                                                                     Mostly phone but
                                                                                                     sometimes post
                                                                                 77%                 Phone the
                                                                                                     helpline



11
We also asked, “if Ask Us Online wasn’t available, would you call the helpline?” Roughly a quarter of
our respondents said they would call us. A significant number (36%) claimed that they would not use
our phone service and the larger number (41%) was
not sure.                                                          If Ask Us Online wasn't
                                                               available, would you call the
While we do not have a comparable set of data for
                                                                         helpline?
all our clients, our participant’s answers to these two
questions indicate that discontinuing or limiting out
Ask Us Online counselling service would have
                                                                           23%               Yes
significant implications for the accessibility of our            41%
total service offerings.                                                                     No

                                                                           36%               Not sure




Sub-Population Trends



F     iltering our data by response or respondent demographics can help us determine if there are
      sub-group based trends or themes. It must be noted, however, that filtering reduces the
      sample size, which has implications for the generalizability of the findings. To determine if
there were any sub-group trends, we filtered the larger data set in the following ways:

       Willingness to use other service channels
             Respondents who would not call the phone line; Respondents who would call the
                 phone line; Respondents who are not sure if they’d call the phone line.
       Respondent age
            • 12-15; 16-20; 21+
       Relationship with the service
            • Infrequent users (those who posted 1-5 times); Heavy users (those who posted 16+
                 times); Historical relationship with service (use over 2+ years); New relationship with
                 service (first use within last 3 months).
       Respondents who write to us about mental health and related issues (including self-injury and
        suicide)
       Male respondents
       Respondents living in a rural area or First Nations community
       Those who had a low overall rating of the service
       Those who prioritized receiving a referral to a community based resource

Not all filters revealed notable trends. Some of the trends we were able to identify include:




                                                                                                           12
Respondents who identified mental health as an area of concern
       A disproportionately high % of our overall respondents noted that they contact us about issues
          related to suicide and self-injury (35.4% and 32.8 respectively)
       More of the respondents who wrote to us about mental health related issues stated that they
          would not call the help line if AUO was not available, and fewer said they were not sure if they
          would call or not.
       Of the heavy users who have used the service 20 or more times, all but one identified mental
          health as one of the issues they contact us about.


     Male respondents
       Our male respondents are older, on average, than all respondents. The majority of respondents
          (57%) are 16, 17 or 18, whereas the majority of female respondents (65%) fall into the 13-16
          range.
       There was a slight skew (approx. 10%) towards living in a rural area among male respondents.
       Lack of privacy was identified by fewer males (41% vs 54% in full sample) as a reason why AUO
          is a good option for them.
       Fewer males identified that they would call the helpline if it AUO was not available (10% said
          they would vs 23% in larger group) and more said they weren’t sure if they would or not (55%
          vs 39% in larger group).
       Males were more likely to identify “getting information about my situation or concern” as a key
          component of a counsellor’s response than the larger group (35% males ranked this first,
          compared to 19% of the larger group); conversely, males were less likely to value “getting a
          supportive response from someone who cares” than average (20% of males ranked this first,
          versus 40% of the larger group)


     Respondents from rural areas or First Nations communities
       On average, this group rated the experience of both writing and post and receiving a response
          from a counsellor more highly than the larger group, with 35% (vs 25%) using a rating of ‘1’ –or
          ‘very helpful’ on the 7 point scale for question 12 (‘how helpful do you find writing out your
          posts?’) and 44% (versus 29%) using a rating of ‘1’ for question 14 (‘how helpful do you find
          counsellors’ responses to your posts?’).


     Heavy or longstanding service users
        Heavy users were more likely to select “I find it easier to express myself in writing,” “writing
           out my problem helps me think,” and “I like seeing the counsellor’s response in writing” than
           the larger group.
        Heavy users were more likely to identify mental health as an issue they write to us about that
           other users (92.6% vs 67%).
        Heavy users were more likely to highlight the importance of ‘getting practical tips or
           suggestions’ in a counselling response (25% ranked as #1 vs 15% in the larger group); this,



13
however, does not apply equally to longstanding service users (those with a 2+ year
       relationship with the service). Longstanding users valuation of tips and suggestions was
       comparable to the larger group, but they were more likely than average to prioritize “getting
       a supportive response from someone who cares” (45% v 40% ranked this #1).
      Longstanding service users had a lower overall rating of service than average (the most
       common ranking was 3 -- where 1 was ‘very helpful’ and 7 was not at all helpful -- compared
       to 1 and 2 tied as the most common ranking among the larger group)
      Longstanding users ranked the act of writing out the post higher than the average group
       (higher, indeed, than the counsellor response).


New and Infrequent users
   Infrequent users were slightly more likely than the larger group to identify bullying as an issue
      they write to us about (32% vs 25%)
   Infrequent users had a higher overall rating of service than average (the most common
      ranking was 1, or ‘very helpful.’
   New users (those who first posted in the last 3 months) were somewhat less likely to identify
      feeling “too nervous or uncomfortable to call the help line” as a reason for choosing AUO
   All new users identified as already using the service more than once (75% said they have used
      the service 2-5 times, and 17% 6-10 times).
   New users were less likely to identify “getting a supportive response from someone who
      cares” as the best thing about a counsellor response (only 30% of new users selected this as
      #1, vs 40% of the larger group)
   New users were more likely to identify that “*the+ response helps me figure out to do next
      with my situation” as the best thing about getting a counsellor response (25% selected this
      option as #1 vs. 17% in the larger group).



Is There Anything Else You Would Like Us To Know?

Four main themes emerged
                                        Is there anything else you would like us to know?
from the 71 responses we
received to our final
question:                                 Other


                                  Want live chat


                               Critical feedback


                               Positive feedback

                                                   0     5       10       15      20       25          30



                                                                                                            14
Other Responses
     Other responses including things like:

           “Please change the KHP name, the site is not just for kids and putting the word kids
           pushes away indirectly some people. Also, please make KHP a little more
           community based. It's good to have support from adults who work on their free
           time to help, but also getting input from someone of our age or background
           ACTUALLY does help too.”

