Behavioural Telehealth: Research and Development at the University of British Columbia
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Incubator Research Grant Progress Report: Year 3

Faculty of Education, University of British Columbia
June 22, 2002

Principal Investigator: Bonita C. Long, Ph.D. (ECPS)
Co-Investigators: Marla Arvay (ECPS)
Linda Stanley Wilson (CUST)
  1. Summary of activities to date
  2. Highlights of the project
  3. Ways in which the research to date has enhanced opportunities for securing future funding
  4. Dissemination and publication of the research results
    1. Publications
    2. Conference Presentations
    3. Other Work
  5. Extent and nature of student participation and training
    1. Directed studies
    2. Travel/conferences
  6. Summary

1. Summary of activities to date

In the third year of the 3-year grant period, we had four primary goals:

(a) to enlarge the education-focused network of telehealth researchers at UBC and elsewhere
(b) to finalize the directory of telehealth information and website
(c) to implement and evaluate new and ongoing telehealth research projects
(d) to seek further funding for new and ongoing telehealth research projects

The research team met in small groups during the year, usually involving individual members of the research team, which consisted of:

Principal and Co-Investigators:
  Dr. Bonita Long

ECPS

  Dr. Marla Arvay

ECPS

  Dr. Linda Stanley Wilson

CUST

     
UBC Collaborators:
  Dr. Kellogg Booth

MAGIC - Computer Science

  Dr. Brian Fisher MAGIC - Computer Science
  Dr. Joanna Bates

Family Practice

  Dr. John Gilbert

Health Sciences

  Marie-Hélène Pelletier

Ph.D. student, ECPS/Counselling Psychology Program

  Kate Collie

Interdisciplinary Ph.D. student, Institute of Health Promotion Research

  Davor Cubranic

Ph.D. student, Computer Science

  Danielle Conrad

MA student, ECPS/ Counselling Psychology Program

     
Community Collaborators:
  Dan Mitchell, M.A. Counsellor, co-founder of "Therapy Online"
  Dr. Robert Wilson Wilson Banwell and Associates, Inc.

2. Highlights of the project

(a) Enlargement of Network of Telehealth Researchers:

The research team meetings were not only an opportunity to develop our research ideas, but also to broaden our network of collaborators. This was done both at UBC and beyond UBC.

At UBC, members of the team met regularly to work on a variety of tasks, including discussing with each other our involvement and expertise relating to telehealth, sharing scientific literature about telehealth, planning the format and content of the telehealth directory, and developing strategies for obtaining further funding.

The listserv developed by Davor Cubranic for the team was used to communicate information about telehealth and inform other members of the team of opportunities and conferences.

Marie-Hélène Pelletier and Kate Collie established connections with psychologists, other mental health clinicians/educators, and community and industry partners from different parts of Canada and the United States. People who have been involved with the project during the third year of the grant include:

James Coyle (Manager, U.B.C. Mental Health Evaluation and
Community Consultation Unit (MHECCU))
Dr. Cristina Conati (Computer Science, UBC)
Bill Enright (independent computer programmer, Pinole, CA)
Dr. Elliott Goldner (Head, U.B.C. Mental Health Evaluation and
Community Consultation Unit (MHECCU))
Dr. Harry Karlinsky (Psychiatrist, Project Director, U.B.C. Mental Health Evaluation and
Community Consultation Unit (MHECCU))
Dr. Maria Klawe (Dean of Science, UBC)
Cathy Malchiodi, (Art Therapist, Salt Lake City, UT)
Dr. Marlene Maheu (Psychologist, San Diego, CA)
Greg Smolyn (Computer Science, UBC)
Dr. Beth H. Stamm ( Institute of Rural Health Studies, Idaho State University, ID)
Paula Wirth (Fine Art, UBC)
Mark Zuberbuhler (U.B.C. Telestudios Director)

Members of the team subscribe to the following telehealth listservs: "Telehealth", “Canadian Society for Telehealth”, and "International Society of Mental Health Online".

