Receptivity towards Remote Service Delivery among Social Work Clients and Practitioners during COVID Times: A Systematic Review

PURPOSE

This systematic review aims to identify and synthesize the available evidence on the receptivity toward, perceived advantages and challenges of remote service delivery among social work clients and practitioners during the context of COVID-19.

METHOD

Two electronic databases were searched from 2020 to 2022. Identified papers were screened against the established eligibility criteria, yielding 15 papers. Two additional papers were further identified through hand-search. As heterogeneity of studies was high, a narrative synthesis was performed to summarize the overall evidence.

RESULTS

Our review provides evidence that remote service delivery holds the potential to increase access to services among selected client populations as well as promote a sense of empowerment for clients and opportunities for practice enhancement for practitioners.

DISCUSSION & CONCLUSION

The findings from our study highlighted the need for innovative solutions and practical considerations for ongoing remote service, including the careful considerations of social work clients' and practitioners' suitability, the need for provision of training and ongoing support to optimize practitioners' well-being. As the delivery of services transition to face-to-face or remain remote, further research is needed to assess the promise of remote practice in optimizing overall service delivery, while maintaining client-reported satisfaction.

School counselors' perceptions of virtual counseling in Lebanon: A qualitative study

Virtual counseling has become an increased necessity as a result of the current pandemic as well as the need for methods that comply with the continuous changes and advancements. Studies conducted have shown that the perceptions of counselors of the benefits and barriers reflect whether or not the counseling service will be successful. This study is a descriptive research design following a qualitative approach. The study aimed to explore (a) the school counselor's perceptions of the benefits and barriers they encounter when using virtual counseling, (b) the perceived differences between conducting virtual counseling and in-person counseling, and (c) whether participation in virtual counseling differs as a result of students' characteristics in the perception of school counselors. Five private schools in the Beirut region were contacted as they were known to have virtual counseling programs. Both the schools and counselors were purposively chosen. Seven in-depth semi-structured interviews and one focus group discussion (FGD) were carried out with the study participants. Interpretational analysis was carried out to assess and analyze the obtained data. The results showed that through these experiences, counselors were able to develop new methods with regard to technology and other practices to limit the effects of obstacles faced. Counselors' communication tools were also fine-tuned since they had to rely on unorthodox methods to understand students and deal with them better. Results showed that the benefits also have to do with time and method flexibility, the main barriers were issues of privacy, change in workplace dynamics, and lack of usage of tools. The findings were discussed in relation to four main themes: (a) service delivery adaptation, (b) working with technology, (c) counselor's practices in delivering virtual counseling, and (d) preparation and training for virtual counseling. Being that it is qualitative research, the interpretational analysis was carried out to assess the obtained data. The results showed that the main benefits have to do with time and method flexibility, and the main barriers were issues of privacy and change in workplace dynamics. The results showed that the new changes and the counselor's experience, along with the personal attributes of counselors and students, all influenced the efficiency of the counseling sessions.

Social determinants and mental health needs of Palestine refugees and UNRWA responses in Gaza during the COVID-19 pandemic: a qualitative assessment

BACKGROUND

Due to pre-existing difficulties, refugees are especially susceptible to the negative effects of the pandemic; nonetheless, the pandemic's effect on this group is still unclear. The purpose of this study was to determine the effects of the COVID-19 pandemic on the mental health of Palestine refugees in Gaza by identifying the role of social determinants. During the pandemic, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) enacted a number of policies and measures. The purpose of this research was to assess their efficacy and acceptability.

METHODS

This qualitative study took place between August and November 2020. Twenty-nine key-informant interviews were conducted remotely with UNRWA Headquarters, field and clinical staff in Gaza and with community members, aged ≥18 years and residing in Rafah and Jabalia camps. We sought informed consent verbally or via email. Data was coded based on the framework for social determinants of mental health.

