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Wright State Delivers Group Treatment via Cloud-Based Video Conferencing

A special program being delivered out of Wright State University to help deaf and hard of hearing people meet online for virtual drug and alcohol abuse treatment has begun expanding its platform to serve other special needs groups as well.

Until recently people who were deaf or hard of hearing had a couple of options for communicating with others. They could meet in person and use an interpreter or sign language. Or they could use a video phone, a special box hooked into high-speed Internet service that attaches to a television for point-to-point conversations.

What those options leave out, however, is the opportunity for group get-togethers, which is exactly what a team at Wright State University in Dayton, OH wanted to offer to its clients. Deaf off Drugs and Alcohol (DODA) is a grant-funded project through Wright's School of Medicine specifically intended to improve alcohol and drug treatment services for people who are deaf or hard of hearing.

This is a group of individuals that is traditionally underserved by virtue of the communication challenges they face, said DODA Project Coordinator Susan Fraker. Most can't simply pop into the local Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) meeting and expect to have the same experience as others in attendance.

In 2007 the Center for Substance Abuse Treatment, a division within the federal agency, Substance Abuse and Mental Health Services Administration, was issuing grants to organizations that wanted to develop an e-therapy project. DODA won funding to pursue a project in which deaf people in Ohio using sign language could meet with others who were in the same place in their "journey of recovery," Fraker said. To expand beyond the one-on-one limitation of the video phone, DODA considered the use of video conferencing.

"The first thing we wanted to accomplish was to bring deaf people together to support their recovery and to give them a chance to meet with a qualified professional in sign language to help develop those tools of group counseling," Fraker explained. "It's very rare that a deaf person could have the opportunity to have group counseling because there may never be another deaf person in the traditional program."

Getting People Together Through the Cloud
Among the criteria set by DODA for its potential solution was a major emphasis on security. Because of the sensitive nature of the conversations that would go on, the product needed to adhere to the requirements of the Health Insurance Portability and Accountability Act. Also, IT people had advised DODA not to create a platform that would require firewall access.

The first idea was to hire an IT team to write the code for a specialized platform. But, noted Fraker, "We didn't have the expertise to do that in-house." Next, DODA evaluated product offerings from a major telepresence and video vendor. That approach was eliminated for a couple of reasons, she said. "We had to have a designated piece of hardware that was relatively expensive at that time. And we would have to strategically place those in locations for people to access. That didn't appeal to us because our concern was that as technology got better, we'd have an outdated piece of technology that we were tied to."

Eventually, the DODA staff learned about video conferencing alternatives, including a cloud-based offering from Nefsis. Said Fraker, "Nefsis was the [company] that got back to us most quickly and gave us the demonstration that helped us show how we could apply [the technology] the way we wanted to." On the client side all that was needed was a high-speed Internet connection and a fairly high-resolution Webcam. The end-user would simply open up a browser window, go to a specified site, and join in on the gathering.

On the screen the end-user sees a set of two to five windows--one for each participant, "like Hollywood Squares or The Brady Bunch," Fraker said--where they can watch a person contributing to the meeting in sign language. No IT intervention needed.

Illustration of the Nefsis videoconferencing system in use at DODAs eCAM program
The presence of a facilitator isn't necessary for the meeting room to stay open. "If the presentation is over and [participants] want to have a moment to talk, we don't have to cut people off," Fraker said.

Nefsis software also offered product specific advantages, such as the ability of each end user to personalize the setup of his or her screen. "We do work with people with low vision, so they may want to have certain boxes bigger than others to see someone more closely. If they needed a certain caller in the call to be bigger so they could see the sign language more clearly, they had that capability," Fraker said. "If they had vision [that was] better in one eye, they could move that person up into a spot where it was clearer for them to see."

The presence of a facilitator isn't necessary for the meeting room to stay open. "If the presentation is over and [participants] want to have a moment to talk, we don't have to cut people off," she said.

