Outreach-online TM

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cCBT Instructions for Administrators & Helpers

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Version 1.2
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Contents

Contents ......................................................................................................................... 2
Introduction ................................................................................................................... 3
Who is it for? .................................................................................................................. 3
Screening assessment .................................................................................................... 3
How is Outreach-online™ delivered? ............................................................................. 5
The workbook ................................................................................................................ 6
The importance of the written record ........................................................................... 7
Brief content .................................................................................................................. 7
Entry to the programme .............................................................................................. 10
Timing........................................................................................................................... 10
Method of contact ....................................................................................................... 10
Pathway........................................................................................................................ 11
The administration zone .............................................................................................. 14
Accessing the administration zone .............................................................................. 14
Downloading documentation ...................................................................................... 16
Assessments ................................................................................................................. 16
Problems? .................................................................................................................... 16
Known issues ................................................................................................................ 17
Further help ................................................................................................................. 18

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Introduction
Outreach-online™ is a Guided Online Self Help (‘GOSH’) programme for the
treatment of common mental health problems – especially stress, anxiety and
depression.

Outreach-online™ can be delivered via the

Internet, local area network or by CD-ROM. It
can even be delivered by paper workbook,
without a computer at all! Although most of the
content is provided by Outreach-online™, the
support provided by ‘helpers’ is central to the
success of the approach.

Who is it for?
Outreach-online™ is intended for the treatment of mild to moderate anxiety and
depression. The anxiety workbook is designed to help those with generalised anxiety
disorder, panic disorder and phobic avoidance. However, Outreach-online™ can be
used with a range of problems of different severity, depending on the nature, quality
and duration of the interpersonal help provided as part of the overall intervention.

Screening assessment

A paper-based screening assessment is downloadable from the ‘administration zone’

(figure 6). An electronic version of this screening measure is also available from the
administration zone and also by simply typing ‘screen’ (without the quotes) from the
‘initial page’ (figure 6).

Outreach-online™ works best for people:

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Who view themselves as responsible, at least in part, for how they feel
Who are able to ‘think about their thinking’ (metacognitive ability)
Who are motivated to work with the programme at home
Who expect the programme to help
Whose symptoms have had a relatively rapid onset
Whose symptoms are of no more than moderate severity
Who are not overly impaired in many areas of their lives

Outreach-online™ is unsuitable, or should only be used with caution or as an

adjunct in the treatment of people:

With severe or very acute problems

Who abuse alcohol or non-prescribed drugs
Who present risks to themselves or other people
Who are mandated, or who may be otherwise reluctant to participate
Who are so impaired by their symptoms as to make guided self-help an
inappropriate choice

Helper’s qualifications

The role of the helper is to support and encourage the client through the
programme. The helper also negotiates with the client such issues as:

How often they will meet, and for how long

How quickly they will progress through the programme
How they will contact one another (usually this will be by telephone)

Clearly the role of the helper is very important. Although no formal training in
psychological therapy is required, it’s important that helpers be optimistic,
interested, involved and supportive. It’s not essential that helpers be qualified
mental health professionals, but all should have the support and clinical
supervision of someone who is.

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It’s important not to underestimate the demands of the role – helpers should be well
supported, and offered additional training if required. The role of helper can be
demanding. Here’s a checklist to help select helpers:

Personal qualities – empathic, genuine interest in the client, optimistic and

involved
Qualification in mental health - not essential, but desirable
Personal experience of mental health issues - advantageous if sufficiently
recovered
Experience of using Outreach-online™ - desirable

Helpers always initiate contact

The helper always initiates contact with the client – this means helpers make
contact with clients, usually by telephone, at agreed times. Although the client may
wish to speak with the helper outside allocated contact times (which may be agreed
by the helper), it is always the helper who contacts the client at their agreed
appointment times. It’s important that helpers initiate contact because:

 Clients may be more motivated to complete ‘homework’ assignments when

they are expecting a call from their helper
 Helpers initiating contact can help reduce any feelings of being ‘left to get on
with it’ that cCBT can engender.

Communication should be clear – helpers should always understand who they can
turn to if they are concerned about a client, and be supported to keep clear records
of their client’s progress.

How is Outreach-online™ delivered?