RESULTS

Interview results indicated that the relationship might be unidirectional, with COVID-19 causing the degradation of living conditions and vice versa, with living conditions exacerbating the COVID-19 situation by facilitating virus transmission. In other instances, the association between mental health determinants and COVID-19 might be bidirectional. In terms of experiencing violence and anxieties, women, children, and daily-paid employees were significantly more disadvantaged than other groups in the community. UNRWA modified its service delivery techniques in order to continue providing essential services. In general, UNRWA's strategies throughout the pandemic were deemed beneficial, but insufficient to meet the needs of Gazans.

CONCLUSION

The pandemic highlights the need to go beyond disease treatment and prevention to address social determinants to improve refugees' health and reduce their susceptibility to future shocks. UNRWA has rapidly implemented telemedicine and mental telehealth services, making it imperative to assess the efficacy of these novel approaches to provide care at a distance. A long-term option may be to employ a hybrid strategy, which combines online and in-person therapy.

Technological Advances in Cognitive-Behavioral Therapy and Clinical Practice: Challenges in an Evolving Field

Technological innovations in cognitive-behavioral therapy (CBT) provide excellent opportunities for mental health clinicians to expand access to mental health treatment among culturally diverse and marginalized populations. This brief report highlights challenges that mental health clinicians encounter as they integrate technological innovations in CBT into their work with diverse clients and provides recommendations for addressing them. The authors identify five key challenges of using technology-driven CBT: development of the therapeutic alliance; potential fit for clients from culturally diverse backgrounds and marginalized groups; geographic and economic access; ethical and legal concerns; and competency in CBT practice, training, and supervision. Technological advances in CBT allow clinicians to treat more individuals from underserved communities. Existing challenges compel clinicians across disciplines to ensure that their practice is congruent with CBT practice values and ethics, policy, and research and that the best available CBT intervention can be integrated into all aspects of mental health practice.

Detecting suicide risk using knowledge-aware natural language processing and counseling service data

RATIONALE

Detecting users at risk of suicide in text-based counseling services is essential to ensure that at-risk individuals are flagged and prioritized.

OBJECTIVE

The objective of this study is to develop a domain knowledge-aware risk assessment (KARA) model to improve our ability of suicide detection in online counseling systems.

METHODS

We obtained the largest known de-identified dataset from an emotional support system established in Hong Kong, comprising 5682 Cantonese conversations between help-seekers and counselors. Of those, 682 conversations disclosed crisis intentions of suicide. We constructed a suicide-knowledge graph, representing suicide-related domain knowledge as a computer-processible graph. Such knowledge graph was embedded into a deep learning model to improve its ability to identify help-seekers in crisis. As the baseline, a standard NLP model was applied to the same task. 80% of the study samples were randomly sampled to train model parameters. The remaining 20% were used for model validation. Evaluation metrics including precision, recall, and c-statistic were reported.

RESULTS

Both KARA and the baseline achieved high precision (0.984 and 0.951, shown in Table 2) and high recall (0.942 and 0.947) towards non-crisis cases. For crisis cases, however, KARA model achieved a much higher recall than the baseline (0.870 vs 0.791). The c-statistics of KARA and the baseline were 0.815 and 0.760, respectively.

CONCLUSION

KARA significantly outperformed standard NLP models, demonstrating good translational value and clinical relevance.

The Effect of Anonymous Computer-Mediated Communication on State Anxiety: An Experimental Study

This study examined the effect of anonymous computer-mediated communication (CMC) on state anxiety, specifically focusing on whether the valence of the interaction affected state anxiety before completing an anxiety-inducing task. Sixty-two female participants aged 18-25 were randomly assigned to one of three conditions: positive CMC, negative CMC, and blog. Self-report measures of state anxiety were taken at baseline; after participants had been given instructions about the anxiety-inducing task; after 10 minutes of CMC/blog writing; and after the anxiety-inducing task had been completed. Results showed that participants in the positive CMC condition showed a significant and moderate decrease in anxiety following the CMC, whereas those in the negative CMC condition showed a nonsignificant but moderate increase in anxiety following the CMC. Anxiety remained relatively unaffected by the blog condition. After completing the anxiety-inducing task, there were no differences in anxiety scores between groups. The findings show that CMC can be beneficial for relieving state anxiety, but the valence of the communication is crucial. This has implications for advice and training given to those participating in and supporting CMC where mental health issues might be discussed.

