Technological innovations such as internet-based therapy, interactive cell phone programs, and computerized cognitive behavioral therapy are increasing access to behavioral health services. Research on these innovations shows some promise, such as computerized CBT programs being as effective as standard counseling for drug treatment. However, the evidence is still limited and mixed. While technology increases access, it lacks the personal connection of direct therapist contact. More research is still needed, especially among criminal justice populations, to fully understand the impacts and cost-effectiveness of these innovations.

1. Intervention Fact Sheet
Technological Innovations in Behavioral Health Services
The Center Authors: Steven Belenko, Ph.D and Brandy Blasko, M.A., Temple University
homework. A drug treatment example is the Therapeutic
The Center for Behavioral Health Services & Criminal
Engagement System (TES), using cognitive-behavioral
Justice Research, funded by the National Institute of
therapy (CBT).4 TES is being tested in prison facilities in
Mental Health, studies the effectiveness of behavioral
four states in a National Institute on Drug Abuse-funded
health interventions to engage and treat people with mental
randomized clinical trial, and can potentially increase the
illnesses (with or without co-occurring substance abuse
percentage of inmates getting drug treatment. CivilWorld5
problems) who have criminal justice involvement. Fact
is a cognitive interactive computer program that teaches
Sheets on other interventions can be found on at
skills to reduce criminal thinking, drug relapse, and im-
www.cbhs-cjr.rutgers.edu.
prove self-control and decision making. The program is on
Introduction computer kiosks, thus requiring no internet connection,
Over the past decade, growing use of technological inno- and has been used in jails, prisons, and drug courts.
vations (internet-based and computerized therapy, interac-
In web-based group counseling, clients anonymously join
tive cell phone and personal digital assistant technology)
an on-line group. Video allows the client to see other
has increased access to behavioral health services. This
group members and the counselor and chat privately with
Fact Sheet summarizes findings from studies of technolo-
the counselor. One example is eGetGoing,6 accredited by
gical innovations in behavioral health care for persons with
the Commission on Accreditation of Rehabilitation Facili-
mental illnesses or substance abuse disorders. It is de-
ties. On-line counseling can be accessed from home and
signed to help policymakers, practitioners, researchers, and
thus facilitate access to group therapy without issues of
advocates make sense of the evidence as they consider
transportation, child care, or confidentiality.
whether to test or adopt such innovations.
Personal digital assistants or cell phones can be used to
About 79% of Americans aged 18+ are online, 66% have
deliver health promotion or prevention messages, behavior
home broadband access,1 and 82% own cell phones.2 The
management (e.g., relapse prevention) or therapy, and
third most frequent online activity for those aged 18+ is
quickly connect clients with counseling or crisis assis-
getting health information (83%). Technology use is com-
tance. It also has potential applications for getting real-
mon even among those earning less than $30,000/year:
time data on the context of risky behaviors, relapse, bar-
75% own a cell phone, 42% a desktop computer, 40%
riers to accessing services, and other factors affecting men-
have home broadband access, and 57% use the internet.3
tal health or substance abuse problems. This technology is
New generations of cell phones and easily downloadable
being tested in studies of drug and smoking cessation.7
applications allow instant access to the internet. The
spread of this technology suggests considering its potential What does the research indicate?
for persons in the criminal justice system: to monitor and These technologies are relatively new, with limited effica-
manage mental health and substance abuse disorders; im- cy research but encouraging results from some studies:
prove medication adherence; provide more access to clini-
 In randomized controlled trials, TES has been found as
cal interventions; facilitate assessment; provide primary
effective as standard counseling for adolescent drug8
and secondary prevention; and provide research data on
and adult opioid4 users, with higher satisfaction. Anoth-
relapse, environmental risks, and recovery. For popula-
er clinical trial found that substance abusers in standard
tions with limited transportation access or physical mobili-
treatment plus six computer-based modules had fewer
ty, or living in remote or rural areas, these innovations
positive urines, longer abstinence, and more satisfaction
have the potential to greatly increase access to behavioral
than the standard treatment only group.9
health interventions, lower behavioral health care costs,
and reduce health care access disparities.  Meta-analyses of computerized or internet-based thera-
py for depression or anxiety found that the largest effect
What are the types of technological innovations? on reducing symptoms was a computerized intervention
“Telerehabilitation” or “telemedicine” includes web-based with support from a therapist.10,11
diagnostic screening and assessment, transmission of bio-  Some computerized interventions for panic and anxiety
logical data and behavioral health information, and web- disorders, social phobia, and psychotic symptoms were
based interactive health promotion programs. efficacious and others had positive outcomes only when
coupled with therapist support.
Computerized substance abuse prevention or treatment,
mental health counseling, or sexually transmitted diseases  A small randomized trial of relapsed methadone main-
(STD) and human immunodeficiency virus (HIV) preven- tenance clients found that those receiving eGetGoing
tion may be DVD-based or loaded on a hard drive, interac- had equal satisfaction and outcomes as those who re-
tive, and include skills training, educational material, and received onsite group counseling.12 Internet counseling
clients reported more convenience and confidentiality.
