Using technology in service delivery to families, children and young people
Using technology in service delivery to families, children and young people
Ken Knight, Cathryn Hunter
Overview
This paper provides an overview of how the innovative use of technology can add value to service delivery in organisations working with families, children and young people.
The main focus of the paper is five case studies that highlight how different organisations have used technology in creative and innovative ways to improve client and organisational outcomes. The case studies look at:
- a well-designed, interactive website;
- e-counselling and online mental health interventions;
- remote access solutions;
- applications (apps); and
- tailored solutions for online family dispute resolution.
This paper also provides a range of resources to stimulate thinking and guide implementation.
Key messages
- Most Australians have access to the Internet and use mobile devices to connect from anywhere, at any time. Research suggests that even isolated and marginalised groups are using technology in their everyday lives.
- For some groups (e.g., young people), technology may be their preferred method of communication.
- There appears to be a difference between how people are using the Internet (regularly, from anywhere, connecting with social networks, investigating services) and how some organisations are engaging with it (infrequently, in one direction).
- Technology works best when used to augment or improve existing services for clients, or to offer innovative approaches to existing services.
- Technology can be used in diverse ways for organisational improvement (e.g., remote access, staff training, professional development) or client services (e.g., online counselling, SMS appointment reminders, access to resources).
- Using technology does not necessarily involve large monetary investments or reinventing the wheel in terms of policy and procedures. Often it is a matter of adapting and refining existing services and policies to better suit the online world.
- Incorporating technology into services takes time, and will need continued assessment and refinement to be successful.
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Introduction
Whether it's connecting with others, finding information or accessing and engaging with services, "going online" has become an integral aspect of modern life in Australia. This paper aims to give an overview of how using technology innovatively can add value to organisations working with families, children and young people. The use of web-based technology can, for example, increase awareness of an organisation and engagement with a broader audience, aid dissemination of targeted information and messages to clients in a timely and cost-efficient manner, and directly improve client outcomes (see Box 1 for definitions of different types of web-based technologies).
Box 1: What do we mean by "technology"?
Throughout this paper we use the term "technology" to refer to a range of web-based and Internet-enabled platforms and tools. This section gives a brief overview of some of the most significant of these.
Web 2.0
The term "Web 2.0" describes websites that use technology to facilitate users' interaction and collaboration with each other, as well as to generate their own content and virtual communities. It is the current overarching context of the Internet, and sits in contrast to earlier websites that limited the user experience to the passive viewing of content. Examples of Web 2.0 include, but are not limited to, social networking sites, blogs, wikis, video sharing sites, and apps.
Social networking sites
A social networking site is a platform for building social networks and relationships among users. Most social networking sites are web-based, allowing users to interact over the Internet and share ideas, images, events and interests with their networks. Social networking sites often involve a recommendation system based on trust, and allow users to express their appreciation (or lack thereof) for particular content. Popular services include Facebook, Twitter, Google+, Tumblr, and LinkedIn.
Mobile devices
A mobile device is a portable computing device, usually featuring a touch screen. Most mobile devices have the capacity to run application software, known as "apps" (see below), and most allow Internet connectivity. Smartphones are a particularly common form of mobile device, as are tablet computers such as iPads.
Apps
An app refers to a program or piece of software designed and written to fulfill a particular purpose for the user, such as playing games, keeping a calendar or surfing the Internet. It may be self-contained or require an Internet connection. For the purposes of this paper, we will focus on apps that assist with the delivery of services to children and families; for example, apps that enable separated families to connect safely and positively (see the MyMob case study for more information). Most often apps are associated with use on a mobile device such as a smartphone.
Podcasts
A podcast is a type of digital media, usually consisting of a recorded audio file, that can be listened to by "streaming" via a website, or downloaded onto a computer or mobile device for later offline listening. The media may also be a video file, which are also sometimes called "vodcasts".
Webinars
A webinar is a seminar conducted over the Internet in real time, using specific software. Users generally log in to view the presentation slides (and sometimes the presenter) via their computer, and can listen to the audio via their computer or telephone. Users may ask questions or make comments during the seminar by typing into a text box and having them responded to by the presenter.
This paper is introductory in nature, presenting a brief overview of the current Australian context and benefits, concerns and barriers regarding the uptake of technologies. Introducing new technology into an organisation does not have to—and most often should not—involve replacing existing face-to-face or "offline" services. Rather, using technology to improve or augment existing services, or to offer new and innovative possibilities, can assist in the enhancement of service delivery, as illustrated by the case studies provided in this paper.
Limitations
Although research on the uptake and effectiveness of technology is growing, there is still relatively little empirical research outlining what works, particularly in service delivery, and most of the available research tends to focus on services for young people. Accordingly, the majority of the research referred to in the paper has been drawn from the youth services field; for example, the Young and Well Cooperative Research Centre’s resource Using Technologies Safely and Effectively to Promote Young People’s Wellbeing: A Better Practice Guide for Services (Campbell & Robards, 2013). This comprehensive guide explores some of the ways young people use technologies; provides examples of best practice for services and learnings from current practice; and supplies an overview of relevant guidelines and policies. While the focus on youth in this research may appear to limit the broad utility of the paper, many of the findings are still relevant and useful for practitioners and organisations working with a diverse range of clients.
This paper, being introductory and broad in nature, does not target the legislative or organisational requirements of specific sectors (e.g., child protection, out-of-home care), and all organisations should take into account their own contexts, client groups and strategic directions when considering the technologies discussed.
Technology use in Australia
Internet connectivity has increased rapidly over recent years in Australia, particularly for young people. The Australian Bureau of Statistics (ABS; 2012) reported that in 2010–11, 79% of Australians aged 15 years and older (including 96% of 18–24 year olds) had accessed the Internet in the previous twelve months. A recent national survey by Sensis and Australian interactive Media Industry Association (2012) reported that 98% of respondents had Internet access and 52% of those who had access used the Internet daily. The same study reported that access was almost universal for both regional and metropolitan locations across Australia, apart from Tasmania, where access was only slightly lower (94%).