(b) finalizing the directory of telehealth information and website:

The directory is now available in the form of a website (created with the assistance of Dr. Linda Stanley Wilson).

We have received several telehealth-related messages as a result of the website. It will be linked to Dr. Marlene Maheu’s behavioural telehealth site, a site that receives considerable traffic.

(c) implementation and evaluation of new and ongoing telehealth research projects:

a. September, 2001, Marie-Hélène started recruitment for her videoconferencing treatment study. This study is her doctoral research and is being supervised by Dr. Bonita Long. Treatment took place between November 2001 and January 2002 (with the help of Danielle Conrad, Debbie Plomp, and eight volunteers), and a 3-month follow-up was performed in April and May 2002. Her department oral is scheduled for July 15, 2002.
 
b. Kate Collie is in the middle of her doctoral research entitled ‘Meaning-making Through Art Therapy for Women with Breast Cancer: A Telehealth Project’. Dr. Bonita Long is on the supervisory committee for this doctoral research project. The research has two parts. One is the development of software to support real-time art therapy with women with breast cancer. The other is the development of a conceptual framework for this service. Both parts will be completed by the end of 2002. Kate is working with a team of faculty, students, and community members on the technical development of the Internet Art Therapy computer system.
 
c. Dr. Bates completed first phase of a study "Barriers to Implementation of New Technology" that looked at the perception in an institution of the facilitators and barriers to using a web-based support system for patients.
d. Dr. Bates completed a Health Canada funded study (HISP) to deliver cardiac rehabilitation information and support to patients living in regional, rural, and remote areas of BC (see website <heartbc.ca> that includes two project reports in downloadable pdf format).
 
e. Dr. Bates is completing a study evaluating the use of a web-based resource by newly diagnosed breast cancer patients.
 
f. Dan Mitchell (with Lawrence Murphy) is planning an outcome research project about online counselling in collaboration with a researcher in Australia.
 
g. Dr. Fisher is a partner in a Web based CME company called Clearmed Medical Knowledge Inc. that has taught Mainpro-C level CME for family physicians online (modules on the care of frail elderly patients).

(d) Seeking Further Funding

a. Dr. Bates and Dr. Gilbert are members of a team of researchers who have received funding for a telehealth project through CHIPP.
 
b. Dr. Bates applied for and received: a grant from Canarie to develop a "readiness tool" for evaluating telehealth receiver communities ($83,000); a grant from BCMSF (Vancouver Foundation) to evaluate efficacy of a Cardiac Rehabilitation Program over the World Wide Web ($42,000); and a grant from Agilent Technologies to provide equipment to patients for a cardiac rehabilitation program over the Web ($62,000).
 
c. Kate and Marie-Hélène were included in a $9 million telehealth grant proposal to CHIPP that was initiated by Dr. Siden, and was funded. Kate and Marie-Hélène were invited to be research assistants for the evaluation component of the project.
 
d. Kate requested funding for her research from Telus through NewMIC.
 
e. Kate, Dr. Long, Dr. Joan Bottorff (School of Nursing), and Dr. Cristina Conati (Department of Computer Science) applied for a Hampton Fund grant and an IDEA grant from the Canadian Breast Cancer Research Initiative to support a telehealth research project that would include Kate’s PhD research. The application to the Hampton Fund was successful.
 
f. Dr. Gilbert was involved in the joint planning of five telehealth grants in partnership with UNBC and the University of Calgary.

3. Ways in which the research to date has enhanced opportunities for securing future funding

The ways in which activities to date have enhanced opportunities for securing future funding include the following:

(a) We have put together a multi-disciplinary team of university and community researchers interested in telehealth and telehealth education that is growing steadily.
(b) We have produced publications and have presented at a range of conferences.
(c) Through our network, we have learned about new sources of funding.

