Altitudes East-West: Effectiveness of a Moderated Online Social Therapy program for First Episode Psychosis carers

Altitudes is a world-first online application, designed and built utilising our Moderated Online Social Therapy (MOST) software framework, which integrates three major functions within one web-based application. These include: (i) online psychoeducation (divided into specific thematic pathways which are further separated into individual “steps”); (ii) expert moderated social networking (via a “cafe menu”); and (iii) peer moderation. Each user can log on at their convenience, 24 hours per day. Participants will have access to the intervention for 6 months. The features of the online psychoeducation: New users are given an introductory welcome to Altitudes which highlights ways to optimise their use of the system and how to access system help. Uses are invited to complete, at their own convenience, a series of “pathways” organised into distinct themes including self-care, understanding psychosis, early warning signs and prevention of relapse, understanding their personal strengths as a carer, managing behavioural problems in their relative, and communicating with their relative. These pathways are divided into thematically-related psychoeducation steps to maximize the usability of the material. The content of these steps, which entail narrative examples, has been specifically designed to improve carer stress, e.g., by encouraging self-care and by targeting problematic appraisals known to increase carer stress. In addition, the content of the steps have been influenced by social cognition concepts of “agency” and self-efficacy in family life. The steps and pathways entail regular prompts to users to share their reactions to material with other users through a series of “talking points”. Users’ responses populate the content of the social networking newsfeed. In addition, users can indicate their preference for material through “like” buttons, share content with others users, and can keep track of which users have completed specific pathways and which users share their specific personal strengths. The social networking features: Users of Altitudes are encouraged to communicate with other users and with moderators through the online “cafe” where all other users are visible in the “network” page. Expert and peer moderators are also identifiable as separate classes of users within the network. Users can visit the “wall” of fellow users where posts (and comments upon posts) are displayed along with profile information and images uploaded by each user. Within each user’s home page the moderators can promote specific content, including suggested actions, which are also related to specific “steps”. A group problem solving function, entitled “talk it out” is also contained in the cafe menu which is based upon moderated problem solving from multi-family therapy research which has a well-established evidence base for its effectiveness in psychosis. Users can suggest everyday problems in caring for their relative, and the moderator invites other users to join in the problem solving “group”. The system stores previous problems and solutions, providing an easily accessible “solution wiki” to subsequent users. The social networking combined with problem solving and psychoeducation has been designed to provide social support, increase carers’ understanding of their relative’s disorder, and increase flexibility of interpersonal problem solving and communication, e.g., carers struggling with high levels of emotional over-involvement can be encouraged through the moderated network to facilitate greater independence in their relative and to increase their self-care. Where high levels of criticism of the young person are evident, psychoeducation, through the structured modules and through social networking, will be aimed at re-attributing causes of behaviour and encouraging increased self-efficacy in carers. The role of online moderators: An expert clinical moderator trained in cognitive behavioural family therapy, together with a peer moderator (i.e., a carer with lived experience) in both Melbourne and Perth will be recruited for the duration of the trial. They will log on at daily intervals to assist with modelling and facilitating interactions. Their goal is to encourage self-care, self-efficacy and positive coping within families such as self-talk, active problem solving and positive reframing. Moderators aim to facilitate these outcomes through the provision of emotional and social support, increased recognition of strengths, and development of problem solving skills within a supportive online environment. In addition, the intervention will also incorporate the involvement of a peer moderator with lived experience of caring for a young person with early psychosis. Usage of Altitudes will be measured by monitoring usage of the online system across the study intervention period (i.e. frequency, duration and patterns of use). This will occur through automated processes built into the platform. A number of self report measures will also be completed by participants to assess their experience of using Altitudes. Perceived competence using Altitudes will be measured by the Altitudes Perceived Competence Scale. Motivation for using Altitudes will be assessed through the Altitudes Self-Regulation Questionnaire. Users’ perception of Altitudes moderation will be assessed via the Altitudes Health Care Climate Questionnaire. Participants attending the Altitudes workshops will also be invited to participate in focus groups to assess their experience using the online system.