A concurrent rapid increase in Internet access via mobile devices, such as smartphones and tablets, has increased users’ access to Internet services from any location at any time. As of December 2012, there were 17.4 million mobile phone subscribers with access to the Internet in Australia (ABS, 2013). Other Australian research, conducted by private organisations, suggests that users are connecting to the Internet from a broad range of locations, such as home, work, public transport or retail outlets (Google & Ipsos MediaCT, 2012). The same study found that 78% of Australian smartphone users had visited social networking sites such as Facebook, with almost half visiting these sites daily (Google & Ipsos MediaCT, 2012).
With the Internet being so widely and regularly used, it makes sense that opportunities exist for organisations to take advantage of this mode of communication. For some populations, such as young people, this may be their preferred mode of communication (Blanchard, Herrman, Frere, & Burns, 2011). However, research indicates that many organisations, particularly non-government agencies, are not taking full advantage of these opportunities (Wirth Consulting, 2012). The research suggests there is a gap between how people are using the Internet (regularly, from anywhere, connecting with social networks, and researching/purchasing a range of services and goods) and how some organisations are engaging with it (irregularly and in a limited manner). While most non-government organisations in Australia have an online presence, only around a third are using social networking sites such as LinkedIn and Facebook (see Box 2), with even fewer using video-sharing sites (e.g., YouTube) or blogs (Wirth Consulting, 2012).
Box 2: Just because we can use social networking sites, should we?
Social networking sites, such as Facebook, Twitter, LinkedIn and Google+, have grown enormously in popularity and use over recent years. They can provide a method for networking and communicating with other like-minded organisations to encourage information sharing and collaboration. They can also provide a way to keep clients updated and disseminate an organisation's message to a broader audience.
These services are simple to set up but accounts do require ongoing attention and investment in time and resources if they are to be effective, engaging and relevant. Assessing client use is fundamental, for while Australians in general are avid users of social networking sites, some groups, such as the elderly, may not be using this technology as regularly, or with the same enthusiasm, as others.
ReachOut.com Professionals Connecting Our Worlds educational module <reachoutpro.com.au/professionaldevelopment/educational-module-overview.aspx> provides a step-by-step guide for assisting professionals to set up profiles/accounts on Facebook and Twitter, giving users a range of important points to keep in mind during this process.
Examples of good policy documents that can be used when setting up social networking sites can be found in the Resources and further reading section at the end of this paper.
Benefits and challenges
This section provides a brief overview of some of the benefits and challenges regarding the use of technology in service provision. There is a range of quality resources available that offer further information on managing risks and concerns, as well as potential methods for resolving these (see the Resources and further reading section for more information). The case studies presented below also illustrate some of the factors considered by these organisations and how they were resolved.
There are many reasons organisations or individual workers may be reluctant to engage with technology. Fear of the unknown or a risk-averse organisational culture may lead to a lack of uptake of technology. Workers may feel they do not have the skills required to utilise technology or may lack an understanding of how their clients use it (Stephens-Reicher, Metcalf, Blanchard, Mangan, & Burns, 2011). Organisations may be unaware of what technologies are available and how they may best be used to improve services and client outcomes. Box 3 presents an overview of some of the benefits and challenges associated with providing online client services.
Box 3: Benefits and challenges associated with online client services
Benefits
- Services can be more accessible, for example, for people living in rural or remote areas (although this is limited by bandwidth and availability of carriers), single or at-home parents, people with a disability, people at risk of violence or intimidation, people with agoraphobia, people who are relocating but want to work with the same organisation or therapist, or shift workers.
- When email is used, the written word may be more expressive for some, enabling clients to think through and reflect on content before sending.
- Clients may feel they have more anonymity, privacy and convenience, often from the comfort of their own home.
- Online services offer enhanced self-reflection, in the case of asynchronous (i.e., not in real-time) communication. Clients can revisit communications from practitioners and can think things through in their own time.
- Practitioners can respond to specialist areas of concern, regardless of geographical location.
- Services may be available at any time of day (where service models permit).
- Services may be particularly viable, and even preferable, for "tech-savvy" adults, young people and children.
- Practitioners' time may be freed up for other clients, as the number of face-to-face sessions are reduced.
- Services can be more flexible.
- Services may be more affordable.
Challenges
- Practical and technical concerns include clients and/or staff lacking the required skills or being computer illiterate. Older people and those from different cultural and linguistic backgrounds, for example, may feel less comfortable using online services.
- Online services may lack visual and non-verbal cues, which may lead to misunderstandings. Without face-to-face contact, the practitioner may not be able to observe how couples or family members interact.
- There may be time delays between contact and response in asynchronous communication.
- There is a diminished capacity to deal with immediate crises.
- It may be difficult to verify the credentials of the practitioner, or that the practitioner and/or client is the person being engaged with online.
- There may be problems with technical failures, limited access to the communications infrastructure, and/or unreliable Internet connections.
- There are security risks, such as email being misdirected through address errors, messages being intercepted by hackers, or data becoming corrupted or stolen due to computer programming errors.
- Clients may expect online services to be free.
- Services need to address legal and ethical issues, including confidentiality and privacy.
- There may be a lack of practitioner training in the specific requirements of providing online services.
Adapted from sources: Abbott, Klein, & Ciechomski (2008); Bischoff (2004); Casey & Halford (2010); Cavanagh & Shapiro (2004); Griffiths, Farrer, & Christensen (2007); Hunt, Shochet, & King (2005); Pollock (2006); Recupero (2005); Rochlen, Zack, & Speyer (2004); Syme (2004).
Issues for professionals
An Australian study of youth health workers' attitudes found that although many felt technology would help them to have a greater influence on young people's mental health, only 9% actually used their work computer to facilitate direct engagement with young people (Blanchard et al., 2012). Most of the workers expressed concerns around young people's privacy, keeping infrastructure secure and ensuring access for young people already experiencing isolation and marginalisation. The workers also had relatively low awareness of evidence-based e-mental health promotion services and interventions. The authors suggested that there was a "digital disconnect" between how young people used technology and the youth health workforce's underutilisation of these potential tools.
Staff may require training to ensure they are skilled and comfortable enough to fully engage with technologies that may help them in their practice and provide enhanced services to their clients. It should also be noted that digital literacy is likely to increase organically as staff become more familiar with, and have the time and space to explore, new and emerging technologies in the workplace.
