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Abstracts of Volume 26 (1) (2-4) of the Journal of Technology in Human Services

Volume 26 (1) General Issue

Psychiatric Information Systems: An Analysis of Inpatient and Outpatient Unit Capabilities by Jennifer Wisdom, Sarann Bielavitz, & Robert French

KEYWORDS: behavioral health, informatics, psychiatric treatment, mental health, information systems

ABSTRACT:  This paper describes how a sample of inpatient and outpatient psychiatric treatment units use technology to aid in patient care through scheduling, tracking, billing, and documenting clinical services. We conducted semi-structured interviews (n = 68) at four inpatient and four outpatient psychiatric facilities in Oregon. Results indicate psychiatric facilities are assembling systems for managing information that include a combination of electronic linked clinical records, paper records, and unit-specific, unlinked databases. Barriers remain in (a) improving the sophistication of psychiatric information systems, (b) improving linkages of behavioral health with other medical information systems, and (c) increasing information technology support.


The Relationship of Computer Attitudes to Reported Use and Observed Behavioral Proficiency by William R. Barcy and Rebecca Tift Barcy

KEYWORDS: computer, attitudes, use, observed behavioral proficiency

ABSTRACT: The current health care delivery system increasingly relies upon information technology (IT) to more effectively and efficiently meet patient needs. This paper reports findings from an observational field study that examined the relationship of computer self-efficacy, computer anxiety, and perceived computer usefulness to behavioral performance utilizing IT programs by clinical staff in a hospital-based social work and nursing case management department. The results indicated significant relationships between observed behavioral proficiency on a computer resource directory search task and self-reported ratings of computer self-efficacy and computer anxiety. Higher task proficiency was associated with higher computer self-efficacy ratings. Lower task proficiency was associated with higher computer anxiety. More frequent self-reported use of the computer resource directory was significantly associated with higher ratings of computer usefulness.


Creating Foster Care Youth Biographies: A Role for the Internet by Nora Gustavsson & Ann MacEachron

KEYWORDS: Foster Care, biography, identity, internet

ABSTRACT:  Large numbers of youth continue to enter foster care despite federal and state efforts to minimize placement.  Some youth will experience lengthy tenure in care with multiple placements and be at-risk for adverse events.  They are also at-risk for losing an accurate biography of their childhoods. We suggest a two tiered approach to help youth develop a personal history. Agencies can establish a digital depository of basic information including pictures that documents the life course of the youth.  Agencies can help youth procure email accounts. These email accounts are under the control of the youth and can function as an electronic diary. Thus, youth would have a portable life biography and sense of self over time.


Using Net Conferencing to Facilitate Cancer Care and Education by Diane B. Mitschke

KEYWORDS:  technology, health communication, oncology, Net Conferencing, strategic planning

ABSTRACT:  Web-based technologies in general, and Net Conferencing in specific, have provided new opportunities to enhance communication among health care professionals, human services providers, and clients and patients in the field of oncology.  This article explores the use of Net Conferencing to enhance cancer education and training, planning, and strategic planning, and examines potential benefits and costs related to its use.  Recommendations for future studies are presented, with a focus on formal evaluation research on the use of Net Conferencing in comparison to other forms of communication technology.


Evaluating Readability of Domestic Violence Information Found on Domestic Violence State Coalitions’ Websites by Alice G. Yick

KEYWORDS:  Grade reading level, readability, domestic violence, state coalitions, health literacy

ABSTRACT:  With the popularity of the Internet, more and more individuals are accessing health and mental health information from an array of websites.  Yet, health literacy has emerged as barrier despite easier access to health information.  The U.S Department of Education (1986) stated that educational materials should be no higher than 8th grade reading level; yet, the reality is that often information written is above this level.  This study examined the grade reading level and readability (as measured by the SMOG, Flesch-Kincaid Grade Level, and the Flesch Reading Ease) of domestic violence materials on the websites of domestic violence state coalitions.  Findings indicated that the average grade reading level of the domestic violence materials were statistically significantly higher than the 8th grade standard. This was true regardless of the region where the domestic violence state coalitions were located.  Implications for social service providers were discussed.


