Transcript Online and telephone

Online and Telephone based
counselling
Lessons from the substance abuse field
Eric Tyssen
Turning Point Alcohol and Drug Centre
Turning Point
Alcohol and Drug Centre
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Established in Australia (Victoria) in 1995
Provides leadership in clinical practice,
research and education in the alcohol and
drug service sector
Employs approximately 220 staff across four
sites
Specialist Telephone
& Online Support Programs
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Our HealthLink program includes a network of 24/7
Telephone Helplines, Telephone consultancy services
and Online services.
Key services includes state-based Gambling Helplines
and Alcohol and Drug Helpline programs across
Australia
Staffed by a multidisciplinary team of ~60 Telephone
and Online counsellors
Responds to 90 – 100,000 calls per year
Integrated, multimodal response capacity
Research-liaison role based across our Helpline and
epidemiology programs
Helpline models in 2007
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Helplines have operated in many countries for the
past 40-50 years.
A majority of Problem Gambling Helplines have
operated for approximately 7-12 years.
Many traditional Helpline models include: brief
intervention counselling, information and referral.
Many Helpline models now include enhanced
services, (e.g. therapeutic counselling, assertive
follow-up and elements of online service delivery)
Research into Helplines remains under-developed,
particularly outcome focused measures
Key characteristics of
the Helpline environment
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Highly accessible
24/7
Immediate
Anonymous/confidential
Attracting new treatment seekers
Support for clients during and between treatment
Providing range of brief intervention and educative
responses (e.g. harm reduction strategies)
‘Gateway’ functions linking to other counselling and
supports in the community
Unique source of data (early warning system)
Re-defining communication and help
seeking in the 21st Century
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Explosion in communications technology and global
inter-connectedness
Changing paradigm of health service delivery (new
ways of accessing information and assistance)
Growth in technology-enabled modes of health
intervention
Multiple methods of online counselling
Expanding models - the need for research and
development into practice standards and outcomes
The online counselling environment
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Global reach and accessibility
Potential to attract new treatment
seekers and provide support to
those in treatment (e.g.
immediate, after-hours).
Potential lowering of help-seeking
threshold (perception of
increased safety and control)
Reduction of stigma in helpseeking
Increased opportunities for
socially inhibited, isolated and
marginalised to access services
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Lack of clinical practice
standards
Regulatory issues - Ethical
guidelines, Qualifications and
training of counsellors, Legal
and Privacy considerations,
Cost
Outcome and efficacy research
Rapid dis-inhibition and
anonymity can increase
potential for fantasy and
misrepresentation (i.e. Web
‘personas’, Internet addiction)
CounsellingOnline: Project aims
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Two-year pilot project funded by Commonwealth
Government
‘Live’, one-to-one access to professional alcohol and
drug counsellor
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Increase access to specialist treatment and support
(particularly in rural areas)
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Improved understanding of who uses and how people
use online counselling
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Help define service standards and practice in this
emerging modality
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Multi-level Program evaluation, including process,
output, impact and economic components
CounsellingOnline: Key elements
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Free
24/7
Anonymous and confidential
Case management capacity for repeat users
Based around minimal access requirements
Integrated within 24/7 Helpline environment opportunity for multi-modal support and referral
Incorporates ‘push’ technologies
12-month development phase, now ‘live’ for
approximately 10-months
CounsellingOnline
www.counsellingonline.org.au
Online Counselling:
Technical challenges
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Demand and uptake remain unpredictable
Appropriate infrastructure for demand management
and resourcing (risk management)
Customising the technology to ‘enable’ online
interaction
Balancing client-centeredness and with ethical and
legal practice requirements.
Online Counselling:
Challenges in service delivery
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Clinical challenges
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Counsellor training & clinical governance
Different neural pathways and processing skills
Minimal cues, concept of ‘identity’
Expressing emotion and nuance online
Tempo of communication
Developing and working with online language
Crisis intervention and protective frameworks
 Technical and mechanical skills
 Text transcripts - clinical accountability and reflective
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learning
Best viewed as a complementary modality, as part
of a wider service system model
Emerging trends: First 10-months
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CounsellingOnline Website has received >20,000
visitors and more than 1 million page views
1200 online counselling sessions undertaken to date
Nearly 70 per cent have occurred outside of
‘traditional’ business hours
High level of accessibility through integrated model
Average duration: 31 minutes
31 per cent of sessions have come from rural/regional
areas
87 per cent anonymous access, 13 per cent registered
(repeat) clients
Emerging trends: First 10-months
Male
31.9%
25
Female
68.1%
17.6
20
18.6
Gender of client
14.2
15
11.9
10.6
10.5
10
5.3
5
5.9
3
1.3
1.2
0
+
60
9
-5
55
4
-5
50
9
-4
45
4
-4
40
9
-3
35
4
-3
30
9
-2
25
4
-2
20
9
-1
15
14
1-
Age of client
Preliminary evaluation data
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59% of clients found the service online, 41% from service
related media & promotional materials
69% of clients reported session as first contact with a
specialist/treatment service
Most common reasons for online access included privacy
(67%), convenience (56%) and preferred medium (49%)
49% of clients reported sense of being better informed
and educated around AOD issues following contact
39% reported sense of having more/improved coping
strategies
26% reported making contact with another
treatment/support service following their online session
88% would recommend service to a friend
The future of Online Counselling
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Expanded range and accessibility of help-seeking
pathways (net-widening effect)
High level of reported safety,control and acceptability
by online clients
Opportunity to build online hub of information and
engagement (online self assessment, self help,
podcasts, online counselling)
The need for further development of online delivery
models, standards and evaluation
Thankyou