Screen to Screen

 

By Barb Veder, Kelly Beaudoin, and Stan Pope

 

In this highly digital world, users demand easy access to services and counselling, and EAP providers are no exception. Technology has made services such as video counselling, telehealth, and telemental health services not only possible, but feasible support options. The expansion of these channels has also created opportunities for more research — to improve not only the method of delivery but also the counselling itself. 

In May 2010, video counselling (VC) was added to the counselling services offered through the Employee and Family Assistance Program (EFAP) at Shepell as a pilot project with a full launch in September 2011. They anticipated that the majority of VC clients would have mobility issues or come from remote areas (those located in areas at least an hour away from the nearest provider). Instead, of the over 3,000 cases opened in the past four years, only 12% percent of users were located more than four hours away from the nearest provider. 

 

Easy to Use and Convenient

In addition to being easily accessible, video counselling is easy to use. Client and counsellor communicate using a webcam, landline, and encrypted custom Internet software through which both parties are able to see and hear each other and participants are able to share and create documents in real-time. Clients are able to use their own personal computers. Post-session feedback has shown that clients are satisfied with VC.

 

* Clients appreciate the convenience of receiving services in their own home; some say that it helps them feel more at ease sharing information with counsellors.

* Clients also value that, because there aren’t any geographic restrictions, they can connect with a counsellor from anywhere in the country. This feature of VC is especially significant to clients in small communities as it affords them with a level of anonymity they could not otherwise experience.

 

Counsellors Report High Satisfaction

Counsellors also report a high level of satisfaction in providing services in this manner. Counsellors find that clients can be more relaxed and expressive when they are in the comfort of their own home and when they aren’t pressed for time or feeling rushed because they had to leave work early or need to get home to their family. Client comfort and convenience as well as the satisfaction and progress that clients report make VC a positive experience for client and counsellor alike.

 

Video Counselling Research

In addition to analyzing data from Shepell’s EFAP clients, several other studies and literature reviews were analyzed to corroborate our findings. These studies — conducted on different mental health providers and professions and on a wide range of populations, ages, and various clinical/mental health issues — examine the clinical effectiveness, user satisfaction, and efficacy of a variety of clinical approaches. 

Recent research shows that video counselling, and televideo counselling, is taking in populations traditionally not seen as viable clients for this type of service (Kornbluh, 2012; Karon, 2014). Research has also found that individuals who used video counselling report high levels of satisfaction and have similar satisfaction and clinical outcomes to individuals accessing in-person counselling (Richardson, Frueh, Grubaugh, Egede, and Elhai, 2009). 

Even larger reviews focusing on therapeutic interventions delivered by videoconferencing for long-term and chronic mental and physical health note that videoconferencing interventions produced similar outcomes, patient satisfaction, and treatment results to patients who received in-person interventions (Steel, Cox, and Garry 2011).

 

Services also Help Veterans

Dealing with the mental health issues of the military is one of the biggest challenges today. A 2012 study representing the largest scale assessment of telemental health services looked at the clinical outcomes of 98,609 US Department of Veteran Affairs (VA) patients over four years (2006 to 2010).

Telemental health services, including video counselling, were provided to veterans at community-based outpatient clinics by a wide range of mental health practitioners, including psychiatrists, psychologists, social workers, and registered nurses. Patients receiving tele-mental health services had not only fewer days of hospitalization but an average of 25% fewer hospitalizations.

They also noted, “The overall VA population of mental health patients did not demonstrate similar decreases during this period.” This included VA patients receiving other forms of mental health services (Godleski, Darkins, and Peters 2012).

 

Promising, but…

Improving accessibility to populations living in remote and underserved areas was a key factor in the EFAP’s decision to develop VC services. As stated, clients who might not be inclined to attend more traditional in-person counselling may view VC/TMH as a viable alternative. Clients may be hesitant to access face-to-face services for many reasons including perceived stigma (Rees & Stone, 2005).

Likewise, convenience and availability factors can play an important role in modality preference (Mallen, Vogel, Rochlen, and Day, 2005). Technology services are also a viable option for clients who do not like certain features of in-person support (Attridge, 2012).

However, none of the current research reflects video counselling in an EFAP/EAP context. Given that EFAP clients often access services with non-psychiatric presenting issues, it is important to compare video counselling’s value in that context.

 

Shepell’s Study Outcomes

This is one of the reasons Shepell chose to review its VC program one year after its launch. They wanted to evaluate the EFAP’s VC clinical service, gain a greater understanding of the client population, and to contribute to current VC literature. 

Shepell recognized the opportunity to compare video counselling with in-person (IP) counselling, and to research clinical outcomes from counsellors who delivered both video and in-person counselling to clients. Furthermore, both modalities use the same case management and case files.

Counsellors also shared positive feedback about their experience using video counselling with clients. Completed client satisfaction surveys indicated that users found the service convenient and clinically beneficial.