Issues for clients
Client access to technology is a consideration for many practitioners, particularly those working with vulnerable groups already experiencing marginalisation or isolation (Blanchard et al., 2012). There is evidence to suggest that some groups - such as Indigenous Australians, those from culturally and linguistically diverse communities, refugee young people, those with a disability and individuals with low levels of educational attainment or literacy - are less likely to have access than others (Stephens-Reicher et al., 2011). In addition, those living in remote or disadvantaged communities may be less likely to have access to quality technology; for example, they may have old hardware or a poor Internet connection.
Other research has suggested that although there may be differences in quality of access, marginalised young people (e.g., carers, those with a disability, socially isolated people) are engaging with technology in diverse ways (Blanchard, Metcalf, Degney, Herrman, & Burns, 2008). For example, young people with few offline friends may use the Internet to increase their social networks, or young people with disabilities may seek information about their disability and available support services. Facilitating positive engagement with technology for clients may create a pathway for building support and knowledge that has previously been unavailable or difficult to access in traditional ways.
As with any service, there is no "one-size-fits-all" solution. Technology-based services may be more effective as an adjunct to other face-to-face or offline offerings (Stephens-Reicher et al., 2011; Thomson, 2011) and there may be some target groups for whom online services are not suitable. As with any service, organisations will need to test and refine their technological endeavours to ensure that they are effectively meeting client needs.
Client privacy and safety
Common concerns about adopting technology often centre on client privacy and safety, and the blurring of professional boundaries, as technology enables the potential for 24/7 access (Berry Street, n.d.; Blanchard et al., 2012; Howard, Friend, Parker, & Streker, 2010; ReachOut.com Professionals, n.d.). Many of the risks and concerns relating to online offerings are similar to those already faced offline; for example, where practitioners are available to clients via mobile phone. Practitioners should set clear limits and expectations around their availability and clearly explain policies relating to critical events to clients. Risk assessments and policies are necessary for online activities, just as they are for offline activities (Youth Action and Policy Association [YAPA], 2011).
Existing organisation policies regarding offline ethical behaviour, client engagement and privacy can usually be amended to include online activities. See the Resources and further reading section at the end of the paper for help with drafting policies and procedures for online services.
Case studies
The five case studies below highlight how organisations have used technology in creative and innovative ways in order to improve client and organisational outcomes. These case studies outline the context in which the technology was developed, barriers or risks that the organisations faced in the implementation process, and how the technologies have benefited the organisations and their clients. The case studies include the outcomes as described by the interviewees, and refer to formal evaluative evidence where available.
While these case studies are provided as illustrative examples, we recognise that there are many other cases of organisations using technology creatively to meet the needs of clients.
Raising Children Network: A well-designed, interactive website
Background
The Raising Children Network (RCN) is an example of a suite of Web 2.0 resources compiled on a website designed to meet the specific needs of users; in this case, Australian parents and carers and the professionals who work with them.
RCN is an online parenting information platform produced and maintained collaboratively by a wide range of stakeholders and content partners.
In 2004, the Australian Government commissioned the Parenting Information Project to find out how parents access information and what issues and gaps existed. This research was conducted by the Centre for Community Child Health and the Parenting Research Centre.
One of the recommendations that arose from the Parenting Information Project was the development of a parenting information website that would be high-quality, accessible, comprehensive and centrally administered. Following its successful tender application, the Raising Children Network was commissioned by the Australian Government to develop the national parenting information website that is now known as.
How does it work?
RCN offers content and features through website and mobile platforms, DVD and podcasting. It provides parents, practitioners and those who care for children with reliable information on pregnancy and parenting, from newborns to teenagers. Information is presented in text, graphic, interactive and audiovisual forms to suit different levels of literacy and learning styles.
Based on ongoing research into how parents seek and use information, RCN resources are developed to be:
- portable - offering up messages and support in multiple modalities, including making the entire website available as a smartphone-friendly resource;
- reliable - employing content review and maintenance processes and quality assurance so that all content reflects current knowledge, evidence and best practice; and
- useable - producing and presenting information in forms that are easy for users to relate to, consume and, most importantly, make use of in their everyday lives.
It is especially important that the site be useable and cater to multiple learning styles, given the range of different levels of literacy among parents. Considerations include parents' level of digital or web literacy and access, cultural and linguistic diversity (including diversity within and across Indigenous families and communities), visual or non-visual learning styles, parents with low literacy and parents with visual, hearing or cognitive limitations. In addition to selecting the appropriate information format to suit users, partnering with stakeholders to tailor the messages and presentation is an important part of RCN's approach to usability. Increasing the inclusiveness of information is an ongoing part of maintenance and development across all RCN platforms.
RCN is highly responsive in the way in which it develops and disseminates its content. For example, RCN's relationship with parents has evolved to include Facebook, Twitter, online user feedback processes and even crowd-sourcing - the practice of obtaining ideas, content or resources by soliciting contributions from a large group of people (in this case, parents) and especially from the online community rather than from traditional sources. These interactions inform content priorities and key messages.
Partnerships and co-development are central to creating RCN content. RCN scopes, develops and reviews new articles, videos or interactive content in collaboration with subject matter experts and stakeholders. For example, in developing a new e-learning resource about infant sleep, RCN worked with clinicians and researchers to adapt, trial and test a previously existing support program as an online intervention.
While care is needed when adapting knowledge translation practices and processes for a digital platform like RCN, the RCN team found there were already existing approaches and processes to draw on when developing their plans for using digital technology. For instance, RCN's approach to quality assurance is based on peer-review processes for establishing reliability, authorship and currency. RCN standards and safeguards for interacting with parents are informed by existing human research protocols and ethical standards.
Digital media has also required RCN to break new ground. Constant monitoring and flexibility in the approach to using digital media has enabled RCN to adapt to the moving target that is parents' changing information needs. Also, because the online consumer experience requires specific approaches to content development and design, RCN uses purpose-specific style guides and web optimisation approaches to ensure accessibility and usability for the user. See Box 4 for more information on web accessibility.
Bumps in the road
When RCN began developing web-based parenting information, Australia was just beginning what has been a rapid integration of digital communications. Managing the digital divide through flexible information formats, including printable and watchable content, is one challenge, but keeping up with new platforms and changing information-seeking habits is just as important. As previously discussed, parents and professionals in Australia now use a wider spectrum of technologies and behaviours in their information-seeking than ever before. Anticipating new platforms and maintaining or retiring others is a constant challenge to the objective of remaining relevant to the RCN audience.