4. Dissemination and publication of the research results

The following list includes papers and conference presentations to date. Publications specific to year 3 are marked with an *:

Publications

* Collie, K. (in press) Interpersonal communication in behavioral telehealth: What can we learn from other fields? In J. Bloom & G. Walz (Eds.) ENCORE edition of cybercounseling and Cyberlearning: Strategies and Resources for the Millennium. American Counseling Association and ERIC Counseling and Student Services Clearinghouse.

Collie, K., & Cubranic, D. (in press) Computer-supported distance art therapy: A focus
on traumatic illness. In H. Resnick (Ed.) Innovations in Social Work and Technology: Practice and Education. Binghamton, NY: Haworth Press.

Collie, K., & Cubranic, D. (1999). An art therapy solution to a telehealth problem. Art Therapy: The Journal of the American Art Therapy Association, 16(4), pp. 186-193.

Collie, K., Cubranic, D., & Booth, K. (1999). Computer-supported distance art therapy: Beyond computerization. In Proceedings of WebNet 2000, AACE: Association for the Advancement of Computers in Education.

* Collie, K., Cubranic, D., & Long, B. (2002). Audiographic Communication for Distance Counselling: A Feasibility Study. British Journal of Guidance and Counselling, 30(3), 269-284.

Collie, K., Mitchell, D., & Murphy, L. (2000). Skills for cybercounseling: Maximum impact at minimum bandwidth. In J. Bloom & G. Walz (Eds.) Cybercounseling and Cyberlearning: Strategies and resources for the millennium (pp. 219-236). Alexandria, VA: American Counseling Association and Greensboro, NC: CAPS, Inc.

*Pelletier, M.-H., Stamm, B. H., Jerome, L., Bates, J., & Long, B. (2001). Psychotherapy via videoconferencing: A critical review of treatment studies. Revista Argentina de Clinica Psicologica, 10 (3), 243-257.

Conference Presentations:

* Buchanan, T., Collie, K., Horovitz, E., Malchiodi, C., Miller, G., & Parker-Bell, B. (2001, November) Computers in Art Therapy: A Palette of Possibilities. Annual Conference of the
American Art Therapy Association, Albuquerque, NM.

Collie, K. (2000, June). Art Therapy & Physical Illness: A Role for the Internet? Annual Conference of the British Columbia Art Therapy Association, Vancouver, BC.

Collie, K. (2000, November). Computer-Supported Distance Art Therapy: New Possibilities for Medical Art Therapy. Annual Conference of the American Art Therapy Association, St. Louis, MO.

Collie, K. (2001, March). Arts-Medicine and Telehealth: A Participatory Workshop. Annual
Conference of the Society for the Arts in Healthcare, Seattle, WA.

Collie, K., & Cubranic, D. (1999, August). The development and evaluation of a computer system for distance art therapy. In P.L. Schneider and M.M. Maheu (Chairs), A Cross Perspective of the Integration of Technology and Mental Health Service. Symposium Presented at the annual meeting of the American Psychological Association (APA), Boston, MA.

Collie, K., Cubranic, D., & Booth, K. (1999, September). Computer-supported distance art therapy: Beyond computerization. WebNet 99: Association for the Advancement of Computers in Education, Honolulu, HI.

Collie, K., Cubranic, D., & Wick, C. (2000, June). Women-Centred Design in Telehealth: A
Participatory Workshop. IFIP Seventh International Conference on Women, Work, and Computerization, Vancouver, BC.

Pelletier, M.-H. (1999, August). Integrating Telehealth and Media: Radio Psychology. In P.L. Schneider and M.M. Maheu (Chairs), A Cross Perspective of the Integration of Technology and Mental Health Service. Symposium Presented at the annual meeting of the American Psychological Association (APA), Boston, MA.

*Pelletier, M.-H. (accepted, 2002). Psychotherapy via email and videoconferencing: Empirical status and future directions. In M.M. Maheu (Chair). Symposium accepted at the annual meeting of the American Psychological Association (APA), Chicago, IL

Pelletier, M.-H., Maheu, M., & Burton, D. (2000, August). Assessment in telehealth : Innovative graduate students research. Symposium accepted at the annual meeting of the American Psychological Association (APA), Washington, DC.