           “It would be nice if there was a more integrated way of replying to posts after a
           counselor has made them. This makes answering any questions the counselor
           asked as well as getting more consisten help easier”

           “I would like a mobile app. like for android or iphone.”


     Support for Live Chat Counselling
     Thirteen of our respondents specifically requested we begin providing live chat counselling:

           “I want to know if you guys are starting and Instant Messaging thing. People like
           me, are to scared/shy to call but they need immediate support, moreover, some
           don't have enough privacey--like me. And asking online, people can't get
           immediate support, but at least they don't feel too scared and they have no one
           eavesdropping.”

            “I really think that it takes to long to get a response.. Like I think the next day you
           should have a response.. Most people go online b/c they dont feel comfortable
           talking to someone on the phone so I think you should give people a more.. fast
           response any way they want it... and i also think that a instant messaging thing
           would be great.. for people who need help now but dont know how to talk on the
           phone”

           “It would be great if there were some kind of live chat type of thing. I am too afraid
           to call but sometimes i would like a faster response.”

           “The counselors are very nice and supportive, I thank you. Please make the IM
           messaging, we need it. :)”




15
Critical Feedback
Critical feedback was most often related to the extended wait to receive a response:

      “Replys take way too long.... If I'm gonna
      commit suicid do you think I'm just gonna                         Critical feedback
      sit around and wait for a resons? The max
                                                                                            Problem w/
      waiting time for a reply should be an
                                                                                            post response
      hour.... Either get caught up with the posts                                          time
      , or hire more councilors!!!!!”                       35%
                                                                            45%             Negative exp.
                                                                                            w/phones
       “It sometimes takes too long for the
      counselors to reply. I know they are                                                  Critique
                                                                  20%
      handling a lot of different posts and phone                                           content of post
      calls, but sometimes things are urgent and                                            response
      need a quick response.”


Critiques of counsellor’s post responses were most often to do with wanting more detailed
responses:

      “Regarding to responses, I find they aren't specific enough to help me. So I make
      more posts hoping for a better response. Maybe if the responses were more
      specific, you wouldn't be as flooded with posts. I hope I helped!”

       “I dont know...msot of the time its a big probleme and i get comments all "Aw im
      sorry you feel this way" Uh yeah that didnt help much......”

      « C'est bien que vous marquez les références pour nous aider. Par contre, moi ce
      que je recherche c'est surtout des suggestions que je pourrais faire pour aider monc
      cas. »


Last, four of our respondents explained that they use Ask Us Online because they had a bad
experience when they called the helpline:

      “So far when ever I send a post to KHP I get pretty helpful responses. But out of the
      three times I've ever called the counsellor's I got seemed frustrated with me infact
      one of them raised there voice at me.....it made me feel like I was annoying and
      kinda made things worse cause I felt that my situatuion was to frustrating for even
      a counsellor.....it wasn't a nice feeling I call only cause I want a quick answer and I
      only post when my situation isn't that bad.....but I don;t plan to ever call anytime
      soon cause the cousellors sound depressed and mono tone when you call.....it's not
      very welcoming or warming. And when you've been pacing back and forth trying to
      gain the courage to call and pour your feelings out over the phone to a stranger




                                                                                                              16
and there sounding unwelcoming it's not a nice feeling......Like they don't even say
            Hello back when you say it to them. Thank you for your time :)”




     Positive Feedback                                                          Positive feedback
     Positive feedback was most often stated in general
     terms:                                                                                         General
                                                                              19%                   appreciation/
             “thanks for being awesome and helping me                                               thanks

            through stuff.”                                                                         Other pos.
                                                                                    81%
                                                                                                    feedback
            “continuer votre bon travail!”


     Some of these answers indicate the role Ask Us Online has played in supporting respondent’s well-being over
     time:

            “You've helped me through a lot of my lifes hard times. Thank you.”


     Other positive feedback included statements like:

            “It's been a great way for me to organize my thoughts without worrying about
            being judged by others”.

     A few stressed the importance of the service to specific participants:

            “Just never stop doing the online help... I have nothing else but this :( Judging from
            these questions, thats what I've concluded, your considering stopping the online
            help... I'd have to start asking Yahoo :(“




17
Appendix A: Client Age Distribution

In the two charts that follow, “Post-Counsellor” refers to web post counselling session data recorded
by counsellors in the month of October (N=1,010). “Post-Client” refers to young peoples’ responses to
our questionnaire (N=234). “Phone-Counsellor” refers to phone counselling session data recorded by
counsellors in the month of October (N=2,642). All data is from the month of October, 2011.




                                                                                                        18
Appendix B: Survey Questions

     Invitation to participate: “We’d love to hear your feedback about our Ask Us Online service. The
     survey is completely voluntary and totally anonymous. Your counsellor will not be able to see your
     responses. If you would like to participate, click here to go to the survey. Thanks in advance, from all
     of us at Kids Help Phone.”

     Thanks for taking the time to give us your feedback about As Us Online!

     This information will help us understand how useful our online post counselling service is and decide
     how to provide this type of support in the future. The information we collect here may also be used in
     conversations with media or other groups who support Kids Help Phone.

     Your answers are always anonymous (none of this information could ever get linked back to you) and
     your counsellor will NOT see your answers.

