Episode 216 - Dr. Ande Nesmith: Text-Based Crisis Intervention Counseling: A Promising Venue to Reach Underserved Young Clients

Monday, May 22, 2017, 9:06:26 AM

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In this episode, Dr. Ande Nesmith takes the path of least resistance and most user-friendly access by utilizing text-based intervention counseling to reach and assist younger clients. She describes her program, her research, and what she is learning about the differences between in-person and text-based counseling formats.

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Average Rating: 5stars  review: ep 216, Sunday, February 09, 2020

By Sean B :

Listening to the work of Dr. Ande Nesmith reminded me of the importance of the social work field keeping in pace with the society in which we serve. Dr. Nesmith reminds us that research shows 88% or more of teens use texting to communicate with their friends, and that statistic may even be greater. Why not, then, would we try and adapt service provision to meet the needs of a technology-dependent generation? If the number 1 advantage, as mentioned by Dr. Nesmith, is that teens are more likely to get help than not get help when texting is an option available to them, then more work needs to be done in this area to develop access, best practices and ethical decision-making models around text crisis intervention. The work of Dr. Nesmith reminded me of the statistic from the Trevor Project in their 2015 survey of LGBT+ youth, wherein 76% of respondents stated they were more likely to reach out for support in crisis via chat or text, whereas only 43% would respond if the option was limited to phone support. Clearly, teens are overwhelmingly supporting text-based service provision, which is something every social worker needs to consider. I appreciate the challenges of text-based services being laid out the way Dr. Nesmith does, as it is important to consider how we will overcome potential barriers or roadblocks to service provision when, in many cases, outside systems control how often, how long and for what purpose we are able to provide services. I was additionally surprised to hear that text-based crisis services can often take six times as long as a typical phone service would take, but am encouraged at the same time that teens were able to reach out “no matter where they are.” Overall, I am encouraged at the research and work that Dr. Nesmith is participating in, and hope to see the helping professions become more accessible and available to those who would seek them.

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Average Rating: 5stars  text-based crisis intervention, Sunday, February 10, 2019

By Amanda McGraw :

Dr. Ande Nesmith makes the case why text-based services are an effective method for young people to access mental health support. She emphasizes the critical fact that many teens would rather not seek help at all if not by text. One of the important points of Dr. Nesmith’s message is that many people are quick to criticize text-based services. A common criticism is that it is more difficult to make a connection. Dr. Nesmith effectively rebukes this argument by sharing many reasons why it makes so much sense that young people prefer to seek help through text. For example, through text, a person can seek help no matter where they are. If they are experiencing abuse, they could potentially access help while in the same room as their abuser. Dr. Nesmith is thorough in discussing associated challenges, including the fact that empathy on the part of the helper has to be very direct and questions must be posed one at a time so that the conversation doesn’t get out of sequence. A different challenge is that the helper may not know what happens to the person due to anonymity. A texter may just disappear, leaving the helper to wonder if they have gone to class, if a parent has walked in, or even if the person has harmed themselves. I appreciated the brief mention of supervision when it comes to training text-based workers. It was interesting to learn about aspects of supervision unique to text-based interventions; for example, the nature of texting allows a supervisor to be there next to a worker as a conversation is taking place in real time. The depth of Dr. Nesmith’s interest and knowledge in this unique topic was impressive, and I appreciated her cautions to not be too quick to judge young people’s preferred methods of communication. She made clear that, for many reasons, it is possible to create an authentic connection using texting, and it is an effective and needed mode of communication to reach underserved youth.

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Average Rating: 5stars  seeking help via text, Sunday, February 11, 2018

By Rebecca Lee :

The idea of text-based counseling is something that I was not all that familiar with prior to listening to Dr. Nesmith’s podcast; however, I find the idea of it fascinating. “Texting” has become more and more of a popular mode of communication, especially for youth, and I completely agree that texting offers a sense of safety and comfort that voice-based counseling does not. Because of the hesitation and ambivalence associated with youth seeking help, having access to text-based crisis counseling services would only seem to enhance the likelihood of teens seeking help altogether.
One of the advantages that Dr. Nesmith mentioned that I consider significant is the accessibility of text-based counseling. Not only does this allow teens to get help no matter where they are, but also it is easier and quicker for them to share what is going on. I know Dr. Nesmith pointed out that pulling information can take some time, especially since counselors have to be careful in asking one question at a time, but I think teens might feel more comfortable sharing their personal feelings through text rather than sharing them "out loud". Like Dr. Nesmith mentioned, people may behave differently online than they do in person. The safety and control associated with texting allows time to figure out how they want to respond and perhaps teens would also experience fewer feelings of vulnerability, judgment, and shame.
While I am not aware of anything like this in my community, I think there is a significant need for it, especially given the high prevalence of teen suicide. From what Dr. Nesmith shared, it sounds like text-based counseling is definitely a successful means of crisis intervention and I’d love to see more of this in our communities. We know the need is there, perhaps it is just a matter of gathering the necessary resources and furthering research to implement such effective and efficient intervention strategies.