Pelletier, M.-H., & Keresztes, C. (2000, June). Telehealth: Clinical and organizational issues in vidoconferencing for mental health care. Symposium at the annual meeting of the Canadian Psychological Association (CPA), Ottawa, On.

Pelletier, M.-H., Taylor, S., & Conrad, D. (2001, July). Cognitive-behavior therapy for social anxiety disorder delivered through videoconferencing: A single case study. Accepted, World Congress of Behavioral and Cognitive Therapies, Vancouver, BC.

Wilson, R. F., & Pelletier, M.-H. (2000, April). Telehealth: An overall perspective. Symposium presented at the annual meeting of the Employee Assistance Services of North America (EASNA), Vancouver, BC.

*Wilson, R., & Pelletier, M.-H. (2002, May). Innovative models of service delivery and compensation. Invited presentation at the annual meeting of the Canadian Psychological Association (CPA), Vancouver, BC.

Other work

In November, 2001, Marie-Helene gave a presentation of her research project to the Mheccu Team, UBC.

In 2001, Kate Collie gave a public presentation entitled “Internet Art Therapy: Beyond Computerization” for the Perception, Action, Cognition, & Interfaces, a Frenzy of Interdisciplinary Collaboration (PACIFIC) seminar series in the department of Computer Science, UBC.

In 2002, Marie-Helene Pelletier has been awarded a Certificate of Merit of the American Psychological Association Division 18 (Psychologists in Public Service) for the excellence of her doctoral research.

Pelletier, M.-H. (1999). Integrating Telehealth and Media: Radio and Internet Psychology. TelehealthNews. Retrieved October 12, 1999 from the World Wide Web: http://www.telehealth.net

Kate Collie was invited to have a video of her Internet Art Therapy project included in a video compendium that will accompany a new clinical art therapy textbook by Judith Rubin, who is Clinical Assistant Professor of Psychiatry at the University of Pittsburgh.

Kate Collie’s work is featured in the book:
Malchiodi, C. A. (2000). Art therapy and computer technology: A virtual studio of possibilities. London & Philadelphia: Jessica Kingsley.

Dan Mitchell and his partner, Lawrence Murphy (both graduates of the UBC Faculty of Education) broke new ground in the field of telehealth by obtaining professional liability insurance for the practice of online counselling. They deployed PrivacEmail(TM), a user-friendly, confidential, ethical email system for use with online clients, and have completely renovated their website with detailed information for clients about how online counselling works and what they can expect. The site now includes services for other counsellors who are establishing online practices, including:

  • PrivacEmail(TM), a 1024 bit encrypted web-based email system for cybercounsellors and cyberclients;
  • Professional Development: training for counsellors who want to develop their online counselling skills;
  • Consultation: for ethical and effective deployment of an online counselling service;
  • eSupervision: online supervision.

Dan has given presentations and workshops about online counselling at counsellor conferences and universities in Ontario and British Columbia.

Brian Fisher is a theme leader on a new proposal to SSHRC on elearning across the professions that has a large health care learning component.

5. Extent and nature of student participation and training

Kate and Marie-Hélène, two doctoral students, are responsible for organizing the team meetings, and are actively involved in managing the grant. Davor Cubranic, Ph.D. student in computer science, is on the team as a computer programming consultant. He is maintaining the listserv. Danielle Conrad, a first year MA student in the Counselling Psychology program, has joined the team as a volunteer and assists Marie-Helene Pelletier in her videoconferencing experiments.

Kate Collie’s dissertation is on the topic of creative expression in distance psychosocial care for people facing life-threatening illnesses. This dissertation research is a continuation of Kate’s Master’s research, which was conducted collaboratively with Davor Cubranic and was supervised by Dr. Long. Dr. Booth was a committee member and continues to assist Kate with her project.