Health Education Online for Individuals with Low Health Literacy: Evaluation of the Diabetes and You Website by Pamela Whitten, Brad Love, Lorraine Buis & Michael Mackert

KEYWORDS:  health education, health literacy, health communication

ABSTRACT:  Health providers are challenged to find efficacious ways to provide health education to a population with diverse levels of health literacy.  This project sought to test the effectiveness of a website (Diabetes and You) about Type II diabetes designed for non-diabetics with low health literacy.  Research participants were observed as they viewed the Diabetes and You website, tested for diabetes knowledge before and after viewing the website, checked for functional health literacy, and interviewed to discover their perceptions of the website.  Results indicate that users were engaged and interested in the website and particularly preferred the interactive risk assessment page. Users demonstrated an increase in knowledge about diabetes and its risks after viewing the website.  Further research into the most effective ways of delivering health information online to this key target population is necessary to minimize the impact of health literacy.


Online Synchronous Audio and Video Environments for Education, Training, and Human Service Delivery: A Review of Three Products by Andrew S. Quinn, Jo Ann R. Coe Regan, & Dick Schoech

KEYWORDS:  Video classroom, online classroom, web based education

ABSTRACT:  This brief report describes the Internet Video Virtual Classroom (IVVC).  The IVVC is a synchronous on-line environment where instructors can deliver course curriculum to students in real time and at a distance.  Features of the IVVC that are described include video, audio, and text communication between participants, information sharing, facilitating participation, promoting group work, and documenting interactions.  In addition, problems and limitations that can exist in the IVVC are discussed.  Finally, to further illustrate the IVVC, three specific products (Adobe Acrobat Connect Professional, Elluminate, and Flashmeeting) are described.

Volume 26 (2-4) Special Issue

 Internet-delivered therapeutic interventions in human services:

Methods, issues, and evaluation

Introduction By Jerry Finn and Dick Schoech


A Comprehensive Review and a Meta-Analysis of the Effectiveness of Internet-Based Psychotherapeutic Interventions by Azy Barak, Liat Hen, Meyran Boniel-Nissim, & Na'ama Shapira

KEYWORDS:  Psychotherapy, Internet, online therapy, Internet Intervention, Meta Analysis

ABSTRACT:  Internet-based psychotherapeutic interventions have been used for over a decade, but no comprehensive review and no extensive meta-analysis of their effectiveness have been conducted. We have collected all the empirical articles published up to March 2006 (n=64) that examine the effectiveness of online therapy of different forms and performed a meta-analysis of all the studies reported in them (n=92). These studies involved a total of 9,764 clients who were treated through various Internet-based psychological interventions for a variety of problems, whose effectiveness assessed by different types of measures. The overall mean weighted effect size was found to be 0.53 (medium effect), which is quite similar to the average effect size of traditional, face-to-face therapy. Next, we examined interacting effects of various possible relevant moderators of the effects of online therapy, including type of therapy (self-help Web-based therapy vs. online communication-based etherapy), type of outcome measure, time of measurement of outcome (post-therapy or follow-up), type of problem treated, therapeutic approach, and communication modality, among others. A comparison between face-to-face and Internet intervention as reported on in 14 of the studies revealed no differences in effectiveness. The findings of this meta-analysis, and review of additional Internet therapy studies not included in the meta-analysis, provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity and suggest several insights in regard to its application. Limitations of the findings and recommendations concerning Internet-based therapy and future research are discussed.


Development of a new approach to guided self-help via the Internet.