Future directions
The practice of embedding reliable content from the RCN website within parent support services is a key focus in the coming years. RCN recognises the importance of engaging with all stakeholders to ensure that developments and technology are genuinely useful. This means responding not only to what parents want and need, but also to what professionals who work with parents want and need. RCN consults widely with support services to find ways to assist them in their work, through the purposeful use of RCN resources.
Take-home messages
Developing and maintaining effective use of technology is not about finding what works and sticking to it; rather, it is about anticipating and adapting to change. Investing from the beginning in the most robust and flexible systems you can allows you to adapt. Keeping a strong focus on what is meaningful and useful to parents and families provides a compass. Great technology will not make up for poor content, nor will great content reach people unless it is delivered in a useable, relevant and accessible way.
Key messages
- Keep the content reliable - Technology can provide an effective platform to disseminate easily updated, reliable information from credible sources.
- Keep it accessible - Technology provides ways to meet the varying needs and levels of literacy of parents in consumable forms, though you will need to analyse your clients' needs and tailor the content to suit them.
- Don't reinvent the wheel - Use and adapt existing policies and practices for online use.
- Do your research - Before you start, make sure you assess clients for readiness.
- It's a process - Keep doing your research, assess effectiveness and be ready to embrace change and do things differently.
MoodGYM: E-counselling and online mental health interventions
Background
E-counselling and Internet-supported mental health interventions have been widely used since the mid-1990s. Many have been found to be effective - often just as effective as face-to-face interventions (see Barak, Hen, Boniel-Nissim, & Shapira, 2008, for a meta-analysis of 92 studies). The Australian Psychological Society offers detailed information on these interventions, including standards and guidelines (see <www.psychology.org.au/essentials/etherapy>). Many online psychological interventions and services are offered in Australia, including ReachOut.com, Kids Helpline and Mensline. These types of services can be accessed as standalone initiatives or may be used in conjunction with face-to-face counselling and other offline services.
The MoodGYM Cognitive Behaviour Training (CBT) Program was created by staff - including researchers, mental health experts and IT specialists - at the Centre for Mental Health Research at the Australian National University. The site was originally released in 2001 and was then revised and upgraded in 2008. MoodGYM is an interactive web intervention based on CBT principles, designed to reduce or prevent depression.
The researchers at the Centre for Mental Health Research identified that there was a problem with access to psychological services for mental health. Although CBT had been found to be effective in reducing depression, services could be prohibitively expensive. Individuals could also struggle to find a suitable clinician, and for those living in rural and remote areas travel could be difficult and expensive to arrange. Others were not accessing face-to-face services due to the perceived stigma attached to mental health problems and help-seeking. This was a significant issue for young people, and particularly for young men. Upon identifying these gaps in mental health service delivery, the researchers worked to come up with an evidence-based solution.
Prior to the creation of MoodGYM there was little available in the way of online solutions for building mental health resilience. MoodGYM was therefore developed to aid in the prevention of depression in young people, and has been used effectively in public health campaigns and classrooms (Calear, Christensen, Mackinnon, Griffiths, & O'Kearney, 2009; O'Kearney, Kang, Christensen, & Griffiths, 2009; Powell et al., 2013). An international study found that people with no depressive symptoms reported increased mental wellbeing compared to a control group after using MoodGYM (Powell et al., 2013).
Thus, MoodGYM fills a service gap by providing an effective solution that could be accessed anonymously, from anywhere and in the client's own time. MoodGYM also provides choice and flexible access for consumers who might prefer this method of service delivery, and for those who want to use it in conjunction with traditional face-to-face therapy (Sethi, Campbell, & Ellis, 2010).
As a research institution, the Centre for Mental Health Research worked to ensure that the design of the solution allowed access to other researchers worldwide for evaluation purposes. The increasing evidence base showing that the online intervention has been effective in decreasing or preventing depressive symptoms in adults and young people has encouraged the broader uptake of the solution. Currently MoodGYM has approximately 650,000 registered users in 220 countries.
Regarding policies and procedures, the Centre for Mental Health Research drew upon strong protocols around privacy and ethics when designing MoodGYM. Although policies were based upon existing face-to-face therapy principles, another layer that drew from information technology (IT) processes and systems needed to be incorporated, and input from IT specialists was essential in ensuring that the solution could support the processes and policies required. The development and implementation of the solution has therefore been a multidisciplinary endeavour, with IT specialists, clinicians, researchers and academics working collaboratively to ensure that ethical principles and policies are supported.
How does it work?
The program includes five modules, an interactive game, anxiety and depression assessments, downloadable relaxation audio, a workbook and feedback assessment (for further information see the MoodGYM FAQ page). Registration is free and users can work through the program at their own pace.
Regarding accessibility for specific groups, MoodGYM was designed to be broadly accessible and has therefore not been tailored to meet the needs of specific groups. Part of the aim of the solution is to reach those for whom physical access to face-to-face services is difficult, so information on whether participants live in rural or remote areas is collected. So far, 24% of MoodGYM users worldwide have been from rural or remote areas.
Several nations have wanted to deliver MoodGYM in their own language, and the program has so far been translated into Norwegian, Chinese and Dutch. It was crucial to ensure that the translations were reviewed by CBT practitioners to ensure that content was culturally acceptable and appropriate, without any loss of the intervention's effectiveness. MoodGYM staff therefore developed a translation web interface to aid communication with people around the world who are looking to translate the intervention into their own language.
Bumps in the road
Some clinicians initially felt an online intervention went against their ideas of practice, and some would not take it up - but many have. The model of online intervention was not designed to take the place of existing face-to-face services, but rather to fill the gap that exists for those who can not, or will not, access face-to-face services. Although there may have been some concern from clinicians initially, the well-documented evidence base demonstrating MoodGYM's effectiveness has largely alleviated these concerns. Many clinicians are now suggesting MoodGYM in conjunction with face-to-face therapy, or offering it as an interim solution for people on their waiting lists.
Future directions
Researchers have created a sister site for MoodGYM, called E-couch, that includes five discrete sub-programs for risk factors for: depression, generalised anxiety and worry, social anxiety, relationship breakdown, and loss and grief. The researchers continue to undertake large-scale evaluations of these automated programs in different population settings around the world, and also coordinate an online peer-to-peer support group for people who have experienced mental health issues. Current projects in development include technological solutions for decreasing stigma and increasing help-seeking for mental health issues in the community.
