Teen Helpline Motivational Interviewing Study

Using Performance Feedback and Facilitation to Integrate Motivational Interviewing in Teen Helpline Services

The proposed study will establish a foundation for research within peer-delivered helplines for teens. It aims to evaluate the impact of a Motivational Interviewing training at peer-to-peer helpline. The study will leverage emerging technologies to surmount the challenges of providing tailored training to a large and diverse mental health workforce at scale.

Aim 1: Adapt Motivational Interviewing (MI) strategies for use in a teen peer-delivered text-based digital helpline.

Aim 2: Co-design performance feedback (PF) and facilitated practice (FP) processes to support MI adherence among peer helpers.

Aim 3: Examine feasibility, acceptability, and initial outcomes in a pilot feasibility trial. Peer helpers (N=50) will be randomized to receive MI training or MI training + PF-FP.

This study will adapt and implement Motivational Interviewing (MI) within Teen Talk App, a text-based teen-to-teen helpline, with the goal of increasing real-world help-seeking among youth users. Using human-centered design methods, teen helpers, supervisors, and users will participate in focus groups, interviews, and iterative prototyping activities to adapt MI for brief text-based interactions and to refine an implementation strategy consisting of performance feedback and facilitated practice (PF-FP). Stakeholder input will be used to ensure the intervention and implementation strategy are acceptable, feasible, and fit within existing helpline workflows.

Following adaptation, a pilot feasibility trial will evaluate the implementation strategy among Teen Talk peer helpers. Helpers who enroll in the study (N=50) will be randomized to receive either training as usual or enhanced training consisting of monthly performance feedback and facilitated practice sessions over a 6-month period. Teen Talk users (N=100) will also be recruited to assess clinical outcomes, including help-seeking behaviors and mental health symptoms. The study will provide preliminary data on implementation outcomes, helper MI skill use, and user outcomes to inform a future fully powered effectiveness-implementation trial.

Inclusion Criteria

Teen Helpers

• Current helpline peer helpers
• Aged 14-19 years.
• Provides assent and documented parental consent (when applicable).
• Completes study measures prior to the first Motivational Interviewing (MI) training session.
• Attends and completes assigned MI training activities.
• Has access to technology required for online participation (computer, tablet, or smartphone with internet access; videoconferencing capability if needed).
• Plans to continue helpline activities throughout the study period.

Teen Users

• Aged 13-19 years.
• Current U.S. resident.
• Has engaged in at least 20 back-and-forth text exchanges with a helpline volunteer.
• Demonstrates active communication and engagement on the helpline platform.
• Has access to technology required to complete online surveys and, if selected, interviews (computer, tablet, or smartphone with internet access).

Exclusion Criteria

Teen Helpers

- Plans to discontinue helpline activities within the next 8 months.

Teen Users

• Identified as currently experiencing acute suicide risk (i.e., assigned a "high-risk" flag by the helpline algorithm or identified as high risk by helpline staff).
• Requires immediate crisis intervention or emergency services that could be disrupted by participation in the research study.