The Digital Divide: Couple and Family Therapy Programs' Integration of Teletherapy Training and Education

The mental health field is increasingly integrating and growing a teletherapy presence, and couple and family therapists are uniquely situated to offer these services based on our history of innovative approaches to therapeutic services. To do so successfully, careful consideration of training and education must occur. To evaluate current teletherapy training and education opportunities of COAMFTE accredited couple, marriage, and family therapy programs, an inductive qualitative content analysis was conducted on the responses of 95 faculty at COAMFTE accredited programs. Findings indicate that more than two thirds of the participants were in favor of teletherapy integration in training programs; however, most programs currently do not offer such opportunities. Barriers that prevent such integration were highlighted as well as existing concerns to training graduate students in teletherapy. Implications for training programs, policies, and regulations are discussed.

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.

Counseling Psychology Model Training Program

The counseling psychology Model Training Program (MTP) was written to reflect new developments in counseling psychology, the American Psychological Association, and the world. The updated MTP is aspirational, intended to guide the development and maintenance of counseling psychology programs. The MTP conforms to the American Psychological Association’s and the Society of Counseling Psychology’s standards and guidelines. A strategic task group appointed by 2015 Society president James W. Lichtenberg sought feedback from the field to assist in its formulation, and the executive boards of the Society and the Council of Counseling Psychology Training Programs approved the final version. The 2017 MTP consists of four core values (i.e., growth toward full potential, holistic and contextual, diversity and social justice, communitarian perspective) as well as 20 principles grouped into six clusters: counseling psychology identity; multiculturalism, diversity, and social justice; health service psychology; developmental, prevention, and strengths orientation; science–practice integration; and relationships within and between professional communities.

Ethical issues in sport psychology

The field of sport psychology is dynamic and growing. To continue building credibility with the public and allied professionals, effective and ethical practice is crucial. Advances in technology have allowed sport psychology professionals to consult with athletes from a distance, but practitioners must be mindful of their competency to use technology, confidentiality concerns, and the suitability of technology for their clients. Movement toward defining competency and clarifying issues of title usage are additional areas in which the field is gaining momentum. Recent attention has also been drawn to the topics of professional development and cultural competency. With the unique settings in which applied sport psychology practice takes place, attention to multiple relationships is another key ethical issue.

Online Counseling

Mallen, Vogel, and colleagues explore the developing field of online counseling from the unique perspective of counseling psychology. They examine the body of available research and relevant clinical, ethical, legal, and practical issues and make recommendations for counseling psychologists who desire to participate in online counseling. This article provides a critique of their contributions, finds support for much of what they present, offers additional suggestions for counseling psychologists, and makes recommendations for counseling psychology to resolve challenges that at present, limit online counseling’s value, effectiveness, and impact. The author makes recommendations for practical research that studies the actual online-counseling process, establishing additional standards, more effectively disseminating information, enhancing training, expanding access through innovative programs, and increasing advocacy efforts.

Online Counseling

This reaction article extends the research and practice recommendations for online counseling from the Major Contribution to the November 2005 issue of The Counseling Psychologist by prioritizing research and practice in online psychoeducation, self-help, and mutual help. Research suggests that tens of millions of Americans use the Internet for psychoeducation, self-help, and support and that this number far exceeds those who would use the Internet for one-on-one counseling. The purpose of this reaction is to advocate and prioritize a research and practice agenda that will reach the tens of millions of Americans and millions more abroad who are already seeking online mental health information, self-help, and mutual help for mental health problems.

