Conversational Media for Inclusive Access to Mental Health Interventions for Schoolchildren

Mental health conditions in children and adolescents have been on the rise, with at least one in ten affected worldwide [15]. In Northern Ireland (NI), one in eight children and adolescents suffers from emotional difficulties, a mood disorder, or an anxiety disorder; one in seven suffers from hyperactivity; and one in ten exhibits conduct problems [4]. Access to mental healthcare systems is hindered by long waiting lists, with over 2,095 total waits in NI by the end of 2023 [5]. Due to this deficiency in mental health support, school teachers are needing to support increasingly complex issues in the classroom. However, teachers may lack sufficient training or resources to manage these difficulties, leading to them feeling ‘overextended’, ‘burnt out’, ‘isolated’ and ‘unsupported’ [7].

To support teachers and schoolchildren, the Verbal charity provides convenient and widespread access to their bibliotherapy-based interventions via the ‘Verbal Wellbeing’ programme. The launch of the ‘Verbal Wellbeing’ programme has unintentionally coincided with the loss of the Healthy Happy Minds funding programme in 2023, leaving school children “without vital support” for their wellbeing [2]. While it is imperative for schools to have access to wellbeing resources to address this resource gap, spreading knowledge and awareness of the ‘Verbal Wellbeing’ programme can be challenging for a charity experiencing time and financial constraints. Therefore, a more pervasive approach is needed that would overcome cutbacks on wellness-supporting activities, the limited resources of the charity, and the time-constraints on teachers.

Conversational media is being increasingly used to complement human-to-human direct interactions in different settings including social care, health provision, and industrial training. With recent increases in investment in AI applications, conversational media has been recognised as having particular potential in education [8]. Wider and easier access to AI technologies including Amazon's Alexa and Apple's Siri has allowed an increase in their application in educational settings [9, 10, 12].

In The Room's proprietary interactive conversational media platform uses pre-recorded videos combined with voice recognition and natural language processing technologies to simulate conversational experiences, where users ask questions and are provided with answers and suggestions of follow-up questions. This enables users to make meaningful connections, and obtain the information they need quickly and intuitively from a trusted source.

This contribution describes insights from a 2024 collaboration between academic researchers, Verbal and In The Room which resulted in a video resource in support of local innovation and growth. The collaboration aims to describe how conversational media can play a role in learning and development, and making interventions and sensitive materials more scalable, approachable, understandable, and long-lasting. The conversational media platform aims to support school teachers and thus they are its target users; schoolchildren are not the direct target users of the platform, and so the platform's indirect impact on the schoolchildren's mental health has not been evaluated as it is outside the scope of the current collaboration.

The Verbal charity runs outreach and participation-based programs which target remote and hard-to-reach marginalised populations in an effort to enhance the mental health and resilience of individuals and communities. The targeted populations include vulnerable children and young adults in school settings as well as those in the care system. Verbal's interventions, known as Shared Reading, are a form of Affective Bibliotherapy which uses storytelling to both teach lessons on mental wellbeing and facilitate discussions surrounding wellbeing using characters and storylines [6, 11]. The benefits include significant improvement in children's wellbeing, emotional management, resilience, and ability to manage their emotions [13, 14].

However, Verbal has limited resources and geographic reach and therefore has developed the ‘Verbal Wellbeing’ programme in 2023 as an online platform and mobile app as a means to provide convenient and widespread access to their bibliotherapy-based interventions. The programme is targeted at informing teachers about Verbal's programmes as well as supporting them to deliver interventions which are effective, evidence-based, and have positive demonstrable impact. Nevertheless, this approach is still limited because teachers have time constraints and many are not familiar with the Shared Reading intervention to start with. Thus, a resource supported by conversational media would benefit the teachers by guiding them in completing Shared Reading sessions as well as providing insight into the psychology behind Shared Reading and Affective Bibliotherapy in a conversational, bite-size format that is easy to understand. It would also be perpetually available, location-independent, and in an interactive format which simulates a face-to-face conversation with an expert whose credentials and identity they can authenticate. The resource would also ease the workload of Verbal staff and save them time while allowing them to have a degree of quality assurance about the type of information communicated to their current and prospective users. Finally, this approach benefits from a resource that has been co-produced with users and staff thus ensuring that it meets the needs of both stakeholders.

