Valley Hope Association Accessible Care Effective Support Services AC/ESS Programming

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Valley Hope AssociationAccessible Care
Effective Support Services AC/ESS Programming

• Holly Krebsbach, MS, LPC, LISAC
• Corporate Clinical Supervisor
• Outpatient Services

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Objectives

• 1. Definition of internet therapy
• 2. Guidelines for internet therapy
• 3. Resistance in the counseling field
• 4. Multi-Modality approach
• 5. Valley Hope Accessible Effective Support
  Services (AC/ESS)

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What is Online Therapy

• Online or Internet therapy or counseling, Is
  referred to as ongoing, interactive, text-based,
  electronic communication between a client and a
  mental health professional aimed at behavioral or
  mental health improvement.
• Telehealth can be defined as the use of
  telecommunications and information technologies
  to provide access to health information,
  assessment, diagnosis, intervention,
  consultation, supervision, education, and
  follow-up programs across geographical distance
  (Glueckauf, Pickett, Ketterson, Loomis,
  Rozensky, 2003 Glueckauf, Whitton, Nickelson,
  2002 Liss, Glueckauf, Ecklund-Johnson, 2002
  Nickelson, 1998).
• E-therapy is defined as a new modality of
  helping people resolve life and relationship
  issues. It utilizes the power and convenience of
  the Internet to allow simultaneous (synchronous)
  and time-delayed (asynchronous) communication
  between an individual and a professional Grohol
  (1999).
• Common terms E-therapy, online counseling, cyber
  therapy, web counseling, and computer-mediated
  psychotherapy.

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Online Therapy

• Synchronous Environment
• Provide a real-time link between users computers
  
• Shared Hypermedia Instant messaging
• Asynchronous Environment
• Occurs when communication is not simultaneous or
  in live time
• Similar to message boards

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Guidelines for Online Therapy

• ACA, AMA, APA, and AMHCA have all published
  specific internet guidelines or advisory
  statements for their members and many others have
  embedded guidelines for e-therapy in their code
  of ethics.
• Informed Consent MD explanation of treatment
  services, counselor scope of practice, risks,
  alternatives for care, expectations.
• Clinical practice-operating procedures
• Emergencies patients at risk, exploitation,
  neglect
• State Guidelines vary from one state to another
• Informed Consent, Mandatory disclosure, minimum
  requirements for computer program, emergency plan
  for patients in crisis, emergency plan for
  technical problems, record of closest mental
  health agency, explanation of risks, grievance
  process.

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Reasons for Resistance

• Expressed opinions about whether professional
  therapy can be done without face-to-face
  interaction
• Ethical issues involving client protection
• Unclear legal jurisdiction
• Regulatory and licensure issues
• Confidentiality of computer-based messages is
  compromised without encryption and user passwords

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Reasons for Resistance

• Verification of the age, gender, and honesty of
  consumer disclosures is complicated
• Need for careful self-assessment of areas of
  professional competence and computer skills prior
  to the initiation of any online clinical service.

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Reasons for Resistance

• Obstacles to getting help to e-clients in crisis
  or at risk for harming others is also a serious
  ethical issue for e-therapists who may be
  thousands of miles (and several time zones) away
  from the client.
• Possibility of technological failure always
  exists

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Research

• A majority of e-therapy web sites have been
  developed by people identifying themselves as
  mental health professionals, though they are not.
  High level of non-compliance with informed
  consent and all other APA guidelines.
• Studies comparing e-therapy with traditional
  psychotherapy, suggest that some people find it
  easier to self-disclose on the computer than in
  face-to-face situations.
• Therapeutic alliances in e-therapy are similar to
  the alliances formed in face-to-face treatment .
• Studies comparing traditional therapy with
  e-therapy found that e-therapy outcomes generally
  parallel traditional service.
• Some consumers seem to find the convenience,
  economy, and relative anonymity of e-therapy
  attractive.
• Heinlen, K., Welfel, E., Richmond, E.,
  O'Donnell, M. (2003). The nature, scope, and
  ethics of psychologists' e-therapy Web sites
  What consumers find when surfing the Web.
  Psychotherapy Theory, Research, Practice,
  Training, 40(1), 112-124.

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HIPPA Requirements

• Electronic Means of Communication
• HIPPA required confidentiality
• Patients are protected as cited by federal laws
• (See 42 U.S.C. 290dd-3 and 42 U.S.C. 290ee-3 for
  Federal laws and 42 CFR, Part 2 for Federal
  Regulations).
• Releases of information disclosure only unless
  there is a threat to self or others

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Valley Hopes Compliance

• Patient signs a consent for treatment
• Detailed outline of treatment services,
  electronic means info, grievance, cost of
  treatment, limitations and risks-outline
  expectations.
• Mandatory Disclosures
• Confidentiality
• Website is secure
• Access to the website done by authorization only
• Encrypted website
• Three levels of security
• Time out for patients inactive in the system
• All inclusive website Electronic documents,
  private messages, group discussion and individual
  assignments are transmitted within this website
  only.