Online Counseling

The rejoinder responds to the four reactions by Jeffrey Barnett, Tai Chang, Delida Sanchez-Page, and Franz Caspar and Thomas Berger in the November 2005issue of The Counseling Psychologist. In doing so, the authors emphasize the important need for further clarity regarding the effectiveness of online mental and behavioral health services in delivering a wide range of psychoeducation, self-help, and mutual-help facilities as well as direct counseling. The authors also highlight many of the reactants’ important insights, including the comments on the appropriateness of online mental and behavioral health services for the underserved and whether online counseling should be used as a primary or secondary tool in counseling.

Online Counseling

This article reviews the online-counseling literature with an emphasis on current applications and considerations for future research. It focuses on primary themes of counseling psychology including the history of process-outcome research and multiculturalism. It explores current gaps in the literature from a counseling psychology framework, including the field’s focus on normal and developmental challenges and tasks, client strength and resilience, education and career development, prevention and wellness, and multiculturalism. In general, current evidence indicates that online counseling may be a viable service option for some clients, especially those who are typically isolated; however, questions remain regarding the effectiveness and appropriateness of online counseling.

Alienation Among College Students and Attitudes Toward Face-to-Face and Online Counseling: Implications for Student Learning

This study examined the relationship between 3 aspects of alienation: powerlessness, meaninglessness, and social estrangement, and attitudes toward face-to-face and online counseling among college students. Participants included 180 undergraduate students at a Midwestern university. Correlations indicated a significant relationship between discomfort with face-to-face counseling and powerlessness (r = .20, p = .008) and meaninglessness (r = .22, p = .003). There were no significant relationships between attitudes toward online counseling and any aspect of alienation. Significant gender differences in value toward face-to-face counseling were found. Higher education should examine the use of online counseling among college students.

Anonymous: the problems, dilemmas and desires of Slovenian adolescents in online counselling

Introduction: Online counselling represents a new medium for finding health information. The aim of the research is to determine the importance of analysis of adolescents' issues in order to understand their problems, needs and desires. Methods: In 2012 the system for the classification of questions by the type of problem was introduced. In relation to the contents the questions were first sorted to the parent category then followed by the categorization according to the subject matter. The calculation comprised the portions, averages and quartiles, and in some cases even Cramer's V coefficients. The analysis covered the entire defined population (3,257 coded questions). Results: Most of the users are girls (76 %), the most representative group encompasses adolescents aged between 14 and 17 years (57 %). Most questions were grouped into the categories Sexuality and sexual health (24 %), Relationships (23 %) and Body (20 %). The length of posts increases with the age of the user (Cr's V = 0.18), but differs by the gender (a higher proportion of longer questions (Cr's V = 0.15) were posted by girls) and the themes (Cr's V = 0.31). Discussion and conclusion: The categorizing of questions is suitable for the identification and analysis of adolescents' problems, needs and desires. Regular categorisation of questions with analysis will serve as a useful research tool for youth work.

Web-based counseling for problem gambling: exploring motivations and recommendations

Background

For highly stigmatized disorders, such as problem gambling, Web-based counseling has the potential to address common barriers to treatment, including issues of shame and stigma. Despite the exponential growth in the uptake of immediate synchronous Web-based counseling (ie, provided without appointment), little is known about why people choose this service over other modes of treatment.

Objective

The aim of the current study was to determine motivations for choosing and recommending Web-based counseling over telephone or face-to-face services.

Methods

The study involved 233 Australian participants who had completed an online counseling session for problem gambling on the Gambling Help Online website between November 2010 and February 2012. Participants were all classified as problem gamblers, with a greater proportion of males (57.4%) and 60.4% younger than 40 years of age. Participants completed open-ended questions about their reasons for choosing online counseling over other modes (ie, face-to-face and telephone), as well as reasons for recommending the service to others.

