MOST around the world

MOST around the world

Orygen Digital has a growing portfolio of outstanding research partners in Australia and overseas.

Our partners contribute to a growing evidence base for MOST and inform new developments, as MOST evolves to meet the changing needs of young people.

We're proud to recognise their work.

Domestic Partners

Death by suicide is the most common cause of death for young people in Australia. Unfortunately, many young people experiencing suicidal thoughts and behaviours are excluded from research trials investigating their mental health. Over time, young people’s absence from this research has resulted in a problematic knowledge gap, as well as leaving some of the most vulnerable people and their families unsupported. There is an urgent need to better understand how to reduce suicidal ideation safely and effectively in young people, while providing the best possible support to their caregivers.

The Affinity trial aims to address these gaps through a randomised control trial that will investigate how MOST might reduce suicidal thoughts and behaviours in young people receiving outpatient care from the Orygen Specialist Program and local mental health services. The trial will compare Affinity over 12-weeks with an active control condition. 50% of young people will have access to the standard version of MOST, and 50% will receive the ‘Affinity condition.

Young people randomised to the Affinity group will gain access to specialised therapy content focused on reducing suicidal thoughts and behaviours, fortnightly recovery group sessions, a regular personalised digital postcard, and optional monthly webinars for caregivers on suicide risk in young people. The Affinity trial is due to commence in 2023.

Bipolar disorder often begins in adolescence and can contribute to disability in young people. If left untreated, bipolar can progress into a serious illness with increased episodes of mania, and depression.

There is strong evidence that early interventions for Bipolar I and II can limit disability and reduce the possibility that a young person will develop a chronic illness. Early intervention models, like the kind the BLEND team are investigating, could address the shortage of specialised bipolar care services in Australia.

The BLEND team are conducting a two-phase randomised controlled trial for young people aged 15-25 who have been diagnosed with DSM-5 Bipolar I or II by the Mood Assessment Service at the Parkville Clinic. “Bipolar Early Interventions Using New Digital Technologies” (BLEND) is a multidisciplinary, blended-care model that offers MOST alongside enhanced standard of care (ESC), including face-to-face individual and group therapy, evidence-based psychopharmacological interventions, and relapse prevention monitoring.

In this study, young people will be randomised to either the BLEND model or ESC. Both groups will have access to MOST, however, only the active arm will have access to BLEND-specific bipolar therapy content. This specialised content was created by young people, a team of clinicians, writers, and artists.

The initial feasibility phase is six months, with an additional 12 months of treatment available for young people that need it. A larger RCT is planned to commence in 2023. The team predict that MOST, alongside specialised, face-to-face individual support and targeted, evidence-based psychopharmacological treatment, or a blended model of care, will be more effective than enhanced standard care.

Of the 1.4 million university students studying in Australia, one in four aged between 15 and 24 will experience mental ill-health. These high numbers have led university counselling and support services to become overwhelmed.

Together with the mental health impacts of the Covid-19 pandemic, which disproportionately affected young people by disrupting their education and restricting social interactions with friends and family, there is an urgent need for accessible, cost-effective, evidence-based, and scalable mental health supports in universities.

The team at ACU in collaboration with Orygen Digital are responding to this need by adapting MOST for university students.

UniMOST is designed to improve psychological wellbeing, reduce mental ill-health, and support students to stay at university. The team are also aiming to improve young people’s access to mental health services and integrate digital health services with face-to-face supports.

UniMOST involves three stages. 

  • The first phase involved online co-design workshops with university students, university counsellors, and disability support staff. Participants were asked to identify priorities for therapy content and provide advice on how UniMOST could work with university counselling services.
  • In phase two, the ACU team partnered with the Orygen Digital content team to design and develop new therapy on procrastination and perfectionism — the two priorities identified by staff and students.
  • The final phase involves a student and staff review of the content and UniMOST on a purpose-built staging site before the team make final modifications. Focus group outcomes may inform a future randomised control trial.

Young people in rural areas face disproportionate disadvantage in completing secondary school. This is a significant problem because failing to complete secondary school can limit a young person’s access to work, study, and career opportunities.

YOTES in Schools aims to challenge the educational inequity between metropolitan and rural regions by piloting an early intervention, career development model with rural students in years eight and nine over 12 months. The trial will test an adapted version of MOST known as YOTES (Youth Online Training and Employment System).

