How to assess a client’s suitability for iCBT programmes

The client’s difficulties

A main feature of any client assessment is to establish the severity level, time of onset and duration of their difficulties. Best practice guidelines recommend low-intensity interventions, including online programmes, for individuals presenting with mild to moderate levels of depression and anxiety (NICE, 2004, 2009). Online programmes are not recommended when active suicidality or psychotic symptoms are present; this level of distress will likely mean the client will need more support than an online solution can offer.

If the client’s difficulties or medication have impacted on their ability to concentrate, it may be more difficult for a client to engage with an online programme.

The level of chronicity of presenting difficulties also needs to be considered. Online interventions may be more suited for clients experiencing recent difficulties; however, online interventions can be considered for people with more chronic difficulties if they have the necessary personal resources. 

The client’s resources

Language and literacy

Clients should be proficient in the language of the online. This is of particular relevance in the online environment as misunderstandings are common because there are no immediate nonverbal cues and fewer opportunities for clarifications. Most programmes are primarily text-based, and so reading ability should be assessed.

Computer literacy and access

Clients need to be moderately computer literate; typically, clients need to have a grasp of web browsing and e-mailing, and the ability to type. They should also have easy, regular, and private access to a computer and/or mobile device.  

Motivation and psychological mindedness

Clients who see themselves as an active agent of change in charge of their own well-being are more likely to benefit from online self-administered programmes. As with face to face interventions that require substantial work between sessions, clients must be self-motivated to work through the content and activities independently. Motivational work prior to an online intervention may be required.

Ability to formulate difficulties and goals

As online programmes tend to be structured and based on CBT protocols, it is important to assess whether these models suit and make sense to the client. Is the client able to recognise & describe their difficulties in terms of their feelings, thoughts and behaviours? Can the client see how working on changing these can directly affect their wellbeing? It is also important that the client be able to formulate clear and specific goals and see how a structured intervention can help them achieve these.

Client preference

Finally a crucial element in assessing suitability for an online programme is whether the individual is keen on using an online programme to help with their difficulties, whether they believe it can help or whether they may have concerns around privacy or feel it may be too impersonal.

Conclusion

A collaborative assessment of all the above mentioned factors will ensure that the treatment plan offered, whether online or otherwise, is the best possible fit for the client. This allows us as clinicians to maximise the probability of a positive outcome for our clients.

(This article is an outline of our whitepaper of the same title, which explores the key points clinicians should bear in mind when assessing their clients’ suitability for online interventions).