3 - (SYM 34) Perceptions of Teens and Caregivers on SMILEY, an Automated Depression and Suicide Prevention Intervention for Online Victimized, At-risk Youth: A Qualitative Study in Pediatric Primary Care Settings

Background: Online victimization (OV) comprises disparaging online remarks, symbols, images, or behaviors intended to inflict harm. OV puts teens at elevated risk for depression and suicide, and risk increases up to threefold for victimized youth from minoritized groups. Technology-based interventions can expand the accessibility and effectiveness of services by engaging patients in self-management. Automated interventions may be ideal for OV because they are confidential, non-stigmatizing, and can help teens cope. We aimed to develop SMILEY, an intervention for reducing the frequency of and perceived stress associated with OV among at-risk teens (i.e., exhibiting depressive symptoms and/or suicide risk) seeking services in pediatric primary care. We sought to identify perceptions about potential intervention content, delivery, utility of intervention-generated reports, and barriers and facilitators toward implementation.

Methods: We conducted individual, semi-structured interviews with at-risk teens who experienced OV (age 12-18; n=13) and their caregivers (n=11). We used a reflexive thematic analysis approach to analyze the data. Themes were informed by the Consolidated Framework for Implementation Research (CFIR).

Results: Teen and caregiver interviews suggested an automated, chatbot intervention as a delivery strategy for SMILEY and noted the importance of teens’ conversations with caregivers and providers in processing and managing OV as key environmental factors. In relation to intervention characteristics, teens perceived SMILEY (1) would be helpful for youth with few supports, (2) beneficial if permanently available and non-judgmental, and (3) should allow teens choice on who sees information from SMILEY (e.g., caregivers, providers). Caregivers perceived SMILEY (4) would be helpful if it offered teens an outlet to process OV, (5) would lack interpersonal connection, given its automated nature, that may be a two-edge sword, and (6) should offer caregivers limited direct involvement but some oversight of the intervention.

Conclusion: An automated intervention that delivers coping skills and social media literacy was perceived to be acceptable in assisting at-risk teens who have experienced OV. The lack of interpersonal experience was perceived as both an opportunity and risk. Teens should have autonomy over how caregivers and providers are involved. Results are informing ongoing iterative intervention development and testing with teens from pediatric primary care settings.