     1. Are you: [dropdown menu]
         Male
         Female
         Transgender/ Genderqueer
         Other (please specify) [text box]

     2.   How old are you? [dropdown menu]

     3. What province or territory do you live in? [dropdown menu]
        Alberta
        British Columbia
        Manitoba
        New Brunswick
        Newfoundland and Labrador
        Northwest Territories
        Nova Scotia
        Nunavut
        Ontario
        Prince Edward Island
        Quebec
        Saskatchewan
        Yukon

     4. What kind of community do you live in?
         City or large town (more than 10,000 people)



19
   Rural area or small town (less than 10,000 people)
       A First Nations community or Métis settlement
       Other (please specify) [text box]

5. How do you usually get in contact with Kids Help Phone?
    Post to the Ask Us Online forums
    Phone the helpline
    Mostly post but sometimes phone
    Mostly phone but sometimes post

6. What is it about posting to Ask Us Online that makes it a good option for you? Check all that
apply:
    I feel too nervous or uncomfortable to call the help line
    I find it easier to express myself in writing
    I don't have enough privacy to talk on the phone
    Writing out my problems helps me think
    I like seeing the counsellor’s response in writing
    I think posting is more anonymous/confidential than calling the help line
    Other (please specify) [text box]

7. If Ask Us Online wasn’t available, would you call the help line instead?
      Yes
      No
      Not sure

8. In total, how many times have you sent us a post?
     This is the first time [trigger to skip the next question]
     2-5 times
     6-10 times
     11-15 times
     16-20 times
     More than 20 times

9. When did you first post to Ask Us Online?
     In the last three months
     In the last six to nine months
     In the last nine to 12 months
     Last year
     Two years ago
     Three or more years ago




                                                                                                   20
10. What issue or issues do you write to us about?

     Choose as many as apply:
         Friend relationships
         Family relationships
         Violence or abuse
         Bullying
         Mental or emotional health
         Substance use or addictions
         Physical or sexual health
         School
         Information about laws or rights
         Sexual orientation or gender identity
         Becoming independent
         Self-injury
         Suicide

     WRITING to Kids Help Phone

     11. Thinking about your experience with posting in general (not just your last post), please rank the
     following in order of importance (with 1 being most important to you and 5 being the least important
     to you).

     The best things about WRITING out my post(s) are: [Forced ranking, 5 levels]
          The chance to express myself/ tell my story
          Writing helps me to sort out my feelings
          Knowing that someone who cares will know about my situation
          Writing helps me figure out what to do next with my situation
          Sharing my story on a public site helps me to feel like I’m not alone

     12. On a scale of 1 to 7, where 1 is very helpful and 7 is not at all helpful:
          In general, how helpful do you find WRITING out your post(s)? 1 - Very helpful 2 - 3 - 4 - 5 -
             6 - 7 - Not at all helpful


     GETTING A RESPONSE from Kids Help Phone

     13. Thinking about your experience with posting in general (not just your last post), please rank the
     following in order of importance (with 1 being most important to you and 5 being the least important
     to you).


     The best things about getting the counsellor's RESPONSE to my post(s) are: [Forced ranking, 5 levels]



21
   Getting a referral (i.e. information about a service in my community)
       Getting information about my situation or concern
       Getting practical tips or suggestions
       Getting a supportive response from someone who cares
       Reading the counsellor's response helps me figure out what to do next with my situation

14. On a scale of 1 to 7, where 1 is very helpful and 7 is not at all helpful:
     In general, how helpful do you find counsellor's RESPONSES to your post(s)?     1 - Very helpful
       2 3 4 5 6 7 - Not at all helpful

One last question!


15. Is there anything else you would like us to know about your experience of our Ask Us Online
counselling service? [Essay box]

Thanks for your feedback!
Once we've had a chance to look at everyone's answers, we will analyze the overall results and report
back to you. Check the website in early December for the results.




                                                                                                         22
Assessing Ask Us Online


               November, 2011

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Kids Help Phone Canada - Web Post Counselling - Report