Results

A content analysis revealed 4 themes related to confidentiality/anonymity (reported by 27.0%), convenience/accessibility (50.9%), service system access (34.2%), and a preference for the therapeutic medium (26.6%). Few participants reported helpful professional support as a reason for accessing counseling online, but 43.2% of participants stated that this was a reason for recommending the service. Those older than 40 years were more likely than younger people in the sample to use Web-based counseling as an entry point into the service system (<italic>P</italic>=.045), whereas those engaged in nonstrategic gambling (eg, machine gambling) were more likely to access online counseling as an entry into the service system than those engaged in strategic gambling (ie, cards, sports; <italic>P</italic>=.01). Participants older than 40 years were more likely to recommend the service because of its potential for confidentiality and anonymity (<italic>P</italic>=.04), whereas those younger than 40 years were more likely to recommend the service due to it being helpful (<italic>P</italic>=.02).

Conclusions

This study provides important information about why online counseling for gambling is attractive to people with problem gambling, thereby informing the development of targeted online programs, campaigns, and promotional material.

Evaluating a knowledge exchange intervention in cancer survivorship care: a workshop to foster implementation of Online Support Groups

PURPOSE

The purpose of the research described here is to assess the overall effectiveness of the workshop format as a Knowledge Exchange (KE) strategy in (1) disseminating scientific evidence, clinical experience, and systems information related to professionally led Online Support Groups (OSG) for cancer survivors and (2) facilitating the implementation of this intervention by a select group of end users--decision makers and clinical leads in psychosocial supportive care.

METHODS

The KE-Decision Support (KE-DS) Model, operationalizing the Health Technology Approach, guided the development of pre- and postworkshop questionnaires, and a follow-up questionnaire administered 5 months after the workshop. Questionnaire results were categorized according to participants' responses to these elements: methods of engagement, evidence (scientific, experiential, systems) and the delivery of this evidence, and external factors at the institutional level, such as administrative support, budgetary issues, etc., that influence decision-maker abilities and strategies.

RESULTS

Traditional KE strategies such as peer-reviewed journal articles are optimal for disseminating scientific evidence, while face-to-face interactions, such as in a workshop, are best used to disseminate systems-level implementation information, such as fiscal implications, budgetary requirements, and policy relevance, which is not found in journal articles or conferences. An apparent shift in workplace culture signifies the availability of institutional support for high-level staff to engage in KE.

CONCLUSIONS

As a KE strategy with identified end users, the workshop format is effective in facilitating the implementation of this intervention in participants' institutions.

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.

Use of the internet in the treatment of obesity and prevention of type 2 diabetes in primary care

Cardiovascular prevention, including emphasising healthy diet and physical activity patterns for weight loss and diabetes prevention, is an important focus of primary care medicine, yet provision of intensive lifestyle counselling in the primary care setting remains uncommon. Online approaches for providing lifestyle counselling are emerging as a new avenue for bringing support to outpatient patient populations. Features of successful programmes include the use of a structured behavioural programme, electronic counselling support and feedback, and uncomplicated user interfaces. Online tools may be used independently or to complement in-person approaches. Limited data also suggest that the internet can be used to support the maintenance of weight loss. In addition, the internet may help overcome various clinical barriers to lifestyle support, including significant time limitations, a need to prioritise acute care and maintain clinical workflow, and the high cost of counselling. Furthermore, the continuity of the primary care patient-provider(s) relationship provides an established source of long-term support which has been difficult to create in other community settings. As the field of online lifestyle counselling matures, nutrition and physical activity experts will face new challenges in providing asynchronous counselling without the assistance of traditional non-verbal communication cues. However, the potential for reaching a wider population in a convenient and accessible manner also creates unique opportunities for providing lifestyle support.

