Telephone Counselors Research Articles

Self-administered behavioural family intervention for parents of toddlers: Effectiveness and dissemination

This study examined the effectiveness of a self-administered behavioural family intervention (BFI) for parents of toddlers, within the context of a regular telephone counselling service provider. Telephone counsellors were trained in the delivery of BFI, and 110 mothers of toddlers completed the intervention. There were significant short-term effects of intervention in terms of child behaviour problems and parenting style, parenting confidence and anger. In addition, there were improvements in mother's personal adjustment, and lower levels of parenting conflict. The intervention effects were maintained at 3-month follow-up. The results provide support for the effectiveness of self-administered BFI, and have implications for the population level delivery of behavioural family interventions.

Implementing a computer-assisted telephone interview (CATI) system to increase colorectal cancer screening: A process evaluation

Objective : Computer-assisted telephone interviewing (CATI) systems used by telephone counselors (TCs) may be efficient mechanisms to counsel patients on cancer and recommended preventive screening tests in order to extend a primary care provider's reach to his/her patients. The implementation process of such a system for promoting colorectal (CRC) cancer screening using a computer-assisted telephone interview (CATI) system is reported in this paper. Methods : The process evaluation assessed three components of the intervention: message production, program implementation and audience reception. Results Of 1181 potentially eligible patients, 1025 (87%) patients were reached by the TCs and 725 of those patients (71%) were eligible to receive counseling. Five hundred eighty-two (80%) patients agreed to counseling. Conclusions : It is feasible to design and use CATI systems for prevention counseling of patients in primary care practices. Practice Implications : CATI systems have the potential of being used as a referral service by primary care providers and health care organizations for patient education.

Preteen Attitudes about Smoking and Parental Factors Associated with Favorable Attitudes

To describe youth smoking-related attitudes and evaluate the effects of parental factors on child adoption of positive attitudes about smoking. This study used baseline and 20-month data from a family-based smoking-prevention study (82.9% completed both surveys). Telephone recruitment from two health maintenance organizations. Children aged 10 to 12 years and one parent of each child (n=418 families) were randomly assigned to a frequent assessment cohort (12.5% of participants). Intervention. Families received a mailed smoking-prevention packet (parent handbook, videotape about youth smoking, comic book, pen, and stickers), outreach telephone counselor calls to the parent, a newsletter, and medical record prompts for providers to deliver smoking-prevention messages to parents and children. Demographics, tobacco status, attitudes about smoking (Teenage Attitudes and Practices Survey), family discussions about tobacco, family cohesiveness (family support and togetherness), parent involvement, parent monitoring, and parenting confidence. Results. One-third of the children endorsed beliefs that they could smoke without becoming addicted, and 8% to 10% endorsed beliefs on the benefits of smoking. Children's positive attitudes about smoking were associated with lower family cohesiveness (p = .01). Parental use of tobacco was the only significant predictor of children's positive attitudes about tobacco at 20 months (p = .03). Children as young as 10 years underestimate addictive properties of smoking, which may place them at risk for future smoking. Parental use of tobacco and family cohesiveness are important factors in the formulation of preteen attitudes about smoking.

Survivors of childhood cancer and their guardians

Survivors of childhood cancer are at increased risk for osteoporosis, cardiovascular disease, and second malignancies-conditions for which modifiable risk factors are recognized and lifestyle interventions have shown benefit. Although some data regarding health behaviors of this population exist, receptivity to health promotion is largely unknown. A survey was mailed to 380 survivors (age range, 11-33 years) of childhood leukemia, lymphoma, or central nervous system carcinomas (and guardians of survivors < 18 years old) to elicit data on exercise, dietary intake of calcium, fat, and fruits and vegetables, smoking status, readiness to pursue lifestyle change, quality of life, and interest in various health interventions. Responses from 209 survivors (a 55% response rate) suggested that most did not meet guidelines for fruit and vegetable consumption (79%), calcium intake (68%), or exercise (52%), 42% were overweight/obese, and 84% consumed > 30% of calories from fat. Older (> 18 years) compared with younger (< 18 years) survivors were more likely to smoke (17% vs. 1%), to be obese (21.6% vs. 14.6%), and to have suboptimal calcium intakes (75.6% vs. 57.6%). No differences in lifestyle behaviors were observed between cancer groups. Compared with interventions aimed at weight control, improving self-esteem, or smoking cessation, the highest levels of interest were found consistently for interventions aimed at getting in shape and eating healthy. Survivors preferred mailed interventions to those delivered in-person, by telephone counselors, or via computers. Survivors of childhood cancer practiced several suboptimal health behaviors. Health promotion interventions aimed at areas of interest and delivered through acceptable channels have the potential to improve long-term health and function of this vulnerable population.