  • 1. Assessing Ask Us Online the utility of web post counselling, as reported by service users
  • 2. November, 2011 © Kids Help Phone This paper was prepared by Tina Wilson, Research Analyst and Lila Knighton, Director, Knowledge Mobilization. Thanks to all counsellors and counselling managers for ensuring the invitation to participate was sent out with counsellor’s responses.
  • 3. Contents Implementation & Data Collection ...............................................................................................1 Sample................................................................................................................................................ 1 Results.........................................................................................................................................2 Demographics .................................................................................................................................... 3 Relationship with Kids Help Phone ..................................................................................................... 4 Counselling Issues .............................................................................................................................. 5 What Young People Find Most Useful About Post Counselling.......................................................... 6 Which is More Important, the Process of Writing, or Receiving a Response from a Counsellor?...... 8 The Best Things about Writing Out My Post(s) Are… .................................................................... 8 The Best Things About Getting Counsellors Response(s) Are…...................................................... 9 If Ask Us Online Wasn’t Available, Would You Call the Helpline Instead? ....................................... 11 Sub-Population Trends ..................................................................................................................... 12 Is There Anything Else You Would Like Us To Know? ....................................................................... 14 Appendix A: Client Age Distribution ........................................................................................... 18 Appendix B: Survey Questions .................................................................................................... 19
  • 4. Ask Us Online Client Survey O ver the month of October 2011, clients of Kids Help Phone’s non-synchronous Ask Us Online web post counselling service were invited to fill out a survey to help us better understand why they find the service helpful. We hoped their responses would help us answer five questions: 1. Overall, what is it about posting to Ask Us Online that young people find most helpful? 2. Which do young people experience as more helpful, writing out their post or the content of the counsellors response? 3. Are posters a different group of clients than callers? 4. Would posters use the phone service if the Ask Us Online option no longer existed? 5. Are there differences in the types of issues young people bring to the post “We’d love to hear your feedback about our Ask Us channel in comparison to the phones? Online service. The survey is completely voluntary and totally anonymous. Your counsellor will not be able to see your responses. If you would like to participate, click here to go to the survey. Thanks in Implementation & Data advance, from all of us at Kids Help Phone.” Collection C ounsellors appended the invitation to participate to the end of web post counselling responses published in the month of October. The invitation to participate process began at about 9am on October 1st and the survey was closed to further responses at 6:30am on November the 1st. Sample A combination of convenience1 and volunteer2 sampling was used to gather survey responses. This means the findings discussed in this report reflect the responses of the group who chose to participate, but may or may not be representative of how all post counselling service clients would have responded. 1 Post clients responded to in the month of October. 2 Data was gathered only from those who self-selected to participate. 1
  • 5. A total of 1,286 counselling responses were published to the websites in the month of October, 1,122 in English and 164 in French.3 We estimate the survey link was sent out with 75- 80% of English responses (about 870 invitations)4 and about 80% of French Final number of 5 volunteer responses (128 invitations), for a total estimated 998 invitations. Of this participants (N= group, 234 young people volunteered to participate, with 214 English 234) 6 and 20 French survey responses. This means Estimated number of invitations sent our response rate is estimated at 23% out (N= 998) overall; 16% for French and 25% for English. Our survey completion Web posts responded to in rate – the number of surveys for October (N=1,286) which every question was answered – was 77% (164) for All post counselling clients English respondents and 80% (16) for French respondents. This is a very good response rate for this type of questionnaire, particularly as no incentive was given to encourage participation. Please note that a single web post counselling client could be asked to participate more than once, if they received more than one response in the month of October. Also, the invitation to participate in the survey is both visible and clickable to anyone viewing the Ask Us Online forums, so there is the possibility that the survey was also filled out by people other than those to whom the invitation was addressed. Results7 P eople who respond to voluntary feedback surveys typically have stronger than average opinions and/or a stake in the topic. This means we need to consider if our respondents are representative of all our Ask Us Online clients or if particular sub-populations are over or under represented. We can estimate this by comparing our participant’s demographic and issue/topic responses with similar data for all post counselling clients. The greater the similarity (i.e. same gender, location and issue breakdown between respondents and all post clients) the greater the confidence we can have that the findings from this exploratory survey also represent the opinions and experiences of all our web post counselling clients. In addition, attending to overall differences in who uses our two counselling channels – web and phone – will help us identify if particular sub- 3 Data source: Flexiforum data, turnEN and turnFR, “Messages Posted by End Users in this Month that made it to the live site” (N=1,286). 4 Data source: Estimated by counselling management. 5 Data source: Estimated by counselling management. 6 Data source: Total number of SurveyMonkey surveys (both complete and incomplete). 7 All data is from the month of October, 2011. 2
