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
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