Outreach-online™ is designed to be provided over the Internet – since it requires no
special software it is especially suited to home treatment. The Outreach-online™
approach combines the use of the program at home, a paper-based record and brief
supportive contact from a trained helper. It’s important to reassure clients that

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Outreach-online™ doesn’t transmit any of their personal data over the Internet.
Some versions of the program ask for the clients name and email address, which is
then stored automatically in a SQL database. This allows the program to retain a list
of users. However, the client keeps their own personal records in their workbook.
This allows Outreach-online™ to be provided as a workbook alone, or delivered in
didactic, psychoeducational groups.

The workbook
The Outreach-online™ programme is comprised of nine sections, or ‘modules’
presented in an easy-to-read workbook format.

The programme is designed to be flexible in its delivery – most clients will use the
440+ page workbook, either by printing it from their computer or by reading it on
screen. The workbook includes more than 60 exercises to encourage clients to think
about their progress through the programme. As the workbook is large, it can be
helpful to present clients with the material one section at a time, to help prevent them
feeling overwhelmed!

Some users may prefer to download the ‘mini workbook’, which has fewer than sixty
pages. This mini-workbook contains all the exercises, and space for recording
progress.

It’s possible to read the workbook on screen and simply print off the mini-workbook, if
users prefer to work this way (pehaps to save paper). The workbooks can be
downloaded from the ‘workbook and audio’ page (figure 1).

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Figure 1 – ‘Workbook and Audio’ page

The importance of the written record

We strongly recommend users keep a written record of their progress in either the full
or the mini-workbook. This becomes a ‘client-help record’ which users retain after
they have completed the programme.

Brief content
There are also almost 120 screens of supplementary information (figure 2) where
information is presented in a form people may find more accessible.

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Figure 2 – Example ‘Brief Content’ page

Those who are in a hurry, or who don’t relish to prospect of reading through a large
volume of material, can use this ‘brief content’ version - accessed by clicking ‘begin’
from the reception page (figure 3). This version can be especially useful where
clients have limited contact with the system – in reception or waiting areas for
example.

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Figure 3 – the ‘Reception’ page

Equipment required

Any computer built in the last two or three years should be powerful enough to run
Outreach-online™. The computer needs speakers and a printer if users wish to listen
to the multimedia content and print their own workbook.

Outreach-online™ runs in a ‘browser’ and works well on a PC running Internet

Explorer® 7 or 6, and in Firefox 2. The computer requires the latest versions of
Macromedia Flash® and Acrobat Reader® (both are free downloads). Opera® users
should configure their browser to identify itself as ‘Mozilla’ for Outreach-online™ to
work correctly.

If using the Internet version (which is identical to the stand-alone version) a fast
Internet connection, such as a broadband connection, is desirable but not essential.

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Entry to the programme

Entry to the programme requires a username and password. Outreach-online™ is
configured to deliver the username and password automatically to the user by email.

Please note - as a security measure, passwords won’t work until they have been
activated by Outreach-online™ staff.

Outreach-online™ license holders (health care providers or commissioners) will be

provided with a referrer code, which is given to the client. Clients then enter this
code into Outreach-online™ when they sign-up. Once signed-up, the client has 12
months access to Outreach-online™.

Timing
We suggest clients work through one module each week if they can, although the
actual timing can be negotiated between the client and helper. Clients are
encouraged to make time for the programme each week, to help maintain a sense of
momentum and progress.

Method of contact
After an initial face-to-face assessment, the helper will contact the client, usually by
‘phone, at the end of each module. We suggest helpers negotiate a series of times
when they will contact the client at the outset, so the client knows when to expect
contact from the helper.

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Pathway

‘Screening’ and ‘Introduction’

The screening assessment is carried out

along with any baseline measures and
assessments of risk.

If the client passes screening, the helper

Week 1 arranges the time and date of the next
contact (usually subsequent contact will
be by ‘phone). The helper provides the
‘Introduction to the programme’
section.

‘Understanding anxiety’

During the brief contact, the helper will

review the client’s progress to date.

At the end of each module, client will

Week 2 record depression, anxiety and stress
(DASS) scores, and discuss progress with
helper. Note that each section may take
longer than one week to complete!

‘Becoming different’

During the brief contact, the helper will

review the client’s progress to date and
record the client’s progress and DASS
scores in the helper’s summary record.
Week 3 The interval between contacts and the
nature of the contract will be mutually
agreed between helper & client. This
section may be longer, as the client will
need support to identify their goals for
the programme.

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‘Everything’s connected’

During the brief contact, the helper will

review the client’s progress to date and
record the client’s progress and DASS
scores in the helper’s summary record.

This section introduces the CBT model.

Week 4 The helper may supply the paper
workbooks, or encourage the client to
download and print their own at home.