In The Room's conversational media platform provides the users with non-linear video resources through a question-based approach. The platform enables users to ask questions using their voice or text. The intent by the question is identified and matched with the pre-recorded media (video) asset that is most relevant to the question. This delivers a conversational experience that provides the user with answers to questions from a trusted, authentic source - Verbal expert in this case. Benefits of this approach include reductions in times organisations need to spend on ‘live’ responses to email enquiries, substantially increased service for audiences/users, deeper knowledge of the needs of an audience, and relationship building at scale.

The conversational media resource is a complementary asset to the Verbal materials and does not act as a filter to accessing human experts like chatbots sometimes do. The asynchronous nature of the resource allows it to be revisited to glean more, or to ask different questions.

The interviews with teachers to assess the script questions resulted in the following insights. First, teachers felt that conversational media would mitigate their anxiety as there is no wrong way to use the system and no prior knowledge is assumed. The conversational experience is helpful for making teachers feel like no question is too small or stupid. One teacher commented that conversational media was “a safe way that doesn't...make them feel silly or undermine them”. This also links to the fact that using the platform is done in an anonymous manner; the platform does not track who uses it - thus ensuring confidentiality - nor does it save the voice clips of the users’ questions - thus it does not raise privacy concerns. Users can choose to provide their email address if they would like a member of the Verbal Wellbeing team to answer their query. Not only is this entirely optional for the user, but their email address will not be shared outside of the Verbal Wellbeing team and will only be used for its intended purpose (i.e. contacting the user to provide them with additional support). Second, interviewees liked the idea of being introduced to the knowledge and expertise of the speaker as it would allow them to feel that the speaker has “the kudos and the credibility” to speak on such topics. Third, because teachers might be pressed for time, they expressed the desire for system to understand when they abbreviate words or shorten sentences. For example, instead of asking “What is Cognitive Behavioural Theory?”, they might ask “what cbt” and would want the system to understand their questions.

In the interviews, teachers brought up the following considerations. First, schools in rural areas usually have weaker internet connections than those in cities, and so teachers worry about not being able to experience the system as designed for wide bandwidth. Second, teachers indicated that they would like the video to still have an option to leave their contact information so that Verbal might approach them if they have additional questions without the teachers sending emails to Verbal. Third, teachers suggested that the system keeps a record of questions which it does not have pre-recorded answers to. If then certain questions are asked by different users, the video should be updated with answers to those questions. Finally, it was suggested that it would be convenient to share particular responses from the resource with other teachers. However, this is out of the scope of the project and thus it is not possible to conveniently share particular responses with other users via the system.

As for Verbal staff, they described how their current system of calling schools and conducting webinars, including designing online booking forms, content delivery etc., is time-consuming and “extremely painful”. Verbal staff were optimistic that conversational media would be an engaging and succinct way to deliver information on Verbal Wellbeing and would “alleviate pressure” from busy charity staff.

The conversational approach creates a hypertextual relationship between user questions and expert responses, with the potential to “augment human intellect” and increase the understanding of the ideas and concepts discussed [1]. Further, this approach builds trust and relationships at scale because, even though chatbots are widely in use, this approach is not only about providing answers but also instilling confidence and trust between Verbal and teachers at a distance.

Interviewees were optimistic about the role of conversational media in spreading awareness of and supporting the delivery of the Verbal Wellbeing intervention. Verbal staff felt that the resource could “alleviate pressure” when sharing and on-boarding the resource within schools, and teachers felt that it could be an effective tool for answering questions related to mental wellbeing that was accessible and user-friendly.

Planned future work includes a large-scale assessment where the conversational video resource will be evaluated with Verbal staff and teachers and comprehensive data will be collected and analysed. Verbal staff will be asked how the resource will ease their workload, be beneficial to the teachers, and what challenges they foresee. Teachers will evaluate how the video addresses their needs, whether answers were helpful or not, and their acceptance of the resource. Moreover, the video will be assessed on on-boarding metrics because Verbal staff have noted that teachers are more likely to sign up to Verbal Wellbeing when interacting with Verbal staff than they are to sign up if simply being emailed a sign-up link after expressing interest in the programme. Finally, the video will be evaluated on the System Usability Scale.