Support Requirements and Effects of Supervision on Telephone Counsellors

The aim of this research was to examine the effects of the implementation of direct one-on-one supervision in a prominent telephone counselling organisation and the support requirements of their telephone counsellors. Ninety-three telephone counsellors participated in this research. The results showed that more experienced telephone counsellors were more satisfied than less experienced telephone counsellors with the support offered by the organisation. Furthermore, female telephone counsellors showed significantly more satisfaction with the support offered by the organisation than their male counterparts. Implications of these findings are discussed in relation to the organisation and other helping organisations within the wider community.

Crisis Intervention and Counseling by Telephone

DAVID LESTER (ED.): Crisis Intervention and Counseling by Telephone. Charles C. Thomas Publisher, Springfield, IL, 2002, 306 pp., $62.95, ISBN 0-398-07324-4. Crisis Intervention and Counseling by Telephone first appeared in 1973. This 2002 update is divided into six components: overview of telephone counseling, how telephone counseling fits into a variety of therapeutic modalities, dealing with specific client behaviors in counseling, the use of adjunct techniques like e-mail, selecting/training telephone counselors, and evaluating telephone counseling services. Psychotherapists who consider telephone therapy as to face-to-face contact should recall that traditional talking therapies often restrict cues available to both the client and therapists. Traditional psychoanalysis places that therapist out of sight behind the client. The Roman Catholic confessional also restricts cues. A survey of psychiatrists found that 45% use the telephone as an adjunct for face-to-face therapy and 19% use the telephone as the primary mode of treatment (p. 7). Therapists who look at telephone therapy as inferior might want to review whether their own values are interfering with sound therapeutic judgment. For example, older people grew up in an era when use of the telephone was restricted to business and emergencies. Younger people, on the other hand, consider the telephone a recreational tool. Talking to a counselor over the phone might be more natural for a young client while unnatural for an older therapist. A second problem revolves around the issue of control. During sessions, clients are in their home and not on therapists' turf. Termination can be accomplished by simply hanging up. This more equal power relationship can produce anxiety for therapists. A third problem concerns the stereotype of telephone counseling being linked to short-term crisis intervention. The book cites a case of a 19-year psychotherapeutic relationship on the phone and hypnotherapy conducted by phone. Certain types of clients are more appropriate for telephone counseling, particularly, suicidal and highly dependent clients like to know that support is close at hand. Ambivalent clients can use the telephone to maintain both distance and control over the therapeutic relationship. Hostile clients may be better able to express themselves. The mechanical and electronic nature of telephones may appeal to certain obsessionals and schizophrenics. Those who suffer from anxiety find telephone counseling of particular value. …

EatSmart: Efficacy of a multifaceted preventive nutrition intervention in clinical practice

Background. We evaluated a multifaceted preventive nutrition intervention to improve dietary habits among adult primary care patients. Methods. We randomized six group practices in a managed care organization. Participants completed baseline and 3-month follow-up surveys. The intervention comprised (1) mailed personalized dietary recommendations and educational booklets focusing on fruits and vegetables, red meat, and dairy foods, tailored to patients' baseline intake and stage of readiness to change eating behaviors; (2) verbal endorsement by the primary care provider of the benefits of these recommendations; and (3) two motivational counseling sessions with telephone counselors to set dietary goals. Results. Among the 230 subjects in the intervention group and 274 in the control group, mean age was 54 years, 70% were female, and 91% were white and 7% African American. Eighty-nine percent of the participants completed the follow-up survey. We measured change in intake of foods using results from the baseline and follow-up food frequency questionnaires. Using an intention-to-treat analysis and adjusting for age, sex, race, and baseline intake, the change in fruit and vegetable intake in the intervention group was 0.6 (95% confidence interval 0.3, 0.8) servings/day higher than in the control group. There was no intervention effect on red meat and dairy products. Conclusions. Tailored clinical nutrition interventions that combine brief physician endorsement with practice supports may be effective in changing patients' eating behavior.