Alternatively, the client may choose to

read the material on screen and record
their progress in the ‘mini workbook’.

‘Learning to relax’

During the brief contact, the helper will

review the client’s progress to date and
record the client’s progress and DASS
scores in the helper’s summary record.
Week 5
This section contains relaxation
practice. The client may download MP3
relaxation files if they wish. The helper
encourages the client to persevere with
the relaxation exercises.

‘Dealing with troubling feelings’

During the brief contact, the helper will

Week 6 review the client’s progress to date and
record the client’s progress and DASS
scores in the helper’s summary record.

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‘Dealing with troubling thoughts’

During the brief contact, the helper will

Week 7 review the client’s progress to date and
record the client’s progress and DASS
scores in the helper’s summary record.

‘Solving problems’

During the brief contact, the helper will

Week 8 review the client’s progress to date and
record the client’s progress and DASS
scores in the helper’s summary record.

‘Staying well’

Final contact, final assessment if

Week 9 required and debriefing. Client identifies
relapse / contingency plan, including
any future supports required.

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Figure 4 – the ‘Initial’ page

The administration zone

The ‘administration zone’ helps users configure Outreach-online™, and provides a
place where important documents can be accessed.

Accessing the administration zone

There are three ways to access the administration zone.

 By typing the keys ‘a’, ‘d’, ‘m’, ‘1’ and ‘n’ (‘adm1n’) at the initial page (figure 4)
 By typing the keys ‘a’, ‘d’, ‘m’, ‘i’ and ‘n’ (‘admin’) at the initial page
 From the ‘Quick menu’ on the ‘Initial’ page.

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Figure 5 – the ‘Password Entry’ page

Figure 6 – the ‘Administration Zone’

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Downloading documentation
Screening assessment forms, summary sheets and assessment recording forms can
be downloaded from the administration zone in Adobe Acrobat® PDF format. The
host computer will need to have a copy of Acrobat Reader® installed - a free
download is available from the Internet.

Assessments

Clients are encouraged to assess their depression, anxiety and stress levels at the
end of each of the modules. Assessment is carried out online using the DASS
instrument, available from a link on the ‘brief content’ pages (figure 2).

Paper versions of the DASS, along with a scoring guide, can also be found in the
workbooks.

These assessments neither transmit nor store any information whatsoever; clients
are encouraged to record their results in their workbooks to see how their scores
change over time. Helpers should also keep a record of client’s assessment scores in
their summary records.

Problems?
If Outreach-online™ fails to work, or behaves in unexpected ways, try the following:

 Make sure you are running the latest browser. Outreach-online™ has been
tested and works best with Internet Explorer™ 7 and Firefox 2.
 Make sure your browser is capable of running JavaScript. Follow your
browser manufacturer’s instructions to turn on JavaScript. Sometimes you
may have to install JavaScript support from the Sun Microsystems™ website.
 Make sure ‘cookies’ are turned on. (Follow your browser manufacturer’s
instructions).
 Make sure your computer is running the latest version of Macromedia Flash®.
 Make sure your computer is running the latest version of Adobe Acrobat
Reader®.

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 If you are using Internet Explorer 7, set your security settings to ‘medium’.

Ensure these
two boxes are
ticked

Figure 7

Known issues
 The default security settings on Internet Explorer™ 7 may prevent secondary
windows from working, or prevent some configuration options working
correctly. Try resetting the default security settings from ‘Medium-High’ to
‘Medium’ (‘Tools’  ‘Internet Options’  ‘Security’).
 Internet Explorer™ may also raise a security alert (a gold coloured bar
appears when starting Outreach-online™ saying ‘active content has been
blocked’). This can be turned off in the ‘advanced options’ menu: (‘Tools’ 
‘Internet Options’  ‘Advanced’  ‘Security’) - see figure 8.
 Some controls may not work correctly under Internet Explorer™ 7 or Windows
Vista™. This issue can be corrected by setting your security level to ‘medium’
- (‘Tools’  ‘Internet Options’  ‘Advanced’  ‘Security’) - see figure 9.
 Sound may not work correctly on versions of Firefox earlier than version 2.
 User colour options may not work correctly when running Firefox under Linux.

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Set your security

level to ‘medium’

Figure 8

Further help
If you have any questions, comments or need further help with the programme,
please contact the author on transactional@gmail.com; further contact details are
available at www.outreach-online.co.uk.

Thanks very much for using Outreach-online™ - I hope you enjoy using it!

Best wishes,

Steve Cottrell

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