July/August 2014 Issue

Texting for Help
By Lindsey Getz
Social Work Today
Vol. 14 No. 4 P. 6

It can’t be ignored that young people are texting—a lot. In fact, it’s now the most popular mode of communication for millennials, with 75% of teens texting regularly, and “heavy texters” sending more than 100 texts in a single day, according to 2012 Pew Research data. Though adults aren’t quite as busy with their phones, they also are beginning to send more texts.

Given the number of people communicating this way, it seems apropos that clinicians are recognizing the opportunities related to this practice.

“Millennials use texting for just about everything,” says Mike Meikle, CEO of the Hawkthorne Group and an IT consultant with experience in the human services sector. “It’s the mode of communication they’re most comfortable with. But it’s also worth noting that young providers of social services or health care are also using their mobile devices more and more, to the point where they’re replacing desktops and even laptops.”

Some providers even are using texting to provide services. It’s a fine line to walk, but it offers those in need a method of communication that they may be more comfortable with—and in a time of crisis, that may be just what they need.

Jared Scherz, PhD, MEd, ACS, a clinical psychologist in Mount Laurel, NJ, sees the opportunity but also the downside. “Texting as an offered service by crisis counseling centers has a strong upside but also an equally strong downside,” he says. “If a 15-year-old is only comfortable with texting, without which they might not reach out, an argument can be made that it will save lives. However, on the contrary, the impersonal nature of texting could potentially increase the risk for the client.”

Scherz says there are nuances that may be lost in a text message. “Text messages, similar to e-mail, are limiting when it comes to making emotional contact, and people in crisis need to make emotional contact with somebody as much as—if not more than—receiving strategic advice. If a crisis counselor is not fully trained in texting—and the majority are not—they may jeopardize their client in distress.”

Reaching Young People
When providers are trained properly, there’s great opportunity. That’s been the case with Crisis Text Line, which is similar to a traditional hotline in that it connects users to counselors. The only difference is that it’s all done via texting.

Nancy Lublin, founder of the service, says the text line has gotten everything from texts about bullying or relationship advice to potential suicide risk or even attempts. In one case, Lublin says a teen took a bottle of pills while being counseled via text. Because the counselor had recognized early on that the teen was at extreme risk and asked the boy for his address, the police were sent and ultimately saved his life.

“Texting is the best way to reach teens,” adds Jen Chiou, executive director of Crisis Text Line. “It has the huge benefit of being private and mobile. A teen could be in the lunchroom or a bathroom or even on the bus texting for help without anyone overhearing. With Crisis Text Line, youths have access to help at their fingertips no matter where they are. The anonymity of texting emboldens youths to be up front and direct with their issues and fears.”

Research is backing up the fact that teens are using technology in their cries for help. Scottye Cash, PhD, MSSW, an associate professor of social work at Ohio State University and the lead author of two studies analyzing technology use and help-seeking behaviors among adolescents and young adults, found that teens and young adults are using social networking sites and mobile technology to express suicidal thoughts and intentions as well as to reach out for help. She says that to be effective, suicide prevention and intervention efforts need to employ this technology. Her study found that texting was the second form of communication for those who were in need of help.

Though Cash hasn’t studied why young people use texting so frequently, she surmises the “once-removed effect” where they don’t have to be so direct is appealing. “Texting may serve as a communication vehicle to be more vulnerable,” she says. “With the increasing use of technology by teens, it also seems to be a method they are very familiar with using.”

Since this is the mode of communication that young people are using, she suggests it may be helpful for providers to also communicate this way. “It appears that our methods of reaching out to adolescents and young adults are not actually meeting them where they are,” Cash says. “If, as adults, we’re saying, ‘This is what we think you need,’ and they tell us they’re not going to use it, should we keep pumping resources into suicide hotlines? We need to find new ways to connect with them and help them manage whatever they’re struggling with. In other words, we need to meet them where they are in ways that make sense to them.”

Chiou agrees: “We think it’s important to meet teens where they are. Text is the No. 1 way that teens communicate. They already use it and trust it, so that lowers the barrier to receiving care.”

Addressing Concerns
While the opportunity to connect with young people using their own preferred mode of communication is great, it does also raise several concerns. Security and privacy are two significant ones, Meikle says. “Although provider/client texting is already taking place, many times it’s done in a way that is not secure and therefore a breach,” he says. “If you’re sending personally identifiable information to a client and not using an encrypted or secure method, you run some risk.”

Meikle adds that these laws don’t just apply to the doctor/patient relationship, as some may think. “If you work within social services, you could open the whole organization up for liability or, at the very least, a breach of trust,” he says. “Health care privacy laws are beginning to apply more and more to the social services sector. Even though the same rules may apply, it’s often true that social services are further behind on the technological curve. It’s important that you get up to speed on what’s appropriate with this kind of communication.”

Although Cash sees great benefit in communicating with at-risk young people via text, she agrees that many issues even beyond privacy and security are raised and need to be addressed. She says that the following points should be considered when conversing via text:

• Do you know the person you are talking to is your client?

• Who is participating in this texting conversation (you and who else)?

• Does texting put the texter at risk given the environment? For example, if you have a client who is experiencing domestic violence, is texting safe?

• Would you need to have some type of technology that erases the texts so others wouldn’t be able to see them if they were to have access to your phone? (This is something for both the client and the therapist to consider.)

• Is the conversation private? This is a hot topic with the supposed spying tactics that have been reported.

Beyond the privacy and security issues, Scherz goes back to the fact that texting is impersonal. Though it may be effective when available in times of crisis, such as the ability to text 911 or a crisis center, he believes that for longer-term counseling, it misses the boat. For this reason, he says that, at this point, he doesn’t plan to offer texting at his practice. “For a pragmatic question about scheduling, it might be nice, but for anything more in depth, I need the commitment of the person on the other end as a minimal starting point to get help,” he says. “That minimum is using the phone or e-mail only as a peripheral with the primary mode being face-to-face.”

The Future
Technology certainly isn’t going away. Cash says social workers can educate themselves on implementing new technology by incorporating more of it into the core curriculum. Of course, that requires professors who are comfortable with using technology as a means to provide intervention. It’s a change that the field certainly needs to begin addressing.

“It’s definitely a more impersonal mode of communicating, but it’s the way that things are going,” Meikle adds. “Social services always follows in where health care is going, and they’re moving this way—text, video chat, electronic communication. It isn’t necessarily comfortable for everyone, but it’s part of the future. That means finding technological ways to grow but doing so in a way that is safe and secure.”

— Lindsey Getz is a freelance writer based in Royersford, PA, and a frequent contributor to Social Work Today.