A descriptive study of e-counsellor attitudes, ethics, and practice

Digital mental health outcome monitoring for a structured text-based youth counselling intervention: Demographic profile and outcome change

BACKGROUND

Digital mental health interventions comprise a potentially effective and accessible form of support for young people, particularly at times when traditional face-to-face service delivery is reduced, as in the COVID-19 pandemic.

AIMS

This study assessed the demographic profile of young people using a digital mental health support service and evaluated outcome change over the course of a structured online counselling intervention (synchronous text-chat sessions with a practitioner).

MATERIALS AND METHODS

The data were collected from 23,260 young people aged between 10 and 25 years engaging with the intervention between April 2019 and June 2021.

RESULTS

Young people accessing these services had high levels of mental health needs, particularly those identifying with non-binary gender identity. Service users were mostly female, with equitable rates of access for young people from racialised communities. Overall outcome change demonstrated small effect sizes according to the YP-CORE (0.19) and CORE-10 (0.38), which increased to a moderate level when young people remained engaged with a dedicated practitioner for at least seven sessions (0.38, 0.58). Regression analysis illustrated the effect of the number of sessions on outcome change, but this can be also influenced by other variables such as age and gender.

DISCUSSION AND CONCLUSION

Further research is required to explore ways to engage with young people using digital web-based services for a longer period and to collect and analyse single-session outcome data.

Innovative technology-enhanced social work service during COVID-19: How 'Garden on the Balcony' promoted resilience, community bonds and a green lifestyle

The ongoing COVID-19 pandemic has motivated social workers to reckon with and transform traditions in service delivery. The development, application, and evaluation of technology-enhanced practices have become more vital than ever. Garden on the Balcony (GOB) was an innovative internet-based social work service designed to respond rapidly to the COVID-19 outbreak in Beijing. This paper introduces the underlying perspectives and design of GOB and reports participants' reflections on the program to understand its mechanisms and implications. Interview data from GOB participants were collected 4 months after the program ended. Thematic analysis generated three major themes, suggesting that GOB had (a) promoted individual resilience and family cohesion; (b) built online and offline community bonds; and (c) cultivated a green lifestyle and spiritual reflection on life. This study demonstrates a practical example of the effective use of technology-enhanced practice.

Breaking Down the Screen: Italian Psychologists' and Psychotherapists' Experiences of the Therapeutic Relationship in Online Interventions during the COVID-19 Pandemic

(1) Background: The COVID-19 pandemic posed new challenges to clinical practice and delineated future directions for online interventions in psychological care. The present study aimed to explore Italian psychologists' and psychotherapists' experiences of online interventions during the pandemic, focusing on the strategies they used to develop and maintain therapeutic relationships with their patients. (2) Methods: Between February and July 2021, 368 Italian psychologists and/or psychotherapists completed an online survey. A mixed-methods analysis was conducted, using Jamovi to analyze quantitative data and ATLAS.ti 9 to analyze qualitative data. (3) Results: Of the participants, 62% had never delivered online interventions before the pandemic; though 95.4% were delivering online interventions at the time of the survey, many reported facing technical disruptions (77.1%) and having little confidence in the online setting (45.3%). Feeling present in online sessions-facilitated by emotional attunement, active listening, and conversational spontaneity-was reported as "very important" by 93.6%. (4) Conclusions: Overall, the COVID-19 pandemic allowed a great leap forward in the use of online interventions by Italian psychologists and psychotherapists. This period of upheaval generated not only a positive change in their attitudes toward and intention to use online interventions but also revealed associated technical and relational issues that must be properly addressed.

Effects of an Online Solution-Focused Psychoeducation Programme on Children’s Emotional Resilience and Problem-Solving Skills

This study investigates the effects of a solution-oriented and approach-based psychoeducation programme, initiated in December 2019 and conducted online during the worldwide COVID-19 pandemic, on children’s emotional resilience and problem-solving skills. In the world that was closed with the pandemic, children were kept away from the social support system of teachers and friends. Pandemic isolated the children. The negative experiences associated with COVID-19 have placed both traditional approaches and important online learning and support applications on the agenda, since both can help to solve the problems we face. Educators and experts have provided psychological support services, questioning the methods used to reach people during the pandemic and rediscovering alternative ways of connecting with individuals through online media. The online framework of this study emerged in response to the needs caused by the pandemic. The study is designed using a real experimental pattern and is based on a pretest-posttest, experimental/control-group model. The Social Support Evaluation Scale for Children and Teenagers was used to select the participants. In total, 18 participants were equally assigned to research groups (experiment n = 9, control n = 9). The psychoeducation programme consisted of six sessions, each lasting 50–60 min on average. Research carried out online during the pandemic shows that this psychoeducation programme is effective in strengthening students’ problem-solving and emotional resilience skills. These findings are discussed within the framework of the literature, followed by recommendations.