YOTES was originally designed to support young people experiencing mental ill-health at risk of disengaging from work and study. Its original form pairs comprehensive information on training, education, apprenticeships, volunteer, work experience with real-time support from career specialists and youth peer workers. YOTES aims to increase young people’s understanding of their core work skills through actions and games that encourage them to explore their skills offline.

YOTES in Schools will adapt YOTES to individual schools and communities, and offer tailored, evidence-based career information and support to students. YOTES in Schools will build the resilience and capacity of school-based career counsellors and invite past students to train as online vocational motivators, or role models. Role models will support younger students by sharing their lived experience of work and study. YOTES in Schools will be an uncontrolled pilot trial and offer young people unlimited access to YOTES in and outside class time for one school year.

YOTES in Schools is due to commence in January 2023.

International Partners

International Partners Logos

Researchers at the University of North Carolina (UNC) are exploring how MOST can be integrated with clinical care and help to maintain the treatment benefits young people gain from attending Coordinated Speciality Care (CSC) services. Common measures of recovery from psychosis include functional outcomes, such as employment, and the remission of symptoms.

UNC are interested in social functioning outcomes such as reducing loneliness, and how MOST can build community, promote inclusivity, social connection, and a sense of safety by offering non-judgemental support that differs from conventional social contact and social networking.;

This research is the first online, strengths-based social networking intervention to be successfully implemented in first episode psychosis services in the United States.

Project: Horyzons, US Open Trial

Between 2016 and 2018 the feasibility and acceptability of Horyzons was evaluated by UNC researchers. Twenty-six participants aged between 18 and 35 diagnosed with a schizophrenia spectrum disorder were given access to Horyzons for 12 weeks. Researchers assessed the relationship between engagement with Horyzons and loneliness, perceived social support, relationship quality, negative emotions, positive emotions, self-esteem, and psychological wellbeing.

Early findings indicate that Horyzons is both feasible, and safe. It was positively received by young people that participated. Those who actively engaged showed improvements in psychosis-related and depressive symptoms, and negative emotions. Self-reported loneliness showed the biggest, upward shift from baseline measures to mid-treatment.

Study outcomes were limited by small participant numbers, the lack of a control condition, a short duration, and a brief follow up period. 

Horyzons US Open Trial was a three-month intervention and finished in 2018.

Project: Horyzons: Implementation in Clinical Practice

In 2021, UNC researchers began investigating the feasibility and acceptability of Horyzons as a part of routine face-to-face care at first episode psychosis clinics in North Carolina. Young people, clinicians and peer support specialists are involved in this research.

Research into the efficacy of Coordinated Speciality Care (CSC) services shows they are reducing psychosis symptoms, improving social functioning, and helping young people get their lives back on track.

While young people benefit from CSC, the gains are often not maintained for more than two years after discharge. Coupled with a limited range of supportive online social communities for young people experiencing psychosis, UNC identified a need to understand the benefits of offering Horyzons alongside clinical care and how it might help to maintain therapy gains after discharge.

UNC researchers are also listening to feedback from young people, peer workers, clinicians, and a range of project staff about how Horyzons ought to look, feel, and operate to achieve the best health outcomes. 

Horyzons: Implementation in Clinical Practice is actively recruiting.   

Project: Horyzons 2.0

UNC researchers are collaborating with Orygen Digital and Australian Catholic University (ACU) to design, develop, and test MOST for caregivers of young people receiving face-to-face support from CSC-First Episode Psychosis (FEP) services in North Carolina.

The trial will build upon two important research studies conducted by Orygen Digital (Horyzons) and ACU (Altitudes). Altitudes used a now retired version of MOST to support caregivers to understand psychosis and its treatment, problem solve, and manage stress and communication with their young person. Horyzons 2.0 will feature updated clinical content for caregivers.

Horyzons 2.0 expands the work of Horyzons: a five-year randomised controlled trial (RCT) that sought to maintain the treatment benefits of specialist treatment services, reduce social isolation, and improve social functioning in young people with a first episode of psychosis.

Horyzons 2.0 is due to start recruiting in 2023 and will investigate the effectiveness of two distinct versions of MOST to young people and their caregivers.

Project: PSYcHE - Improving Psychosocial Supports in Youth Mental Health

Researchers from the National University Galway are conducting a single-blinded randomised controlled trial (RCT) to investigate how MOST can support the social and occupational functioning of young people receiving care from student counselling and early intervention psychosis clinics.

In response to feedback from young people, the team now hold regular online MOST events. In these sessions, young people play online games, and talk about MOST.

