Web based substance abuse interventions for offenders ng-reviewed 8-2-15

Web-Based, Substance- Abuse Interventions for Rural and Underserved Offenders

Tom Wilson, MA, LCPCTom Wilson Counseling Centers, Inc.

www.TomWilsonCounseling.com

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A comma needed to be added after Based as there are two compounds with hyphens before the noun

www.nfarattc.org

Agenda

Part 1: Overview of the past and current use of technology-based interventions for substance-use disorders.

Part 2: Description of how software solutions and web-based interventions have been used to deliver services to rural and underserved offenders—by Tom Wilson Counseling Center, Boise, Idaho.

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This rewording seems clearer as computers aren't actually delivering the services--so replaced with software solutions

Why Rural Offenders?

Approximately one quarter of the U.S. population (62 million people) lives in

frontier/rural areas

16–20% of those individuals experience substance dependence, mental illness, or

both conditions(NRHA, 2008)

Individuals residing in remote areas have higher mortality rates, higher suicide rates, and more severe alcohol/drug problems

(Baca et al., 2007; Goldsmith et al., 2002)

People in rural areas use substance-abuse treatment less often than in urban areas

They have more personal, social, and geographic barriers to accessing services.

There may be a stigma associated with treatment.(Finfgeld-Connett & Madsen, 2008; Oser et al., 2012)

Barriers to Treatment

Common Barriers to Entering Treatment

• Travel Costs• Transportation Access• Time Away From Work • Child Care • Lack of Service Providers

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Please note that I changed this title partly for capitalization but also for consistency

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SUD hasn't been introduced here so if reading from the notes may wish to say it completely and then "often referred to as SUDs"

Privacy and Confidentiality

(Moyer & Finney, 2004/2005)

The lowest concentration of mental health professionals was

found in frontier/rural areas(counties with fewer than 10,000 people)

(Ellis et al., 2009; HRSA, 2011)

How could addiction treatment or other behavioral health providers expand their reach and overcome

barriers to serving these populations?

(Kazdin & Blase, 2011; Perle & Neirenburg, 2013)

One Answer…Telehealth Technologies

Telehealth Definition: The use of telecommunications and information technologies to provide access to health information and services across a geographical distance. Technologies included in telehealth are:• Videoconferencing• Telephones (smart and dumb)• Email and texting• Web-delivered programs• Apps

(Institute of Medicine (IOM), 2012)

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Please note that the first word was 48-pt. type and the next title word 40--so if other title changes are made, it's good to check to ensure that the words in the line are the same point size.

1879

TELEHEALTH Is Not New

(Aronson, 1977; Backhaus et al., 2012; IOM, 2012; Wittson et al., 1961; Wittson & Benschoter, 1972)

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Consider adding a follow-on statement to Is Not New but it IS being deployed in more far-reaching effective, and flexible ways to suit the needs of various populations.

Why Use Telehealth Technologies?

Reason #1

Most telehealth research supports that outcomes are as good or better than in-person strategies for behavioral health services (mental health and substance abuse).

(IOM, 2012)

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The slide itself says "as good or better" but this is not consistent as it just states "as good as"

Largest provider of telemental health services using videoconferencing(Godleski et al., 2008; Darkins et al., 2008; IOM, 2012; Deen et al., 2012; Godleski et al., 2012)

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Didn't introduce VA so may wish to say the complete name and then introduce VA

VA Services• 146 hospitals provided 55,000 community-based

outpatient clinic patients with 140,000 telemental health visits

• 6,700 patients received home-based telemental health services

• 25% decrease in hospitalization for receiving telemental health services between 2006-2010

• 30% reduction in admissions during the first 6 months of care in 2011

(Darkins et al., 2008; IOM, 2012)

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Bullet style not consistent but did not change though recommendation is to use one style for top level, another style for the next level of subbullets, etc., throughout

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They don't actually go by that name any longer and though it's odd--they do not use an apostrophe. If you were going to use one regardless, it would need to be plural possessive, Veterans' but it's the title with the Affairs that was just used on previous slides so better to standardize

Indian Health Services (IHS)

• Serves 2 million American Indians and Alaska Natives representing 566 federally recognized tribes

• Includes 600 hospitals, clinics, and health stations under tribal governance

• Implemented mobile telemedicine services in the 1970s

• Alaska Federal Health Care Access Network utilizes telehealth

(IOM, 2012)

University of Virginia’s telehealth program has documented the avoidance of

7.2 million miles of travel(Rheuban, 2012)

Case Study: Delivering Medical Services at the University of Virginia using

Telehealth Technology

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This slide doesn't really follow directly from the IHS slide--so perhaps a title at the top would help, even if it's simple like Case Study: University of Virginia or similar

Why Use Telehealth Technologies?Reason #2: Access to technology is widespread.

