A case study of a WebGUI-powered, online treatment program for sufferers of anxiety disorders

Who are we?• SDH Consulting Group– Patrick Donelan (CTO)– Andy Smith (CEO)

• Working with WebGUI for 5 years• Primarily work in the educational and

research sectors providing managed, hosted solutions built on WebGUI

• 2009 WebGUI contributors of the year

Overview

• What is Anxiety Online (AO)?• What is eTherapy?• Who are the major stake-holders in AO?• AO requirements and how they were met:– WebGUI solutions– Extending WebGUI

• Giving back to the community• Future plans

What is Anxiety Online?• Anxiety Online is a comprehensive online mental

health service offering information, assessment, online diagnosis and treatment programs ("eTherapy") for anxiety disorders.

• It is the world's first, fully internet-based treatment clinic for people with anxiety disorders.

• AO differs from many other web-based treatment programs by offering a full service from diagnosis to treatment without the need for therapist intervention.

What is eTherapy?

• eTherapy refers to the 'delivery of structured treatment programs for clinical disorders/ symptoms via the internet with and without human support’.

• eTherapy has been around in some form or another for 30 years beginning with formally organised online support groups as far back as the early 80s.

Examples of Australian-based eTherapy programs and services

• eCouch• MoodGYM• CRUfAD• Reach Out

Why eTherapy?

• Accessibility • Service the needs of many • A viable, cheaper alternative• Suits the delivery of structured programs• It works!

Is eTherapy suited to everyone?

• eTherapy is not suited to people in the midst of a serious crisis.

• eTherapy requires a certain degree of computer literacy… and an internet connection.

• eTherapy requires a certain degree of self-motivation.

The stakeholders

• National eTherapy Centre (NeTC)• Department of Health and Aging• SDH Consulting Group• Procolix• Host Networks

NeTC• Program developers• Located at Swinburne University of

Technology• Made up of– Researchers– Program writers– Program managers– eTherapists

• Funded by the Commonwealth Department of Health and Aging

SDH Consulting Group• Web and software developers• Handled project from the requirements

gathering, specification through to design, implementation, training and delivery.

• Key contributors:– Patrick Donelan (SDH: patspam)– Andy Smith (SDH: andyiomoon)– Colin Kuskie (contractor: perlDreamer)– Kaleb Murphy (contractor)– Plainblack and WebGUI community

Hosting partners

• ProcoliX – provide 24/7 support and maintenance of the web services. Co-architects of the server cluster that powers AO

• Host Networks – Queensland-based, world-class data centre

AO requirements

• Online diagnosis tool with rich feedback on 33 psychological disorders

• Fully automated delivery of 5 anxiety disorder treatment programs and 2 training programs

• Self-help and therapist-assisted program streams with payment gateway

• SPSS-compatible data collection• Tailored user experience

AO requirements

• Rich program content (Video, Audio, FLASH)• Interactive tools to assist program delivery• Friendly content-management tools• Message centre• Manager and research portals• Automated reminders• Secure, scalable hosting• Ongoing hosting maintenance and support

AO consumer path

Hooking into WebGUI’s workflow engine was crucial for setting up the structured pathways our different user groups travel through AO.

Online diagnostic tool (e-PASS)

• Electronic, abridged version of the DSM• Complex branching, tagging and scoring• Built on Kaleb Murphy’s work on Survey• Multiple survey instances concatenated into

one user session• Able to be completed over multiple sessions

within 24hr period if desired• Results in rich feedback for consumer and

detailed SPSS data for researchers

e-PASS: sections

e-PASS: Questions

e-PASS: Answers

e-PASS: tagging & scoring

e-PASS: simple branching

e-PASS: complex branching

e-PASS: test suite

e-PASS: front end

e-PASS: final report

Treatment and training programs

• 5 anxiety disorder treatment programs:– General Anxiety Disorder– Social Anxiety Disorder– Obsessive Compulsive Disorder– Panic Disorder– PTSD

• Two training programs:– Therapist– Supervisor

Tailored summary page

• First thing users see when they login• Info on last time they logged in, number of

new messages• Link to next step in their pathway• Links to e-PASS report, Inbox, and Mood

Monitor• Consumers, eTherapists, Managers and

Researcher specific links and content

Consumer summary page

Self-help and Therapist-assisted

• Two streams available for each AO program• Therapist-assisted (TA) consumers have email

access to an eTherapist for a nominal fee• TA consumers see extra program content• Programs are 12 weeks in length• Programs contain program-specific measures

in addition to the main pre and post assessments

Message centre

• All communications between eTherapists, managers, researchers and consumers occurs securely through Message Centre.

• Messages are sent to external email addresses to inform user of a new message waiting for them when they next login.

• Built from a number of RFEs and customisation of WebGUI’s friends network and implemented by perlDreamer

Message centre - Inbox

Automated messages

• Consumers receive a variety of different automated messages. E.g.:– Inactivity– e-PASS expiry– Milestones– New eTherapist mail

• Automated messages are templated and editable by administrators

• Email and SMS

Data collection

• Custom perl library based on PSPP generates native SPSS data files for all survey instances

• Custom SPSS reports for major pre and post assessments

• Custom reports for different research groups• Database encryption – CRYPT• Passive analytics

Rich program content

• Dashboard navigation widget• Prev/Next buttons• Video and Audio– Hosted on Amazon cloud– Delivered by FLASH player

• FLASH “interactives” delivered in a custom version of Carousel

Video content

Audio content

FLASH content

Interactive tools

• Simple Thingy instances configured to allow consumers to write diary entries, build lists and rate experiences before and after treatment.

• Mood Monitor for capturing weekly ratings of depression and anxiety (and number of panic attacks).

• Program managers alerted to “dangerous” scores

Mood Monitor

Manager portal

• For managing consumers, eTherapists, Supervisors and Read-only users

• Assigning consumers to eTherapists• Tracking progress of consumers and

eTherapists in training• Creating new read-only accounts and

assigning viewing permissions• All custom code extending WebGUI’s users

and groups system

Consumer tables

eTherapist tables

Secure, scalable hosting

Virtual server configuration

ProcoliX: Maintenance and support

• 24/7 Monitoring• Nagios and Cactii• Issue management• Disaster recovery• Change management– Software upgrades– Security patches

Why was WebGUI a good fit?

• All necessary content management features out of the box (add, edit, delete, RTE)

• Granular user and group system• Survey and Thingy• Workflow• Highly configurable• Highly customisable• Sensational community

Giving back to the community

• FilePump• Crypt• Carousel• Passive Analytics• Survey ++

Future plans

• Improved message centre• RCT• Variable length programs• Trans-diagnostics• Mental health portal