PSYcHE began early intervention in psychosis recruitment in January 2021.

Horyzons Canada (HoryzonsCa) is an online platform and intervention that provides access to mental health support services, including evidence-based therapy tools, clinical moderators, peer support moderators, and a community of peers.

HoryzonsCa is available in English and French to accommodate the anglophone and francophone populations living in Montreal, Canada. HoryzonsCa is an adaptation of the MOST platform, originally designed and tested in Australia. 

The Canadian team are interested in how to appropriately adapt and implement MOST for a Canadian cultural, geographical, and healthcare context. The Covid-19 pandemic has significantly impacted access to mental health services. In its wake, there is a clear incentive to explore the acceptability and utility of digital health interventions.

Several studies of Horyzons-Canada have been conducted and more are underway. 

Phase One: Adaptation Study

This study aimed to adapt Horyzons to the Canadian context and evaluate its acceptability before pilot testing. The research took place in two specialised first episode psychosis (FEP) clinics located in two Canadian provinces (Ontario and Quebec).

The study recruited 11 participants between the ages of 19 and 37 along with 15 clinicians. Following data collection, the research team began to adapt the MOST platform for a Canadian context. Positive feedback from participants living with FEP and their clinicians, gave the research team the necessary insights to move forward with phase two: a live pilot study using the adapted Horyzons platform (HoryzonsCa).

Phase Two: Live Pilot Study

In this live pilot study, 20 young adults receiving specialised care for a first episode of psychosis (FEP) were invited to participate in a study exploring the acceptability, utility, and safety of the newly adapted HoryzonsCa platform. The research team investigated the potential role of the HoryzonsCa platform in sustaining recovery and preventing relapses in young adults receiving specialized services for FEP.

Participants were interviewed about their mental health and well-being at the beginning of the project and after eight weeks of accessing the intervention in English. They also participated in focus group discussions to share their experiences and impressions of the HoryzonsCa platform.

The success of this pilot study gave the research team the evidence to translate the intervention and design a live implementation study involving up to 100 English and French speaking Canadian adults living with schizophrenia spectrum and other psychotic disorders (SSPD).

Phase Three: Pragmatic Feasibility Study

This study aims to evaluate the feasibility, acceptability, safety, and utility of the HoryzonsCa platform with 100 to 150 participants between the ages of 18 to 50 living with schizophrenia spectrum and other psychotic disorders (SSPD). Participants are recruited from two Montreal-based clinical healthcare settings.

In this phase, Horyzons is available in both English and French with a bilingual moderation team. Participants can choose to participate in either French or English languages and will receive clinical and peer support from moderators. Participants are interviewed about their mental health and well-being at the beginning of the project and after 12 weeks of access. Focus group discussions are also conducted. Clinical and peer moderators will write journal entries and share their experiences of receiving training on Horyzons as well as their experiences with its implementation.

This important adaptation, implementation, and evaluation research sets the foundation for expanding HoryzonsCa to other mental health populations in the province of Quebec and across Canada.

The ENgage YOung people earlY (ENYOY) project is investigating how MOST can support young people aged 16-25 years in the Netherlands experiencing early signs of mental ill-health.

The Dutch team are motivated by the need to reform their mental health system to better address the needs of young people. Young people, who are experts by experience, highlighted several challenges with the Dutch system. In the Netherlands, young people face transitioning into an adult mental health system at the age of 18, which can impair the continuity and relevance of their care. Young people have also asked for individualised, tailored mental health support that goes beyond a DSM model.

Inspired by Australia’s headspace, early intervention services have rolled out in the Netherlands, but waitlists are long. ENYOY aims to improve mental healthcare for young people, bridge the gap between adolescent and adult mental health services, and treat emerging mental health problems with a specialised, cost-effective, non-stigmatising, and 24/7 digital health intervention.

ENYOY is the first translation of MOST into a language other than English. It began in early 2018 and is due to finish in 2023.

The ENYOY implementation study has four primary objectives:

  • To investigate the effects of the adapted MOST platform in the Netherlands on measures of empowerment, psychosocial functioning, quality of life, hope and recovery, and the mental health of young people.
  • To investigate the relationship between stress and mental health and the role of stress biomarkers in prognosis and the development of new treatment options.
  • To invite young people who experience mental ill-health to share their feedback on ENYOY and assist the project team to improve the platform.
  • Analyse young people’s feedback and assess the usability, friendliness, accessibility, acceptability, connections between peers, and better understand how ENYOY can improve mental health.