ImpactofOnlineCounseling2 by chenshu


									Farrokh Alemi, Ph.D. & Angela Harge
What Is Online Counseling?
 Daily email/phone contact
    Motivational Interviewing
 Weekly relapse prevention assessment
 On demand peer-to-peer anonymous support
 Within 24 hours answers to questions
 Bi-weekly urine tests
 On demand visits              This definition is
                                  different from others
              Online counseling         Face to face counseling
 Frequency           Near daily               Less frequent
 Availability       On demand                By appointment
 Initiated by   Mostly by provider                Patient
 Method       Motivational interviewing           Varies
 Content        Today & tomorrow                  Varies

Not replacement but two different
Different content, different methods,
 pursuing same outcomes
Population Served
1.       Poor
2.       Low education
3.       Dual diagnosed
4.       Homeless
5.       Court involved
     •     On probation
6. Addicted to illegal
Delivery Mode
  1990s studies:
  Computer services
  delivered through
  Interactive Voice
  2000s studies:
  Free net appliance
  installed in patients
Peer Support Reduced Visits
 53 recovering
  parents of infants                100
 Randomly                            50
  assigned                             0
 Less attrition online              -50
 Real emotions                    -100
 Reduced use of
                                              Counseling visits            MD visits          Clinic visits

                                                                  Online    Face to face
  service over 4
 Same health status

              Alemi F, Mosavel M, Stephens RC, Ghadiri A, Krishnaswamy J, Thakkar H.
          Electronic self-help and support groups. Med Care. 1996 Oct;34(10 Suppl):OS32-44.
Reminders Increased Visits
 213 mothers of                                             65
  infants                                                    55
 Urban clinic                                               50
 Reminders:                                                 40
   to keep
    appointment                                                        Not          Reminded
   reschedule                                                       reminded
    missed                                                         On time immunization

          Alemi F, Alemagno SA, Goldhagen J, Ash L, Finkelstein B, Lavin A, Butts J, Ghadiri A.
     Computer reminders improve on-time immunization rates. Med Care. 1996 Oct;34(10 Suppl):OS45-51.
Online Relapse Prevention
 Recovering drug users contacted weekly
 Prospective not after the fact
 Asked to call in, otherwise called by computer
 Asked 25 questions, including: “Have you
  visited a place where you used before?”
 Client reaction at end of program: “You have
  mothered us for months. How dare you stop?”

               Alemi F, Stephens R, Parran T, Llorens S, Bhatt P, Ghadiri A, Eisenstein E. Automated
   monitoring of outcomes: application to treatment of drug abuse. Med Decis Making. 1994 Apr-Jun;14(2):180-7.
Different Population Reached
  ~240 TARGET city
  patients                                                        60.00%

  Referred to both                                                50.00%

                                             Percent of Clients

  face to face &                                                  30.00%
                                                                                                             In person

  online services                                                 20.00%


  Online reaches                                                  0.00%
                                                                           No use   1-60     61-990   >990
  clients not                                                                       Minutes of use

  available for face
  to face
        Mosavel M. The Role of Technology in Mediating Drug Abuse Treatment.
         Journal of Social Work Practice in the Addictions, Vol 4 (2) 2004, p 65-83
More Online, More in Treatment
 82 pregnant
  substance abusing
  patients                                                                85

 1.5 times more

                                                         % in treatment
  likely to be in                                                         60

  treatment                                                               50

 1.7 times more                                                               Less online   More online

  likely to use self
            Alemi F, Stephens RC, Javalghi RG, Dyches H, Butts J, Ghadiri A. A randomized trial of a
   telecommunications network for pregnant women who use cocaine. Med Care. 1996 Oct;34(10 Suppl):OS10-20.
What did not work?
Simultaneous group therapy on
 telephone lines
  Too many crisis
  Too few kept time
  Too much noise in background

   Alemi F, Jackson M, Parren T, Williams L, Cavor B, Llorens S, Mosavel M. Participation in teleconference
       support groups: application to drug-using pregnant patients. J Med Syst. 1997 Apr;21(2):119-25.
Impact of Online Therapy
   81 clients randomly assigned
   Net appliances not sold
   Variations in effectiveness (differences not significant)

                                                           Experimental                Control

                                                                    Number                  Number
                                                        Average     of cases    Average     of cases
                                  Urine tests            8.02%         27        12.95%           22
                    Drug use
                    30 days       Self report            6.94%         24        7.01%            19
                    prior to
                                  Self report &          8.38%         32        10.52%           27
                                  urine tests
                    Self reported alcohol use 30         2.36%         24        1.75%.           19
                    days prior to exit
                          *Statistically   significant difference at alpha level less than 0.05

    Alemi F, Haack M, Nemes S, Harge A, Baghi H. Online Substance Abuse Treatment: a Pilot Study of
    Effectiveness. In review, 2005
Panel Size of Counselors
Online: 300 patients
  Unpublished data that needs to be
Face to face: 20 patients
What We Know?
 Patients want computer services & feel entitled
  to it, once available
 It is possible to deliver online treatment to
  under privileged populations
 Online treatment affects use of services
 Attrition is lower in online treatment
 Outcomes maybe better or worst
      More studies are needed.
 Costs are drastically lower
Careers in Online Therapy
Entrepreneurs needed
  Not for risk averse individuals
Hangout around universities
  Grant funded activities
Marketing Savvy is needed
  80% of costs

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