Telemedicine in alcohol liver disease and transplantation care: Addiction therapy through video-conferencing-A case report

Alcohol use disorder is a major public health concern, contributing to significant morbidity and mortality worldwide. Alcohol-associated liver disease is a major consequence of alcohol use disorder, with liver transplantation becoming the leading indication for this condition. This abstract describes a case study of a 39-year-old Native American man with severe alcohol-associated liver disease, illustrating the challenges and solutions in providing comprehensive care in a remote location. The patient's treatment involved a multidisciplinary approach, combining hepatology, addiction therapy, and telemedicine services. Despite initial difficulties, the patient achieved complete abstinence and significant improvement in liver function, avoiding the need for transplantation. This case highlights the importance of interdisciplinary care and the potential of telemedicine for managing complex cases of alcohol-associated liver disease and alcohol use disorder in remote areas, ultimately improving patient outcomes and reducing healthcare burdens.

Mental Health Clinician Practices and Perspectives on Treating Adults with Co-Occurring Posttraumatic Stress and Substance Use Disorders

OBJECTIVE

Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) commonly co-occur and represent a complex, challenging clinical comorbidity. Meta-analytic studies and systematic reviews suggest that trauma-focused treatments are more efficacious than non-trauma focused interventions for co-occurring PTSD/SUD. However, relatively little is known about mental health clinicians' practices or preferences for treating co-occurring PTSD/SUD. The present study aimed to describe the current clinical practices of mental health clinicians who treat PTSD and/or SUD-related conditions and to assess interest in novel integrative treatments for PTSD/SUD.

METHODS

Licensed mental health clinicians (N = 76; Mage = 39.59, SD = 8.14) who treat PTSD and/or SUD completed an anonymous online survey from April 2021 to July 2021.

RESULTS

The majority (61.8%) of clinicians reported using integrative treatments for PTSD/SUD. The most commonly used trauma-focused treatments were 1) Cognitive Processing Therapy (CPT: 71.1%) and 2) Prolonged Exposure Therapy (PE: 68.4%) for PTSD. Approximately half (51.3%) of clinicians endorsed using Relapse Prevention (RP) for SUD. The vast majority (97.4%) of clinicians were somewhat or very interested in a new integrative CPT-RP intervention, and 94.7% of clinicians believed patients would be interested in a CPT-RP intervention. In the absence of an available evidence-based integrative treatment using CPT, 84.0% of clinicians reported modifying extant treatment protocols on their own to address PTSD and SUD concurrently.

CONCLUSIONS

The findings demonstrate mental health clinician support of integrative treatments for PTSD/SUD. The most commonly used trauma-focused intervention was CPT and clinicians expressed strong interest in an integrative intervention that combines CPT and RP. Implications for future treatment development are discussed.

Examining the influence of rurality on frequency of cannabis use and severity of consequences as moderated by age and gender

AIM

A number of important health disparities associated with place of residence have been reported in the literature. The Remoteness Index (RI) was developed to account for community size, population density, and proximity to larger population centres. This exploratory analysis uses the RI to examine community level associations related to cannabis use.

DESIGN

This secondary analysis uses data collected as part of a randomized controlled trial of a brief cannabis intervention. Participants' place of residence was matched to a corresponding value on the RI. Univariate regressions of RI and cannabis related outcomes were modeled with age and gender as moderating variables. Three outcomes were analyzed separately: 1) total number of days of cannabis use in the past 30 days; 2) risk of experiencing cannabis related problems; and 3) number of self-reported consequences related to cannabis.

FINDINGS

Participants living in more remote areas were significantly more likely to drive within an hour of using cannabis, but also reported fewer consequences and less risky cannabis use. Although the overall regression models tested in the moderation analyses were significant, there were no interaction effects between RI and age or gender.

CONCLUSION

While this analysis did not find significant conditional effects of age or gender on the relationship between cannabis use and place of residence, further research is needed to investigate other factors which may contribute to health disparities related to substance use between individuals living in different geographic regions.

Telehealth for Substance Use Disorders: A Rapid Review for the 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Management of Substance Use Disorders

BACKGROUND

Approximately 20.4 million Americans met criteria for a substance use disorder (SUD) in 2019; however, only about 12.2% of persons with an SUD receive specialty care. Telehealth offers alternatives to traditional forms of substance use treatment.

PURPOSE

To synthesize recent findings on the efficacy of telehealth for SUDs.

DATA SOURCES

MEDLINE, Embase, PubMed, and the Cochrane Library from January 2015 through August 2021 (English language only).

STUDY SELECTION

Randomized controlled trials (RCTs) of adults with a diagnosis of SUD based on the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases.

DATA EXTRACTION

One investigator abstracted data and assessed study quality, and a second checked for accuracy.

DATA SYNTHESIS

This rapid review synthesized evidence from 17 RCTs. Evidence is very uncertain that telehealth provided as videoconference therapy (1 RCT) or web-based cognitive behavioral therapy (CBT) (3 RCTs) has similar effects to in-person therapy for improving abstinence from alcohol or cannabis. Low-strength evidence suggests that web-based CBT has similar effects for improving abstinence in multiple SUDs (2 RCTs). Low-strength evidence suggests that adding supportive text messaging to follow-up care improves abstinence and amount of alcohol per day (2 RCTs) but does not improve emergency department visits or frequency of consumption (2 RCTs). Enhanced telephone monitoring likely reduces readmissions for SUD detoxification compared with usual follow-up alone (1 RCT) but does not reduce days of substance use (low-strength evidence).

LIMITATION

Narrative synthesis, heterogeneity of telehealth interventions, no assessment of publication bias, and study methodology.

CONCLUSION

Evidence is very uncertain that telehealth is similar to in-person care for SUD outcomes. Limited evidence suggests some benefit of adding telehealth to usual SUD care.

PRIMARY FUNDING SOURCE

U.S. Department of Veterans Affairs Veterans Health Administration.

Consensus statement on the problem of terminology in psychological interventions using the internet or digital components

Since the emergence of psychological interventions delivered via the Internet they have differed in numerous ways. The wealth of formats, methods, and technological solutions has led to increased availability and cost-effectiveness of clinical care, however, it has simultaneously generated a multitude of terms. With this paper, we first aim to establish whether a terminology issue exists in the field of Internet-delivered psychological interventions. If so, we aim to determine its implications for research, education, and practice. Furthermore, we intend to discuss solutions to mitigate the problem; in particular, we propose the concept of a common glossary. We invited 23 experts in the field of Internet-delivered interventions to respond to four questions, and employed the Delphi method to facilitate a discussion. We found that experts overwhelmingly agreed that there were terminological challenges, and that it had significant consequences for conducting research, treating patients, educating students, and informing the general public about Internet-delivered interventions. A cautious agreement has been reached that formulating a common glossary would be beneficial for the field to address the terminology issue. We end with recommendations for the possible formats of the glossary and means to disseminate it in a way that maximizes the probability of broad acceptance for a variety of stakeholders.

The impact of rurality on opioid-related harms: A systematic review of qualitative research

INTRODUCTION

Over the past decade, there has been mounting recognition that opioid use and related mortality and morbidity is a significant public health problem in rural, non-urban areas across the globe. Taking what has been termed the 'opioid crisis' as a starting off point, this article aims to systematically review the qualitative literature on the ways in which rurality shapes the risk for opioid-related harm.

METHODS

A systematic review was undertaken using database searches and secondary reference list searches for qualitative literature on rural and non-urban opioid-related harms. A total of 32 qualitative studies met the inclusion criteria. Data extraction was performed in NVivo 12 using a codebook based on the 'risk environment' framework.

RESULTS

The findings explore how rurality shapes the risk environment for opioid-related harms through four environment influences: (1) economic conditions, including economic transition and deindustrialisation that has occurred in many rural areas, and the high levels of economic distress experienced by rural residents; (2) physical conditions, including a lack of infrastructure and recreation opportunities, larger geographic distances, and limited transportation; (3) social conditions, where social networks could be both protective but also amplify risk through a lack of knowledge about treatment and risk behaviours, a lack of anonymity and stigmatisation of people who use opioids in rural areas; and (4) policy conditions including limited coverage and availability of harm reduction and drug treatment services, and stigmatising service provider practices.

CONCLUSIONS

The impact of rurality on risk of opioid-related harm is multifaceted. We suggest that future research on rural opioid use would benefit from drawing on the theoretical toolkit of rural criminology to attend to the ways the 'rural crisis', and attendant insecurities, anxieties and strains, impacts upon rural communities and shapes risk, along with how socio-cultural characteristics of the rural 'organise' risks of drug use.

A pragmatic randomised trial of two counselling models at the Swedish national alcohol helpline

BACKGROUND

Alcohol telephone helplines targeting alcohol consumers in the general population can extend the reach of brief interventions while preserving in-person counselling. So far, studies of client outcomes in the setting of alcohol helplines are scarce. This study aims to compare the 6-months alcohol-related outcomes of two counselling models delivered at the Swedish National Alcohol Helpline.

METHODS

A pragmatic randomised trial was set up at the Swedish National Alcohol Helpline. First-time callers with current hazardous or harmful alcohol use who contacted the helpline, from May 2015 to December 2017, were invited to participate. Clients were allocated with 1:1 ratio to two groups: (1) brief, structured intervention (n = 128), including self-help material and one counsellor-initiated call, and (2) usual care (n = 133), i.e. multiple-session counselling using Motivational Interviewing (MI). The primary outcome was a downward change in AUDIT risk-zone between baseline and 6-months follow-up. The analysis followed an intention-to-treat approach.

RESULTS

Recruitment ended in December 2017. At 6-months follow-up, 70% of the enrolled participants had data on the outcome. In the brief, structured intervention (n = 107) 68% changed to a lower risk-level, compared to 61% in the usual care group (n = 117), yielding a risk ratio (RR) of 1.12 (95% CI 0.93 to 1.37) and risk difference of 0.08 (95% CI -0.05 to 0.20). The total AUDIT score and the scores from the AUDIT consumption questions (AUDIT-C) did not reveal any between-group differences in the mean change at follow-up.

CONCLUSIONS

The counselling at the Swedish National Alcohol Helpline was followed by a significant decrease in alcohol use among clients, without clear superiority for either counselling model.

TRIAL REGISTRATION

This trial was retrospectively registered with ISRCNT.com (ID: ISRCTN13160878 ) 18/01/2016.

Differences in Receipt of Alcohol-Related Care Across Rurality Among VA Patients Living With HIV With Unhealthy Alcohol Use

PURPOSE

It is unknown whether receipt of evidence-based alcohol-related care varies by rurality among people living with HIV (PLWH) with unhealthy alcohol use-a population for whom such care is particularly important.

METHODS

All positive screens for unhealthy alcohol use (AUDIT-C ≥ 5) among PLWH were identified using Veterans Health Administration electronic health record data (10/1/09-5/30/13). Three domains of alcohol-related care were assessed: brief intervention (BI) within 14 days, and specialty addictions treatment or alcohol use disorder (AUD) medications (filled prescription for naltrexone, disulfiram, acamprosate, or topiramate) within 1 year of positive screen. Adjusted Poisson models and recycled predictions were used to estimate predicted prevalence of outcomes across rurality (urban, large rural, small rural), clustered on facility. Secondary analyses assessed outcomes in the subsample with documented AUD.

FINDINGS

4,581 positive screens representing 3,458 PLWH (3,112 urban, 130 large rural, and 216 small rural) were included; 49.1% had diagnosed AUD. PLWH in large rural areas had highest receipt of BI (urban 56.6%, 95% CI: 55.0-58.2; large rural 66.0%, CI: 58.6-73.5; small rural 60.7%, CI: 54.6-67.0). PLWH in urban areas had highest receipt of specialty addictions treatment (urban 28.2%, CI: 26.7-29.8; large rural 19.7%, CI: 13.1-26.2; small rural 19.6%, CI: 14.1-25.0). There was no difference in receipt of AUD medications, although overall receipt was low (3%-4%). Results were similar in the subsample with AUD.

CONCLUSION

Among PLWH with unhealthy alcohol use, those in rural areas may be vulnerable to under-receipt of specialty addictions treatment. Targeted interventions may help ensure PLWH receive recommended care regardless of rurality.

Patterns of Alcohol Use Among Patients Living With HIV in Urban, Large Rural, and Small Rural Areas

BACKGROUND

For people living with HIV (PLWH), alcohol use is harmful and may be influenced by unique challenges faced by PLWH living in rural areas. We describe patterns of alcohol use across rurality among PLWH.

METHODS

Veterans Aging Cohort Study electronic health record data were used to identify patients with HIV (ICD-9 codes for HIV or AIDS) who completed AUDIT-C alcohol screening between February 1, 2008, and September 30, 2014. Regression models estimated and compared 4 alcohol use outcomes (any use [AUDIT-C > 0] and alcohol use disorder [AUD; ICD-9 codes for abuse or dependence] diagnoses among all PLWH, and AUDIT-C risk categories: lower- [1-3 men/1-2 women], moderate- [4-5 men/3-5 women], higher- 6-7]), and severe-risk [8-12], and heavy episodic drinking (HED; ≥1 past-year occasion) among PLWH reporting use) across rurality (urban, large rural, small rural) and census-defined region.

FINDINGS

Among 32,699 PLWH (29,540 urban, 1,301 large rural, and 1,828 small rural), both any alcohol use and AUD were highest in urban areas, although this varied across region. Predicted prevalence of any alcohol use was 54.1% (53.5%-54.7%) in urban, 49.6% (46.9%-52.3%) in large rural, and 50.6% (48.3%-52.9%) in small rural areas (P < .01). Predicted prevalence of AUD was 14.4% (14.0%-14.8%) in urban, 11.8% (10.0%-13.5%) in large rural, and 12.3% (10.8%-13.8%) in small rural areas (P < .01). Approximately 12% and 25% had higher- or severe-risk drinking and HED, respectively, but neither differed across rurality.

CONCLUSION

Though some variation across rurality and region was observed, alcohol-related interventions are needed for PLWH across all geographic locations.

CBI-20: Psychometric Properties for the Coping Behaviors Inventory for Alcohol Abuse in Brazil

For any professional, it is of crucial importance to know not only how coping styles and strategies are present in an individual, but to know about its role to the treatment of alcohol abuse. Moreover, new approaches have emerged in this area in terms of relapse prevention and the counseling by phone can be an alternative. The aim of this study is to examine the factor structure of the Coping Behaviors Inventory (CBI) and to test its invariance across groups face-to-face and phone counseling in Brazil. For this purpose, two studies were carried out: study I, the factor structure was revisited in terms of exploratory factor analysis. Study II, face-to-face and phone counseling were examined through confirmatory factor analysis and multigroup analysis. The results confirmed the 4-factor solution with a revised model for the removal of 16 items. Thus presented, a reduced version with better indexes than the previous versions developed over the last 30 years that was ones reformulated from 60 items. The Internal consistency for study I presented α = 0.90 and homogeneity was between 0.17 and 0.5). In addition the KMO = 0.9 = 0.932, X ( df = 630 ) 2 = 6091.94, p < 0.0 < 0.001. In study II, cronbach's alpha = 0.91 and homogeneity 0.23-0.61 (telemedicine treatment) and α = 0.90 0.17 to 0.63 (face-to-face treatment). In the CFA, the examination of the current version has better fit than the that the traditional model. Moreover, the new version showed convergent validity with the IDHEA questionnaire. In the multigroup analysis no significant changes between groups to a metric level. Finally, the Brazilian version of inventory showed no differences between the phone counseling and face-to-face participants in a metric level after a multigroup analysis.

Effectiveness of Optional Videoconferencing-Based Treatment of Alcohol Use Disorders: Randomized Controlled Trial

BACKGROUND

Treatment of alcohol use disorders (AUDs) is characterized by an adherence rate below 50%. Clinical research has found that patient adherence enhances treatment effect; hence, health authorities, clinicians, and researchers strive to explore initiatives contributing to patients receiving treatment. Concurrently, videoconferencing-based treatment is gaining ground within other addiction and psychiatric areas.

OBJECTIVE

The aim of this study was to test whether optional videoconferencing increases adherence to and effectiveness of AUD treatment in a randomized controlled trial (RCT). We hypothesized that the intervention would decrease premature dropout (the primary outcome), as well as increase successful treatment termination, treatment duration, and treatment outcome (secondary outcomes).

METHODS

We conducted this study in the public outpatient alcohol clinic in Odense, Denmark, between September 2012 and April 2013. It was an RCT with 2 groups: treatment as usual (TAU) and treatment as usual with add-on intervention (TAU+I). The TAU+I group had the option, from session to session, to choose to receive treatment as usual via videoconferencing. Data consisted of self-reported responses to the European version of the Addiction Severity Index (EuropASI). We collected data at baseline, at follow-up at 3, 6, and 12 months, and at discharge.

RESULTS

Among consecutive patients attending the clinic, 128 met the inclusion criteria, and 71 of them were included at baseline. For the primary outcome, after 180 days, 2 of 32 patients (6%) in the TAU+I group and 12 of 39 patients (31%) in the TAU group had dropped out prematurely. The difference is significant (P=.008). After 365 days, 8 patients (25%) in the TAU+I group and 17 patients (44%) in the TAU group had dropped out prematurely. The difference is significant (P=.02). For the secondary outcomes, significantly more patients in the TAU+I group were still attending treatment after 1 year (P=.03). We found no significant differences between the 2 groups with regard to successful treatment termination and treatment outcome.

CONCLUSIONS

The results indicate that offering patients optional videoconferencing may prevent premature dropouts from treatment and prolong treatment courses. However, the small sample size precludes conclusions regarding the effect of the intervention, which was not detectable in the patients' use of alcohol and severity of problems.

TRIAL REGISTRATION

The Regional Health Research Ethics Committee System in Denmark: S-20110052; https://komite.regionsyddanmark.dk/wm258128 (Archived by WebCite at http://www.webcitation.org/6tTL3CO6u).

Videoconferencing-Based Treatment of Alcohol Use Disorders: Analyses of Nonparticipation

BACKGROUND

We recently conducted a small randomized controlled trial (RCT) aiming to examine the effectiveness of videoconferencing-based treatment of alcohol use disorders in a real-life setting. The patient and participation rates were lower than anticipated.

OBJECTIVE

The objectives of our study were (1) to examine differences between participants and nonparticipants, and (2) to examine the characteristics of nonparticipants and their reported reasons for not participating.

METHODS

First, we analyzed nonparticipation through a comparative analysis of participants and nonparticipants using data from a clinical database, covering all patients starting treatment at the clinic. Second, on the basis of data from an anonymous questionnaire filled out by nonparticipants, we analyzed barriers to participating and the descriptive sociodemographics of nonparticipants who reported technical barriers versus those who did not.

RESULTS

Of 128 consecutive patients starting treatment during the study period, we found no significant differences between participants (n=71) and nonparticipants (n=51) according to sociodemographics, alcohol measures, and composite scores. Of 51 nonparticipants, 43 filled out the questionnaire with reasons for not participating. We derived 2 categories of barriers from the questionnaire: scientific barriers, which were barriers to the scientific study in general (n=6), and technical barriers, which were barriers to using a laptop or videoconferencing specifically (n=27). We found no significant differences in sociodemographics between nonparticipants who reported technical barriers to participating in the study and those who did not note technical barriers. A total of 13 patients elaborated on technical barriers, and 9 patients found videoconferencing impersonal, preferred personal contact, and would rather attend face-to-face treatment at the clinic.

CONCLUSIONS

Patient barriers to participating in the RCT were mainly concerned with the technology. There were no significant differences between participants and nonparticipants, nor between nonparticipants who noted technical barriers to participating and those who did not. If a similar study is to be conducted or the solution is to be upscaled and implemented, attention should be given to the user friendliness of the technical equipment and the recruitment process, preparing the patients by emphasizing the information given to them about the technical equipment and its advantages.

Patient Satisfaction With Videoconferencing-based Treatment for Alcohol Use Disorders

OBJECTIVES

The objectives of this study are (1) to compare the satisfaction between patients who have received treatment as usual face-to-face (TAU group) and patients who have received optional videoconferencing-based treatment for alcohol use disorders (TAU+I group); and (2) to elaborate on the TAU+I group's satisfaction with the treatment in general and the technical equipment.

METHODS

The design consisted of mixed methods: a survey and a qualitative study. Data consisted of self-reported data from questionnaires filled out by both groups and semistructured interviews with the TAU+I group. Data from the questionnaires were analyzed statistically using Stata. The semistructured interviews were analyzed using a general inductive approach.

RESULTS

The survey indicated that the TAU+I group and TAU group were equally satisfied with the elements in the treatment. The interview indicated that the TAU+I group seemed to have a high satisfaction with most elements in the treatment. Patients who used videoconferencing were satisfied with establishing the videoconferencing connection and with the picture quality but less satisfied with the sound quality.

CONCLUSIONS

Overall, the patients were satisfied with the treatment. We saw a nonsignificant tendency that the TAU+I group were more satisfied with the treatment in general, compared with the TAU group. It is a possibility that patients in this group felt more satisfied with the treatment as they had the opportunity to choose videoconferencing. Offering videoconferencing-based treatment may be a positive feature in the treatment and lead to improved outcomes of the treatment courses. The technical equipment and routine using it should be improved in future studies or during implementation.

Trends in telemedicine use in addiction treatment

Introduction

Telemedicine use in addiction treatment and recovery services is limited. Yet, because it removes barriers of time and distance, telemedicine offers great potential for enhancing treatment and recovery for people with substance use disorders (SUDs). Telemedicine also offers clinicians ways to increase contact with SUD patients during and after treatment.

Case description

A project conducted from February 2013 to June 2014 investigated the adoption of telemedicine services among purchasers of addiction treatment in five states and one county. The project assessed purchasers’ interest in and perceived facilitators and barriers to implementing one or more of the following telemedicine modalities: telephone-based care, web-based screening, web-based treatment, videoconferencing, smartphone mobile applications (apps), and virtual worlds.

Discussion and evaluation

Purchasers expressed the most interest in implementing videoconferencing and smartphone mobile devices. The anticipated facilitators for implementing a telemedicine app included funding available to pay for the telemedicine service, local examples of success, influential champions at the payer and treatment agencies, and meeting a pressing need. The greatest barriers identified were: costs associated with implementation, lack of reimbursement for telemedicine services, providers’ unfamiliarity with technology, lack of implementation models, and confidentiality regulations. This paper discusses why the project participants selected or rejected different telemedicine modalities and the policy implications that purchasers and regulators of addiction treatment services should consider for expanding their use of telemedicine.

Conclusions

This analysis provides initial observations into how telemedicine is being implemented in addiction services in five states and one county. The project demonstrated that despite the considerable interest in telemedicine, implementation challenges exist. Future studies should broaden the sample analyzed and track technology implementation longitudinally to help the research and practitioner communities develop a greater understanding of technology implementation trends and practices.

Evaluation of an alcohol intervention training program for nurses in rural Australia

Aim

This paper reports on the development, implementation and evaluation of the Alcohol Intervention Training Program (AITP) designed to enhance nurses’ capacity to work with farming men and women who misuse alcohol.

Background

In rural and regional areas where alcohol-related behaviours and problems are relatively elevated, nurses may be the key health professionals dealing with individuals who misuse alcohol. However, they are often ill-equipped to do this, have low confidence in their ability to do so, and perceive numerous barriers. Training is required for these nurses.

Methods

We developed the AITP to enhance nurses’ capacity to work with people with alcohol-related problems. The data were collected during 2010. An intervention group of 15 rural nurses completed the AITP. Nurses’ perceived barriers, attitudes, and perceived performance in working with clients with alcohol problems, and the frequency of engaging with this client group were evaluated. Scores on these measures were compared to those of a control group of 17 nurses’ pre-treatment, post-treatment and at 3-month follow-up.

Results

Participation in the AITP resulted in initial improvements in attitudes to working with alcohol problems, but no change in perceived barriers to doing so. The level of engagement with clients having alcohol-related problems increased, as did perceptions of work performance.

Conclusion

The AITP enhances the ability of rural nurses to address the alcohol and associated health issues of clients in rural and regional areas. However, the program needs refinement and further evaluation.

Faked depression: comparing malingering via the internet, pen-and-paper, and telephone administration modes

BACKGROUND

The Internet and telephone are valuable resources for mental health practitioners when access to face-to-face assessment or therapy is difficult. However, despite the high stakes (such as access to medication or financial compensation) often involved in psychological testing, little is known about how test administration mode influences test scores when patients are malingering. The aim of this research was to examine for the first time the equivalence of a malingered measure of depression when administered over the Internet, over the telephone, and with pen and paper.

SUBJECTS AND METHODS

A mixed experimental design was used with participants (n=91) randomly allocated to Internet, telephone, or pen-and-paper groups. Participants completed the Edinburgh Depression Scale, first under standard instructions and then under instructions to fake as if experiencing severe depression. A manipulation check was included to ensure participants had understood and followed instructions to fake.

RESULTS

As predicted, participants were able to significantly increase their depression scores when asked to fake depression. Participants reported significantly lower faked depression scores over the telephone than in pen-and-paper format. Faked depression scores in the online group did not differ significantly from those in the telephone and pen-and-paper groups. However, participants in all groups met criteria indicative of a provisional diagnosis of depression.

CONCLUSIONS

Overall, the results indicate that there may be no meaningful difference between malingering across administration modes. If an individual is malingering depression, administration mode has minimal influence. These findings provide preliminary support for the use of online/telephone technologies in the assessment of depression.

Access to, Use of, and Attitudes Toward Telecommunication Among Rural VR Clients

Telecommunication offers rural vocational rehabilitation (VR) clients a method of communicating with their VR counselor between face-to-face visits. Unfortunately, certain telecommunication methods may not be available to many rural VR clients or may pose barriers in the rehabilitation process. This article describes findings from an exploratory survey of 225 rural VR clients recruited from seven VR agencies across the United States. The mail-based survey explored client access to telecommunication, current telecommunication use during the VR process, and client attitudes about using telecommunication to receive VR services. Although 61% of respondents said they had personal access to a computer with Internet and 63% reported that email would be a “very” acceptable or “somewhat” acceptable method of communicating with their counselors, only 39% reported communicating via email with their counselors. Although a variety of factors play into the effectiveness of telecommunication as a VR service delivery mode, email communication might increase the frequency and productivity of VR client and counselor interactions.

The Use of Telecommunication to Deliver Services to Rural and Urban Vocational Rehabilitation Clients

Telecommunication offers a cost-saving alternative to face-to-face vocational rehabilitation (VR) service delivery, yet little is known about the current use. This article describes findings from an exploratory survey of 1,187 counselors, representing 13 VR agencies across the United States. The online survey explored agency, counselor, and client facilitators and barriers to telecommunication use during the VR process. Staff with training in telecommunication strategies reported significantly higher rates of email telecommunication ( p < .01). Counselors with a higher rural caseload mix engaged in significantly less email telecommunication during the VR process, and rural clients as compared with urban clients were characterized as having less personal access to a computer with Internet. Although counselors use and rely on simple telecommunication methods such as phone and email to serve their clients, strategies to address barriers are needed to expand telecommunication use during the VR process.