Internet Resources for Clinical Social Workers – and Our Clients!

James W. Drisko, PhD, LICSW
Smith College School for Social Work
Northampton, Massachusetts 01063
www.drisko.net

) For general information and introductions to new areas, the internet is great! The internet (or world wide web, or web) can also offer certain up-to-the-minute information and contacts for social support, but much more caution is in order.

If you are a real beginner - read this Introduction first!

• Look first for overviews, screening tools, advice (to be used cautiously), questions and answers, references and links to list-servers and chats.

• Start by locating an omnibus overview site, get an introduction and learn the keywords and terms. With this base, move on to seek specifics.

2) The internet is no substitute for a real clinical social worker or physician.

• Working on the internet is a solitary activity. Real clinical providers offer a relationship and experience which can improve differential assessments, offer support when bad news arrives, help emphasize and mobilize strengths and help find, organize and mobilize human supports.

• Some searches and many screening tools can yield overwhelming and frightening results. Imagine taking a screening tool for depression, scoring in the serious clinical range, while sitting alone facing the computer.

• Use of online screening tools raises important, and as yet unresolved, ethical dilemmas.

• Online clinical resources and doctor visits are in preliminary stages of development –which may be hard to keep in mind given their sophisticated look and often, their well known academic locations.

• Establishing credibility, an even identity, can be difficult. Even with live online chat, you do not know with certainty with whom you are interacting.

• So how do I do this? Little by little. Get to know your web browser—at least a bit. It is important to set "bookmarks" or "favorites" so you can return to sites you find useful. Some hidden features re also useful. For example, clicking "Alt and F" together will open a "Find" window, allowing you to search for a keyword within a web page.

• Pick a widely used search engine. Try Google, HotBot or [Fast] Alltheweb. Pick one and, over time, get familiar with its search features. For example, enclosing your search terms in quotation marks ("the infertility experience") will make most search engines look for the full phrase, rater than searching or each word independently. (Words like "the" and "of" will typically be ignored with no impact on your search.)

• Try some "Advanced Search Features" – every search engine has them.

• Depression can generate over 50,000 results, prompting you to give up! So use a search strategy:

• You can usually locate some sites that offer overviews in lay terms. These provide background and very importantly generate relevant terms for use as keywords. Get an overview and find keywords.

• Then, refine or narrow your search. Add another term or two (all within " ").

• You will get lots of "hits" (web site which include your search terms), but have to use you own judgment about which are most relevant and useful.

• As you gain skill, you may wish to learn about the advanced or refined search features of your favorite search engine. These can combine search terms and exclude others (Boolean searches).

• Be skeptical of all internet resources, but look for the site’s institutional affiliation and physical location. Major institutions (NIMH, top universities) tend to be more credible. Lone author sites without institutional connections should be more suspect. Sites run by commercial companies should encourage the most skepticism! They can, nonetheless, offer useful information.

• You will find banner ads and links on many useful and credible sites (Dr.Koop.com) – but…
• Any provider can give misinformation or make an error (the internet is set up by people!) So…

• Internet sites may repeat information found on others sites or print resources – which doesn’t mean they are accurate or useful. Check new information across credible sites if it has pivotal importance.

• A review in the August 1999 issue of the journal Cancer found 42% of internet sites on Ewing’s sarcoma (a bone cancer) had information that had not been reviewed by, and passed, full hard-science, academic review. 6% included outright inaccurate information on Ewing’s sarcoma. One site included a gross overstatement of the sarcoma’s morbidity (death) rate – that 95% will die! This can be devastating. Imagine learning this sitting alone – when it’s wrong: over two-thirds will survive!

• The guidelines for ethical and professional conduct on the web are still being developed. To reduce threats of lawsuits and to avoid conflict of interest between the selling of information and products and advice, the American Medical Association formulated Ethical Guidelines for Internet Health and Medical Information in March, 2000. Another set of guidelines is being developed by a coalition of industry, academics and consumers (note the order!) and is due in May, 2000. (URL addresses below). Recently Drkoop.com and the American Medical Associations have had paid tie-ins to corporate "sponsors." (Both organizations claim they no longer have such tie-ins.)

• Remember that the placebo effect is real and useful. If you learn about and try something, it may well make you feel better.

• The question is – is it enough. Again, then internet is a resource but no replacement for real human clinical providers.

8) Encourage clients to use internet-based information to start, or to add depth to, conversations with you as clinician. (Or for you in conversation with yours!)

• Good information, and more knowledge about your situation, can make it easier to ask questions of your providers. While you search, make a list. Try to determine what it is about your situation that is different from others you learn about. Consider the strengths and resources you bring.

• E-mail contacts have been of great support to oppressed populations such as adolescents struggling with gay and lesbian identity, women with problem pregnancies and lesbians who have breast cancer. Try http://www.deja.com

• Chat rooms allow contact among families of the chronically mentally ill.

• Internet-based video allow working parents to see what’s happening in their child’s day care center from work; or to see what’s happening to frail parents in nursing homes rooms.

10) Bear in mind your use of the Internet is probably being monitored!!

• No need to be overly paranoid, but you are probably being watched! For profit services "profile" how particular users (you!) visit web sites and specifically what types of information you seek out. This is true even if your internet address is solely numeric. (Do you know yours?) Advocates say this allows sites to better serve you by making links and ads available which match your interests. Doubters note web profilers can make inferences about medical concerns or conditions which might be sold for commercial purposes (ads, e-mails solicitations) or possibly even to insurers.

        Many employers also monitor and record the web sites visited by their employees during
        work hours.

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© 2000, J. Drisko   last update 5/10/02