Using Technology and Online Counseling to Help Integrate Persons with Mental Illness Into the CommunityChelsea SheaTech Plan PresentationProfessor Gordon5/1/2014

Outline

• What is Technology?

• PROS and SRV

• Technology Recommendations:

• Smartphones

• Text-based

• EMI & Mobile Technology

• Web-based Interventions

• Ethical and Legal Concerns

• Interviews

• References

What is Technology?• Technology is used to invent and or solve problems.

• It is defined as the sum of the ways in which social groups provide themselves with the material objects of their civilization.

• It is an understanding that deals with ways of inventing and solving problems that related to everyday life.

Influences the mental health field in two significant ways:1) Because technology is becoming so advance, we are constantly

springing forward with new knowledge, methods, and potentials.

2) Technology somehow found a way to integrate itself into our social and cultural world in such a way that our generation and future generations do not know any other way to communicate.

PROS and SRV• The program that I based my Tech Plan off of is the PROS program. I am

going to be interning with the program at The Guidance Center of Westchester in Mt. Vernon. I thought it would be a nice introduction in which I could learn more about this program as well as start my internship off with some helpful ideas when I am asked to do group work, and input my own thoughts and opinions.

• The PROS program stands for Personalized Recovery Oriented Services. The goal of this program is to help adults (18+) with serious or persistent mental illness integrate into the community. This is done through establishing goals, creating realistic plans, building skills for independent living, creating personal resources for support and recovery efforts, and enrolling in vocational or educational programs.

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• SRV or Social Role Valorization is defined as “the use of culturally valued means to enable, establish, enhance, maintain and/or defend devalued social roles for people at value risk.”

• Social Role Valorization programs are created for devalued populations, giving them a chance, advocating for them, as well as enhancing their social roles, and competencies.

Technology Recommendations:Smartphones

• Smartphones allow users to remain connected throughout the day. It has helped people engage in activities on their phone, in the same manner that they would on a computer, with the advantage of having mobility and it right in the palm of their hands.

• Smartphones have thousands upon thousands of apps for all different types of categories, including counseling. Some of these include apps for anxiety, depression, relaxation, relationships, and so forth.

Monitoring:• Smartphones are great for self-assessment and monitoring. Through

apps they can monitor their behaviors, feelings, and symptoms at certain times of the day, and see if a pattern exists.

• Once they see this pattern then can work with their PROS counselor to develop goals, and plans, that help satisfy the problem or need.

• Some smartphones have alerts for signs of distress. When the information is plugged in, and there are abnormalities, the smartphone can instantly link the client to either hotlines, or to seek their counselor.

Smartphones continued:Recording:

• Smartphones have the ability to record and video sessions, keep contact information, take notes, and other useful information.

• In the PROS program the client and counselor can come together with goals and plans, in which the client can record on their phone and keep for future reference. Perhaps they forgot what exactly their homework assignment was, maybe they wanted to hear that motivational line that their counselor said. Now they can because it is saved right at their fingertips.

• This is a great way to help a client adhere better to treatment, and goal compliance as well because there is no excuse that they forgot what the assignment was.

Coaching:• Virtual coaching or visual instructions are great for clients who are in

a social situation that they cannot escape from. Maybe there counselor is not available. Apps that help decrease anxiety or stress symptoms are available to keep the client as calm as possible.

Technology Recommendations:Text-based Counseling

• Synchronous Counseling:• Real-time, direct conversation, where communication is quickly received.

• IM, Google Chat, Texting etc.

• Asynchronous Counseling:• Delayed communication where there is time in between communication.

• Email, Discussion boards.

• Use of Text-based Counseling:• Text-based counseling is great in the PROS program when the client is in the

community and not in the office. If they are in a situation where they feel they are unable to handle it, they can quickly text their counselor with their problem.

• It is also great if the client has a question that may need to be answered at that moment, instead of having to wait until they see their counselor next.

• If they have a question or statement that does not need tending to right away, emails are great, just to keep the idea in mind. We have busy lives, and sometimes important statements can leave our minds for good.

Technology Recommendations:Ecological Momentary Interventions (EMI)

Mobile TechnologyOne of the main goals of PROS is to tailor interventions to the clients needs, EMI uses two different strategies to help do this:

1. EMI can be specifically designed based on what information the client provides during the initial intake assessment based on pre-intervention behaviors and thoughts.

2. EMI is used to deliver interventions at specific moments when the individual is in need of additional support.

• Mobile Technology is not just the use of cellphones. It can be phones, tablets, computers, anything that you can take on the go where information can be delivered and received instantly. These electronics are able to adapt to customized programs, book appointments, keep schedules, notes, ideas, etc. By incorporating EMI into these tools into the PROS program, goals and plans, can be accessed and updated at all times.

