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Help is on the line

November 1, 2008
by George E. Hargrave, PhD, ABPP, Deirdre Hiatt, PhD, Rachael Alexander, and Ian A. Shaffer, MD, MMM
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Telephone-based counseling is just as effective as face-to-face service

The application of telecommunications to healthcare, or “telecare” as it has become known, is rapidly emerging as one of the most popular forms of clinical practice.1-3 Initially applied to extending medical services (e.g., assessments, diagnoses, and consultation) to distant locations, telecare has been incorporated into counseling behavioral healthcare patients.4,5 Reported research has noted that telephone counseling is convenient for clients and provides them with a sense of anonymity and control. Data also have shown that telephone counseling enables clients to experience both global and specific improvements. Finally, ratings of satisfaction and outcome for telephone counseling have been similar to those reported in face-to-face counseling studies.2,5

Two of the major outcome studies in this area were conducted by Reese et al2 and Stephenson et al.5 Reese et al collected outcome data on participants who had received telephone counseling. One of their main findings was that outcome ratings of both effectiveness and satisfaction for telephone counseling clients were similar to those reported by face-to-face clients.6

Stephenson et al's study involved employee assistance program (EAP) clients. They compared results from telephone counseling cases (defined as those clients with fewer than 50% face-to-face counseling sessions plus those cases with no face-to-face counseling) with results from face-to-face cases (defined as those individuals with fewer than 50% telephone counseling sessions plus those with no telephone counseling sessions). EAP counselors who provided the treatment collected the outcome data. This study, like Reese et al's, found telephone and face-to-face counseling to have similar results.

MHN, a national provider of EAP services, initially designed and implemented its telephone assistance program in 1996. At that time, we augmented traditional treatment by offering a confidential, effective, early-intervention telephone-based program. This service was designed to address personal and work-related issues that impact productivity and overall functioning. The overwhelming need for services after the disastrous events on September 11, 2001, led us to extend our telephone services. We developed teleconference trauma-response groups that enabled us to overcome such barriers to service as geographic location and limited clinician availability.

We subsequently responded to the increasing demand for telephone services by developing a standardized consultation model that we could administer on a large scale. This model employed licensed clinicians who possessed broad clinical expertise, including clinical skills specific to solution-focused consultation. We developed a training manual that provided clinicians with the theoretical framework, context, and techniques for providing successful telephone services to clients. At present, approximately 100 new clients per month request and receive this service.

We designed a study to add knowledge in this area by comparing data from telephone and face-to-face counseling, controlling for population differences and time duration. In addition, clients were given the choice of receiving either telephone or face-to-face counseling, enabling us to examine any differences related to their choice. In 2007, we surveyed 78 MHN telephone counseling clients and compared them to similar individuals who received face-to-face counseling during the same period. Finally, the data on both client groups were collected after treatment by MHN staff using a mailed survey that used the same forms for both groups. The treating clinicians were not involved in data collection. The variables examined were the general types of presenting problems (relationship, job, psychological, or other), treatment outcome, and satisfaction with services.

Figures 1 and 2 illustrate the primary problems for which both telephone and face-to-face clients sought counseling. Although the frequency patterns are similar, the two groups differed significantly. Members who used telephone services were much more likely to have accessed treatment for psychological or job problems and less likely for relationship difficulties.

Figure 1.

Figure 2.

We have a standard process for surveying treatment satisfaction and outcome in our EAP. Satisfaction is assessed with a five-point scale ranging from 1 (“poor”) to 5 (“excellent”). Outcome is assessed with an 11-point scale ranging from -5 (“very much worse”) through 0 (“no change”) to +5 (“very much improved”). Results using these scales have been reported previously.7-9 These surveys were used to assess the treatment of the 78 EAP clients who received telephone consultation. The forms were sent to recipients four months after they accessed services.