Ethical Issues in Private Practice: A Phenomenological Investigation of Music Therapy Business Owners

As a music therapy private practice is both a business and a healthcare service, it should adhere to ethical standards from both disciplines. However, this topic has rarely been examined in the music therapy literature. The purpose of this phenomenological study was to explore ethical dilemmas experienced by music therapy business owners (MTBOs) in their private practice and how MTBOs avoid or address ethical dilemmas. Utilizing convenience and snowball sampling techniques, 21 MTBOs in the United States were interviewed using semi-structured interviews. To answer the two areas of inquiry, we identified three themes and 12 subthemes: (1) Ethical issues related to client welfare, (2) Ethical issues related to business relationships and operation, and (3) Strategies to address or avoid ethical dilemmas. MTBOs also shared how they ensure ethical behavior in themselves, with their employees or independent contractors, and when interacting with professionals outside the private practice. These findings provide a better understanding of MTBOs' lived experiences of ethics in their private practice and may benefit other music therapists who are in private practice or are wanting to go into private practice. Limitations and recommendations for further research are provided.

#socialwork: An International Study Examining Social Workers’ Use of Information and Communication Technology

Information and Communication Technologies (ICTs) permeated social work practice before coronavirus disease 2019 (COVID-19). In addition to ICT-based formal services (e.g. e-counselling), social workers used ICTs informally as an adjunct to face-to-face practice. Building on our previous research, our cross-sectional online survey examined social workers’ informal use of ICTs in four countries: Canada, the USA, Israel and the UK. The survey was administered through Qualtrics software among social workers across Canada (n = 2,609), the USA (n = 1,225), Israel (n = 386) and the UK (n = 134), and analysed using IBM SPSS Statistics version 26. The findings substantiate the ubiquitous use of informal ICTs in social work practice, as an adjunct to face-to-face treatment, across the four countries. Given the current, unprecedented context of COVID-19, we discuss the meaning of our findings related to access, ethical considerations (e.g. professional boundaries) and supervision in the context of restricted face-to-face practice. We discuss the implications for social work practice, education and research, and conclude that in the COVID-19 context, there is an even greater need for research, clinical discussion, supervision and policy on informal ICT use in social work practice.

Ethical Issues in Online Psychotherapy: A Narrative Review

BACKGROUND

The provision of psychotherapy over distance using technology is a growing market reaching many patients and therefore the risks and benefits need to be known by all psychotherapists whether they themselves practice online or not. This comprehensive review of the main ethical arguments for and against different forms of online psychotherapy aims to enhance discussion of ethical issues in this growing area.

METHODS

A search of three databases (PubMed, PsycINFO, Web of Science) was conducted in August 2019 using a specific search protocol yielding 249 publications.

RESULTS

Of 24 ethical arguments in favor of online psychotherapy and 32 against, the top five ethical arguments in favor of online psychotherapy were (1) increased access to psychotherapy and service availability and flexibility; (2) therapy benefits and enhanced communication; (3) advantages related to specific client characteristics (e.g. remote location); (4) convenience, satisfaction, acceptance, and increased demand; and (5) economic advantages. The top five ethical arguments against engagement in online psychotherapy were (1) privacy, confidentiality, and security issues; (2) therapist competence and need for special training; (3) communication issues specific to technology; (4) research gaps; and (5) emergency issues.

CONCLUSIONS

The findings may be of help to practitioners in deciding whether to engage in online psychotherapy, and in informing patients about risks and benefits, improving ethical guidelines, and stimulating further ethical discussion. The findings are argumentative and qualitative in nature, and further quantitative research is needed.

Telemental Health in Low- and Middle-Income Countries: A Systematic Review

Introduction

The rising incidence of mental illness and its impact on individuals, families, and societies is becoming a major public health concern, especially in resource-constrained countries. Consequently, there is an increasing demand for mental health services in many middle- and low-income countries (LMIC). Challenges such as inequality in access, lack of staff and hospital beds, and underfunding, often present in the LMIC, might in part be addressed by telemental health services. However, little is known about telemental health in the LMIC.

Methods

A systematic review was performed, drawing on several electronic databases, including PubMed, PsycINFO, Web of Science, Springer Link, and Google Scholar. Original English language studies on the practice of telemental health in LMIC, involving patients and published between 1 January 2000 and 16 February 2017, were included.

Results

Nineteen studies met the inclusion criteria. Most of the articles were recent, which may reflect an increasing focus on telemental health in the LMIC. Eight of these studies were from Asia. Eight of the studies were interventional/randomized controlled trials, and 11 examined general mental health issues. Videoconferencing was the most frequently (6) studied telemental modality. Other modalities studied were online decision support systems (3), text messaging and bibliotherapy (1), e-chatting combined with videoconferencing (1), online therapy (2), e-counseling (1), store-and-forward technology (1), telephone follow-up (1), online discussion groups (1), audiovisual therapy and bibliotherapy (1), and computerized occupational therapy (1). Although many of the studies showed that telemental services had positive outcomes, some studies reported no postintervention improvements.