Marie-Hélène Pelletier’s dissertation is in the area of efficacy of psychological services (education, therapy) provided through videoconferencing. After having done her Master’s focused on the treatment of people suffering from panic disorder with agoraphobia, she has paired her interest in anxiety disorders with telehealth. Dr. Long is supervising Marie-Hélène’ doctoral research.

Both dissertations are directly supported by the Incubator Grant.
(a) Directed Studies

Kate Collie has completed a telehealth directed study with Dr. Kellogg Booth and Dr. Joanna Bates. The purpose of the directed study was to bring information from the fields of computer-mediated communication, human-computer interaction, computer-supported collaborative work, distance education (and other related fields) to bear on questions raised in literature about behavioural telehealth. The directed study involved a review of literature about behavioural telehealth (mental health care from a distance) and review of literature from other fields addressing key questions derived from the telehealth literature review. A paper reporting on the project is being prepared for publication. This directed study enabled Kate to conduct part of the literature review for her PhD research project, to focus her research question, and to begin creating a directory of telehealth information.

In June 1999, Marie-Hélène Pelletier started a directed study that was supervised by Dr. Joanna Bates (UBC instructor), Dr. Beth Stamm (Institute of Rural Health Studies, Idaho State University, ID), and Dr. Leigh Jerome (Psychology Department, AKAMAI and Tripler Army Medical Center, HI). Drs. Stamm and Jerome supervised Marie-Hélène through email. The goal of the directed study was to examine the empirical literature and projects in the field of telehealth associated with the use of videoconferencing in psychotherapy, with a particular focus on the kind of data that are collected. Course readings covered such topics as the conceptual issues related to psychotherapy done through videoconferencing, conceptual and methodological issues in data collection, individual differences, and influences of gender, culture, and context. This directed study enabled Marie-Hélène to conduct part of the literature review for her PhD research project, to focus her research question, and to begin creating a directory of telehealth information. This directed study was completed in December 1999, and resulted in a publication in 2001.

(b) Travel/Conferences – those specific to year 3 are marked with *

Marie-Hélène Pelletier and Kate Collie both presented at the American Psychological Assocation in August 1999.
Kate Collie and Davor Cubranic both presented at the WebNet 99 conference (Association for the Advancement of Computers in Education). Marie-Hélène Pelletier presented on telehealth at the Canadian Psychological Association in June 2000 and June *2002 and visited the Pacific eHealth Innovation Center and Department of Defense Telemedicine Program in August 2000.
Kate Collie presented on telehealth at the annual conference of the American Art Therapy Association in 2000 and *2001, at the annual conferences of: the British Columbia Art Therapy Association in 2001, and at the annual conference of the Society for the Arts in Healthcare in 2001.

6. Summary

During the third year of the project, the team made significant headway toward all four of the primary goals.

(a) The network of telehealth researchers at and beyond UBC was expanded and solidified.
(b) The website was completed.
(c) Pilot projects and other research initiatives are completed or under way.
(d) Members of the team applied for additional funding from a range of sources. Some applications are still pending; many were funded.

The team’s collective knowledge about telehealth increased greatly during the year, in particular knowledge about how to make best use of telecommunications technologies for telehealth services and for distance health and wellness education.

The project continues to be a success in terms of meeting its objectives, and, according to the team members, it continues to serve a useful function by linking telehealth researchers at UBC and elsewhere. Telehealth and distance health education are intrinsically interdisciplinary areas of research. Team members have reported that it is extremely valuable to have access to researchers in other disciplinary areas whose research is directly related to their own. Involvement in the project has helped the members stay up-to-date about telehealth and distance health education research, trends, and research gaps—something that is only possible through the kind of interdisciplinary sharing that this project has enabled.

The team successfully disseminated results of research projects and other activities through publications, conference presentations, and presentations at UBC, and thereby significantly increased the visibility of the project.

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