Social work practice in the digital age: therapeutic e-mail as a direct practice methodology

The author addresses the risks and benefits of incorporating therapeutic e-mail communication into clinical social work practice. Consumer demand for online clinical services is growing faster than the professional response. E-mail, when used as an adjunct to traditional meetings with clients, offers distinct advantages and risks. Benefits include the potential to reach clients in geographically remote and underserved communities, enhancing and extending the therapeutic relationship and improving treatment outcomes. Risks include threats to client confidentiality and privacy, liability coverage for practitioners, licensing jurisdiction, and the lack of competency standards for delivering e-mail interventions. Currently, the social work profession does not have adequate instructive guidelines and best-practice standards for using e-mail as a direct practice methodology. Practitioners need (formal) academic training in the techniques connected to e-mail exchanges with clients. The author describes the ethical and legal risks for practitioners using therapeutic e-mail with clients and identifies recommendations for establishing best-practice standards.

Facilitating online support groups for cancer patients: the learning experience of psycho-oncology clinicians

OBJECTIVE

Counsellor familiarity and engagement with technology-mediated communication represents an important factor in the ability to implement support programs to cancer patients. This study describes the experiences of a cohort of expert psycho-oncology counsellors who learned to facilitate online support groups (OSGs) and identifies the important elements of their learning experience that led to their engagement. PROCEDURE AND METHOD: Six psycho-oncology counsellors were trained to facilitate OSGs and later facilitated OSGs in their own practice context. They subsequently reflected on and discussed their experiences with OSGs over time: in a panel discussion within 6 months of training, and in two focus groups. A participatory method was used to describe and interpret key elements of the learning process.

RESULTS AND DISCUSSION

Three themes of the counsellors' learning experience emerged: immersion in experiential learning, perceptions of clinical value and benefit, and overcoming challenges with adapted skills. Counsellors described components of their experiential learning: co-facilitating online cancer support groups with an expert, debriefing online, and participating in an online peer supervision group, as critical to their becoming engaged. Despite initial challenges, the counsellors learned new skills, and adapted known clinical skills, to the text-only environment.

CONCLUSION

With appropriate training and practice over time, counsellors familiar with delivering face-to-face support groups to cancer patients became skilled and engaged in leading OSG's for cancer patients. Learning to facilitate OSGs shifted practice by significantly expanding the scope of services they were able to provide their patients and has implications for expanding access to support services.

Current Directions in Videoconferencing Tele-Mental Health Research

The provision of mental health services via videoconferencing tele-mental health has become an increasingly routine component of mental health service delivery throughout the world. Emphasizing the research literature since 2003, we examine: 1) the extent to which the field of tele-mental health has advanced the research agenda previously suggested; and 2) implications for tele-mental health care delivery for special clinical populations. Previous findings have demonstrated that tele-mental health services are satisfactory to patients, improve outcomes, and are probably cost effective. In the very small number of randomized controlled studies that have been conducted to date, tele-mental health has demonstrated equivalent efficacy compared to face-to-face care in a variety of clinical settings and with specific patient populations. However, methodologically flawed or limited research studies are the norm, and thus the research agenda for tele-mental health has not been fully maximized. Implications for future research and practice are discussed.

Children's experiences with chat support and telephone support

BACKGROUND

In line with the wider trend of offering support via the Internet, many counseling and referral services for children have introduced online chat, often in addition to a traditional telephone service.

METHODS

A comparative study was conducted between the telephone service and the confidential one-on-one online chat service of the Dutch Kindertelefoon. The design included a concise pretest and a posttest (n = 902). The study also comprised a follow-up test (n = 213), which included the Strengths and Difficulties Questionnaire.

RESULTS

Children experienced a higher sense of well-being and a reduced severity of their problems after consulting the Kindertelefoon. The results were slightly more favorable for the chat service than for the telephone service. The follow-up survey showed that many of the children who contact the Kindertelefoon suffer from relatively severe emotional problems.

CONCLUSIONS

Both the telephone and the web-based support improved the children's well-being and decreased their perceived burden of problem. The results of this study underline the need for closer cooperation between child helplines and mental health and child welfare services.