EatSmart: efficacy of a multifaceted preventive nutrition intervention in clinical practice.

We evaluated a multifaceted preventive nutrition intervention to improve dietary habits among adult primary care patients. We randomized six group practices in a managed care organization. Participants completed baseline and 3-month follow-up surveys. The intervention comprised (1) mailed personalized dietary recommendations and educational booklets focusing on fruits and vegetables, red meat, and dairy foods, tailored to patients' baseline intake and stage of readiness to change eating behaviors; (2) verbal endorsement by the primary care provider of the benefits of these recommendations; and (3) two motivational counseling sessions with telephone counselors to set dietary goals. Among the 230 subjects in the intervention group and 274 in the control group, mean age was 54 years, 70% were female, and 91% were white and 7% African American. Eighty-nine percent of the participants completed the follow-up survey. We measured change in intake of foods using results from the baseline and follow-up food frequency questionnaires. Using an intention-to-treat analysis and adjusting for age, sex, race, and baseline intake, the change in fruit and vegetable intake in the intervention group was 0.6 (95% confidence interval 0.3, 0.8) servings/day higher than in the control group. There was no intervention effect on red meat and dairy products. Tailored clinical nutrition interventions that combine brief physician endorsement with practice supports may be effective in changing patients' eating behavior.

Telephone crisis intervention skills: a simulated caller paradigm.

Counseling skills were evaluated in a telephone counseling service for Vietnam veterans. Thirty simulated crisis calls were made to telephone counselors by experienced clinical psychologists. The counselors' responses were rated on dimensions that indexed general counseling skills, knowledge of veteran needs, and provision of appropriate advice. Whereas the majority of callers demonstrated adequate counseling skills, many lacked knowledge of veterans' posttraumatic stress, common veteran terminology, and the nature of veterans' experiences. The findings suggest that telephone counseling services that target specific populations should employ comprehensive training to ensure that counselors possess adequate and relevant knowledge about callers and their presenting problems. The simulated caller paradigm appears to be an effective paradigm for training and evaluation of telephone counselors.

Home sample collection tests for HIV infection.

Home sample collection (HSC) tests allow persons to test themselves for human immunodeficiency virus (HIV) infection at home without medical supervision. Characterizing the use of such tests can help assess their potential effect on public health efforts to prevent and control HIV. To describe use of HIV HSC tests. Retrospective descriptive analysis from data collected by test manufacturers during 1996 and 1997. United States. Volunteer sample of consumers who used either of 2 HSC tests. Demographic and behavioral aspects of users. During the first year of availability, 174316 HIV HSC tests were submitted to the manufacturers for analysis; 0.9% of the results were positive for HIV, and 97% of all users called to learn test results. Survey responses from 70620 HIV-negative and 865 HIV-positive users revealed that most were men, white, and aged 25 to 34 years; HIV prevalence was highest among nonwhites, aged 35 to 44 years, men who have sex with men, and injection drug users. Bisexual men accounted for a large proportion of HIV-positive users. Nearly 60% of all users and 49% of those who tested HIV positive had never been tested before. Telephone counselors found that 23% of HIV-positive users already had a source of follow-up care, 65% accepted referrals, and 12% had tested themselves to evaluate the effects of antiretroviral therapy. Home sample collection tests for HIV were used by persons who were at risk for HIV and by persons who did not use other testing. Most HIV-positive users either had a source of medical care or received referrals.

The Telephone Counseling Interview as a Complex, Dynamic, Decision Process: A Self-Regulation Model of Counselor Effectiveness

The authors assert that new frameworks for conceptualizing the counseling process are needed in order to advance understanding of the determinants of counselor effectiveness. In the present study, a self-regulation model of performance on complex, dynamic, decision tasks proposed by Omodei and Wearing (1995) was tested in an analog study with 40 telephone counselors who varied in amount of experience. Client-perceived effectiveness of the counselors was found to be related to levels of counselor expertise, intentional motivated cognitive effort, emotional involvement with the caller, and anxiety. Conceptualizing a counseling interview as a complex, dynamic, decision process may lead to theoretical and practical advances in the field.