The application provides the coordinator with the ability to gain access to the client's desktop to provide computer support should that be needed in order to get him or her into the meeting. "It was just user friendly enough for us that we could have people who didn't have a whole lot of technical experience be up and running relatively quickly with a short training session," she pointed out. "In 20 or 30 minutes we could show them everything they needed to do to participate in a meeting even though we weren't there to provide extra support."

The first time DODA ran a test of a virtual AA meeting, a few deaf people came online, and one woman signed the sign for jumping up and down, Fraker recalled. "She signed, 'I'm jumping up and down. I want this for home. I want to talk to my friends in groups. I want to talk to two or three of my deaf friends. Can I buy this for my home?'" Immediately, Fraker added, that end user "felt like she finally had some connection to others just like her in her recovery."

After three years of usage, the organization was working with about 149 people stateside. The average distance between the DODA office and a client is 140 miles.

DODA accomplishes its video-based services with about 15 licenses for the Nefsis software. That licensing isn't dedicated to any one person's computer, Fraker marveled. "So we could have seven meetings going on at the same time with two people in each or we could have two meetings with six people in them or one large meeting with 15 people. We have that flexibility."

By 2010 the program, now called eCAM ("electronic Consumer Advocacy Model"), had burst outside of state borders and been taken up by participants nationwide. Now DODA schedules an AA meeting every day. "We never expected to have this outside of Ohio," Fraker said. "It's been very refreshing for the deaf community to have something they could go to and possibly meet with other people in a more confidential way than trying to access a meeting in their home community."

A schedule of those meetings is published online through the Nefsis Web site at The page includes a Join link. "If a user is computer-savvy enough to be able to follow the prompts to download the software independently--which most people can do--they can be in their first meeting in about two and a half or three minutes if they have the authority to download stuff on that computer," Fraker said.

For confidentiality's sake, none of the virtual meetings is recorded, though the software includes the ability to capture what's said and shown.

That original federal grant that supported eCAM ended a year ago. Now the federal agency runs its funding through the Ohio Department of Alcohol and Drug Addiction Services, which subcontracts with DODA to continue delivering the service.

Expanding Virtual Treatment
The impact on the deaf community has been dramatic, Fraker said. "What we hear a lot of deaf people say is, 'I just want to belong.' When they felt like they found a virtual place they could belong to so quickly and with people just like them, we were able to keep people engaged in treatment much longer than their experiences when they were the only deaf person in a treatment program. This service allowed us to reduce isolation and increase communication with people."

Likewise, the technology has enabled DODA to help its deaf clients in other ways too, especially those with poor reading abilities. If they've received a letter from a probation officer or hospital, previously, they would have had to travel to where DODA was or have a DODA person come to where they were in order to get help interpreting the terms of the letter. Now they can simply hold it up to the camera for a DODA person to read. If it's in digital form, a counselor can pull it up using a whiteboard space in Nefsis and read it section by section to explain it to the client. When a counselor is working with clients, he or she can use pictures to show what treatment will be like or what recovery is like. During training that uses printed material, the counselor can hold up the workbook to show participants what page they should be on too.

Or if a counselor is concerned that a client is isolating himself or still using drugs or alcohol, the camera may expose elements of the home environment in the background that shows what's really going on in that person's life. "This has really allowed us to make home visits much more often than we do in the real world," Fraker said.

Now, added DODA Program Director Kristen Dunn, the same technology is being extended to other constituents, including people with other disabilities and veterans. For example, she explained, "We've started to be able to use this same program with individuals with developmental disabilities and actually get them access to psychiatric care for the first time in a long time. So we're also seeing that decrease in isolation with those individuals."

DODA has also begun using the Nefsis platform to deliver training to other programs in and out of the state where it isn't practical or financial feasible to fly to the other site and deliver training in person. Now this approach to program delivery is being considered for other social services not related to treatment. "I don't think that was something that Nefsis envisioned at first," Fraker said. "When they started, they were really looking at the business world. To take it to the non-profit and social services world has been very exciting."

An online video demo of the use of Nefsis technology within the DODA program is located on the eCAM site:

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