Online and Telephone based counselling Lessons from the substance abuse field

1. Online and Telephone based counsellingLessons from the substance abuse field Eric Tyssen Turning Point Alcohol and Drug Centre

2. Turning Point Alcohol and Drug Centre • 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

3. Specialist Telephone & Online Support Programs • 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

4. Helpline models in 2007 • 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

5. Key characteristics of the Helpline environment • 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)

6. Re-defining communication and help seeking in the 21st Century • 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

7. The online counselling environment • 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 help-seeking • Increased opportunities for socially inhibited, isolated and marginalised to access services • 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)

8. CounsellingOnline: Project aims • Two-year pilot project funded by Commonwealth Government • ‘Live’, one-to-one access to professional alcohol and drug counsellor • Increase access to specialist treatment and support (particularly in rural areas) • Improved understanding of who uses and how people use online counselling • Help define service standards and practice in this emerging modality • Multi-level Program evaluation, including process, output, impact and economic components

9. CounsellingOnline: Key elements • 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

10. CounsellingOnline www.counsellingonline.org.au

11. Online Counselling: Technical challenges • 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.

12. Online Counselling: Challenges in service delivery • Clinical challenges • 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 learning • Best viewed as a complementary modality, as part of a wider service system model

13. Emerging trends: First 10-months • 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

14. Emerging trends: First 10-months

15. Preliminary evaluation data • 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

16. The future of Online Counselling • 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

17. Thankyou