The Swedish experience by Gerhard Andersson, Jan Bergström, Monica Buhrman, Per Carlbring, Fredrik Holländare, Viktor Kaldo, Elisabeth Nilsson-Ihrfelt, Björn Paxling, Lars Ström, Johan Waara

KEYWORDS:  Internet, cognitive behavior therapy, guided self-help, anxiety disorders, mood disorders, behavioral medicine

ABSTRACT:  This paper describes the development and empirical status of guided Internet-delivered self-help. The treatment approach combines the benefits of bibliotherapy with book length text materials and the support given online via web pages and e-mail. Interactive features such as online registrations, tests, and online discussion forums are also included. Cognitive behavior therapy (CBT) guided the research and clinical implementations of this approach, as it lends itself more easily to the self-help format compared with other presently available psychotherapy approaches. We include an overview of the research, current issues and research in service delivery, lessons learned through a program of research, and directions for future investigations.


An Internet-based Self-help Program for the Treatment of Fear of Public Speaking: A case study  by Cristina Botella1, M.J. Gallego1, A. Garcia-Palacios, R.M. Baños, S. Quero1 & V. Guillen

KEYWORDS:  telepsychology, online therapy, cognitive-behavioral therapy, exposure, social phobia, fear of public speaking

ABSTRACT:  This paper discusses the development of the first totally self-administered online CBT program for the treatment of a specific social phobia (fear of public speaking) called Talk to Me. The online program includes three parts. The assessment protocol gives the patient information about the problem, including impairment, severity, and the degree of fear and avoidance regarding the main feared situations. The structured treatment protocol ensures that the patient does not skip any steps in the treatment. The treatment protocol is a CBT program that provides exposure to the feared situation using videos of real audiences. Finally, the control protocol assesses treatment efficacy, not only at posttreatment, but also at every intermediate step.  In this work we describe Talk to Me and its practical application through a case study.


Evaluation of the RAINN National Sexual Assault Online Hotline by Jerry Finn and Penelope Hughes

KEYWORDS: Rape, Sexual Assault, Crisis Intervention, Program Evaluation, Internet

ABSTRACT: This paper describes the evaluation of RAINN National Sexual Assault Online Hotline, a new model for delivery of rape and sexual assault crisis services through a secure, confidential chat-based online hotline. Outcome data from 623 visitors and 54 volunteers for the first 11 months of the program are presented. The results indicate that the model is viable and useful for approximately 80% of visitors and volunteers are satisfied with the program. Recommendations for program development and further research are presented.


A Safe Place for Predators: Online Treatment of Recovering Sex Offenders by Poco D. Kernsmith and Roger M. Kernsmith

KEYWORDS: Sex Offenders, Support Group, Online Intervention, Self-help

ABSTRACT:  This study examines the process and effectiveness of a voluntary online support group for recovering sex offenders.  The study used unobtrusive observation of the group for a period of ten months.  The support group was facilitated by two non-professional, recovering sex offenders.  The group was found to be a positive therapeutic environment, with members providing positive support and confrontation through the process of change.  Among those who were active participants, there was significant improvement in several indicators of change.


The need for Web-based cognitive behavior therapy among University students by Ove K. Lintvedt, Kristian Sørensen, Andreas R. Østvik, Bas Verplanken, and Catharina E. Wang

KEYWORDS: CBT, Depression, TPB, Internet-based intervention, Mental Health, Counseling

ABSTRACT:  This study investigates students’ need for a Web-based cognitive behavior therapy (CBT) intervention program for preventing depression, the mental health status of those who felt a need for such a program, and underlying factors of the intention to use Web-based self-help. A conceptual model for explaining intention to use Web-based self-help is proposed. Nearly half of the participants reported a need for help with psychological problems but only a third of these actually sought help from traditional mental health services. In conclusion, there is a need for Web-based self-help and Web-based CBT has the potential to attract a group of students who, so far, have not been reached by traditional mental health services.


