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May/June 2012 Issue

Mobile App Technology for Social Workers
By Lindsey Getz
Social Work Today
Vol. 12 No. 3 P. 8

There will never be an app that does social work as we know it, but there are apps that may help social workers and other clinicians work more efficiently and effectively.

The use of mobile technology in healthcare has secured a foothold. But while opportunities exist for social workers to adopt these technologies in their practices, acceptance has been slow. The reluctance is not surprising as the foundation of social work is built on human interaction. But the research and experience thus far indicates that mobile application technology has the capability to support the social worker-client relationship.

“The mental health field tends to be slower in terms of adopting new technology than other sectors of healthcare,” says Adrian Aguilera, PhD, an assistant professor in the University of California, Berkeley School of Social Welfare. “That’s because our focus is naturally on relationships with clients.  I think in some ways social workers are threatened by technology and believe it could be a barrier to forming relationships. But the truth is that its adoption is inevitable. Yes, technology can be a barrier in some ways, but the whole idea is finding ways to harness that technology and make it helpful in improving the mental health field. It can actually help support relationships.”

Apps to Consider
Nancy Smyth, PhD, LCSW, dean and a professor at the University at Buffalo School of Social Work, says there are several categories of apps that may be useful to social workers. “Apps that are designed to be references can be very helpful to social workers,” she says. “These types of apps would allow you to quickly look up information or terminology.”

There are apps that provide data on prescription drugs that social workers may find helpful as a reference tool. “These apps offer data on symptoms and side effects of mental health drugs that patients may be taking,” explains Joseph R. Gianesin, PhD, a professor in the Springfield College School of Social Work in Massachusetts. “In [a clinician] going to a client’s home, the client can show their clinician the prescriptions they are taking, and they can be quickly looked up on a smartphone. If a client is experiencing side effects of a particular drug, this is an easy way to figure out why.”

This category of apps is also proving helpful for today’s social work students. “For recently graduated social workers prepping for licensure, the exam prep apps out there may prove particularly useful,” says Jack Monell, PhD, an assistant professor of justice studies in the department of social sciences at Winston-Salem State University in North Carolina.

The University of Southern California School of Social Work has taken it a step further and recently introduced a new mobile app that allows students to access multimedia course content and intraschool social networks via their smartphone. It’s believed to be one of the first efforts to include comprehensive access to recorded lectures, course content, videos, and social networking features through mobile app technology.

Apps designed to collect and store data over a set period of time can also be useful to the clinician, according to Smyth. “There are a variety of health symptom trackers or daily mood ratings that can be a helpful resource,” she says. “I’ve found that it saves me time in sessions. I no longer have to spend a lot of time reviewing how the client’s week went because it’s all been captured in the mobile app. The truth is that many people are not their own best historians. Being able to record how they’re feeling in the moment, right into their phone, is much more effective. It’s also much easier for those who are tech savvy to use their phone—which is almost always right on them—than to pick up a pen and paper to track something like a panic attack or mood rating.”

Aguilera says patients may find it easier to track their mood using mobile technology, particularly if there’s a reminder system involved. He’s utilized www.mood247.com, which uses texting technology to remind patients to report their overall mood each day. “A client signs up to receive daily text reminders that ask them to rank their mood,” Aguilera says. “They can then give access to the clinician to see the data.  It’s a simple technology, yet it can be very helpful. We often tell people to track their moods, but the task is forgotten. Clients who are struggling with severe stressors or mental health disorders may really benefit from the reminder as these clients are sometimes the most likely to forget. We try to preach to clients that they can’t make changes unless they realize how they’re doing, and this is a tool that allows them to do that.”

Apps in Session
There are many other purposes for apps beyond quick references or data tracking. Some social workers may find it useful to introduce apps into an actual session though the idea of introducing technology during a session may seem uncomfortable at first, Smyth says. She adds that any social worker who has had a cell phone ring during a session may be inclined to think of technology as more bothersome than helpful.

