Wilfrid Laurier University
Scholars Commons @ Laurier
Social Work Faculty Publications
Faculty of Social Work
12-15-2015
A comparison of walk-in counselling and the wait
list model for delivering counselling services
Carol Stalker
Wilfrid Laurier University, cstalker@wlu.ca
Manuel Riemer
Wilfrid Laurier University
Cheryl-Anne Cait
Wilfrid Laurier University
Susan Horton
University of Waterloo
Jocelyn Booton
Wilfrid Laurier University
See next page for additional authors
Follow this and additional works at: http://scholars.wlu.ca/scwk_faculty
Part of the Social Work Commons
Recommended Citation
Stalker C.A., Riemer, M., Cait, C.A., Horton, S., Booton, J., Josling, L., Bedggood, J. & Zaczek M. (2015). A comparison of walk-in
counselling and the wait list model for delivering counselling services. Journal of Mental Health. Published on-line: 15 December
2015. DOI:10.3109/09638237.2015.1101417. This study was funded by Canadian Institutes of Health Research (CIHR) FRN
119528.
This Article is brought to you for free and open access by the Faculty of Social Work at Scholars Commons @ Laurier. It has been accepted for inclusion
in Social Work Faculty Publications by an authorized administrator of Scholars Commons @ Laurier. For more information, please contact
scholarscommons@wlu.ca.
Authors
Carol Stalker, Manuel Riemer, Cheryl-Anne Cait, Susan Horton, Jocelyn Booton, