1. Online and Telephone based counselling Lessons from the substance abuse field Eric Tyssen Turning Point Alcohol and Drug Centre

2. Established in Australia (Victoria) in 1995 Provides leadership in clinical practice, research and education in the alcohol and drug service sector Employs approximately 220 staff across four sites

3. Specialist Telephone & Online Support Programs Our HealthLink program includes a network of 24/7 Telephone Helplines, Telephone consultancy services and Online services. Key services includes state-based Gambling Helplines and Alcohol and Drug Helpline programs across Australia Staffed by a multidisciplinary team of ~60 Telephone and Online counsellors Responds to 90 – 100,000 calls per year Integrated, multimodal response capacity Research-liaison role based across our Helpline and epidemiology programs

4. Helpline models in 2007 Helplines have operated in many countries for the past 40-50 years. A majority of Problem Gambling Helplines have operated for approximately 7-12 years. Many traditional Helpline models include: brief intervention counselling, information and referral. Many Helpline models now include enhanced services, (e.g. therapeutic counselling, assertive follow-up and elements of online service delivery) Research into Helplines remains under-developed, particularly outcome focused measures

5. Key characteristics of the Helpline environment Highly accessible 24/7 Immediate Anonymous/confidential Attracting new treatment seekers Support for clients during and between treatment Providing range of brief intervention and educative responses (e.g. harm reduction strategies) ‘Gateway’ functions linking to other counselling and supports in the community Unique source of data (early warning system)

6. Re-defining communication and help seeking in the 21 st Century Explosion in communications technology and global inter-connectedness Changing paradigm of health service delivery (new ways of accessing information and assistance) Growth in technology-enabled modes of health intervention Multiple methods of online counselling Expanding models - the need for research and development into practice standards and outcomes

7. The online counselling environment Global reach and accessibility Potential to attract new treatment seekers and provide support to those in treatment (e.g. immediate, after-hours). Potential lowering of help-seeking threshold (perception of increased safety and control) Reduction of stigma in help- seeking Increased opportunities for socially inhibited, isolated and marginalised to access services Lack of clinical practice standards Regulatory issues - Ethical guidelines, Qualifications and training of counsellors, Legal and Privacy considerations, Cost Outcome and efficacy research Rapid dis-inhibition and anonymity can increase potential for fantasy and misrepresentation (i.e. Web ‘personas’, Internet addiction)

8. CounsellingOnline: Project aims Two-year pilot project funded by Commonwealth Government ‘Live’, one-to-one access to professional alcohol and drug counsellor Increase access to specialist treatment and support (particularly in rural areas) Improved understanding of who uses and how people use online counselling Help define service standards and practice in this emerging modality Multi-level Program evaluation, including process, output, impact and economic components

9. CounsellingOnline: Key elements Free 24/7 Anonymous and confidential Case management capacity for repeat users Based around minimal access requirements Integrated within 24/7 Helpline environment - opportunity for multi-modal support and referral Incorporates ‘push’ technologies 12-month development phase, now ‘live’ for approximately 10-months

10. CounsellingOnline www.counsellingonline.org.au www.counsellingonline.org.au

11. Online Counselling: Technical challenges Demand and uptake remain unpredictable Appropriate infrastructure for demand management and resourcing (risk management) Customising the technology to ‘enable’ online interaction Balancing client-centeredness and with ethical and legal practice requirements.

12. Online Counselling: Challenges in service delivery Clinical challenges oCounsellor training & clinical governance oDifferent neural pathways and processing skills oMinimal cues, concept of ‘identity’ oExpressing emotion and nuance online oTempo of communication oDeveloping and working with online language oCrisis intervention and protective frameworks  Technical and mechanical skills  Text transcripts - clinical accountability and reflective learning Best viewed as a complementary modality, as part of a wider service system model

13. Emerging trends: First 10-months CounsellingOnline Website has received >20,000 visitors and more than 1 million page views 1200 online counselling sessions undertaken to date Nearly 70 per cent have occurred outside of ‘traditional’ business hours High level of accessibility through integrated model Average duration: 31 minutes 31 per cent of sessions have come from rural/regional areas 87 per cent anonymous access, 13 per cent registered (repeat) clients

14. Emerging trends: First 10-months

15. Preliminary evaluation data 59% of clients found the service online, 41% from service related media & promotional materials 69% of clients reported session as first contact with a specialist/treatment service Most common reasons for online access included privacy (67%), convenience (56%) and preferred medium (49%) 49% of clients reported sense of being better informed and educated around AOD issues following contact 39% reported sense of having more/improved coping strategies 26% reported making contact with another treatment/support service following their online session 88% would recommend service to a friend

16. The future of Online Counselling Expanded range and accessibility of help-seeking pathways (net-widening effect) High level of reported safety,control and acceptability by online clients Opportunity to build online hub of information and engagement (online self assessment, self help, podcasts, online counselling) The need for further development of online delivery models, standards and evaluation

17. Thankyou