“There’s certainly some fear of technology, and many people just aren’t comfortable with it,” she says. “In terms of a technology ‘adoption curve,’ most social workers tend to be in the late stage. That said, there’s a national movement to accountability both from payers and from consumers. People want to know if there are mobile apps available to support them, and social workers are going to have to start familiarizing themselves with the technology as clients request it. Digital life skills is a new skill set that we need to have as social workers. As a practitioner, I can now capture symptom outcomes among patients much more easily over time. Clients are now carrying around devices that allow them to easily report data. These apps may even teach skills and allow clients to access support systems. These are all things that can be helpful, and that national move to accountability is pushing for it. ”

A variety of apps are available that clinicians might consider introducing in a session and then encouraging a patient to continue to use at home. “There’s an app that helps clients with speech therapy that social workers might consider,” Monell notes. “The I Love Mom Picture Book [by GrasshopperApps.com] can help kids speak out in a comfortable environment. And then parents or guardians can use it at home to reinforce skills. I’ve found that apps for children can be particularly helpful. There are apps coming out that address a range of learning deficiencies. The child can interact with the app. I’m finding sometimes the child doesn’t want to talk to the old guy that’s a doctor or clinician but they’re willing to work with the app.”

The use of a language interpreter app may even prove beneficial in a session that may otherwise not be able to take place. Gianesin shares the story of a social worker who was able to communicate with a client only through an interpreter app. “The social worker and client were handing the iPhone back and forth, and it was their only method of communication,” he says. “The client had recently immigrated and was homeless, and this was their only way to receive help.”

Social workers may even find apps to be helpful for their own use. “There’s a note taker app where the social worker can take some simple notes and remember what was said during a session,” Gianesin says. “Or some may even use, with the client’s permission, a recording app where they can record a session.”

Apps for Addiction
Clients who struggle with some addictions may have something to gain from the use of mobile application technology. But like any other technology introduced into the social worker-client relationship, mobile apps for addictions are not meant to replace in-person treatment.

“I view supportive/self-help [treatment-related] apps as just that—assistive,” says Monell. “Similar to 12-step programs for alcohol or Narcotics Anonymous programs, which both have supportive literature to help with abstaining, nothing should ever replace the clinician. These tools should be used as quick remedies but never in place of the clinician. More importantly, for those in deep crisis, these apps may not be conducive in addressing such illnesses.”

Many of the apps dealing with addiction focus on antianxiety methods of coping with withdrawal symptoms rather than the actual behavior cessation, making it even more important that face time with a clinician or support group is not ignored. But mobile apps can be an excellent support in between sessions by helping a client with meditation or relaxation techniques to deal with the difficult quitting process.

While it seems that apps can be a supportive tool, clients may have trouble finding ones relating to alcohol addiction. A search of the Apple iTunes Store revealed that it was easier to find apps for drinking games rather than apps available to help with cessation. Apps for smoking or gambling cessation were more easily located. Amy Cohn, PhD, an assistant professor in the departments of mental health law & policy and criminology at the University of South Florida, has been studying the use of apps for alcohol addiction and surmises this may be because, traditionally, treatments and research for alcohol users have been directed toward individuals with a more severe clinical presentation.

“Research has shown that a variety of face-to-face psychosocial and pharmacologic treatments are effective for these individuals,” Cohn explains. “Usually the people who have more problems from their drinking are the ones seeking treatment and are therefore the ones entering into our research-based clinical trials. So a substantial focus of the research on alcohol treatments has been on those individuals who seek treatment and are therefore more severe. A mobile app, on the other hand, as I see it, would be designed for use with the population of problem drinkers who may be less severe in clinical presentation and problems and who are more likely to quit or reduce on their own and thus less likely to seek formal treatment venues. This comprises a large proportion of the population of drinkers. There has been a recent shift in the focus on our research, in the past 10 years, on those who may not seek traditional therapeutic outlets, and I believe that mobile apps would be a great intervention venue for these individuals.”

