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Online and Telephone based counselling Lessons from the substance abuse field

Online and Telephone based counselling Lessons from the substance abuse field

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Online and Telephone based counselling Lessons from the substance abuse field

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  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