176 Ryders Lane, New Brunswick, NJ 08901 Tel: 732.932.1225 Fax 732.932.1233 Website: www.cbhs-cjr.rutgers.edu

2.  Computerized, self-paced health prevention interven- Technology innovations in behavioral health services can
tions reduced STD/HIV risk behaviors and increased expand access to interventions. Without the need to travel
knowledge the same as person-delivered interventions.13 or make appointments, services can be tailored to clients’
 Computerized risk assessment predicted violence among schedules and needs. Diagnoses and assessments can be
offenders with mental health disorders.14 Among female facilitated, and real-time relapse prevention and health
drug abusers, data from a brief computerized interven- promotion messages disseminated through cell phones.
tion predicted substance abuse and treatment attrition.15 Although the evidence base is still limited, these interven-
tions offer exciting potential for improving and expanding
 Clients in anxiety therapy were randomly assigned to
the delivery of effective prevention and treatment to un-
computer treatment with technician assistance, computer
derserved populations, augmenting traditional behavioral
treatment with clinician assistance, or standard outpa-
health services, and informing new research on risk factors
tient treatment. Both computer-based groups significant-
and relapse.
ly decreased symptoms compared to the standard outpa-
tient group; the clinician-assisted group did better than References
the technician-assisted group.16 1
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 The Robert Wood Johnson Foundation’s Health eTech- Internet and American Life Project, Pew Research Center.
2
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health promotion discussion groups, internet assessment Internet and American Life Project, Pew Research Center.
3
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holds. Washington DC: Pew Internet and American Life
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Project, Pew Research Center.
Outcomes were mixed, with several internet-based dis- 4
Bickel, W. et al. (2008). Computerized behavior therapy for
ease management systems showing no effect on health opioid dependent outpatients: A randomized, controlled trial.
behavior outcomes. Experiments in Clinical Psychopharmacology, 16, 132-143.
5
Limitations and concerns about the innovations www.medleaprograms.com
6
www.egetgoing.com
7
New technology innovations offer great potential for im- Ferguson, S., & Shiffman, S. (2011). Using the methods of
proving outcomes and access to behavioral health services. ecological momentary assessment in substance dependence re-
Research findings are mixed but some studies have found search – smoking cessation as a case study. Substance Use and
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8
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9
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and therapeutic engagement from direct therapist contact. assisted training program for CBT: A six month follow-up of
Although online group counseling may provide a certain CBT4CBT. Drug and Alcohol Dependence, 100, 178-181.
10
level of anonymity and confidentiality, it is relatively easy Andersson, G., & Cuijpers, P. (2009). Internet based and other
for marketers or computer hackers compromise anonymity computerized psychological treatments for depression: A meta-
analysis. Cognitive Behaviour Therapy, 38, 196-205.
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Spek, V. et al. (2007). Internet-based cognitive behavior thera-
Many offenders are low-income with less access to lap- py for symptoms of depression and anxiety: A meta-analysis.
tops, new generation cell phones, and the internet. Prison Psychological Medicine, 37, 319-328.
12
and jail inmates lack internet access. Aside from the TES King, V. et al. (2009). Assessing the effectiveness of an Inter-
study, research is lacking on the feasibility, acceptability, net-based videoconferencing platform for delivering intensified
and efficacy of technology innovations among offenders. substance abuse counseling. Journal of Substance Abuse Treat-
ment, 36, 331-338.
13
Finally, the unregulated nature of the internet can allow Noar, S. et al. (2010). Can computer mediated interventions
untrained or unlicensed persons to offer assessment, coun- change theoretical mediators of safer sex: A meta-analysis. Hu-
seling, and other behavioral health services. man Communication Research, 36, 261-207.
14
Wjik, L. et al. (2009). A pilot for a computer-based simulation
Future research on technological innovations system for risk estimation and treatment of mentally disordered
offenders. Informatics for Health and Social Care, 34, 106-114.
More research is needed, especially in criminal justice set- 15
Ondersma, S. et al. (2011). The potential for technology in
tings, about the effectiveness of these technologies, and brief interventions for substance use, and during-session predic-
acceptance and feasibility among staff and clients. These tion of computer-delivered brief intervention response. Sub-
interventions are potentially cost-effective by reducing stance Use and Misuse, 46, 77-86.
16
transportation and infrastructure costs, and allowing lower Robinson, E. et al. (2010). Internet treatment for generalized
clinician-client ratios, but there has been little research on anxiety disorder: A randomized controlled trial comparing clini-
their net economic benefits or incremental cost effective- cian vs. technician assistance. PLoS ONE 5(6): e10942.
ness. Comparative effectiveness research should gauge doi:10.1371/ journal.pone.0010942.
17
impacts against existing interventions. www.rwjf.org/reports/npreports/ibr.htm
176 Ryders Lane, New Brunswick, NJ 08901 Tel: 732.932.1225 Fax 732.932.1233 Website: www.cbhs-cjr.rutgers.edu