Young people's perceptions and recommendations for conversational generative artificial intelligence in youth mental health

Motivational interviewing (MI) is a collaborative approach to elicit autonomous motivation for health behavior change. Generative AI (GenAI) offers new ways to deliver MI via conversational systems, but evidence on their design, assessment, and translation into interventions remains fragmented. This scoping review characterized evidence on GenAI-MI chatbots across system design, safety, MI quality, user perceptions, and intervention outcomes. We conducted a PRISMA-ScR scoping review. Nine datasets were searched for studies published or publicly available from January 1, 2015 to June 2, 2026 that used GenAI to generate MI chatbot responses or counselor utterances. Data were extracted using a predefined framework and synthesized descriptively. Forty-seven reports (48 studies) were included. Twenty (41.7%) focused on system design without direct participant use; 28 (58.3%) involved direct interaction. Most systems were text based and disembodied; 23 (47.9%) incorporated dynamic adaptation. Safety measures were unevenly reported. Among studies with direct use, 21/28 (75.0%) reported informed consent or user education. Thirty (62.5%) assessed MI quality, generally suggesting MI-consistent interactions. User perceptions were favorable, especially empathy, usability, helpfulness, and intention to use, though measures were heterogeneous. Eighteen (37.5%) reported intervention outcomes, mostly after a single session. Positive findings were more consistent for short-term motivation than sustained behavioral or functional change. GenAI-MI chatbots can deliver MI-consistent interactions perceived favorably, but evidence for sustained behavioral or functional change is limited. Future research should strengthen runtime safety monitoring, standardize MI quality assessment, and use longer-term comparative designs with behavioral and functional outcomes.

Youth increasingly turn to AI chatbots for social and emotional support, raising concerns about how these systems respond, especially in high-stakes situations. However, existing child safety evaluations of AI lack grounding in real-world harms that youth experience, rely on unvalidated assumptions about what counts as an appropriate output (e.g., refusal), and typically focus on detecting adversarial prompts or surface-level harms in outputs only. Thus, these evaluations can fail to detect responses that pose harm to youth in practice. To better understand the limitations of current evaluation practices, we conducted interviews with 19 practitioners working directly with youth in vulnerable situations, including social workers, therapists, and psychologists, asking them to reflect on chatbots' responses to risky situations commonly faced by youth, as established in prior empirical work. Practitioners identified chatbot behaviors likely to cause harm as well as those that could meaningfully support youth in difficult moments, discussed the role that chatbots should (and should not) play in these interactions, and offered concrete recommendations for improving chatbot responses. Based on these findings, we provide recommendations for AI child safety evaluation and infrastructure, and highlight the need for incorporating practitioners' perspectives into safety work.

This paper studies how parents want to moderate children's interactions with Generative AI chatbots, with the goal of informing the design of future GenAI parental control tools. We first used an LLM to generate synthetic child-GenAI chatbot interaction scenarios and worked with four parents to validate their realism. From this dataset, we carefully selected 12 diverse examples that evoked varying levels of concern and were rated the most realistic. Each example included a prompt and a GenAI chatbot response. We presented these to parents (N=24) and asked whether they found them concerning, why, and how they would prefer the responses to be modified and communicated. Our findings reveal three key insights: (1) parents express concern about interactions that current GenAI chatbot parental controls neglect; (2) parents want fine-grained transparency and moderation at the conversation level; and (3) parents need personalized controls that adapt to their desired strategies and children's ages.