Rapport Building in Written Crisis Services: Qualitative Content Analysis.

BACKGROUND: Building therapeutic relationships and social presence are challenging in digital services and maybe even more difficult in written services. Despite these difficulties, in-person care may not be feasible or accessible in all situations. OBJECTIVE: This study aims to categorize crisis counselors' efforts to build rapport in written conversations by using deidentified conversation transcripts from the text and chat arms of the National Child Abuse Hotline. Using these categories, we identify the common characteristics of successful conversations. We defined success as conversations where help-seekers reported the hotline was a good way to seek help and that they were a lot more hopeful, a lot more informed, a lot more prepared to address the situation, and experiencing less stress, as reported by help-seekers. METHODS: The sample consisted of transcripts from 314 purposely selected conversations from of the 1153 text and chat conversations during July 2020. Hotline users answered a preconversation survey (ie, demographics) and a postconversation survey (ie, their perceptions of the conversation). We used qualitative content analysis to process the conversations. RESULTS: Active listening skills, including asking questions, paraphrasing, reflecting feelings, and interpreting situations, were commonly used by counselors. Validation, unconditional positive regard, and evaluation-based language, such as praise and apologies, were also often used. Compared with less successful conversations, successful conversations tended to include fewer statements that attend to the emotional dynamics. There were qualitative differences in how the counselors applied these approaches. Generally, crisis counselors in positive conversations tended to be more specific and tailor their comments to the situation. CONCLUSIONS: Building therapeutic relationships and social presence are essential to digital interventions involving mental health professionals. Prior research demonstrates that they can be challenging to develop in written conversations. Our work demonstrates characteristics associated with successful conversations that could be adopted in other written help-seeking interventions.

"The Stay at Home Order is Causing Things to Get Heated Up": Family Conflict Dynamics During COVID-19 From The Perspectives of Youth Calling a National Child Abuse Hotline.

The purpose of this study was to identify changes in family conflict and abuse dynamics during COVID-19 stay-at-home orders from the perspectives of youth calling a national child abuse hotline. We analyzed text and chat transcripts from Childhelp's National Child Abuse Hotline from May-June 2020 that were flagged as coming from a child with a COVID-19-related concern (N = 105). Thematic analysis was used to identify COVID-19 related influences of family conflict as well as how COVID-19 constraints influenced coping and survival for youth reporting distress or maltreatment to the hotline. Family conflict most commonly disclosed stemmed from parental or child mental health concerns, often manifesting in escalated child risk taking behaviors, parental substance use, and violence in the home. Conflict was also mentioned surrounding caregiver issues with child productivity while sheltering-in-place, commonly related to school or chores. Youth often voiced feeling unable to find relief from family conflict, exacerbated from physical distance from alternative social supports, technological isolation, and limited contact with typical safe places or supportive adults. To cope and survive, youth and crisis counselors found creative home-based coping skills and alternative reporting mechanisms. Understanding the unique impact of COVID-19 on youth in homes with family conflict and abuse can point to areas for intervention to ensure we are protecting the most vulnerable as many continue to shelter-in-place. In particular, this study revealed the importance of online hotlines and reporting mechanisms to allow more youth to seek out the help and professional support they need.

In their own words: Child and adolescent perceptions of caregiver stress during early COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has exacerbated multiple stressors for caregivers of children in the United States, raising concern for increased family conflict, harsh parenting, and child maltreatment. Little is known regarding children's perceptions and experiences of caregiver stress during the COVID-19 pandemic. OBJECTIVE: To examine how children and adolescents identify and experience caregiver stress during the early COVID-19 pandemic. METHODS: We analyzed 105 de-identified helpline text and online chat transcripts from children under age 18 who submitted inquiries to the Childhelp National Child Abuse Hotline from March to June of 2020, with COVID-19 as a presenting issue. Inductive, thematic analysis was used to identify how child helpline users: 1) perceived and experienced drivers of caregiver stress and 2) used words to describe manifestations of caregiver stress during the COVID-19 pandemic. RESULTS: Children experienced multiple drivers of caregiver stress during COVID-19, including intrapersonal (e.g. caregiver health concerns), interpersonal (e.g. parental discord, perceived dislike of child), and extrapersonal (e.g. financial insecurity, sheltering in place) stressors. Regardless of the driver, caregivers' stress was internalized by children. "Anger," "control," and "blame" were most commonly used to label manifestations of caregiver stress, which were often externalizing behaviors, including yelling, name calling, and blaming of others. CONCLUSION: In text and online chat inquiries to a national child helpline during the COVID-19 pandemic, children described multiple drivers of caregiver stress, often feeling as though they were to blame. Providers serving children should address household stress spillover effects by including caregivers and directly acknowledging children's concerns using their own words.