• Access to the Internet has increased dramatically

• 90% of individuals worldwide have access to mobile phone services.

• Smartphone access is expected to triple by 2019

• Internet and mobile access is growing among traditionally underserved populations Marsch, 2014

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Another instance of the inconsistency where some references say "as good as or better" and some, like this one, says just "as good as." All should match.

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Note: The word "Internet" should be capped at all instances, but I cannot edit this image to fix it in the italics

87% of Americans use the Internet

(Pew Report, 2012)

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Add a statement about the issue, such as is an issue that continues to beg for creative solutions or an issue that telehealth advocates and experts still struggle to address (or mitigate)

85% O

F AM

ERICAN

ADU

LTS H

AVE M

OBILE

PHO

NES

OR

TABLETS

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Better to clarify "before what"--perhaps this was to say one hour in advance of when the next testing was to take place or similar?

80% send and receive text messages

(Pew Report, 2012)

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Add a statement here as to how that correlates perhaps with the population needed services of this type to reinforce effectiveness of the outreach?

Over HALF have gathered health information on their phones

Almost 20% have a health app

(Pew Report, 2012)

Videochat platforms offer

opportunities to connect

remotely

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These notes don't seem to connect directly to this particular slide about videochat but if you flip the order of the points here to open with the Skype compliance it will help

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As "we" is not defined, consider rewording to It has not been confirmed whether or not Skype is storing videochat sessions or not...

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Since you are saying this and not NFAR ATTC from what I can tell, switch to its website instead of our website.

Videoconferencing Is Mainstream

Why Use Telehealth Technology? Reason #3: High Customer Acceptability

Customers are more likely to use services that are available as needed

and less costly than scarce providers or

services.

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This word was just switched from all caps but something is unclear or seems missing as the Although doesn't seem to follow as increased demand is not a counterpoint to the first part of the sentence, which Although implies

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May wish to define what on-demand means (e.g., available as needed, 24/7/365--known as on-demand services (or similar)

Adopting Innovation is a Personal Choice

(Balas & Boren, 2000; Benavides-Vaello et al., 2013; Ryan & Gross, 1943)

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Please check this wording as it seems to counter some of what was cited before--and can then be perceived as a negative on the subject so if wording to stay--consider adding a positive transition statement so it doesn't seem to invalidate the concept perhaps by saying though the incidence of writings on the subject in professional journals is increasing OR the need for growth in this arena is compelling or something similar

The Promise of TechnologySeveral research studies demonstrate that technology-based behavioral health tools:

Can be useful and acceptable to diverse populations

Have an impact on health behavior and outcomes

Can produce outcomes comparable to (and in some cases better) than providers.

(Marsch, 2014) Dartmouth Center for Technology and Behavioral Health

The Promise of TechnologyTechnology-based behavioral health tools… Increase quality, reach, and responsivity of care

Can be more cost effective than in-person services

Can increase service capacity of organizations

Can be responsive to an individual's behavioral need trajectory over time

(Marsch, 2014) Dartmouth Center for Technology and Behavioral Health

Examples of Technology for Substance-Use Disorders

Decision Support Systems- e.g., Let’s Talk About Smoking (Brunette)Assessment- ASI-MV (Butler) - CHAT (Comprehensive Health Assessment

Tool for Teens) (Lord)Brief Intervention- Drinker’s Check-Up (Hester)

Examples of Technology for Substance-Use Disorders

• Treatments/PsychoeducationTherapeutic Education System [“TES”] (Marsch, Bickel)Cognitive Behavior Therapy CBT4CBT (Carroll) SHADE (Kay-Lambkin)

• Recovery SupportAddiction–Comprehensive Health Enhancement Support System [“A-CHESS” ] (Gustafson)

Web-Based Screeners

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Note: While not flagging most of the edits I'm making, please do note that I reordered this wording for clarity

Web-Based Support Groups

Web-Based Support

PsychoeducationalSelf-Help

Mutual Support

Virtual Reality

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Please revisit this wording as seems a bit unclear--perhaps ...reality programs have been used as complementary support tool to... or something. Intent not completely clear

Use of computers to deliver some aspects of psychotherapy or behavioral treatment

directly to patients through interaction with a computer program located on a device or

virtual learning environment [the cloud].

