Safeguarding on Kooth: Protecting children and young people from online harms

Written by Dr Lynne Green, Chief Clinical Officer - Kooth Digital Health

The online world is vibrant and fast-moving. The constantly evolving nature of the threats - from websites promoting suicide to social media channels celebrating restricted eating - has rightly heightened the need for safety measures to protect young people from harm. 

For Kooth, creating a truly safe space online has always been central to our mission to bring mental health support to all. In relation to the Online Safety Act, our safeguarding processes are being fully aligned; our moderation guidelines prioritise the safety of children and adults and provide clear age ratings to prevent children in particular, from being exposed to inappropriate or harmful content.  

Key to remaining at the forefront of online safety is our in-depth and ever-evolving safeguarding governance and assurance policies, managed by our experienced clinical and safeguarding teams. These ensure we are keeping our hundreds of thousands-strong community of children and young people safe - and can be summarised into four Kooth principles:

1. We pre-moderate every single word on Kooth

What does this mean? This means that no user generated content is published to our site, and therefore visible by any other user until it has been “moderated” by one of our moderating team. This content may be an article, a poem, a story, a discussion post, a journal entry, a live forum comment or any subsequent interaction.

Our moderating team is composed of dedicated emotional wellbeing practitioners who are qualified to degree level as well as having experience in a range of backgrounds, from youth work and social care to mental health nursing and teaching. We adopt a number of specialised resources, NHS guidance and government frameworks to guide our moderation and each practitioner completes bespoke Kooth training before they can begin moderating the platform. 

As outlined above, the team carefully reviews and checks over every comment, every submitted article or poem and every forum thread: nothing is published to the platform without first being reviewed. 

The first stage of the review identifies any safeguarding concerns. In imminent risk situations where we already hold identifiable information, the moderator will contact emergency services. This will be followed up with a same day referral to children’s social care.  In non-imminent risk situations, a same day referral will be made to social care and/or other relevant services (eg. CAMHS crisis services, the school).  Additionally, the young person will be messaged to explain our concerns about their safety, advise them of the actions we’ve taken (if it’s deemed safe to do so) and provide them with immediate safety advice including a list of local services.

Where we do not hold identifiable information, our moderators will immediately message the young person to request this. If we don’t get that information, safety planning advice will be shared with the young person and they will be invited to join a live chat with a counsellor. They will be assigned as high risk on our system and prioritised when entering any of our services.  

In all scenarios above, the moderator will add a safeguarding case note to the system with the concerns, rationale and actions taken after which the safeguarding case note is added to a triage queue and all safeguarding concerns are reviewed again.

The second stage is to ensure the post meets our safety guidelines for publishing. This is where we review the post in accordance with our moderation guidelines that are informed and developed from a number of specialised resources, NHS guidance and government frameworks. If something isn’t publishable - perhaps it contains details of a sexual assault or mentions class A drugs, for example - the team will notify the young person explaining why and linking them to our guidelines. 

The final stage is to determine the age appropriateness of the post and which age bracket it is suitable for. As explained below, content that is either user-generated or Kooth generated that is published on our site is all age rated based on our moderation guidelines.  We also have an age rating framework. All content and resources are assessed against the age rating framework by a qualified health, education or social care professional with appropriate subject matter expertise and safeguarding trained to at least Level 3.

2. All service users are pseudonymous 

Pseudonymity describes our approach to offering a level of anonymity at signup, whereby users are only asked to share their location, month/year of birth, ethnicity and gender. This data, along with all subsequent data gathered, is then linked to a unique username for that user. However, as the user engages with the service, there are various points where they can choose to share more identifiable information, with some choosing to fully identify themselves with us.  

This pseudonymous approach supports effective safeguarding. Young people consistently tell us that pseudonymity enables them to disclose things that they wouldn't otherwise tell anyone. Giving young people this type of anonymity is often the key to them beginning to trust services and to feel able to open up and receive vital support. 

If a young person tells us something that constitutes a concern around their safety, we ask for their personal identifiable information to help us safeguard them. When young people share this with us, they remain unidentifiable to others within our platform.

Sometimes, however, young people do not feel comfortable giving us this information. If this is the case, our team will work with them to develop an agreed safety plan and to understand and address the barriers to accessing other services. We will also signpost them to other relevant services for young people who might be able to support them, such as SHOUT and Samaritans.

3. All content on Kooth is age-gated

All of the therapeutic content that we create and all of the content and comments submitted by service users is age gated to ensure service users only see what is appropriate and relevant for their age. Our age rating framework is informed by a variety of evidence sources, including from DfE Guidance, NHS Digital Manual, NSPCC, Home Office Online Safety Guidance, and a number of specialist mental health sources for particular topics eg. BEAT, Mind and the Samaritans.

Our age ratings on Kooth are:

• 10-11
• 12-13
• 14-17
• 18+

In addition, there are aspects relating to particularly sensitive and risk related topics which we would never publish for any age group, such as details or methods of self harm and unhelpful content relating to eating disorders including details of purging, bingeing recognised to be potential triggering to others who may be vulnerable to this. 

4. All of our interventions are based on available clinical evidence

All interventions are based on the available evidence base, including (but not limited to) CBT-informed practice and person-centred counselling. Our ‘whole person’ approach has steered us away from a focus on diagnosis and our combined clinical experience over the years confirms a growing consensus that a single evidence based approach may be useful for some, but not all. We have developed comprehensive guidance for our practitioners to ensure they are knowledgeable about the evidence-base for the broad spectrum of mental health diagnoses and, importantly, are able to consider the application of this to online counselling. It also provides insights into the current evidence bases and NICE recommendations. 

Our approach aligns with the Thrive Framework developed by the Anna Freud Centre, and adopted by the NHS - the Kooth model enables access at all four levels, some simultaneously, depending on need.

Over our 20+ years delivering digital text-based support, we have embedded the bespoke ‘i-RESPOND’ clinical model to guide all our therapeutic work and interventions. This ensures that all our work is Integrative, Responsive, Evidence-informed, Safe, Person-focused, Outcomes-driven, Non-judgemental and Data informed. It includes:

• The Digital Training Programme, which helps practitioners learn skills for offering safe, person-centred care through text-based, drop-in support
• Proactive clinical practice audits against i-Respond to build a culture of continuous improvement
• Strengths and goals-based approach to achieve positive outcomes
• Evidence-informed practice as well as practice-informed evidence
• Quality Improvement with external benchmarking and validation - core to the approach (DTAC, CQC assessment informed)
• ORCHA score of 90% for Qwell and 86% for Kooth, amongst the highest of reviewed digital mental health services.

All of our processes are designed to support young people to access safe and effective help. We have robust governance structures in place to monitor our processes and we work in line with NHS frameworks to ensure that we are adhering to best practice and that lessons are learned in a timely manner. 

For us, safety is always our first priority. We know that this means constantly monitoring the situation both on the platform and also in the wider online world, something we have done since we began over twenty years ago and something we’re equally as committed to today. 

For more detail on our safeguarding governance and assurance approach, click here.

If you have any questions we’d love to hear from you. Please email safeguarding@kooth.com