Cohn says since mobile app technology is already being implemented in other forms of healthcare, it’s only a matter of time before it “catches fire in the alcohol treatment field.” Still, like Monell, she does not believe that app technology will replace the clinician.

“I believe that an app could augment skills learned in a therapy session,” she says. “An app could help a client practice skills throughout the week such as tracking triggers, identifying high-risk situations, or problem-solving alternatives. This information could even be shared with the clinician and downloaded to a computer or uploaded to a website and be a foundation for further discussion in the treatment session. As clinicians, we only see clients one or two hours of the week. An app could essentially provide support like the clinician for the other 167 hours in the week.”

Potential Concerns
Mobile app technology may not work for every client, but Smyth says to be careful not to say never. While older adults—perhaps those in their 80s or 90s—are likely not going to be interested, Smyth says clients can surprise you. “It comes down to assessing who your client is and what they need,” she continues. “I’d never automatically assume something wouldn’t work for your client. Err in the direction of ‘let’s try this’ and mention mobile technology even if you aren’t sure it will necessarily be accepted. Give them all the options.”

Though social workers shouldn’t be quick to assume a client won’t embrace or benefit from mobile technology, treating a client who is addicted to technology is one situation where it should be avoided. “Every practitioner conducts a biopsychosocial assessment when they meet with a new client,” says Frederic G. Reamer, PhD, a professor in the School of Social Work at Rhode Island College. “Part of that protocol covers substance use and abuse. That assessment might include questions about technology addiction so that the practitioner can determine whether it might be inappropriate to introduce technology as part of the relationship.”

“If you become a clinician that moves to being primarily computer based and spend more of your time looking at technological devices than the client, it can be irritating,” Gianesin says. “But for some mental health patients, it’s more than irritating. It can be something that can trigger paranoia. People who are having psychotic symptoms may think someone is giving you orders to talk to them. They may find it intrusive, and you have to be careful. It’s important to assess clients on a case-by-case basis and make sure it’s something that’s supporting the relationship and not becoming a barrier.”

Once it’s determined that mobile app technology may help support the social worker-client relationship, there are some additional concerns that need to be addressed, including privacy. “You have to consider who has access and who doesn’t,” Gianesin says. “It can become a slippery slope if you become too dependent on the technology and you lose that personal connection.”

But Aguilera points out that some methods used today aren’t necessarily more secure. “When you ask clients to record their mood on a sheet of paper on a daily basis, it’s just a piece of paper that’s hanging around,” he says. “Maybe the client carries it around or loses it. That’s not really a foolproof system. But when you have that data on your mobile phone, you can incorporate a PIN code and actually make it much more secure.”

“App overload” is a concern with the introduction of mobile technology, a phenomena related to the sheer number of apps on the market (currently about 500,000). Weeding through apps can become cumbersome, so clinicians must be careful not to introduce so much mobile app technology that it becomes a time drain.

“To some, mobile app technology can be overwhelming and become a tedious chore,” Monell says. “It’s like shopping. To find the best deals, you often have to take time and sift through many. That’s how it is with mobile app technology now that there are so many apps available. They are categorized, so I would encourage social workers who are new to this technology to do searches focusing on education and lifestyle.”

The bottom line when introducing mobile app technology is to take it on a case-by-case basis. “Like anything else, you have to set limits with clients,” Smyth says. “If you’re using an app to stay connected in any way, you and your clients need to be clear on what’s protected and what’s not. With any use of technology, parameters need to be discussed up front. I have clients that e-mail with me, but I make it clear that e-mail is not the place to tell me if they’re suicidal. The same conversation about what is and isn’t appropriate with app technology is important to have up front.”

Gianesin says social workers should maintain a sense of whether the technology is helping facilitate the client relationship rather than overtake it. “Mobile app technology is a wonderful tool, but it has to be used as a tool and not the main piece,” he says. “The whole concept of working in the mental health field or as a clinician is to have a conscious use of self. If you get beyond that point, you’re in trouble. Mobile apps are great, but you just have to be careful they’re supporting the relationship with your clients and not replacing them.” 

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