Issues in the Evaluation of an Online Prevention Exercise by Bhavana Pahwa and Dick Schoech

KEYWORDS:  Online prevention, substance abuse, evaluation, anger management

ABSTRACT:  The rapid growth of computer and Internet technologies and their acceptance as a viable medium for human services delivery has opened up new possibilities for providing effective prevention programming.  This article reviews some of the major online prevention web sites and evaluations of their effectiveness.  Additionally, it reports the struggle to evaluate an interactive multimedia anger management exercise that is part of a teen substance abuse prevention web site.  The evaluation provided some support that a 30 minute exposure to a web-guided prevention exercise could increase teens’ prevention knowledge and that completing the online exercise as supplemental homework reinforces the classroom experience.  However, positive changes in other measures of behavior change were not supported.  The study pointed to many issues that occur when developing and evaluating online interventions in real world environments. 


The “LivePerson” Model for Delivery of Etherapy Services: A Case Study  by Jerry Finn and Sharon Bruce

KEYWORDS: etherapy, online therapy, counseling, psychotherapy, Internet

ABSTRACT:  There are several models for the delivery of etherapy on the Internet. This paper presents a case study of one model, the LivePerson website. The model is based on a privately owned infrastructure through which etherapy is practiced by licensed counselors using chat or email for service delivery. A content analysis of the website is presented, including policies, number of consumers, consumer ratings, and therapist’s degree, licensure, age, sex, race, fees, and languages offered. In addition, the experiences of one LivePerson practitioner are presented to highlight methods, processes, and ethical concerns. This case study of the LivePerson model for service delivery highlights many of the benefits and concerns previously discussed in the literature related to etherapy. In addition, concerns are raised that there may be some conflict of interest when ethical standards of practice are delivered within the context of a profit making company.


Ethical Issues in the Provision of Online Mental Health Services (Etherapy) by Donna M. Midkiff and W. Joseph Wyatt

KEYWORDS:  Ethics, Internet, psychotherapy, etherapy

ABSTRACT:  A number of ethical issues involved in face-to-face therapy are examined in relation to on-line therapy [etherapy]. Etherapy is defined and its strengths and weaknesses discussed. Specific ethical issues addressed include boundaries of competence, basis in science, avoidance of harm, confidentiality, avoidance of false or deceptive statements, forums, testimonials, solicitation of clients, fees and informed consent. A concluding section briefly addresses legal issues, particularly interstate etherapy. It is recommended that federal licensing legislation be enacted, informed by the NASW, the APA and similar groups.


How Sturdy is that Digital Couch?  Legal Considerations for Mental Health Professionals Who Deliver Clinical Services Via the Internet by Jason S. Zack

KEYWORDS: law, counseling, therapy, Internet, ethics

ABSTRACT:  This paper reviews legal issues related to providing metal health services via the Internet.  It provides a general overview of the field and discusses jurisdiction, licensure, legal duties (competence, consent, confidentiality), and other legal concerns related to the business of online counseling.  It surveys potential criminal and civil liability issues, noting procedural and substantive aspects of the relevant law.  The author concludes that although providers face a variety of challenges to providers, their efforts in providing a service needed and desired by an important segment of the help-seeking population is worthwhile.


Best Practices in Online Therapy by Jo-Anne M. Abbott, Britt Klein, Lisa Ciechomski

KEYWORDS: Internet therapy, online therapy, best practice, professional ethics, mental health.

ABSTRACT:  This paper discusses important issues in delivery of best practice Internet-based therapy (etherapy). Etherapy is first defined as the interaction between a consumer and a therapist via the Internet (commonly via email), in association with the use of a structured web-based clinical treatment program. A summary of the professional and ethical issues is provided, along with illustrated examples of best-practice principles experienced in clinical and research work by members of the Swinburne University of Technology etherapy Unit (formerly the etherapy Research, Education and Training Unit in the Department of General Practice at Monash University). Etherapy has been found to be effective in treating a range of psychological disorders. Future research investigating methods of enhancing consumers’ ability to engage in etherapy should further increase the effectiveness of this type of therapy.


