The paper describes the 5 year development and testing of a web-phone system that delivers a series of voice or text messages as well as questions that require voice or text responses from clients. Based on these responses, the system branches to additional messages or questions or performs other tasks such as playing an audio file. The paper then describes system implementations in 5 different settings and the lessons learned that are applicable to anyone developing state-of-the-art systems for social service agencies.
The system, called Teleherence, uses text-to-speech, speech recognition, texting (short message service or SMS), and voice over internet protocol (VOIP) with landline, cell, and smartphones. Teleherence typically (1) sends voice or text messages to clients such as appointment reminders and therapy reinforcement information, and (2) records and charts client responses. The target users of Teleherence are care managers, who identify client risk, support and monitor change, follow up to provide booster interventions if necessary, predict successes and potential failures, and evaluate outcomes.
Teleherence implementations occurred in a mental health clinic, two court related addictions clinics, a Taiwan university anti-smoking intervention, and a university program to support student veterans. Lessons learned concern the difficulty of:
- Integrating advanced technology into antiquated agency computer systems
- Preventing sensitive clinical information from creeping into the automated Teleherence dialogue
- Structuring addictions communications where agency services are continually changing due to severe budget cuts
- Separating out the effects of just receiving Teleherence calls vs the therapeutic content of those calls
- Changing agency policies and work patterns of busy staff to insure effective use a state-of-the-art technology.
The most challenging part of advanced system development involves continued development and marketing. Cutting edge systems like Teleherence use a prototyping or trial and testing approach resulting in many changes in direction based on a better understanding of user requirements, technology requirements, and new technology advances such as the rapid move from voice phone calls to mobile texting. The programming code driving Teleherence needs a total re-write to streamline functionality and to harden the system against bugs and conflicts with other applications. Keeping a development team together is difficult, especially a team that uses computer science research assistants as programmers. These additional coding, testing, marketing, and sales tasks take time, effort, and especially money, which has not been procured to date.
Contact Dick for a copy of the paper.
Dick Schoech e: Schoech@uta.edu | w: http://wweb.uta.edu/faculty/schoech/cussn/personal/schoech.htm