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

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

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

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

Highly accessible 24/7ImmediateAnonymous/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

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

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)

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

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

CounsellingOnline www.counsellingonline.org.au

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.

Online Counselling: Challenges in service delivery

Clinical challengeso Counsellor training & clinical governanceo Different neural pathways and processing skillso Minimal cues, concept of ‘identity’o Expressing emotion and nuance onlineo Tempo of communicationo Developing and working with online language o 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

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

Emerging trends: First 10-months

1.3

10.5

17.618.6

14.2

11.910.6

5.3 5.9

3

1.2

1-1415-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60+

Age of client

0

5

10

15

20

25

Male31.9%

Female68.1%

Gender of client

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

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

Thankyou