  • 6. populations gravitate more to one service than the other. This comparison is important because it draws attention to service accessibility and/or service reach. In the charts that follow, “Post-Counsellor” refers to web post counselling session data recorded by counsellors in the month of October (N=1,010). “Post-Client” refers to young peoples’ responses to our survey (N=234). “Respondent” refers to those clients who filled out our questionnaire. “Phone- Counsellor” refers to phone counselling session data recorded by counsellors in the month of October (N=2,642). Demographics Demographic comparisons between our survey respondents and all post users will be briefly touched upon here and any differences highlighted. Gender: The gender breakdown between those who self-selected to participate in our questionnaire and all Ask Us Online clients is fairly similar. This said, our phone service receives proportionately more male callers than does our post counselling service.8 Age: The bulk of our respondents were between the ages of 14 and 16. In comparison to all Ask Us Online clients, 14 and 16 year olds are slightly over represented in our sample. Overall, those who use Ask Us Online tend to be a bit younger than those who use the phone service. Official Language: We received 20 French-language survey responses and 214 English. This is roughly proportionate to the language breakdown for all post counselling sessions recorded in October. Location: The regional distribution of our respondents was quite similar to that of all post counselling records completed in the month of October. The only notable differences are that we received proportionally more responses from Quebec (roughly 7% more) and proportionally fewer responses from Ontario (roughly 7-8% less) than the post counselling record data indicates we received overall. Data for urban or rural location is not regularly collected for all counselling contacts which make comparisons between our respondents and all post clients especially limited. This said, 72% of young people who responded to our questionnaire were located in urban areas (N=169) and 24% in rural areas or small towns (N=56). One respondent was from a First Nations community or Métis settlement. Of those post counselling records that did contain this data, 78-80% of clients were from an urban area. This suggests, very roughly, that our respondents included about 6% more rural clients than is the norm for our post service. 8 This higher proportion of male callers may have something to do with the number of prank calls the helpline receives. 3
  • 7. Relationship with Kids Help Phone T here are a few different ways we can think about our respondents’ relationship with the Ask Us Online counselling service: Absolute numbers of new and returning clients; the frequency with which respondents contact us; the length or duration of their relationship; and if they use one or both of our counselling services. About 80% of our respondents were repeat service users and a little more than 20% stated that this was their very first time posting to the Ask Us Online New vs. repeat service users counselling service. As this 100% chart illustrates, this is a much 250 172 495 higher proportion of returning 80% clients than Ask Us Online 60% 1,141 receives overall. This said, Repeat more than half (N=539) of 40% 221 New October’s post counselling records did not include data 20% 47 about new/repeat status. 0% Post-Counsellor Post-Client Phone-Counsellor While 80% of respondents were returning clients, the majority (51%) had only started using our service in the last year, with 31% of all respondents contacting us in the last three months. The majority of our respondents had submitted between When did you first post to Ask Us one and five posts (N=137) to the service. The highest Online? number had submitted 2-5 posts (N=90), and the second highest (N=47) were first time posters. Last 3 months 14% If we cluster numbers of responses, we see that the 3-12 months 31% majority of our respondents (63%) were also “new” 17% 1 year ago service users in that they had submitted five or fewer 2 years ago posts. 18% 20% 3+ years ago At the same time, our respondents also contain a sub- group of longer term clients (2+ years, N= 53 or 32%) Contact frequency and very regular service users (11-21+ posts, N=46 or 21%). Overall, while our sample includes more New users (1-5 returning clients than is average for the service as a posts) whole, newer service user and those that have only 21% posted a few times are also well represented. Repeat service 16% users (6-10 posts) 63% Regular service users (11-21+ posts) 4
  • 8. Counselling Issues C omparing what our respondents’ write about when posting to Ask Us Online to what our counsellors document for all post counselling clients also helps us understand if our survey participants are representative of all web counselling clients. However, it is important to note that counsellors and clients will assess and label issues differently. For example, a counsellor might note a substance misuse issue. The client may not identify this in our survey, either because it is not a presenting issue for them at the time of posting, or they do not identify any issues with their use more generally. With this major caveat in mind, this chart compares our respondents’ answers with the both the post and phone counselling records completed by counsellors in the month of October: Counselling topics, by data source Phone-Counsellor Post-Counsellor Post-Client Information about laws or rights Substance use or addictions Sexual orientation or gender identity Becoming independent Physical or sexual health Violence or abuse Bullying Self-injury Suicide and related issues School Family relationships Friend relationships Mental or emotional health 0% 5% 10% 15% 20% 25% 30% 5
  • 9. Clients who chose to participate in our survey told us they write to counsellors about proportionately more school, suicide, self-injury and independence related concerns. They were less likely to identify their concerns as related to mental or emotional health, or about friend or family relationships. Counsellors recognize more friend and more health issues in their work with posters to Ask Us Online. Counsellors also identify more family issues, and a few more bullying, legal, and violence and abuse issues in work with phone clients. What Young People Find Most Useful About Post Counselling W e asked post clients to tell us the reasons why the Ask Us Online counselling service was a good option for them; they could pick as many responses as applied to them as well as enter their own response in an essay box (N=217). What is it about posting to Ask Us Online that makes it a good option for you? I think posting is more anonymous/confidential than calling the help line 70 Writing out my problems helps me think 92 I like seeing the counsellor’s response in writing 111 I don't have enough privacy to talk on the phone 117 I find it easier to express myself in writing 126 I feel too nervous or uncomfortable to call the help line 163 6
  • 10. The majority of respondents told us that they feel too nervous or uncomfortable to call (75%) and that they find it easier to express themselves in writing (58%). •“I'm scared to talk to someone about this.” •“i stutter :/ so i like being able to write it out rather than try to talk with the person on the phone” •“When I talk on the phone I cry uncontrolably about my situation” This was followed by privacy issues (54%) and then by a preference for seeing the counsellors’ response in writing (51%). •“Im not aloud to us the phone :(“ •“I don't have a cellphone, but I have a personal computer.” •“I can look back on the replies from the counselors if I still need to” •“it helps to be able to go over the response a few times” Many also stated that writing out their problems helps them think (51%). A smaller but still sizable number also perceive web post counselling to be more anonymous and confidential than the phone service (32%). Of the 17 free-text responses we received, three offered a critique of our phone counselling service as a reason for choosing Ask Us Online. •“I tried calling once and the person wasn't that nice” Another way to look at responses to this question is to divide the questions and answers into two categories – those related to access (things like ease of expression, comfort level, privacy and perceptions of anonymity and confidentiality) Access vs. therapeutic benefit and those that relate more to therapeutic benefit (things like finding writing helpful and being able to review the counsellors’ Access (easier, less response in writing). Results suggest the discomfort, privacy, majority of those who responded to our 30% anon. & conf) survey use Ask Us Online for reasons related to accessibility. Therapeutic benefit (like writing, 70% reviewing the counsellors response) 7