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AC/ESS Programming

• Intention of developing program is to reach
  populations that are underserved
• Rural areas
• Physical disabilities or ailments that prohibit
  attendance of traditional outpatient programming
• Driving restrictions
• Work schedule that prevents patients from
  consistently attending traditional programming
• Unique circumstance where outpatient would not be
  feasible
• Removes Barriers to Treatment for patients /family

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AC/ESS Programming

• AC/ESS programming is a multi-modality program.
• Includes in person clinical assessment, treatment
  planning, additional assessment for
  appropriateness for the AC/ESS program and
  individual sessions.
• Phone therapy when sessions are not able to be
  done in person
• Online therapy room with group members
• 18 modules includes individual lectures and
  assignments
• Individualized treatment

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AC/ESS IOP

• Intensive Outpatient Programming (IOP)
• 9 hours per week of therapy
• Individual, marital and family sessions as it
  pertains to the addiction
• Chaplain sessions offered
• Family program attached to the IOP program

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Additional Features

• Offline attendance counselors can input time
  spent with the patient in treatment planning,
  individual sessions, family sessions, and
  chaplain. This adds to cumulative total for an
  accurate account of time per week spent in IOP.
• Survey results IOP and CC patients are asked to
  take a Please Help US survey at specific times in
  their treatment episode. This helps Valley Hope
  to gather recovery data and patient satisfaction
  data. This can be submitted anonymously.
• IOP the survey is given at admission, 3 weeks and
  6 weeks into treatment.
• CC the survey is given at 3, 6,9, and 12 months.
• Supervisors have access to staff attendance and
  staff private messages. Supervisors can also
  view journals.

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AC/ESS Family IOP

• Created for family members to be involved in a
  primary level of care.
• Length of program is 3 weeks
• 9 hours per week
• 1 individual face to face session or phone
  session per week
• Chaplain availability
• Family sessions available
• Daily discussion topic in therapy room
• 11 Educational modules in online therapy room
  with lectures and assignments that must be
  completed each week.
• Group therapy in the online therapy room
• Private message communication in online therapy
  room

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AC/ESS Continuing Care

• 1 hour per week of online therapy
• Individualized treatment for level one
  programming
• Phone or in person therapy offered

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AC/ESS Concurrent Programming

• Patients attend on ground group therapy once per
  week and online one hour per week.
• Two hours of group therapy per week for one year.
• Accountability increased
• Accessibility to counselors and group increased.
• Flexibility to both options is attractive to
  patients.

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Data for AC/ESS

• After two years of programming data was gathered
• Compared four data sets of 50 patients in each
  set
• The data set was on ground IOP, on ground
  continuing care, AC/ESS IOP and AC/ESS continuing
  care.

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Demo Room for IOP
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Demo Room for IOP
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Demo room for IOP
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Data for Length of Stay

• Compared length of stay for continuing care
• Average length of stay (ALOS) for patients
  discharged from AC/ESS continuing care was 28.8
  weeks in treatment compared to 19.01 weeks in
  treatment for patients discharged from on-ground
  continuing care.

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Length of Stay for IOP

• AC/ESS comparative to on ground Services
• At 5.54 average weeks in treatment AC/ESS
  patients length of stay is greater than the 4.24
  weeks in treatment reported for on-ground
  patients.

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Sobriety Data

• 74 percent of AC/ESS CC (continuing care)
  patients remained sober through the entire
  treatment episode compared to 62 percent of the
  on-ground patients.
• Similarly, 80 percent of AC/ESS IOP patients
  remained sober through the entire treatment
  episode compared to 58 percent for on-ground
  patients. The results were similar for the other
  sobriety measures.

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Sobriety Data

• AC/ESS patients were less likely to relapse than
  on-ground patients and the rate of sober
  discharge was higher for AC/ESS patients than for
  on-ground patients.

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Family Participation

• In the AC/ESS IOP family program, family member
  data showed the following
• 45 out of the 50 AC/ESS IOP patients episodes
  included family participation. For on-ground
  patients 29 out of 50 episodes included family
  participation.
• This may be due to flexibility of program.
• Could eliminate the shame or fears of expressing
  feelings around addiction for family.
• Removal of barriers

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New Statistics for AC/ESS

• Time between online logins
• 1.48 Days
• Average Minutes Per Session
• 25.41 Minutes
• Average Sessions Per Week
• 4.73 Per week
• Average Minutes Per week
• 120.2 Per week

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New Statistics for AC/ESS

• Data shows that patients log on frequently
• Average is 25 minutes per log in
• Patients average 2 hours per week online
• Data are from the sample of actual AC/ESS
  continuing care patients that were active on
  8/16/2010 after removing 3 percent of the largest
  outliers and 3 percent of the smallest outliers
  as measured by days in treatment since admission,
  count of sessions logged, and total login time.
  The result was n311. The 18 outlier records
  were removed from the sample to ensure data
  showed typical program results.

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Summation of Data

• Valley Hope has delivered care via the AC/ESS
  option for more than four years and the outcome
  data clearly suggest that AC/ESS produces
  treatment outcomes on the various measures
  included in this report that are equal to or more
  effective than the outcomes produced by on-ground
  treatment programs.

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DUI Programming

• DUI Screening
• Must be conducted in person
• DUI Education
• 16 hours of group and individualized programming
  
• DUI Treatment
• 32 hours or more of DUI treatment
• First online DUI program in the State of Arizona

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Questions?

• For further questions on this program please
  email Holly Krebsbach at hollyk_at_valleyhope.org.
• Visit our website at www.valleyhope.org