Part 3 - Case studies

Case Studies

Part 3. Using technology in practice

ReachOutPro.com.au Educational Module

1. Using websites to assist with
developing rapport
In practice
Melanie was a 15 year old girl referred to a psychologist working within a youth
organisation following a serious suicide attempt. Melanie presented with symptoms
of Major Depressive Disorder including low mood, social withdrawal, tearfulness,
irritability, and poor sleep. She had failed to engage with several of her previous health
professionals and had limited family support.

For the first three sessions, Melanie remained mostly silent and with minimal verbal
communication with the psychologist at all. Discussions with her parents suggested
that Melanie was motivated to attend sessions and wanted to talk during session, but
became overwhelmed in discussions about herself and tended to “shut down”.

Melanie’s mother reported that Melanie did spend a lot of time on the computer
using social networking sites. Armed with this information in the fourth session, her
psychologist asked her about these sites and which ones she enjoyed. Although
Melanie was not forthcoming with information, she was able to nod in response and
agreed to show the psychologist her Facebook page.

While both were looking at the page her psychologist was then able to ask questions
about the items on the page, and whilst looking at the screen, Melanie was able to
answer the questions, thus facilitating a less confronting discussion about aspects of
her identity, friendships and difficulties. This paved the way for building rapport and
more open communication.

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2. Using SMS to enhance
engagement
In practice: The Adelaide SMS project
A recent study published in the Journal of Adolescent Health has shown that SMS
communications can be effectively used by clinical staff to engage adolescents [1].
The study which examined the content of SMS exchanges between therapists and
young people, aimed to identify the extent of inappropriate SMS use.

Since its formation in 2000, the Youthlink team has recognised the challenge
of maintaining contact with young people within their service. As with many
communications, referrals coming through to their service often only included home
telephone numbers. Whilst this is often a suitable method of contact for adults,
response rates indicated that there was a limited likelihood that young people would
either answer or return calls. Based on this observation, it was evident to the team
that the use of mobile phones (both SMS and calls) increased the chance of more
consistent contact being made.

By clinicians providing their mobile phone numbers to young people, and being open
to using SMS, therapists at Youthlink were able to organise appointments directly
with the young person, instead of through an administration officer. In addition,
an SMS message was sent to the young person before they were contacted by
the team. This provided the young person with a warning about the pending call
and helped to ‘break the ice’, therefore, increasing the chance of the call being
responded to.

The team initially had concerns about inappropriate SMS use by clients and
how they would be best to respond to messages surrounding safety. An audit
of messages received from clients indicated that only 2% were deemed as
inappropriate. The majority (60.68%) of messages received from clients were
classified as being appointment related (eg. time, place, logistics). The study also
revealed that the use of SMS between client and therapist provided reassurance for
the young person; allowing them to make contact on their terms. This allowed for
mutual trust and respect to develop between the therapist and the young person.

Such results therefore indicate that the use of mobile phones, particularly SMS, are
not only beneficial for making and maintaining contact with young people, but a safe
and efficient way to coordinate appointments.

“It is the use of SMS in coordinating and negotiating appointments (phone, face
to face, home visits etc) that has been of most benefit to the Youthlink team. The
real time contact made through SMS gives clients and therapists a chance to build
on their relationship outside more formal appointments.” Ann Crago Youthlink
Coordinator

To read the full interview conducted by ReachOut.com Youth Ambassador, Helen
Pepper, refer to
http://reachoutpro.com.au/using-technology/interviews-with-professionals/
using-sms-to-support-youth-services.aspx

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3. Fun ways to provide psycho
education
In practice
As a clinician I enjoy working with young people – particularly those that present
with complex problems, or those that are difficult to engage. Many of the clients I
work with have been sent to our service by the school, their parents, or their doctor
– and have not really come along because they “want to see a psychologist”. Often
problems are down played during the initial few sessions, and at times, not even
disclosed.

Often I find that online sites can really help with building the relationship. This often
starts with sharing clips and media that we both like, and then exploring sites like
tumblr or Facebook. More often than not there are posts on these sites that give
hints towards other difficulties that can be explored further.