(Carroll & Rounsaville, 2010)

Computer-Based Treatments

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Italics were used on an earlier slide whose content was just a definition. Could use here, too, though generally best to avoid italics and could change the other one

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Rewording recommended as The issue is but doesn't seem to be the intended message. What's key here is that multitudes of people are already doing their banking online taking full advantage of XXXX

Using Web-Based, Substance-Abuse Interventions With Rural

and Underserved Offenders

© 2012 Tom Wilson Counseling Center

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Check this slide versus opening of presentation PLUS check the copyright date

Rural Nature of Idaho

Thirty-five of Idaho’s forty-four counties are rural or frontier and many areas have limited access to specialty care.

While rural Idaho continues to face challenges recruiting and retaining medical and behavioral professionals, telehealth and telemedicine are playing an increasingly important role.

(Idaho Telehealth Alliance, 2015)

Objectives of Web-Based Services To expand the reach of substance-use

services to our remote, rural, or challenged clients through technology

To help clients overcome personal, social, and geographical barriers to substance-

use disorder services

To deliver substance-use services guided by evidence-based practices and

principles

The Aim of Prevention

The aim of prevention is to:• Deter the onset of alcohol or other

drug abuse • Provide individuals with the

information and skills necessary to prevent the problem.

Importance of Early Prevention

“…It is easier to build strong children than to repair broken men...”

—Frederick Douglass

Theory of Prevention

Drug abuse can be prevented if: Risk factors in a population are

identified and reduced Protective factors are identified

and strengthened

ABOUT OUR PROGRAM

Tom Wilson Counseling Center specializes in providing alcohol and

drug-abuse prevention education services for

forensic (court–ordered) clients.

Most of our clients are low-risk offenders

charged with substance-abuse-

related offenses and are on diversion or bench probation.

Challenges of In-Person Classes

Traditional in-person classes are difficult for offenders who:

• Travel for work• Have a suspended

license• Live in rural areas• Have child/family

obligations• Experience

communication problems

• Have no local substance use disorder provider

• Have privacy concerns

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As noted earlier, SUD wasn't defined and this is far enough later that may be better to spell out PLUS couldn't a added bullet point be "Have privacy concerns about participating in person" or similar?

Why Adopt Technology?

Information technology is now an effective way to deliver health

information/content

Cost has dropped significantly due to open source movement, cloud technology, etc.

Access to well-designed applications has increased dramatically

Advantages of Online Learning

Self-paced learning can take place anywhere,

anytime.

Accessible to virtually all learners—regardless of disability, location, or

learning schedule.

Providers can use creative methods and delivery

modalities.

Disadvantages of Online Learning

Requires computer or mobile device and Internet access, and some computer literacy.

Some participants may be uncomfortable with or distrustful of technology

Does not work well for some learning styles or activities that require group interaction

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Consider a positive closer to this in parentheses, such as (though the preponderance of the evidence is clearly indicating that the benfits of such learning greatly offset the disadvantages or similar if applicable to support your methodology and medium?

Program Design

Target Behavior: Harmful

alcohol use

Objective: Change

attitudes toward drinking

Target Population: Underage Drinkers

Delivery Medium:Web-based education

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These fonts and use of bold vary--not sure if intended so leaving as is

Evidence-Based Components

Motivation- Enhancement Techniques

Stages of

Change Activities

Cognitive Behavioral

Skills

Web-Based Programs Include:

Using Principles of Moti vati onal Enhancement Therapy

Non-confrontational intervention

Begins with self-assessment

Personalized feedback report on pattern of use

Feedback includes normative comparison of results

Moving Through Stages of Change

Precontemplation Contemplation Preparation Action Maintenance

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Is the slide itself to actually say "introduce the" as seems to be directed to the trainer as a note rather than what would appear on the slide and perhaps this would be where you'd possibly name them or perhaps omit this bullet plus who is to do the identifying noted in bullets 2 and 3?