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Average Rating: 5stars  crisis textline, Saturday, February 10, 2018

By rstahl :

I had not heard of text-based counseling prior to this podcast, but the information Dr. Ande Nesmith provided left me wanting to learn more. As social workers, we must remain at the forefront of technological advances that increase accessibility to services for our clients. For many, text-based crisis counseling could be the difference between them getting help or not getting help. Dr. Nesmith references the benefit of this type of service in rural areas and I completely agree. Lack of services, transportation barriers, and concern over encountering someone you know are issues that often come up in rural areas. Text-based crisis counseling would eliminate these barriers, while providing a critical service to individuals.
I also think this type of counseling could be beneficial cross culturally. With all of the advances in texting and translating, this could be groundbreaking in dealing with language barriers to receiving crisis interventions. I could also see this being a positive development for individuals with cultural backgrounds where there is stigma surrounding mental health issues and seeking treatment. Not having to see the counselor or vocalize the issue may help these individuals ease into treatment without feeling unnecessary shame.
It is clear there are some real concerns surrounding text-based counseling such as silences, conveying empathy, and healthy endings and transitions. Dr. Nesmith has committed to further research of text-based counseling and I am excited to see how her findings address these concerns and help improve this unique service.

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Average Rating: 5stars  interesting therapeutic alternative, Saturday, February 10, 2018

By JudahBuddha :

As an MSW student who works in crisis counseling and a mother of two teens, I found this discussion to be fascinating and very promising. I had never heard of text based crisis counseling before hearing this discussion, but I will certainly look more into this as another outlet to offer to youth (and adults) in crisis. As Dr. Nesmith pointed out, there is a lot of criticism and judgement around youth and texting, a lot of which is made through surface assumptions based upon the visual appearance of it. Seeing someone sitting silently with all attention on their phone and seemingly totally disconnected from their surroundings looks bad, but as Dr. Nesmith points out - there is another person on the other end of the line.
It seems that text based crisis counseling potentially opens up real therapeutic possibilities for youth in crisis who would otherwise resist seeking help. It is so interesting that many of the youth texting in were in a setting surrounded by other people, including in the room with their parents. I can absolutely imagine this and it shows us that this is a realistic and viable resource available to youth, wherever they are.
Even with the challenges mentioned pertaining to this new format for crisis counseling, and the extra vigilance required to convey empathy, I see this as a very positive alternative to phone counseling. A lot of young people are not comfortable making phone calls. Knowing that suicide is the third leading cause of death amongst youth in the US, and that youth are generally resistant to reaching out for help, says a lot. As a community that supports practice informed research, what reason is there to not further explore and promote this potentially life saving resource? As Dr. Nesmith points out, this is essentially about getting help vs. not getting it.

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Average Rating: 5stars  intriguing method, Tuesday, January 30, 2018

By MakeAdifference :

I appreciate such important services looking to ensure all generations are able to seek help utilizing their choice of technology or communication. This is a form of contact that I have yet to hear about. From a stand point of a tester, I feel it is much easier to convey personal information through text message or email due to the inability to see or hear judgment, or allow another to see or hear how hurt or upset we are. Such communication almost removes the vulnerability piece allowing us to fully reach out to a stranger or friend and really go into detail. The individual that we are texting does not know us, and we do not know them. On the other hand, as mentioned, it is very hard to portray the empathy and emotion through a text message. Thus, allowing the reader to misinterpret or put emphasis on the wrong words conveying a much different message than the writers original intent. Additionally, the time it takes to write the message and receive a response is alarming due to the fact if an individual is truly in crisis, an hour long 10 text message conversation may be depleting precious time. It would be very hard to have a text conversation with an individual in crisis and not know if they just simply stopped texting or if something terrible happened. I understand that the unknown is the same for those who call crisis hotlines, but not evening being able to validate that an individual is truly taking away anything beneficial from the text conversation would be hard. None the less, those who utilize such services must find them beneficial or text-based counseling would not exist. I agree with Dr. Nesmith, such a service is better than nothing at all. I look forward to learning more about this form of counseling and I really enjoyed the podcast and wonderful insight. Thank you so much for sharing your knowledge and perceptions of the topic.

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Average Rating: 5stars  crisis intervention via text, Tuesday, January 30, 2018

By WarmHeart90 :

This podcast was very enlightening. I believe Dr. Ande Nesmith did a wonderful job of presenting both the positives and negatives of providing crisis intervention via a text medium. I don’t want to spoil the podcast, but there are a lot of interesting ideas that she brings to light that I would not have thought about. For example, the knowledge that a ten-minute verbal conversation translates to about an hour text-based conversation. This is concerning to me. Perhaps it is my limited knowledge, I am a MSW student, but I question the to ability handle the urgency of a crisis if it takes so long. As the podcast mentions, the texting clients take longer to open up. If I were reaching out to a crisis hotline via text, I would get frustrated with that length of time. Additionally, when speaking via text, the reader will assign the emotion to what they read. If I was in a poor mental space and I felt that no one cared about me, then I could interpret the texts with a condescending or fake concern. That being said, this is a medium that bridges a gap of service. I believe that even though the process can still be refined, the additional avenue for those in crisis has and will continue to be a necessary next step in crisis intervention. I am grateful for the work being done!

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