Conclusion

The review shows a rising trend in telemental activity in the LMIC. There is a greater need for telemental health in the LMIC, but more research is needed on empirical and theoretical aspects of telemental activity in the LMIC and on direct comparisons between telemental activity in the LMIC and the non-LMIC.

Clinician behaviors in telehealth care delivery: a systematic review

Literature on telehealth care delivery often addresses clinical, cost, technological, system, and organizational impacts. Less is known about interpersonal behaviors such as communication patterns and therapeutic relationship-building, which may have workforce development considerations. The purpose of this study was to conduct a systematic literature review to identify interpersonal health care provider (HCP) behaviors and attributes related to provider-patient interaction during care in telehealth delivery. Electronic searches were conducted using five indexes/databases: CINAHL, ERIC, PsychInfo, ProQuest Dissertations, PubMed; with hand-searching of the immediate past 10 years of five journals. Search concepts included: communication, telehealth, education, and health care delivery. Of 5261 unique article abstracts initially identified, 338 full-text articles remained after exclusion criteria were applied and these were reviewed for eligibility. Finally, data were extracted from 45 articles. Through qualitative synthesis of the 45 articles, we noted that papers encompassed many disciplines and targeted care to people in many settings including: home care, primary and specialist care, mental health/counseling, and multi-site teams. Interpersonal behaviors were observed though not manipulated through study designs. Six themes were identified: HCP-based support for telehealth delivery; provider-patient interactions during the telehealth event; environmental attributes; and guidelines for education interventions or evaluation of HCP behaviors. Although unable to identify current best practices, important considerations for practice and education did emerge. These include: perceptions of the utility of telehealth; differences in communication patterns such as pace and type of discourse, reliance on visual cues by both provider and patient especially in communicating empathy and building rapport; and confidentiality and privacy in telehealth care delivery.

Necessary but not sufficient? Engaging young people in the development of an avatar-based online intervention designed to provide psychosocial support to young people affected by their own or a family member's cancer diagnosis

Objective

This study discusses the challenges and successes of engaging young people in a project aimed at developing an online counselling intervention for young people affected by cancer.

Context

For younger people with a diagnosis of cancer or who are caring for someone with cancer, the psychosocial consequences can create significant challenges for their social and educational development. Whilst young people have been shown to be reluctant to make use of traditional face‐to‐face counselling, research is beginning to suggest that effective therapeutic relationships can be formed with young people online.

Design

The first phase of the study involved working with a ‘Young Persons’ Panel’ of healthy school pupils and university students to develop and pilot an online counselling intervention and study materials in preparation for a pilot evaluation of the intervention.

Intervention

An avatar‐based virtual reality counselling world was created where young people can create their own avatar and receive counselling over the Internet from a qualified counsellor via an avatar in a virtual reality world.

Findings

The process of engaging young people in the C:EVOLVE project enabled a unique intervention to be developed and demonstrated positive developmental opportunities. However, despite the rigorous approach to the development of the intervention, initial attempts within the pilot evaluation phase of the study showed difficulties recruiting to the study, and this phase of the study has currently ceased whilst further exploratory work takes place.

Conclusion

This study has demonstrated the complexities of intervention development and evaluation research targeted at young people and the challenges created when attempting to bring clinical practice and research evaluation together.

Social work, technology, and ethical practices: a review and evaluation of the national association of social workers' technology standards

Information and communication technologies (ICTs) are becoming essential to social work practice by providing increased treatment possibilities and reducing barriers to service. While recognizing the importance of ICTs in practice, social work practitioners have had concerns about ethical use. In response, NASW compiled the Standards for Technology and Social Work Practice. While the guidelines set the groundwork, they were not embedded in a process that would allow them to adapt to the swift pace of ICT changes. This article reviews the current Standards, evaluates how these have been implemented by practitioners, and offers suggestions for updates.

Psicoterapia pela Internet: viável ou inviável?

A psicoterapia pela internet é uma prática que, no Brasil, só é permitida aos psicólogos na forma de pesquisa. O objetivo do presente artigo foi realizar uma revisão dos estudos em psicoterapia pela internet, discorrendo sobre os recursos e os limites desse atendimento psicológico e suas implicações para a relação terapêutica e para a efetividade do tratamento. São apresentadas questões legais e éticas concernentes à prática. Os resultados apontaram similaridades entre a relação terapêutica online e a presencial, mostrando-se a psicoterapia pela internet efetiva nas mais distintas modalidades, embora a maioria dos estudos seja sobre intervenções cognitivo-comportamentais. As questões legais e éticas podem ser parcialmente solucionadas com diretrizes claras das organizações profissionais e com o treino de terapeutas na modalidade online. Concluímos que a psicoterapia pela internet, embora requeira maiores estudos, anuncia-se como uma prática viável e promissora.