Characteristics of effective telephone counselling skills

In a study of the telephone counselling process, 40 experienced telephone counsellors each responded to a standardised crisis call from the same scripted role-playing client. All the interviews were audio-recorded. At the conclusion of each call the subjectively-perceived helpfulness of the counsellor was assessed by the caller. Seven of the counsellors were rated as being extremely helpful, while nine counsellors were rated as being notably less helpful. Analysis of the calls showed that what distinguished the more helpful counsellors was that they were more verbally active, took the initiative to structure the interview and systematically explore all aspects of the problem situation, and addressed practical as well as emotional concerns of the caller. Overall, the more effective counsellors altered the caller's perspective on her circumstances.

Characteristics of effective telephone counselling skills

Abstract In a study of the telephone counselling process, 40 experienced telephone counsellors each responded to a standardised crisis call from the same scripted role-playing client. All the interviews were audio-recorded. At the conclusion of each call the subjectively-perceived helpfulness of the counsellor was assessed by the caller. Seven of the counsellors were rated as being extremely helpful, while nine counsellors were rated as being notably less helpful. Analysis of the calls showed that what distinguished the more helpful counsellors was that they were more verbally active, took the initiative to structure the interview and systematically explore all aspects of the problem situation, and addressed practical as well as emotional concerns of the caller. Overall, the more effective counsellors altered the caller's perspective on her circumstances.

Telephone support by elderly volunteers to inner-city children

This study describes the “Grandma Please” program, an after-school help line that uses elderly volunteers as telephone counselors for inner-city children. We analyzed phone records of 4,678 calls made to the “Grandma Please” program, and interviewed callers, noncallers, and volunteers of the phone line. Below we discuss four key areas that have not been previously examined in children's phone line literature. First, we found that inner-city children, especially older girls, benefitted from utilization of the program. Girls were more likely to call the phone line, more likely to discuss high levels of interpersonal and school problems, and more likely to receive support from the “Grandmas.” Second, we found high rates of children's positive events and accomplishments (i.e., uplifts) in the phone records. Children who report positive events and accomplishments and receive adult approval gain important, often overlooked, components of social support. Third, our interviewed sample of children who had never called “Grandma Please” indicated that a lack of information and not perceiving a need for assistance were prime reasons for not using the phone line. Fourth, we examined characteristics of the elderly volunteers who talked to the children. We found that volunteers were utilized regardless of health or financial status as they participated within their own homes. Elderly volunteers, including frail elderly, also rated the program highly and expressed their satisfaction and enjoyment in interacting with children. This study indicates that intergenerational, interracial telephone contact can provide support for two at-risk groups: inner-city children and the elderly. © 1996 John Wiley & Sons, Inc.

Evaluation of a Dutch Community-Based Smoking Cessation Intervention

Background. Until 1990, smoking cessation interventions in the Netherlands were limited. The utility and effectiveness of community-based smoking cessation programs have not been examined. Methods. In a treatment city (Den Bosch) a multicomponent community-based smoking cessation intervention was implemented in which local mass media and general practitioners draw smokers′ attention to a local quit line. Telephone counselors advised applicants on their choice between self-help and group treatment and optional telephone counseling. Another Dutch city (Apeldoorn) sewed as a control. Population samples of smokers ( n = 547 and n = 546) were interviewed three times at approximately 7-month intervals. Self-help manual requesters ( n = 84) and group participants ( n = 83) were interviewed before and 6 months after treatment. Results. Treatment modalities were successful; 13% of self-help manual requesters and 22% of group participants were abstinent after 6 months. On a population level the intervention resulted in significantly higher recall of self-help manual and group program in the treatment city. A modest intervention effect on prevalence of abstinence was found at the community level. Conclusions. Treatment modalities were effective within their participants, but the intervention effectiveness on a community level was limited. No significant difference was found between quit rates after 14 months (7% in treatment city and 9% in control city). Several system failures could be identified. However, probably the intervention effect was seriously confounded by two national governmental publicity campaigns introducing and reinforcing a mandatory smoking ban and a series of national campaigns initiated by the united Dutch tobacco producers opposing the ban.