When there are other difficulties, sites like ReachOut.com are great. You can
browse through the sites with the young person; allowing them to navigate towards
the areas that they are interested in. Sometimes they go immediately to the problem
area, or ignore it completely, but more often than not they will go back to it another
time (usually outside of session).

These websites are often great to help young people communicate with their
parents or friends about their difficulties. Downloadable information sheets, links
posted on Facebook, and the sharing of other people’s experiences means that they
can use other ways to communicate what’s going on. It can also help to normalise
the experience, and more importantly the process of help seeking and therapy.
Sometimes it’s even helped mum and dad understand a bit better too about what’s
going on. Where possible I chose sites that are multidimensional – that combine
information, forums and activities to hold their interest for longer.

These resources are invaluable and add so much to the sessions.

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4. Treating mild to moderate
anxiety and depression
In practice
Stephen was a 16 year old boy living in an intact family in Western Sydney. He
had been referred to a youth counselling service by his school counsellor who
noticed a deterioration in his mood following a relationship break-up. Stephen
had not connected well with his school counsellor and was reluctant to discuss
personal issues with others. At initial assessment, Stephen was found to be
suffering some symptoms of mild to moderate depressive illness and although
he did not meet full criteria he was certainly at risk. Due to staff constraints at the
youth service Stephen was placed in a waiting list and could expect to be seen
in approximately four weeks. The health professional providing this assessment
provided links to both e-couch and moodgym and encouraged him to have a look
at these in the meantime. She followed up with weekly phone calls to check on his
progress. When Stephen attended his first appointment with his assigned youth
health worker he appeared brighter and described an improvement in his mood,
he continued to be reluctant to discuss personal issues with his worker but could
relate to concepts linking his thinking to self-esteem and mood and was able to
benefit from individual work.

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5. Assisting with monitoring of
mental state
In practice
Whilst not everyone is technology savvy (clinicians and patients alike), you can
utilise mood diaries that are sent to the patient electronically rather than in paper
format. I use this regularly in practice because once you have sent the diary once,
the young person then has a copy of that can be used many times. The young
person then emails me the diary on the day of the session. This means it’s waiting
when they arrive, I have a chance to review it, there’s no chance of it getting lost
(or the dog eating it), and it also means that mum or dad, or their friends, won’t
find it lying around and read it.

Electronic copies also make it easier to upload notes to our practice software
which means I can track mood over time easily.

Alternatively, if the young person is really technology savvy and has an iPhone,
I often use the Moody Me app with them. Although they’re often a bit sceptical
about keeping a diary on their phone, the ability to upload photos is often quite
appealing and they take to it with zeal. By the time they come to the next session
they have loads of mood ratings and a rich source of information about their
triggers.

Since using these technologies, I’ve found that it’s really important to set the
scene with the young person about what you are getting them to do, and why. This
is really important if you want them to use the tool and to use it properly. A clear
rationale and setting expectations of frequency of use is important for everyone to
get the benefits.

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6. Encouraging community
engagement and connection
In practice
The ReachOut.com Community Forums.
The real value of the online forums is helping the young person to feel they are not alone.
So many young people feel that they are the only one experiencing what they are feeling.
The forums offer a safe place where young person can express how they feel which they
can’t necessarily do with their friends or family. They might post “I have been feeling down
lately and am thinking about seeing a counsellor”. In posting such a comment they receive
validation from their peers on the legitimacy of how they are feeling and encouragement
to take action and seek help. A common theme often emerging from the forums is around
help seeking. Through peer support and expressing their fears, many young people go
on to seek professional help. Young people will use the forums for a period of time or to
address a particular concern and will often return when they feel down and are looking for
further support.
Reachout.com Community Forums Coordinator, April 2011

“to the RO community, thank you thank you thank you! you guys are always here. you let
me grow in my own space. you’ve made me so much stronger. thank you for commenting
on my little vents (thank you t_p, you have no idea how happy it makes me to hear that
you like my writing), and for giving me a space where I feel safe and supported.”

“there are so many times when I am freaking out and feeling totally down, and just coming
here and chilling out, and seeing how you’ve all been going, it just makes me feel so much
more connected, and just so much better.”

