Integrating Social Media Literacy Into Virtual Mental Health Care for Adolescents

Question: How can clinicians incorporate social media literacy into virtual mental health treatment plans for adolescents? 

Answer: Telemental health care encounters are an important opportunity for helping adolescents with mental health conditions develop a healthy relationship with social media. Virtual mental/behavioral health visits via telehealth platforms can: 

• Increase accessibility to treatment (no transportation needed),  
• Give clinicians a sense of an adolescent's home environment and social determinants of health, and 
• Enhance a teen’s feeling of comfort in sharing their feelings and experiences, since they’re physically located in their own home. 

Why incorporate social media counseling into telemental health encounters? 

The link between social media and youth mental health is complex and bidirectional: this means that social media can impact a young person’s mental health, and also that a young person’s mental health can impact their experiences and use of social media.  

Mental health challenges like anxiety, depression, or concerns with self-regulation may drive heavier media use (ie, through compulsive checking, posting, or consumption of content). In addition, using too much social media can get in the way of other activities that are known to promote mental health, including getting enough sleep and socializing with friends/family in person. A study with a sample of youth receiving care for depression, suicidal ideation, and/or suicidal behaviors found that 40% of patients reported problematic social media use. In another study, problematic internet use in children ages 7-15 was found to be associated with a variety of mental and behavioral health conditions. That said, recent studies show that social media can support social connection and identity development in teens and young adults, as well as provide a place for mental health support and finding health information. 

Social media use can impact children’s mental health in both positive and negative ways. Most studies of social media and mental health outcomes are cross-sectional, meaning that they can’t show a cause-and-effect relationship. This means it’s important to incorporate conversations about youth media use into mental health encounters to understand how youth are interacting with social media and how these interactions are impacting their emotions, relationships, and quality of life.  

How can clinicians screen for problematic media use during telemental health visits? 

There are several assessment tools that can be utilized in telemental health visits: 

• The PRIUSS-3 is a 3-item screening tool that can be used to help identify problematic or risky internet use. If the screen is positive, clinicians can follow up with the full 18-item PRIUSS, which includes three sub-scales: social impairment, emotional impairment, and risky/impulsive internet use.   
• The HEADS-4 screening tool is an addition to the HEADSSS tool commonly used in pediatric and adolescent practices which assesses home life, education, activities, drugs, sexual activity, safety, suicide, and/or depression. This tool adds a fourth “S” to the HEADSSS acronym (making it HEADS-4) to assess social media usage. Notably, the HEADS-4 focuses on screen time and risks related to social media use, including sexting, cyber-bullying, and predation. 
• The Bright Futures guidelines, developed in collaboration with the American Academy of Pediatrics (AAP), outline health guidelines for pediatricians. The 4th edition of Bright Futures includes a new health theme called “Promoting Healthy and Safe Use of Social Media,” and the chapter that addresses that theme has some helpful guidance around discussing social media during appointments.  
• Chapter 2, “Social Media and Screen Time in the Clinical Interview: What To Ask and What It Means?” includes questions clinicians can use to determine if a teen is struggling with or at risk for negative consequences of media use – some questions are specific to apps like Snapchat or TikTok. 

The 5 Cs of Media Use, developed by the AAP Center of Excellence on Social Media and Youth Mental Health, is a mnemonic that can be used to talk to parents about teens and screens. They are: Child, Content, Calm, Crowding Out, and Communication.  

Example screening questions: 

• Child: Questions focused on the individual experience. How are you feeling about your media and technology use lately? How do you feel during or after you’ve used media and technology? Are there any particular topics or experiences in this area you’d like to talk about?
• Content: Questions focused on what content the adolescent experiences. What types of content do you enjoy with your media and technology use? Have you experienced any negative or scary content lately? How did you feel about that? What sources of support did you use to navigate that situation? Have you seen any health-related content that you want to ask me about?  
• Crowding out: Questions about whether media is displacing other activities. Do you feel like your media and technology use is crowding out any important activities lately? What are your thoughts on how to balance your online and offline time or activities?  
• Calm: Questions about resources for calm. I know that many of my patients use media to distract or calm down. How do you use media for these purposes? What are other ways you can help calm yourself after a stressful day?  
• Communication: Questions about communicating with parents, guardians and trusted adults. Communicating with trusted adults about your media and technology use is really important to help you feel supported. How is that going for you? Who can you talk to? How often do you and your parents/guardians communicate about media and technology use? What are ways to make those conversations helpful to you? 