  • 11. Which is More Important, the Process of Writing, or Receiving a Response from a Counsellor? The Best Things about Writing Out My Post(s) Are… We asked young people, “thinking about your experience with posting in general (not just your last post), please rank the following in order of importance (with 1 being most important to you and 5 being the least important to you). The best things about WRITING out my post(s) are:” and gave five options (below). We expected to see a clear ranking of options, but instead found considerable dispersion, with a loose trend becoming evident as high count responses were clustered together. This is illustrated in the following table (N=182): 1st 2nd 3rd 4th 5th Response choice choice choice choice choice count Knowing that someone who cares will N=143 know about my situation 34 32 34 21 22 The chance to express myself/ tell my N=135 story 33 35 25 15 27 Writing helps me to sort out my N=133 feelings 23 36 30 27 17 Writing helps me figure out what to N=151 do next with my situation 22 28 36 40 25 Sharing my story on a public site helps N=156 me to feel like I’m not alone 35 16 24 31 50 As another way of looking at the responses to this question, the next chart contrasts the combined number of first and second choices with the combined forth and last choices. Looking at the data this way, we can see that in terms of numbers, each possible response was important to a sizable number of clients but not important to another sizable number: The best things about writing out my post(s) are... choice 1+2 & choice 4+5 combined: 1st &2nd 4th &5th Writing helps me figure out what to do next with 50 my situation 65 Writing helps me to sort out my feelings 59 44 The chance to express myself/ tell my story 68 42 Knowing that someone who cares will know about 66 my situation 43 Sharing my story on a public site helps me to feel 51 like I’m not alone 81 0 10 20 30 40 50 60 70 80 90 Number 8
  • 12. Next, we asked young people to tell how helpful they find the process of writing out their post(s) overall. 73% of respondents told us that writing was helpful to them (scale points 1-3 falls on the “helpful” side of the neutral midpoint on our scale). 25% told us they find writing On a scale of 1 to 7, where 1 is very helpful and 7 is not at to Ask Us Online “very helpful.” all helpful, in general, how helpful do you find WRITING out your post(s)? Overall, the majority of our respondents find the process of writing out their response very helpful, but the reasons Not at all Very for this vary from person to person. helpful helpful 1 2 3 4 5 6 7 Respondents’ rankings show a tendency to value “the chance to In general, how helpful do you find WRITING express myself,” “knowing that some out your post(s)? who cares will know about my 1% 3% situation,” and “writing helps me sort out my feelings” more highly. 1 - Very helpful 9% 25% 2 14% 3 The Best Things About Getting 4 Counsellors Response(s) Are…. 5 Similarly, we asked young people, 19% 6 “thinking about your experience with 29% posting in general (not just your last 7 - Not at all helpful post), please rank the following in order of importance (with 1 being most important to you and 5 being the least important to you). The best things about getting the counsellor’s RESPONSE to my post(s) are:” and gave them an additional five options. Compared to the “best things about writing” question, we can see somewhat clearer trends as to which aspects of counsellor’s responses our participants consider to be more and less important. Out of the number who ranked the options, 57% chose “getting a supportive response from someone who cares” as most important and “getting a referral” as least important (65%): 1st 2nd 3rd 4th 5th Response choice choice choice choice choice Count Getting a supportive response from someone who cares 55 27 24 20 18 144 Getting practical tips or suggestions 25 36 38 29 8 136 Reading the counsellor's response helps me figure out what to do next with my situation 27 41 28 34 25 155 Getting information about my situation or concern 26 32 35 36 12 141 Getting a referral (i.e. information about a service in my community) 22 15 15 24 73 149 9
  • 13. The following chart, representing the respondents’ first and second choice combined and their fourth and fifth choice combined, reinforces this trend. The best things about getting the counsellors' response to my post(s)... choice 1+2 and choice 4+5 combined: 1st & 2nd 4th & 5th Getting a supportive response from someone who 82 cares 38 Reading the counsellor's response helps me figure 68 out what to do next with my situation 59 Getting practical tips or suggestions 61 37 Getting information about my situation or concern 58 48 Getting a referral (i.e. information about a service in 37 my community) 97 0 20 40 60 80 100 120 Number When we asked young people to rate, on a scale of one to seven, how helpful they find responses from counsellors, more than 80% of respondents indicated that they find them helpful. 29% rated counselling responses “very helpful.” In general, how helpful do you find counsellor's RESPONSES to your posts(s)? 6% 3% 1 - Very helpful 3% O ne of the questions 2 we hoped to better 8% 29% 3 understand was if the process of writing was 4 22% more, less or equally 5 important to getting a 29% 6 response from a counsellor. 7 - Not at all helpful If writing was clearly more important, than our counsellor moderated Express Yourself forum might be a reasonable substitute for our Ask Us Online counselling service.9 9 Clients can submit posts to either Ask Us Online, where they will receive a counsellor’s response, or Express Yourself, where counsellors review the submission before it goes live on the website, but do not provide a response. 10
  • 14. Looking at the ratings of how helpful writing and getting a response are side-by-side shows that while both are rated as helpful, counsellor’s work is rated as more helpful by most participants. Comparing user reported helpfulness for 'writing' & 'getting a counsellor's response' In general, how helpful do you find WRITING out your post(s)? In general, how helpful do you find counsellor's RESPONSES to your post(s)? 60 50 53 53 50 40 45 44 30 34 20 25 10 16 12 4 3 9 5 6 0 1 - Very 2 3 4 5 6 7 - Not at all helpful helpful If Ask Us Online Wasn’t Available, Would You Call the Helpline Instead? A n additional important area to explore was whether limiting or discontinuing the Ask Us Online counselling service would result in Kids Help Phone cutting service to a group of young people who would not seek out support from our other services. To this end, we asked our respondents which Kids Help Phone counselling services they use. A How do you usually get in contact with significant majority were dedicated Ask Kids Help Phone? Us Online service users; they do not use the phone service. 19% of our 3% 1% respondents mostly post but sometimes Post to the Ask Us phone. Only 4% use the phone service Online forums 19% more than they post. Mostly post but sometimes phone Mostly phone but sometimes post 77% Phone the helpline 11
  • 15. We also asked, “if Ask Us Online wasn’t available, would you call the helpline?” Roughly a quarter of our respondents said they would call us. A significant number (36%) claimed that they would not use our phone service and the larger number (41%) was not sure. If Ask Us Online wasn't available, would you call the While we do not have a comparable set of data for helpline? all our clients, our participant’s answers to these two questions indicate that discontinuing or limiting out Ask Us Online counselling service would have 23% Yes significant implications for the accessibility of our 41% total service offerings. No 36% Not sure Sub-Population Trends F iltering our data by response or respondent demographics can help us determine if there are sub-group based trends or themes. It must be noted, however, that filtering reduces the sample size, which has implications for the generalizability of the findings. To determine if there were any sub-group trends, we filtered the larger data set in the following ways:  Willingness to use other service channels  Respondents who would not call the phone line; Respondents who would call the phone line; Respondents who are not sure if they’d call the phone line.  Respondent age • 12-15; 16-20; 21+  Relationship with the service • Infrequent users (those who posted 1-5 times); Heavy users (those who posted 16+ times); Historical relationship with service (use over 2+ years); New relationship with service (first use within last 3 months).  Respondents who write to us about mental health and related issues (including self-injury and suicide)  Male respondents  Respondents living in a rural area or First Nations community  Those who had a low overall rating of the service  Those who prioritized receiving a referral to a community based resource Not all filters revealed notable trends. Some of the trends we were able to identify include: 12