The forums host a weekly live discussion which covers more serious topics such as cyber
safety and help seeking in a solution focused way. These sessions are held every Monday
for two hours and are peer facilitated but held under ReachOut staff supervision. For a full
list of topics please see: http://forums.reachout.com/forumdisplay.php?6-Getting-Real

In addition to the peer lead conversations, the forums host a monthly live discussion on a
serious topic that is facilitated by a mental health professional. The topics of the mental
health professional facilitated forums can be viewed here: http://forums.reachout.com/
forumdisplay.php?5-Infobus-and-features-guests.

The forums also provide a space for discussing practical tools and activities for increasing
wellbeing with a positive psychology focus. You can find these topics at: here: http://
forums.reachout.com/forumdisplay.php?7-Toolbox-amp-Zen-Den

Some recommended sites include:

ReachOut .com
ReachOut.com is an Australian based website designed to support young people who
are struggling to cope. The site contains information sections, stories from other young
people, and online forums.
http://au.reachout.com/

The Low Down
The Low Down is a New Zealand based website designed to support young people going
through a difficult time. The site contains information, a quiz, shared media and a place to
ask questions and get support.
www.thelowdown.co.nz

Something Fishy
Something Fishy is pro-recovery eating disorder website. The site is dedicated to raising
awareness and providing support to people with Eating Disorders as well as supporting
their loved ones. The site contains psycho-education, a game and an online forum.
www.something-fishy.org
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7. Enhancing wellness and relapse
prevention
In practice
With so much information out there, and the relative ease of access, the young
people are going to seek information; particularly if you don’t direct them.
Clinically, there are many websites that offer lots of support and/or information for
patients that can help guide them post-service discharge.

When I work with eating disorder clients I often introduce them to the site
www.something-fishy.org in the second to last session. The site has lots
of information about recovery from eating disorders, an online game, and a
moderated forum that patients can get support from. I think this is so important
given the pro-ana sites that are available. By educating the young people I work
with about which sites are good and directing them to these, it can help to keep
them focussed in the right direction.

My patients tend to like it, and I frame it as “now that you are in recovery you can
join this ‘recovery’ community”. We go through the site together and I follow-up
their use of it in the final session. When writing their discharge plan we include
accessing the site if they want to check information, and also that the YP can
contact me via email if they have any further questions or need support. This
contact doesn’t have to be problem related either – they can email me just to let
me know that they are doing well. It keeps the doorway open for communication
and access should the need arise in the future.

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8. Using social media for health
promotion
Using social networking in practice - Stealth Mission
ReachOut.com uses social media as a key way to connect to young people in
spaces where the young people are. In doing so, our aim is to raise awareness
and reduce stigma around mental health, particularly in those who may not yet be
seeking help.

The Stealth Campaign was a competition run entirely through the ReachOut.com
Facebook page. Through a specially designed application on our Facebook page,
young people were able to enter the competition to win a Mac Computer and digital
camera. They needed to order promotional material and then upload a photo to the
Facebook page that showed a creative and unusual place that they had placed a
ReachOut.com sticker, postcard or badge in their local community. Those photos
were then voted on by the ReachOut.com Facebook community.

The campaign was a huge success, with 170 photos entered and 3,258 votes cast.
The winning photo collected 648 individual votes. It also proved a particularly good
way to engage young males, with 52% of those entering the competition being male
- a significant statistic given how difficult it is to engage young males around mental
health issues.

In addition to the high engagement with males, 25% of people who went to the
collateral form ordered the stealth kit (the average conversion rate for this kind of
campaign is usually between 2 and 6% so this highlighted how successful this form
of media was).

The reach of the media was not just limited to those involved in the competition
either. A minimum of 27,950 people saw the Stealth Campaign in their newsfeed
shared by friends – with the number probably being closer to 83,850 as anecdotal
evidence suggests young people’s average number of friends is three times that of
site average.

This highlights the extensive reach and value of social media as a tool for promoting
health, access to services and engaging young people.

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Part 3 - Case studies

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Part 3 - Case studies