Take-home messages
Staff from the Centre for Mental Health Research report that the creation of these types of technological solutions requires ongoing multidisciplinary collaboration; it is not simply the case of having an idea and getting a web company to create a website. Although you might come up with what you consider to be a comprehensive list of website requirements, there may be a range of requirements that are implicitly understood or assumed that you may not realise you need to explicitly specify. Collaboration between researchers, academics, clinicians and IT specialists is key to ensuring that a complete and effective solution is developed.
For the team at the Centre for Mental Health Research, a major learning from the project has been the importance of building an effective inhouse team. This can be difficult, given the way many projects are funded, but for them it meant input from all involved resulted in robust multidisciplinary outcomes.
Further resources
Key messages
- Technology can offer an effective alternate mode of delivery, rather than replacing an existing service - If a gap in traditional service provision has been identified, technology can often be used innovatively to fill it.
- Increase accessibility - Adopting technology can increase access for groups who may otherwise not use mental health services: for example, those in rural or remote areas, young people, and particularly young men.
- Collaborate - This is pivotal at all stages of the project, with various specialists (IT, clinicians, researchers) adding their specific expertise to help create a complete picture.
- Don't reinvent the wheel - Policies can be adapted, but it is important to collaborate with IT to ensure that the technology can support your specific policy and procedural requirements.
Client Portal and Online Learning: Remote access solutions
Background
Investing in technology can provide a wealth of benefits for a large, geographically diverse organisation, especially one that delivers a range of services to clients with a variety of needs. It can also provide efficient alternatives to more traditional methods of record keeping and service delivery. The model devised by Relationships Australia South Australia (RASA) exemplifies how an investment in a robust technological solution can benefit a large organisation directly, and ultimately improve client outcomes.
RASA uses a variety of web-based technologies to engage and support clients, as well as to provide online learning for professionals. A new client portal that will enable secure and efficient communication with clients and RASA staff is currently being developed, and is scheduled for release in early 2014. In addition, RASA has offered online learning for professionals through the Australian Institute of Social Relations since 2009. As a geographically diverse organisation, this use of technology successfully enables streamlined access to information and resources for clients and professionals across Australia.
RASA offers a range of services for families and children, and has worked to foster a strong culture of innovation and an ongoing organisational investment in technology in order to continually improve its products. The starting point for all technological innovation has been an analysis of client needs, and how processes can be effectively implemented to improve outcomes and promote the safety and wellbeing of families and individuals. Enabling easy access to clients with specific needs, as well as professionals working throughout South Australia, is a prime requirement of the organisation.
For a number of years RASA has collaborated with a solution provider who has developed an integrated client information and case management software package for human services. An outcome of this collaboration has been the initiation of a roadmap to develop a new online portal for secure, streamlined communication with clients.
Since 2009, RASA has also offered online learning for professionals. Their approach begins with an evidence-based framework that encompasses principles of adult learning, as well as national vocational education and training assessment guidelines, the technical skills of students and the information and digital literacy skills required for the courses offered. The learning management system is the open-source Moodle platform, which allows for a range of resource and activity types to be used. As the largest open source education project in the world, Moodle has a thriving community of passionate users who create smaller programs called plugins that introduce new capabilities.
How does it work?
At the beginning of 2014 RASA's solution provider is planning to release a new, secure client portal, accessible from a computer or mobile device, that will support direct engagement for agencies such as RASA. The portal will allow RASA staff and their clients online interactions, including:
- email contact with case workers and practitioners;
- online chat and discussion;
- SMS reminders and notifications;
- homework and links to relevant resources and additional support;
- frontline screening questionnaires; and
- the ability to digitally sign and record official documents.
The new client portal will therefore provide a range of augmentations and extra tools to facilitate better outcomes for RASA clients, especially considering the ease of access for clients living in rural or remote areas. Offline policies governing client–staff interactions and security will be adapted to the online environment, culminating in a new policy document that underpins the client portal.
In addition, RASA, through the Australian Institute of Social Relations, delivers online training to a range of services and organisations. The institute's online programs involve an intensive face-to-face component used especially for practicum aspects of each program and for assessment role playing.
Commonly provided online training includes:
- Diploma of Financial Counselling;
- Graduate Diploma of Family Dispute Resolution; and
- Certificate IV in Training and Assessment.
These programs are tailored to meet specific organisational needs, and are designed to be responsive to individual requirements, including varying levels of technological literacy. The Institute has also endeavoured to “go green”, with students provided with data storage devices that include all essential and required documents in an accessible digital format. Expanding the number of programs that use online platforms for the delivery of education, information and assessment also increases the accessibility of the training, as well as reducing the use of paper and other resources.
Bumps in the road
While some clients and professionals have expressed reservations over the use of technology, including concerns over varying levels of digital literacy and confidence in the online realm, these have been addressed in a generally positive way. Internally, a strong change methodology focus at RASA, combined with flexible software, has allowed the technology to be adapted to meet the disparate needs of both staff and clients. Ongoing training has also helped ameliorate concerns, and traditional face-to-face services are always available for those who do not, for whatever reason, feel comfortable using online services.
Future directions
RASA has asked their solution provider to investigate linking with video/voice for integrating online counselling in the new client portal. A consultative, culturally aware approach will also be applied to monitoring the use of the portal, with additions and augmentations added as required.
Take-home messages
Sandra Vallance, Director of IT and Marketing at RASA, encourages services and organisations to take the following points into consideration:
- Invest in good process, and then invest accordingly in technological solutions to meet the needs of clients and staff. Being smart about the investment in technology means it won't blow the budget, and can be highly flexible and adaptable.
- Hiring appropriately skilled staff, or contracting experts, is the most successful way forward.
- Technology projects such as the online portal impact the entire organisation, touching every individual in the minutiae of their day-to-day working lives. Cross-organisation projects such as this therefore require extensive collaboration, agile, network-like structures and a set of processes that strongly consider project management and change management principles.
- It is very important to re-visit and review the extent to which the benefits hoped for were realised from the investment in technology. If they haven't, was it the approach, deficiencies in the technology, or insufficient training? A continuous improvement approach is necessary.