Shepell chose to examine data points from these surveys to determine if specific outcome measures supported the anecdotal feedback, comparing VC client clinical outcome measures with those of IP clients. The results showed that video and in-person counselling were similar in many respects:

 

* Clients were mostly younger females, which matches traditional EFAP demographics. However, within their age groups, clients over 40 chose VC over IP more than those under 39 and under; and more couples chose video counselling than in-person.

 

* Sessions were comparable in length and received similar helpfulness ratings from clients.

 

* Goal attainment ratings were high for VC clients, and showed no statistical difference from those of in-person clients. 

 

These results were expected given that a significant number of these cases consisted of couple/conjoint cases, which historically have higher drop-out rates than individual cases, and that not all users access EFAP services for mental health concerns. 

Of the four general counselling issues (addiction, couple/family, personal/emotional, and work-related) counsellors saw a similar distribution of cases across issues for both VC and IP, except video counselling had an almost even representation of couple/family cases and personal/emotional. 

Getting a client to sign up for counselling is one thing; getting them to go through with it is another. Video counselling also had a lower no show/late cancellation rate than in-person counselling.

As stated previously, Shepell thought that people living in remote regions would be the predominant users of video counselling, but this wasn’t the case. Rather than remoteness, time and location were much bigger factors in using VC.

For instance, for users who live in an Eastern Time zone, there is greater availability for evening appointments with video counsellors in the West (e.g., a client from Toronto may have a 9 p.m. ET appointment with a BC counsellor who is working at 6 p.m. PT). Or a shift-worker in the West could access a counsellor in the East during pre-local business hours.

Conversely, clients who use in-person counselling are constrained in terms of travel time and must operate in the same time zone as their counsellors. But VC clients do not need to deal with the logistics of leaving work or home, parking, and balancing work and home life demands, making this modality very appealing.

 

Summary

The past decade has seen a significant technological evolution; making the use of VC/TMH/TH increasingly feasible for and available to different providers and populations. The expansion of this modality, possibilities for clients, and the growing amount of research are exciting developments.

EFAPs are in a unique position, offering multi-modal clinical services to thousands of clients a year across different demographics, locales, and presenting issues. Expanding your services with video counselling can only benefit you and your clients. 

 

Barb Veder, MSW, RSW, is the Vice President of Clinical Services and Research Lead with the Canadian-based Shepell, considered a leading pioneer in delivering alternative EAP counseling modalities.

 

Kelly Beaudoin, BA, is the Clinical Communications Manager with Sheppel.

 

Stan Pope, RW, is Regional Clinical Manager, National Capital Region, the Ottawa Valley, also with Shepell.

 

References

Attridge, M. “Employee assistance programs: evidence and current trends.” In Handbook of Occupational Health and Wellness, edited by R.J. Gatchel and I. Z. Schultz, p 441-467. New York: Springer, 2012.

 

Karon, Amy. “Extended telepsychiatry outperformed primary care follow-up for ADHD. Clinical Psychiatry News. October 23, 2014. www.clinicalpsychiatrynews.com.

 

Kornbluh, Rebecca A. “Telepsychiatry is a tool we must exploit.” Clinical Psychiatry News. August 7, 2014. www.clinicalpsychiatrynews.com.

 

Mallen, M.J., D.L. Vogel, A.B. Rochlen, and S.X. Day. “Online Counseling: Reviewing the Literature from a Counseling Psychology Framework.” The Counseling Psychologist 33, no. 6 (2005): 819-87. DOI: 10.1177/0011000005278624.

 

Rees, Clare S., and Sheona Stone. “Therapeutic Alliance in Face-to-Face Versus Videoconferenced Psychotherapy.” Professional Psychology: Research and Practice 36, no. 6 (2005): 649–653 DOI: 10.1037/0735-7028.36.6.649.

 

Richardson, L.K., B. Christopher Frueh, A.L. Grubaugh, L. Egede, and J.D. Elhai. “Current directions in videoconferencing tele-mental health research.” Clinical Psychology: Science and Practice 16(2009):16:323–38. PMID:20161010.

 

Steel, Katie, Diane Cox, and Heather Garry. “Therapeutic videoconferencing interventions for the treatment of long-term conditions.” Journal of Telemedicine and Telecare 17(no. 3) (2011):109-17. PMID:21339304.

 

Veder, Barb, Kelly Beaudoin, Michèle Mani, Stan Pope, Janice Ritchie. “EFAP Video Counselling: a post-launch retrospective and comparison with In-Person Counselling outcomes.” Morneau Shepell, 2013. http://www.shepell.com/en-ca/knowledgeandmedia/news/research%20report/pdf/Shepellfgi%20Video%20Counselling%20Research%20Report_EN.pdf 

 

Veder B, Pope S, Mani M, Beaudoin K, Ritchie J. “Employee and Family Assistance Video Counseling Program: A Post Launch Retrospective Comparison With In-Person Counseling Outcomes.” Medicine 2.0 Journal. Med 2.0 2014;3 (1):e3 DOI: 10.2196/med20.3125 http://www.medicine20.com/2014/1/e3/