Imaginator 2.0: Co-design and early evaluation of a novel blended digital intervention targeting self-harm in young people

Abstract

ABSTRACT Background Self-harm (SH) affects around 20% of all young people in the UK. Treatment options for self-harm remain limited and those available are either non-specific or long and costly and may not suit all young people. There is an urgent need to develop new scalable interventions to address this gap. IMAGINATOR is a novel imagery-based intervention targeting self-harm initially developed for 16- to 25-year-olds. It is a blended digital intervention delivering Functional Imagery Training (FIT) via therapy sessions and a smartphone app. In this study, we piloted a new version of IMAGINATOR extended to adolescents from age 12 after co-producing a new app with a diverse group of young people experts-by-experience. Here we report on feasibility of delivering IMAGINATOR 2.0 in secondary mental health services and clinicians’ feedback on the intervention. Methods Participants were recruited from West London NHS Trust Tier 2 CAMHS and adult Mental health Integrated Network Teams (MINT) teams. They received three face-to-face FIT sessions in which the app was introduced followed by five brief phone support sessions. Outcome assessments were conducted after completing therapy, approximately 3 months post-baseline. Two focus groups were conducted to gather the therapists’ perspectives on the IMAGINATOR 2.0 intervention. For quantitative data, descriptives are reported. Qualitative data were analysed using a co-produced thematic analysis method with lived experience co-researchers. Results Eighty-three participants were referred and 29 (28 female, 1 transgender, mean age = 18.9) were eligible and completed screening. Out of 27 participants who started, 59% completed therapy per protocol while only 15 completed the quantitative outcome assessment. There was an overall reduction in number of SH episodes over 3-months from pre-to post-intervention (baseline: median = 6.5, IQR = 35; post-intervention: median = 0, IQR = 7; median diff = -6.5, r = 0.69). Five themes were identified through analysis of therapists’ feedback, including therapy impact, mental imagery efficacy and limitations and need for better integration of the IMAGINATOR 2.0 app with therapy sessions. The app was overall well received, and therapists highlighted the need for an intervention like IMAGINATOR in their services. Conclusion We show that IMAGINATOR can be extended to adolescents, is acceptable and has potential as a brief intervention reducing self-harm in young people under mental health services. A future RCT is needed to robustly test the intervention efficacy, after considering issues around high attrition in outcome measures.

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