- Finally, what new opportunities does success in implementing the technology now afford? How can previous investments in technology be leveraged for the next opportunity for growth or improved service delivery?
Key messages
- Think accessibility - If yours is a geographically diverse organisation, technology can allow clients and practitioners ease of access to resources and support.
- Add value - Technology works best as an augmentation, to fill gaps and tighten an approach, rather than replacing an existing service. Some clients will still prefer face-to-face interactions.
- Don't reinvent the wheel - With a little work and close collaboration with software designers and IT professionals, existing policies are often easily adapted to suit the online space.
- Do your research - Make sure you assess your clients and staff for readiness, be flexible in accounting for varying technological literacy, for both clients and staff, and provide training, tips and support for those who aren't confident.
MyMob app: Providing mobile support and networking
Background
With increased access to the Internet from mobile devices such as smartphones and tablets, there has been a massive increase in the development of applications (apps) that provide additional functionality to these devices. There are various general and mental health and wellbeing apps available, with many being free to download. Most of these have not been empirically evaluated, however, and their effectiveness remains unclear. Benefits of apps include accessibility for diverse audiences, from any location at any time (e.g., via smartphone), with a multitude of functions. For example, SuperBetter is an app that aims to increase personal resilience; Girls Gotta Know offers young Tasmanian women access to free legal information; and the Raising Children Network allows users to download children's songs to a mobile device in order to encourage parents to sing with their children.
The MyMob app is a new resource for engaging families who have experienced separation. It is a free, fun and practical tool that fosters positive communication in an accessible format, enabling families to connect in a safe online environment, free from issues that can arise in direct communication.
drummond street services (including Stepfamilies Australia), Interrelate and Deakin University have an ongoing collaboration in family research, program development and evaluation. The MyMob project was developed in response to findings from a range of research and community engagement projects with families who change as a result of a relationship separation.
A number of risks are associated with parental separation, including mental health problems, alcohol and other drug abuse, high conflict and family violence. Separated parents can also experience high levels of stress around the required level of ongoing contact when parenting is shared, particularly in the context of new intimate relationships. Interactions between former and new partners, and with children and step-children, can be complex.
Innovative, non-judgemental interventions that provide and encourage safe and supportive communication between family members within their new living and parenting arrangements can ameliorate these risks. As Australians are increasingly using mobile technologies, and as drummond street services and Interrelate have successfully delivered online resources and services to clients in the past, an app was viewed as the logical next step in a suite of resources for changing families.
MyMob recognises that families who experience separation and re-formation often need to learn new ways of being and communicating. Family members are therefore viewed as learners, and the app is a direct response to learner needs, looking at the state of the learner, and making simpler the difficult task of re-learning non-conflictual ways to communicate.
How does it work?
As families change (post-separation) and/or expand (in the case of step- or blended families), the MyMob app provides a technological framework that connects family members to support, information, resources and tools to promote positive communication, parenting and family functioning. The app contains a family diary, so that families can see - at a glance - the monthly parenting schedule of individual events, such as extracurricular activities, and responsibilities, including who will collect the children from school or take them to events. Adults, including grandparents, can communicate with each other via drop-down comments, providing an avenue for communication that is transparent, straightforward and stress-free. The app also enables children to engage with siblings who live elsewhere. Tip sheets are available to download via the app, and links to peer and professional support are accessible at any time.
The core principles guiding the development of this technology remain the same as with any family intervention provided by drummond street services and Interrelate, and have been successfully adapted to an online environment, in close collaboration with the software developer. The safety and wellbeing of families is at the heart of all elements of the app's design.
Why an app? Letting go of the fear of exclusion
Instead of asking “who are we excluding?” from the app, the developers turned the question around by asking who might be excluded from more traditional face-to-face services. Indeed, men involved with drummond street services and Interrelate have indicated that they value the anonymity afforded by online tools, and even prefer to seek information and support online. The app also allows extended family members, including grandparents, to cooperate and communicate positively.
It is important to remember that the app is a tool, and not a substitute for other services relevant to families who have experienced separation. drummond street services and Interrelate therefore view the app as an enhancement to the one-on-one and group support offered by both organisations. The organisations understand that families are diverse and dynamic, and their needs are not fixed. Effective communication between family members as they try to negotiate these changing needs is therefore key to positive outcomes for everyone. MyMob allows co-parenting arrangements to be a “work in progress”, recognising that families require flexibility as their situation develops and changes over time.
Future directions
An evaluation is planned with a pilot group of families, and a range of opportunities are being explored for expansion based on existing family support services, including tailored resources for African-Australian families.
Take-home messages
Rachael Hood from drummond street services recommends letting go of the fear of exclusion when innovating - that is, not worrying about who will not benefit from a new way of doing something - and instead actively seeking out ways of engaging with groups who are missed in more traditional services. Having the ability to explore client needs in innovative ways is therefore essential. Take a chance, consider your clients as allies, and you can both grow together.
Key messages
- Safety focus - Again, this technology was developed to improve the safety and wellbeing of clients. By providing new and secure ways of communicating, issues and stresses in face-to-face interactions can be overcome.
- Think accessibility - Some clients, particularly men, may prefer online methods of communication, and it allows clients to engage at any time, from almost any location.
- Don't reinvent the wheel - Offline policies can be easily adapted, with collaboration from software developers.
- Do your research - Assess your clients for readiness, and ensure the technology is something they need and want to use.
- Let go of the fear of exclusion - Focusing too strongly on who may be missed in new approaches can hold an organisation back, especially if traditional services are being maintained. It is therefore best to use technology to enhance face-to-face services, rather than replace them altogether.
Online family dispute resolution: Tailored solutions
Background
Although some technologies may be introduced into an organisation at relatively low cost or with few resources, there are others that require extensive investigation, investment of resources and upfront costs. These more complex types of technology may respond to an unmet need, and can lead to organisational efficiencies and savings in the long run, as well as positive outcomes for clients. One such solution is the online family dispute resolution service provided by Relationships Australia Queensland (RAQ).
RAQ has provided online family dispute resolution since 2009. Building upon the success of the national Telephone Dispute Resolution Service, operated by RAQ since 2007, the online service offers a uniquely accessible, relevant and user-friendly online alternative to traditional forms of mediation.
