Table 2 Good Practice Indicators for asking young people about online activities during mental health consultations

1. All young people attending a mental health consultation should be asked about their online activities

2. Practitioners should ask young people about online activities at their first meeting and then at regular intervals

3. There are red flags that indicate circumstances (times/ young people) where it might be particularly necessary/ helpful to initiate a conversation (Table 3)

1. There is a set of key topics that it is important for clinicians to always ask about when exploring online activities (Table 4)

2. There is a set of key topics that clinicians should ask young people with disordered eating when exploring online activities (Table 4)

3. There is a set of key topics that clinicians should ask young people presenting with self-harm or suicidal thoughts when exploring online activities (Table 4)

4. Discussions about worrying online activity should usually include asking for the names of sites visited, descriptions of content created by the young person and details of participation in online groups

5. Asking about online activities should take the form of a deeper conversation in which clinicians encourage the young person to reflect on their behaviour patterns and the impacts of these (Table 5)

6. Adapted approaches may be necessary if asking younger age groups or young people with neurodevelopmental disorders

‘HOW’ to encourage disclosure and ensure a non-judgemental approach

‘OUTCOMES’ – following up on conversations

1. Discussion about online activities should be started spontaneously as part of the flow of conversation, with questions naturally embedded within broader topics rather than as a standalone item

2. Conversations should be supported by open-ended prompts

3. All young people should be offered an opportunity to discuss their online activities without their parent/ guardian being present

4. When discussing online activities, clinicians should be curious and ask questions

5. When discussing online activities, clinicians should be up-to-date in their knowledge of the online world and able to use up-to-date language

1. Online activity that causes concern should be flagged in notes so that it can be followed-up at other appointments

2. Clinicians should involve parents in conversations about a young person’s online activities if the young person is under 12-years-old

3. Clinicians should encourage the young person to be active in taking care of their own online safety

4. A clinician should not simply recommend stopping online activities but support the young person to engage with the online world in a more positive way

5. Aspects of online safety should be incorporated into treatment/ safety plans (Table 6)

6. When recommending apps, it is important for a clinician to offer several choices of app, always offer to demonstrate apps, and then follow-up on whether the recommendation was helpful or not

Clinicians should:

6. Ask about positive aspects of online activities before addressing the negative

7. Always explain why they are asking the young person about the online activities

8. Always openly communicate understanding that online activities can be beneficial

9. Normalise online activities and acknowledge how commonplace online harm can be when discussing this with young people

10. Explicitly address fears of judgement or of ‘being in trouble’ when introducing questions about online activities

11. Explicitly discuss confidentiality and its limits when asking questions about online activity

12. Let young people know that they ask questions about online activity routinely during consultations