Grounding Online Prevention Interventions in Theory: Guidelines from a Review of Selected Theories and Research by Brian Wuder Peng and Dick Schoech

KEYWORDS: online prevention, online intervention, social science theory, etherapy

ABSTRACT:  Literature suggests that grounding online interventions in theory improves their success. This article reviews ten theories selected from the fields of psychotherapy, social work, health promotion, gaming, and innovation dissemination that can be used for grounding the design, development, implementation, and evaluation of online interventions. Selected studies are reviewed to illustrate how these theories have been used in online human service interventions. After this review, an integrated theoretical approach for grounding online interventions is proposed along with guidelines suggested by the review.


Design Imperatives to Enhance Evidence-Based Interventions with Persuasive Technology:

A Case Scenario in Preventing Child Maltreatment by Walter LaMendola and Judy Krysik

KEYWORDS:  technology design, child maltreatment, persuasive technology, human services

ABSTRACT:  This paper examines how current thinking in persuasive technologies may be applied to evidence-based therapeutic interventions through a planned and multidisciplinary design process. Design steps identified in the human services and the design sciences are merged to generate six design imperatives. The need for human service knowledge to inform design is discussed in each design imperative. A case scenario using Healthy Families America (HFA), a broadly implemented child abuse and neglect prevention program, is presented as illustrative. The final design imperative argues for continuous attention to ethics across all disciplines. The design imperatives provide an initial framework for optimizing the development of persuasive technology applications in the human services.


Therapeutic Applications of Online Gaming by Paul P. Freddolino and Christina M. Blaschke

KEYWORDS:  online gaming, games, etherapy, gaming applications

ABSTRACT:  This article discusses online gaming in the 21st century: describes online gaming; considers negative and positive aspects of gaming; and proposes several possible research, practice, and educational strategies for subsequent development of this genre into a useful tool for human service interventions. Positive characteristics of online gaming environments such as high levels of social interaction and the potential for transformative experiences strongly suggest that many clients will be utilizing such environments. Additionally, practitioners must not only learn to assess client use of gaming but also develop the necessary knowledge and skills to utilize online games as therapeutic tools.


Cybercounseling online: The development of a university-based training program for email counselling by Robert MacFadden, Lawrence Murphy, and Dan Mitchell

KEYWORDS: cybercounseling, email counseling, etherapy, online therapy, training

ABSTRACT:  The development of a university-based cybercounseling certificate program through the continuing education department of a graduate faculty of social work is described. This web-based program consists of two levels: introductory and advanced and offers experienced face-to-face counselors training in an asynchronous, email form of cybercounseling. Ethical issues such as cross-jurisdictional concerns, client appropriateness, and counselor insurance are discussed. A system developed to provide online email security through web-based access and encryption is highlighted. Several techniques for email counseling such as presence, spacing and pacing are discussed and illustrated. Demographics of learners and feedback from graduates are presented and lessons learned are discussed.


E-therapy: a training program for development of clinical skills in distance psychotherapy by  Gloria Cárdenas, G., Serrano, B., Flores, L. & De la Rosa, A.

KEYWORDS: E-therapy, training, clinical skills, competency training

ABSTRACT:  This paper describes a project by the Virtual Teaching and Cyberpsychology Laboratory of the National Autonomous University of Mexico to: 1) implement a teaching program for clinical psychology students to teach therapeutic skills in providing psychological services online; 2) evaluate the students’ acquisition of knowledge and skills in diagnosis, case formulation treatment, and adherence to treatments protocols; and 3) incorporate technologies for creating training settings and online professional services in order to develop the students’ clinical competency in this treatment modality. A pilot study was conducted with 17 Clinical Psychology students in the first phase of the teaching program and 6 students during the second phase. Preliminary results indicate that students increase knowledge of clinical interventions and improve in clinical skills. It is necessary to continue the evaluation of the teaching program with larger samples and further research is suggested.


Conclusion by  Dick Schoech and Jerry Finn