  • 16. Respondents who identified mental health as an area of concern  A disproportionately high % of our overall respondents noted that they contact us about issues related to suicide and self-injury (35.4% and 32.8 respectively)  More of the respondents who wrote to us about mental health related issues stated that they would not call the help line if AUO was not available, and fewer said they were not sure if they would call or not.  Of the heavy users who have used the service 20 or more times, all but one identified mental health as one of the issues they contact us about. Male respondents  Our male respondents are older, on average, than all respondents. The majority of respondents (57%) are 16, 17 or 18, whereas the majority of female respondents (65%) fall into the 13-16 range.  There was a slight skew (approx. 10%) towards living in a rural area among male respondents.  Lack of privacy was identified by fewer males (41% vs 54% in full sample) as a reason why AUO is a good option for them.  Fewer males identified that they would call the helpline if it AUO was not available (10% said they would vs 23% in larger group) and more said they weren’t sure if they would or not (55% vs 39% in larger group).  Males were more likely to identify “getting information about my situation or concern” as a key component of a counsellor’s response than the larger group (35% males ranked this first, compared to 19% of the larger group); conversely, males were less likely to value “getting a supportive response from someone who cares” than average (20% of males ranked this first, versus 40% of the larger group) Respondents from rural areas or First Nations communities  On average, this group rated the experience of both writing and post and receiving a response from a counsellor more highly than the larger group, with 35% (vs 25%) using a rating of ‘1’ –or ‘very helpful’ on the 7 point scale for question 12 (‘how helpful do you find writing out your posts?’) and 44% (versus 29%) using a rating of ‘1’ for question 14 (‘how helpful do you find counsellors’ responses to your posts?’). Heavy or longstanding service users  Heavy users were more likely to select “I find it easier to express myself in writing,” “writing out my problem helps me think,” and “I like seeing the counsellor’s response in writing” than the larger group.  Heavy users were more likely to identify mental health as an issue they write to us about that other users (92.6% vs 67%).  Heavy users were more likely to highlight the importance of ‘getting practical tips or suggestions’ in a counselling response (25% ranked as #1 vs 15% in the larger group); this, 13
  • 17. however, does not apply equally to longstanding service users (those with a 2+ year relationship with the service). Longstanding users valuation of tips and suggestions was comparable to the larger group, but they were more likely than average to prioritize “getting a supportive response from someone who cares” (45% v 40% ranked this #1).  Longstanding service users had a lower overall rating of service than average (the most common ranking was 3 -- where 1 was ‘very helpful’ and 7 was not at all helpful -- compared to 1 and 2 tied as the most common ranking among the larger group)  Longstanding users ranked the act of writing out the post higher than the average group (higher, indeed, than the counsellor response). New and Infrequent users  Infrequent users were slightly more likely than the larger group to identify bullying as an issue they write to us about (32% vs 25%)  Infrequent users had a higher overall rating of service than average (the most common ranking was 1, or ‘very helpful.’  New users (those who first posted in the last 3 months) were somewhat less likely to identify feeling “too nervous or uncomfortable to call the help line” as a reason for choosing AUO  All new users identified as already using the service more than once (75% said they have used the service 2-5 times, and 17% 6-10 times).  New users were less likely to identify “getting a supportive response from someone who cares” as the best thing about a counsellor response (only 30% of new users selected this as #1, vs 40% of the larger group)  New users were more likely to identify that “*the+ response helps me figure out to do next with my situation” as the best thing about getting a counsellor response (25% selected this option as #1 vs. 17% in the larger group). Is There Anything Else You Would Like Us To Know? Four main themes emerged Is there anything else you would like us to know? from the 71 responses we received to our final question: Other Want live chat Critical feedback Positive feedback 0 5 10 15 20 25 30 14
  • 18. Other Responses Other responses including things like: “Please change the KHP name, the site is not just for kids and putting the word kids pushes away indirectly some people. Also, please make KHP a little more community based. It's good to have support from adults who work on their free time to help, but also getting input from someone of our age or background ACTUALLY does help too.” “It would be nice if there was a more integrated way of replying to posts after a counselor has made them. This makes answering any questions the counselor asked as well as getting more consisten help easier” “I would like a mobile app. like for android or iphone.” Support for Live Chat Counselling Thirteen of our respondents specifically requested we begin providing live chat counselling: “I want to know if you guys are starting and Instant Messaging thing. People like me, are to scared/shy to call but they need immediate support, moreover, some don't have enough privacey--like me. And asking online, people can't get immediate support, but at least they don't feel too scared and they have no one eavesdropping.” “I really think that it takes to long to get a response.. Like I think the next day you should have a response.. Most people go online b/c they dont feel comfortable talking to someone on the phone so I think you should give people a more.. fast response any way they want it... and i also think that a instant messaging thing would be great.. for people who need help now but dont know how to talk on the phone” “It would be great if there were some kind of live chat type of thing. I am too afraid to call but sometimes i would like a faster response.” “The counselors are very nice and supportive, I thank you. Please make the IM messaging, we need it. :)” 15