Strategies for embedding social media literacy into mental health treatment: 

• Offer Interactive Social Media Literacy Modules. Telehealth platforms such as Social Media TestDrive: Social Media for Education include resources that help teens understand how social media influences them. Modules can cover topics such as recognizing unrealistic portrayals, evaluating content reliability, and identifying how online trends affect mental health and self-image. These tools empower teens to critically engage with their social media environments. 
  • For Parents/Caregivers: Encourage your teen to explore these modules and engage in discussions about what they learn. 
  • For Professionals: Use these resources as part of therapy or group discussions to deepen understanding. 
• Integrate Social Media Discussions into Therapy Sessions. Therapy offers an ideal setting for structured conversations about social media use. Adolescents can reflect on their habits, emotions, and relationships, exploring how social media affects their self-esteem and mental health. Therapists can guide teens in setting boundaries and developing strategies to use social media in a supportive way. 
  • For Parents/Caregivers: Be open to discussing therapy takeaways at home to reinforce lessons. 
  • For Professionals: Regularly assess how social media habits intersect with treatment goals. 
• Teach Digital Boundaries and Screen Time Management. Teens benefit from setting healthy boundaries around screen time. Telehealth platforms and providers can offer tools such as reminders to take breaks, personalized screen-time limits, and offline activity suggestions. These features can help teens achieve more balanced social media use. 
  • For Parents/Caregivers: Collaborate with your teen to create family guidelines for screen use. 
  • For Professionals: Incorporate these tools into treatment plans and check in on progress. 
• Provide Parent and Caregiver Education. Educating parents and caregivers on social media literacy enables them to support their teens effectively. Telehealth platforms can offer webinars and resources to help families understand the impact of social media and learn strategies for monitoring usage without being overly restrictive. 
  • For Parents/Caregivers: Consider participating in these educational opportunities to learn how to model healthy online behavior and maintain open communication. 
  • For Professionals: Consider providing these resources during therapy sessions and encourage caregiver involvement. 
• Facilitate Peer Support Groups on Media Literacy. Peer support can be a powerful tool for adolescents. Telehealth platforms can incorporate group therapy sessions focused on social media literacy, where teens share experiences, learn strategies, and gain support from peers facing similar challenges. 
  • For Parents/Caregivers: Encourage your teen to participate in these groups if offered. 
  • For Professionals: Use group dynamics to foster shared learning and collective problem-solving. 

Editor’s Note: We’d like to acknowledge the National Council on Mental Wellbeing’s partnership with the Center and their expert advice in helping draft this response.    

Additional Resources: 

• Navigating Social Media Use: Examples for Clinicians: This video features tips and strategies from Dr. Radesky and Dr. Moreno of the AAP Center of Excellence on Social Media and Youth Mental Health on how to effectively address social media use during clinical visits. 
• Problematic Media Use: This resource is a guide for Clinicians to understand the definition of problematic media use (PMU), identify signs of PMU and highlight screening tools available. 
• Using Motivational Interviewing to Discuss Family Media Habits: This series of brief videos, based on concepts from the 5 Cs of Media Use, offers healthcare providers guidance on using motivational interviewing (MI) as a tool to engage in meaningful conversations with families about their child or teen’s media use. 
• Talking Points for Media Use Based on Parent/Child Concerns: This tool offers specific talking points and practical solutions based on the level of concern from both the parent and the child. It helps identify the best approach depending on where each party stands. 
• Media Literacy Now: Offers resources for teaching media literacy, suitable for both adolescents and caregivers. 
• The American Psychological Association (APA) Guidelines for Adolescents and Social Media Use: Provides insights and recommendations that can be adapted into telehealth treatment plans. 
• Common Sense Media: Offers educational tools and content reviews to help parents and teens make informed decisions about media consumption. 

References 

• American Academy of Pediatrics. (2017). Bright Futures: Guidelines for health supervision of infants, children, and adolescents (4th ed.).  
• Jelenchick, L. A., Eickhoff, J., Christakis, D. A., Brown, R. L., Zhang, C., Benson, M., & Moreno, M. A. (2014). The problematic and risky Internet use screening scale (PRIUSS) for adolescents and young adults: Scale development and refinement. Computers in Human Behavior, 35, 359-367.  
• Kennard, B. D., et al. (2025). Problematic social media use and relationship to mental health characteristics in youth from the Texas Youth Depression and Suicide Research Network (TX-YDSRN). Journal of Affective Disorders, 374, 128–140.  
• Moreno, M. A., Arseniev-Koehler, A., & Selkie, E. (2016). Development and testing of a 3-item screening tool for problematic Internet use. Journal of Pediatrics, 176, 167–172.e1.  
• Orben, A., & Przybylski, A. K. (2019). The association between adolescent well-being and digital technology use. Nature Human Behaviour, 3(2), 173–182.  
• Restrepo, A., Scheininger, T., Clucas, J., Alexander, L., Salum, G. A., Georgiades, K., Paksarian, D., Merikangas, K. R., & Milham, M. P. (2020). Problematic internet use in children and adolescents: associations with psychiatric disorders and impairment. BMC Psychiatry, 20, Article 252.  
• Social Media TestDrive. (n.d.). Practice digital literacy skills in a social media simulation. Cornell University. Retrieved October 27, 2025, from  
• Sood, A., & Avari, J. M. (2023). Social media and screen time in the clinical interview: What to ask and what it means? In A. Spaniardi & J. M. Avari (Eds.), Teens, Screens, and Social Connection (pp. 11–30). Springer.  

Age: 10- 17 

Topics: Telehealth, mental health providers, behavioral health, social media literacy, social media in pediatric visits 

Role: Clinician