Qualitative Research with Youth in Mental Health Settings: Recommendations, Implications and a Study Case
The implications of conducting qualitative research with children have been discussed in the literature (Darbyshire, MacDougall, & Schiller, 2005), including in medical contexts (Kirk, 2007). There is an absence of discussion geared specifically toward qualitative, interview-based research embedded in mental health clinical trials with children and adolescents (hereon referred to as youth). Although construct-specific or diagnostic interviews exist, mental health researchers may need to develop tailored qualitative interviews to assess client engagement and satisfaction with the specific protocol used, and may need to assess other contextual factors specific to the clinical trial. The current presentation addresses this need by discussing the nuanced considerations related to the development and administration of qualitative interview research with children and adolescents in clinical, mental health settings. These considerations involve ethical, developmental, and clinical aspects to conducting such research with youth. In particular, youth need to have flexible lines of questioning that take in account the youth's language, social, and cognitive abilities, as well as interpersonal dynamics and youth’s mental health difficulties. Below we discuss the aforementioned considerations, and also describe a qualitative interview study with youth which will illustrate each consideration.
It is imperative for interviewers of youth in mental health settings to consider the youth's language ability and proficiency. This consideration might necessitate a flexible interview guide that has prompts appropriate for youth at different linguistic and cognitive levels. The interview guide can also gauge comprehension by embedding open-ended definitional prompts (e.g., what does term X mean to you?), and/or providing support for the youth’s understanding of certain constructs (e.g., ‘construct X’ in this question means Z). Relatedly, multicultural studies should carefully consider the cultural backgrounds and acculturation levels of the youth, and may need to include prompts that probe cultural contexts of the clinical research question. As part of preliminary work toward a clinical trial with multicultural participants, mixed-method researchers can also conduct measurement equivalence statistical tests on their quantitative measures, and can strengthen the conceptual argument of equivalence with congruent qualitative data. In terms of language proficiency, the interview guide should always be in the youth’s preferred language.
Qualitative research in a clinical context also requires a sensitivity toward power relations in the family, and with clinical or research staff, as applicable. There are some instances in which youth should be instructed on the interviewer's positionality. For example, clinicians who provide mental health services to the youth may need to acknowledge their role in both the conduct of research and the provision of treatment. The research interview guide can include a statement on how the youth’s responses will not benefit or hinder the clinician if the questioning is related to the client’s satisfaction with the clinical approach. Further, confidentiality must be preemptively addressed if the questions involve potential responses that result in breaking of confidentiality (e.g., narratives that relate to harm to self or others).
Certain types of child psychopathology also introduces the need for an interviewer with understanding of child psychopathology. An illustrative example is that of youth experiencing social anxiety and depression who may communicate in brief utterances due to social evaluative fear or low engagement, and/or who may communicate narratives that they think are desirable to the interviewer. Interviewers need to recognize such threats to disclosure and quality of information, and take active steps toward enhancing rapport-building and management of the youth's difficulties. One strategy involves ‘warming up’ to sensitive and difficult lines of questioning by beginning with rapport-building, and benign or positive mood-inducing questions (e.g., “what are some of your favorite hobbies?”). Further, disclaimers stating “there are no right or wrong answers,” and that “the next questions are to make the program more helpful for other teens” can appeal to the youth’s altruism and reduce social desirability. Ultimately, the prompts and type of disclaimers used are highly contextual as per the participants’ developmental stage, mental health, and the clinical setting, and researchers are encouraged to carefully evaluate all of these factors as they construct the interview guide.