Reader-Based Document Testing at VA

Reader-based document testing by writing teams in the Department of Veterans Affairs (VA) has resulted in writers who now focus on their readers rather than on their supervisors. Document testing has enabled the writers to understand and anticipate the needs and the reading habits of their readers. This article focuses on the testing used by VA writing teams to guide and validate document revisions, presenting VA's goals for document testing, methods of testing, and results of testing. THE PROBLEM Officials of the Department of Veterans Affairs knew they had a problem with their form (boilerplate) letters. Lawyers had called to complain that they could not understand the complicated VA letters their clients brought in. A quick check of college-educated VA employees revealed that often even they could not understand letters sent out from other divisions of VA. When VA officials in the Jackson, Mississippi, office started considering a solution, they surveyed their files and then reviewed the Mississippi Literacy Assessment (Crosby, Howell, Carr, & Miller, 1991). These sources show that 50% or more of the target audience in Mississippi has a 9th grade education or less and can be expected to read at or below the 5th to 6th grade level. The national reading level is not much better than Mississippi's. The National Adult Literacy Survey (1993) by the Educational Testing Center reports that the literacy skills of 76% of those 65 and older are inadequate. The Educational Testing Center studied a representative VA letter and judged VA's letter to be so difficult that only about 5% of those 65 and older across the nation could read it. This 65-and-older age group includes the target audience for the most frequently written VA letters nationally as well as in Mississippi. As a communications consultant, I established the guidelines for revising VA letters and trained VA employees in regional offices across the country to produce these revisions. In order to accomplish this task, I have trained teams of writers in VA regional offices across the nation to revise letters collaboratively and to test them to ensure that very poor readers can read and respond appropriately. GOALS OF TESTING Early in the project to revise form letters, VA management agreed that the only way to assure readability of VA documents was to test them on the intended readers. Therefore, VA committed to reader-based testing and established these goals for early testing of revised form letters: * to verify the vocabulary level * to determine comprehension * to verify reader satisfaction Later, as the regional writing teams who were revising the form letters learned more about testing and became more reader-oriented, these goals were added: * to ensure that readers understand what the document tells them to do * to learn how readers use documents * to train the VA writing team METHODS OF TESTING VA writers used a variety of testing methods to meet their goals for the new-style documents, ranging from informal reader feedback to more formal cued-response reader testing combined with retrospective interviews. Informal Reader Feedback The Jackson, Mississippi, VA writing team (the prototype for other VA writing teams around the country) received informal feedback about or from the intended readers in several ways. The first feedback came from members of the writing team who worked as telephone counselors for veterans calling in with questions generated by form letters they had received. These counselors could anticipate the problems veterans would have with wording or procedures because they spent their normal workday on telephones answering veterans' questions about VA letters. In addition, the Jackson, Mississippi, writing team conducted two focus groups with veterans who were also members of veterans' support groups, which assist veterans in their contacts and negotiations with VA. …

Telephone counsellors' conceptualising abilities and counselling skills

Abstract Telephone counsellors must make accurate assessments of callers' needs so as to provide appropriate counselling help or referral. But few researchers have examined counsellors' conceptualising abilities in relation to their counselling skill. Two studies involving telephone counsellors were carried out. The first relied on counsellors' post-interview conceptualisations of callers' problems and needs and found no link between the accuracy of these conceptualisations and counselling skill. The second used Kagan's Interpersonal Process Recall (IPR) to retrieve counsellors' conceptualisations made during the course of their interviews. The accuracy of these conceptualisations-in-action was related to level of counselling skill. Implications for training and research are discussed

Telephone counsellors' conceptualising abilities and counselling skills

Telephone counsellors' conceptualising abilities and counselling skills

Counselling Help For Child-Abusing Parents: Parents Anonymous

SynopsisThis paper reports a study of the counselling services offered by Parents Anonymous, a mutual-aid organisation which offers help to persons with problems involving child abuse. The overall goals of the study were to determine the effectivenes of the program of recruiting, training and supervising volunteer telephone counsellors; and to determine the level of client satisfaction with the face-to-face counselling help provided. It was concluded that the volunteer counsellors were likely to be able to respond adequately to most presenting problems, with the possible exception of calls concerning sexual abuse of children. The mayority of clients surveyed were satisfied with the face-to-face counselling help received.

The evolution and effectiveness of telephone counseling services.

Despite dramatic expansion of telephone counseling services during the last three decades and widespread belief in their preventive and therapeutic value, empirical evidence of their effectiveness is limited, partly because of methodological and practical difficulties associated with research in the field. A review of existing studies indicates that telephone counselors may perform valuable listening, information giving, and referral roles. Evidence is lacking, however, on the ability of telephone counseling to produce behavior change in callers or to reduce suicide rates. Recent studies indicate that contract telephone counseling may have considerable therapeutic potential for monitoring and supporting clients with ongoing problems or chronic disabilities.