In 2009 RAQ was funded by the Commonwealth Attorney-General's Department to conceptualise, develop and evaluate online family dispute resolution capabilities, including video-conferencing. Online family dispute resolution was not designed to replace the existing telephone service, but rather to add to its reach and functionality. Although initially there were no plans to extend the project beyond the scope of the original funding agreement, as of March 2013 it has been reinvigorated and reinstated - with all Telephone Dispute Resolution Service staff now trained in the online system.
The policies and procedures used in the online service are based on principles and standards that had been developed by RAQ for family dispute resolution more broadly, and the telephone service in particular. The core principles remain the same, and have been successfully adapted to an online environment, in close collaboration with the software developer.
Subsequently, a variety of safety measures have been incorporated into the system to ensure that the information shared is kept secure, and that the confidentiality of the participants and family dispute resolution practitioner is maintained. These include the use of a firewall, passwords, and masking the phone numbers and location of the clients, as well as the surname of the practitioner.
How does it work?
Clients are usually referred to the Telephone Dispute Resolution Service if they live in a remote or rural area, or if one of the parties is overseas. The initial screening process involves a telephone interview to assess clients' suitability for the online service, including whether clients have access to a computer, the Internet and a private space in which to conduct a session. Questions are also asked to assess client readiness, including comfort with online services and computer literacy. For clients who do not meet these requirements, the telephone service is always there as an alternative. The preliminary screening also allows hostile and distressed clients to be referred to a more traditional service.
Online family dispute resolution is a web-based solution that “provides a safe, secure online environment in which a family dispute resolution practitioner may actively facilitate a mediation session” (Relationships Australia, 2011). Thus, an online mediation proceeds as a face-to-face family dispute resolution normally would, but the difference is that clients log in to the online system via their computer, and also connect by phone (ensures that if one system “goes down” the session can still continue).
A range of features have been incorporated into the technology to enable effective family dispute resolution:
- video streaming, so that each participant can safely see and communicate with the other;
- screen features, including small windows (pods) that can be scaled, resized and repositioned and hold a variety of information;
- visual sharing of information, including document sharing, online demonstrations and a whiteboard feature; and
- the ability to record notes that can subsequently be emailed to the practitioner.
An evaluation report (Relationships Australia, 2011) outlined a number of ways in which the online service offered clear benefits when compared to the telephone service. Clients found the online service more convenient than other forms of family dispute resolution, and appreciated the added engagement and increased rapport that the use of webcams enabled. The ability to use “break-out rooms” for private chats between one party and the practitioner was also a major improvement; in the telephone service, the session would be terminated if a private discussion was necessary. Additionally, the online service allows agenda points and agreements to be discussed collaboratively on screen, and the sharing of documents for straightforward record keeping.
Aboriginal and Torres Strait Islander clients use the service, and online family dispute resolution has been particularly successful with this population. Community consultation in the development phase ensured that the online system was as culturally appropriate as possible. Online family dispute resolution may be particularly useful for Aboriginal and Torres Strait Islander families, as many live in rural or remote areas, and after relationship breakdown one partner often relocates to another area.
Bumps in the road
An evaluation of the service revealed that most clients still prefer face-to-face family dispute resolution, and this is always still an option, as is the telephone service (Relationships Australia, 2011).
As with any foray into uncharted technological territory, there were initial concerns from practitioners and clients about embarking on an unfamiliar approach to family dispute resolution. However, these concerns have been allayed through increased familiarity, and a system that is robust and easy to use. Interestingly, the technology itself provided most of the answers to the issues raised, and has proven flexible enough to accommodate the various needs of both clients and practitioners. Furthermore, ongoing training in the technical specifics of the online service has been implemented for practitioners, and an instructional video has been produced.
Future directions
While the service is not currently supported on mobile devices, this is on the cards for future development. Interpreters have not yet been used, as this was outside the scope of the original project. However, interpreters are used in the telephone service, so there is scope to pursue their use in the online system, as well as AUSLAN interpreters via webcam.
Take-home messages
Mark Thomson, Director of Virtual Services at RAQ, encourages services to be innovative and to take calculated risks. However, if investing in infrastructure, Mark advises to do your research properly, and that good technical infrastructure should be flexible and applicable for other uses in case the initiative in question doesn't go as planned.
Key messages
- A safe and secure alternative - Using technology allows safety and security features to be practically implemented.
- Think accessibility - Clients can log in from anywhere in the world, and those with special needs can be catered for. Indigenous communities have given useful feedback, and are using the service.
- Think flexibility - The technology itself provided the answer to most issues, and ongoing training was simple to set up.
- Technology can be an effective alternative mode of delivery, rather than replacing an existing service - If a gap in traditional service provision has been identified, technology can often be used innovatively to fill it.
- Don't reinvent the wheel - Policies can often be adapted simply and effectively.
- Do your research - It is imperative to do your research and assess your clients and staff for readiness (see Box 4 for more information).
Box 4: Considering web accessibility
Have you considered web accessibility? Web accessibility refers to a range of measures to make accessing online information easier for people with a disabilty. It is important because:
- Almost 20% (or one in five) Australians have a disability.
- One in ten men have some form of colour blindness.
- Accessible websites and technology make using the Internet easier for people with disability.
- Two of the biggest groups assisted by improved accessibility are older people and those with low literacy skills.
Considerations in this area are important because they allow people with disability to:
- access information like everyone else;
- interact with others without being categorised as being disabled; and
- undertake activities that they may not otherwise be able to do.
If you're new to accessibility, a couple of good places to start are:
- Australian Human Rights Commission - What is accessible web design; and
- W3C - Introduction to web accessibility.
Conclusions
It is worth reiterating that not every technology will suit every organisation. However, this paper demonstrated that the inherent flexibility and diversity of the technological solutions on offer means that it is more than likely there will be a good fit for you and your organisation. As with any business requirement, planning, testing, re-testing and refining will be required to ensure that both organisational and client needs are being met.
Introducing technology does not require throwing out what your organisation currently does, or reinventing the wheel in terms of policy and procedure development. Technology can be effectively used to augment and improve existing organisational or client services. It can also be used to fill a gap in service delivery or offer new services. In terms of policies and procedures, it may be that offline policies may simply need amending to suit the specific requirements of the online world. Many of the concerns that are faced online are similar to those experienced offline.