Technology Recommendations:Web-based Interventions

Web-based Portfolios:• In the PROS program a web-based portfolio is great for the counselor and

client to see the growth and progress that the client has made by using the portfolio to update, and add, assignments, notes, questions, etc. throughout the clients work from beginning to end.

• It also is great for to monitor client adherence to treatment by assigning work to be handed into it by certain days, or at least before the next meeting.

• Discussion boards, support groups, blogs:• Peer-led and peer-focused interventions in which the clients help one

another or express themselves in a more unstructured manner with little or no direct professional help (except monitoring from a counselor, unless it is an outside source.)

• Peers can help each other overcome problems they they have in common. It gives a sense of confidence, encouragement, and support. Also to let the clients know that they are not the only ones.

• Nearly 2/3rd of those with diagnosable mental disorders do not seek treatment for many reasons: one being that they do not want to face the stigmatization.

Ethical and Legal Implications• Since records and information are online, there is more room for that

information to be hacked into.

• Counselors may or may not be qualified or fit to be an effective online counselor. There will have to be training on apps, tools, and the background of the interventions.

• Because we are dealing with persons with severe mental illness, they have to fully understand and consent the use of technology in their situations.

• Information has to be backed up, and stored safely, and securely.

• PROS is a community based program, so the legality would have to be addressed. How would technology affect the entire organization, rather than private practice.

• Jurisdiction: Some clients travel to the PROS program from far distances, such as New Jersey or Connecticut. The jurisdiction between states can change.

• As an organization with multiple locations, they may have to have licensure to practice online counseling, and the use of technology in their counseling.

• Because the client and counselor would implement the technology tools, there is less worry about anonymity, however it still has to be played into account to ensure the client and counselor safety.

• As far as cost there would be questions raised as to if the organization provides payment for apps, tablets, etc. if the client does not have access to them.

• Not everyone is technologically savvy. If a client is not comfortable, then they cannot be forced into using technology. This raises questions about quality of assurance. Will the treatment be beneficial rather than f2f counseling?

• Concern about legal duties, standard of care, and miscommunication. When technology is involved the concern for risk is compromised when you are not with the client directly. Texts can be misunderstood, and verbal and nonverbal cues are not there in case the client is at harm.

Interviews

• A. Bilotto, LMHC – In charge of employment services at The Guidance Center of Westchester, PROS program.

• R. Liegner, LMHC – Director of the PROS program at The Guidance Center of Westchester, as well as housing.

References:

1) Aubry, T., Flynn, R. J., Virley, B., & Neri, J. (2013). Social role valorization in community mental health housing: Does it contribute to the community integration and life satisfaction of people with psychiatric disabilities?. Journal Of Community Psychology, 41(2), 218-235. doi:10.1002/jcop.21524

2) Bilotto, A (2014, April 24.) Email Interview.

3) (n.d.). Dictionary.com Unabridged. Retrieved May 01, 2014, from Dictionary.com

4) Eonta, A. M., Christon, L. M., Hourigan, S. E., Ravindran, N., Vrana, S. R., & Southam-Gerow, M. A. (2011). Using everyday technology to enhance evidence-based treatments. Professional Psychology: Research And Practice, 42(6), 513-520. doi:10.1037/a0025825

5) Heron, K. E., & Smyth, J. M. (2010). Ecological momentary interventions: Incorporating mobile technology into psychosocial and health behaviour treatments. British Journal Of Health Psychology, 15(1), 1-39. doi:10.1348/135910709X466063

6) Liegner, R. (2014, April 26.) Email Interview.

7) Luxton, D. D., McCann, R. A., Bush, N. E., Mishkind, M. C., & Reger, G. M. (2011). mHealth for mental health: Integrating smartphone technology in behavioral healthcare. Professional Psychology: Research And Practice, 42(6), 505-512. doi:10.1037/a0024485

8) McAdams, C., & Wyatt, K. (2010). The regulation of technology-assisted distance counseling and supervision in the United States: An analysis of current extent, trends, and implications. Counselor Education And Supervision, 49(3), 179-192. doi:10.1002/j.1556-6978.2010.tb00097.x

9) Online Counseling: A Handbook from Mental Health Professionals (2011) edited by R. Kraus, G. Stricker and C. Speyer, Elsevier Academic Press. ISBN:978-0-12-378596-1.

10) Personalized recovery oriented services (pros). (2014, 03 07). Retrieved from https://www.omh.ny.gov/omhweb/pros/

11) The guidance center (pros). (n.d.). Retrieved from http://www.theguidancecenter.org