Stages of Change Acti viti es

What stage am I in?

Readiness to change example

Decisional Balance—Benefits vs. costs of change

Sample Lesson Process

Read content and answer

review questions

Receive feedback

If correct, continue or

retry questions

Feedback Example

Your Response:

You told us you drink 8–14 drinks per week on average when you drink.

Based on your response, you drink more than 81% of all males and 94% of all females.

You

Example of Calculation ExerciseYour typical blood alcohol content is the amount of alcohol in your blood on a typical day when you drink.

To calculate your typical BAC (blood alcohol content), use the online BAC calculator provided.

Online BAC Calculator

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Provided where? Also the words "of" and "per" in the graphic should be lower case but I cannot edit them

Feedback for Typical Drinking BACs Your response:You calculated your BACs for a typical drinking occasion as falling between .06 to .10.

At BAC Levels of .06 to .10, you will have impairment of muscle coordination and a slower reaction time, and disregard for personal safety.

Sample Lesson PageBinge Drinking

• Is defined as 5 or more drinks on the same occasion at least once in the past 30 days.

• Health, social, and academic problems occur when men drink 5 or more drinks per occasion, and women drink 4 or more per occasion.

• Binge drinking is the most common pattern among underage drinkers.

• Less than 25% of persons aged 12 or older participated in binge drinking

Click for Review Question

Other Mediums of Delivery

Using text messaging as an Intervention “In a recent study, text messaging to emergency

patients reduced their alcohol consumption” 12-week trial of receiving automated text messaging

asking about drinking Men who had 5 + drinks and women who had 4+

drinks received text messaging of concern about level of use

Asked if they would cut down. + for “yes”, ask to reconsider drinking for “no”

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All of the words in this blue quote would normally be lower as other than the first word but as it's quoted--was this a direct citation that needs to be noted? Otherwise, please lower case and remove quotes

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Check the wording please

Other Mediums of Delivery• Example of online

assessment and feedback with “E-checkup to Go” for university freshmen

• Example of online assessment and feedback with “Brief Assessment and Intervention for College Students”

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Clarify explain or describe that this is an example of an ongoing, successful program or otherwise explain? Plus the word "Alcohol" appears in the echeckup to go graphic below but is not lised in number 2

Conclusions

The tools of information and computer technology are successfully being implemented to remotely treat and prevent substance abuse.

The tools of technology can increase accessibility of behavioral health services to

rural offenders through web-based delivery.

Technology-assisted services will help offenders improve compliance—reducing the burden on

diversion and community supervision services.

Current Research on Outcomes

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Perhaps transition to this with a statement that acknowledges the earlier statement about not much published in books about it but that there IS a growing volume of reputable research that has identified (or indicated) XXX

A Comparison of Recidivism Rates for Online DUI Classes vs. In-person Classes

• Participants were 557 adults who completed online DUI classes at Tom Wilson Counseling Center. 68% were male, 32 % were female.

• Mean age of participants: 35• Completed online DUI classes between 2010–

2013.• Completed a cognitive-behavioral curriculum

use in Colorado called “Driving with Care” but was adapted for internet delivery.

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Check font size change PLUS perhaps directly compare to other results and ensure they know what DWC and CDBH are and TWCC not introduced and as this is critical--want to have the success message be clear

Results of Study

• 557 participants completing online DUI classes at Tom Wilson Counseling Center had an average recidivism rate of 7.5% as of 4/21/2015.

(Raissa Miller, Ph.D. Boise State University; 4/30/15)

• 16, 194 participants completing in-person classes using the same curriculum adopted by the state of Colorado between 2001 and 2004 had an average recidivism rate of 7.8% as of 2004.

(Colorado Division of Behavioral Health, 6/2008).

Contact InformationTom Wilson, LCPC, CPS

Tom Wilson Counseling Center 514 S. Orchard Street, Suite 101

Boise, ID 83705Office: 208.368.9909

http://www.TomWilsonCounseling.comemail: [email protected]

Twitter: twcc_tom

http://www.tomwilsoncounseling.com/

mailto:[email protected]

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Consider adding the name of your organization, too

Presentations & Public Speaking

Web based substance abuse interventions for offenders ng-reviewed 8-2-15