Finally, most Australians, even many from vulnerable and disadvantaged groups, now have access to the Internet and are using it regularly and comfortably to communicate, socialise and investigate services and products. As access will only continue to increase over time, it is worth considering how harnessing some of the benefits of new technologies can improve and expand services for families that will allow clients and practitioners to connect easily and efficiently, engage and ultimately benefit from improved outcomes.
As this is an introductory paper, we are keen to hear your views so that we can address different issues in forthcoming resources. Please let us know what you need more assistance with, or, alternatively, how you’ve approached the integration of technology in your practice, and the lessons you’ve learnt along the way.
Resources and further reading
These resources provide a starting point for organisations considering the use of web-based technologies, or looking at innovative ways of delivering services.
Connecting Our Worlds
ReachOut.com Professionals has developed a practical and user-friendly online education module—Connecting Our Worlds—to assist professionals to understand and integrate technology into their practice. The free module consists of four parts designed to be used together, and is an excellent first port-of-call for professionals considering a more robust foray into the online world. Sections include use of technology; common sites, platforms and programs being used; and steps to integrate technology into practice. The detailed Ethics and Boundaries module is especially useful when adapting your existing policies for online use, with guidance given in the areas of maintaining professional boundaries; security; privacy and confidentiality; and managing risk. While this particular resource has been developed with young people’s needs in mind, the core messages for best practice are applicable to any organisation or practitioner engaging with clients online. Connecting Our Worlds is available at <au.professionals.reachout.com/overview-using-technology-PD-package>.
Using Technologies Safely and Effectively to Promote Young People’s Wellbeing: A Better Practice Guide for Services
This comprehensive guide from The Young and Well Cooperative Research Centre explores some of the ways in which young people use technologies, provides examples of best practice for services and learnings from current practice, and supplies an overview of relevant guidelines and policies. While the guide focuses on services for young people, it provides a wealth of applicable information for all services “going online”.
Australian Government resources
The Australian Government offers a range of resources to assist businesses and organisations wishing to engage online with their customers and clients:
- The Digital Business website <www.digitalbusiness.gov.au> provides information that may assist businesses and community organisations, with simple and practical tips on what they could be doing online and how they can do it.
- The Australian Communications and Media Authority (ACMA) website provides businesses and organisations with information on Internet security, how to make online content complaints and what constitutes illegal social networking activity.
- The Australian Competition and Consumer Commission (ACCC) website provides businesses and organisations with information on appropriate and inappropriate use of social media for interacting with existing and potential customers and clients and promoting their products and services.
- The Community ICT Transformation: Case Studies website <www.archive.dbcde.gov.au/2009/may/community_connectivity/community_ict_transformation_case_studies> provides a set of case studies of a cross-section of communities and organisations sharing their experiences on how they introduced ICT, the barriers and challenges they overcame and the lessons learned in the process. The case studies present the ways in which these groups and organisations are using ICT from three perspectives: enhancing operational efficiency and capability; delivering services and support; and building communities, networks and connections.
Connecting Up: Unleash the Power of Not-for-Profits
Connecting Up, Inc. is a not-for-profit organisation that works to unleash the power of not-for-profits by providing information, products, resources and programs. It provides free resources to support not-for-profits wanting to use social media to reach clients and deliver services.
Australian Infoxchange: Technology for Social Justice
Infoxchange Australia is a not-for-profit community organisation that delivers technology for social justice by working to strengthen communities and organisations. It offers resources aimed at enhancing the digital proficiency of organisations, including social media toolkits.
WorkVentures: Social Inclusion Through Technology
WorkVentures is a social enterprise that works with people at risk of social and economic exclusion who are seeking to improve their lives. It provides access to technology (including low-cost PCs) to individuals and not-for-profit organisations.
Pro Bono Australia: Technology for the Not-for-Profit Sector
Pro Bono Australia acts as an online hub for people who want to engage with Australia’s not-for-profit organisations and community. It has a passion to use new technologies to help not-for-profits deliver and do what they do effectively and efficiently.
Our Community: Community Technology Centre
Our Community is a social enterprise that provides advice, tools and training for Australia’s community groups, and practical linkages between the community sector and the general public, business and government. Its Community Technology Centre helps community groups to understand technology better, use it more effectively and find out where to get what they need.
Department of Human Services Victoria Social Media Policy For Employees
The Department of Human Services Victoria’s social media policy is a good example of an engagingly presented workplace social media policy. It includes information on personal use of social media that may affect the workplace. The social media policy can be viewed at <www.dhs.vic.gov.au/aboutthe-department/documents-and-resources/policies,-guidelines-and-legislation/social-media-policy-foremployees>.
Department of Finance and Deregulation social media policy for Commonwealth Members of Parliament staff
This is also a good example of a clear set of rules for appropriate staff use of Internet, email and social media in the workplace. <maps.finance.gov.au/enterprise_agreement/2010-2012/guidelines/docs/EA_2010-2012_Guidelines_Social_Media.pdf>.
YAPA social media policy guide
The Youth Action and Policy Association provides a guide for creating an ethics-based procedure to follow in developing a social media policy.
Online Counselling, Therapy and Dispute Resolution: A Review of Research and its Application to Family Relationship Services
This 2009 paper reviews research on the use of technology in therapy, counselling and dispute resolution. The use of online services within the family relationship sector is considered and key principles are suggested.
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Further reading
An overview of online safety for parents, including useful resources and practical tips for monitoring and protecting children online
Outlines definitions of cyberbullying, differences between cyberbullying and offline bullying, and parents' roles in dealing with cyberbullying.
What is the function of supervision in services for adolescents?
What works in supervision in services for adolescents? We asked two senior practitioners - please share your views in the comments below.
Authors and acknowledgements
Ken Knight is a Senior Communications Officer and Cathryn Hunter is a Research Officer, both at the Child Family Community Australia information exchange at the Australian Institute of Family Studies.
The authors would like to acknowledge the valuable contributions of Kylie Bennett, Andrew Campbell, Rachael Hood, Robin Jeffs, Shaun Lohoar, Cheryl Mangan, Derek McCormack, Kate Naish, Rhys Price-Robertson, Elly Robinson, Penelope Rush, Mark Thomson and Sandra Vallance.
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