  • 19. Critical Feedback Critical feedback was most often related to the extended wait to receive a response: “Replys take way too long.... If I'm gonna commit suicid do you think I'm just gonna Critical feedback sit around and wait for a resons? The max Problem w/ waiting time for a reply should be an post response hour.... Either get caught up with the posts time , or hire more councilors!!!!!” 35% 45% Negative exp. w/phones “It sometimes takes too long for the counselors to reply. I know they are Critique 20% handling a lot of different posts and phone content of post calls, but sometimes things are urgent and response need a quick response.” Critiques of counsellor’s post responses were most often to do with wanting more detailed responses: “Regarding to responses, I find they aren't specific enough to help me. So I make more posts hoping for a better response. Maybe if the responses were more specific, you wouldn't be as flooded with posts. I hope I helped!” “I dont know...msot of the time its a big probleme and i get comments all "Aw im sorry you feel this way" Uh yeah that didnt help much......” « C'est bien que vous marquez les références pour nous aider. Par contre, moi ce que je recherche c'est surtout des suggestions que je pourrais faire pour aider monc cas. » Last, four of our respondents explained that they use Ask Us Online because they had a bad experience when they called the helpline: “So far when ever I send a post to KHP I get pretty helpful responses. But out of the three times I've ever called the counsellor's I got seemed frustrated with me infact one of them raised there voice at me.....it made me feel like I was annoying and kinda made things worse cause I felt that my situatuion was to frustrating for even a counsellor.....it wasn't a nice feeling I call only cause I want a quick answer and I only post when my situation isn't that bad.....but I don;t plan to ever call anytime soon cause the cousellors sound depressed and mono tone when you call.....it's not very welcoming or warming. And when you've been pacing back and forth trying to gain the courage to call and pour your feelings out over the phone to a stranger 16
  • 20. and there sounding unwelcoming it's not a nice feeling......Like they don't even say Hello back when you say it to them. Thank you for your time :)” Positive Feedback Positive feedback Positive feedback was most often stated in general terms: General 19% appreciation/ “thanks for being awesome and helping me thanks through stuff.” Other pos. 81% feedback “continuer votre bon travail!” Some of these answers indicate the role Ask Us Online has played in supporting respondent’s well-being over time: “You've helped me through a lot of my lifes hard times. Thank you.” Other positive feedback included statements like: “It's been a great way for me to organize my thoughts without worrying about being judged by others”. A few stressed the importance of the service to specific participants: “Just never stop doing the online help... I have nothing else but this :( Judging from these questions, thats what I've concluded, your considering stopping the online help... I'd have to start asking Yahoo :(“ 17
  • 21. Appendix A: Client Age Distribution In the two charts that follow, “Post-Counsellor” refers to web post counselling session data recorded by counsellors in the month of October (N=1,010). “Post-Client” refers to young peoples’ responses to our questionnaire (N=234). “Phone-Counsellor” refers to phone counselling session data recorded by counsellors in the month of October (N=2,642). All data is from the month of October, 2011. 18
  • 22. Appendix B: Survey Questions Invitation to participate: “We’d love to hear your feedback about our Ask Us Online service. The survey is completely voluntary and totally anonymous. Your counsellor will not be able to see your responses. If you would like to participate, click here to go to the survey. Thanks in advance, from all of us at Kids Help Phone.” Thanks for taking the time to give us your feedback about As Us Online! This information will help us understand how useful our online post counselling service is and decide how to provide this type of support in the future. The information we collect here may also be used in conversations with media or other groups who support Kids Help Phone. Your answers are always anonymous (none of this information could ever get linked back to you) and your counsellor will NOT see your answers. 1. Are you: [dropdown menu]  Male  Female  Transgender/ Genderqueer  Other (please specify) [text box] 2. How old are you? [dropdown menu] 3. What province or territory do you live in? [dropdown menu]  Alberta  British Columbia  Manitoba  New Brunswick  Newfoundland and Labrador  Northwest Territories  Nova Scotia  Nunavut  Ontario  Prince Edward Island  Quebec  Saskatchewan  Yukon 4. What kind of community do you live in?  City or large town (more than 10,000 people) 19
  • 23. Rural area or small town (less than 10,000 people)  A First Nations community or Métis settlement  Other (please specify) [text box] 5. How do you usually get in contact with Kids Help Phone?  Post to the Ask Us Online forums  Phone the helpline  Mostly post but sometimes phone  Mostly phone but sometimes post 6. What is it about posting to Ask Us Online that makes it a good option for you? Check all that apply:  I feel too nervous or uncomfortable to call the help line  I find it easier to express myself in writing  I don't have enough privacy to talk on the phone  Writing out my problems helps me think  I like seeing the counsellor’s response in writing  I think posting is more anonymous/confidential than calling the help line  Other (please specify) [text box] 7. If Ask Us Online wasn’t available, would you call the help line instead?  Yes  No  Not sure 8. In total, how many times have you sent us a post?  This is the first time [trigger to skip the next question]  2-5 times  6-10 times  11-15 times  16-20 times  More than 20 times 9. When did you first post to Ask Us Online?  In the last three months  In the last six to nine months  In the last nine to 12 months  Last year  Two years ago  Three or more years ago 20
  • 24. 10. What issue or issues do you write to us about? Choose as many as apply:  Friend relationships  Family relationships  Violence or abuse  Bullying  Mental or emotional health  Substance use or addictions  Physical or sexual health  School  Information about laws or rights  Sexual orientation or gender identity  Becoming independent  Self-injury  Suicide WRITING to Kids Help Phone 11. Thinking about your experience with posting in general (not just your last post), please rank the following in order of importance (with 1 being most important to you and 5 being the least important to you). The best things about WRITING out my post(s) are: [Forced ranking, 5 levels]  The chance to express myself/ tell my story  Writing helps me to sort out my feelings  Knowing that someone who cares will know about my situation  Writing helps me figure out what to do next with my situation  Sharing my story on a public site helps me to feel like I’m not alone 12. On a scale of 1 to 7, where 1 is very helpful and 7 is not at all helpful:  In general, how helpful do you find WRITING out your post(s)? 1 - Very helpful 2 - 3 - 4 - 5 - 6 - 7 - Not at all helpful GETTING A RESPONSE from Kids Help Phone 13. Thinking about your experience with posting in general (not just your last post), please rank the following in order of importance (with 1 being most important to you and 5 being the least important to you). The best things about getting the counsellor's RESPONSE to my post(s) are: [Forced ranking, 5 levels] 21
  • 25. Getting a referral (i.e. information about a service in my community)  Getting information about my situation or concern  Getting practical tips or suggestions  Getting a supportive response from someone who cares  Reading the counsellor's response helps me figure out what to do next with my situation 14. On a scale of 1 to 7, where 1 is very helpful and 7 is not at all helpful:  In general, how helpful do you find counsellor's RESPONSES to your post(s)? 1 - Very helpful 2 3 4 5 6 7 - Not at all helpful One last question! 15. Is there anything else you would like us to know about your experience of our Ask Us Online counselling service? [Essay box] Thanks for your feedback! Once we've had a chance to look at everyone's answers, we will analyze the overall results and report back to you. Check the website in early December for the results. 22
  • 26. Assessing Ask Us Online November, 2011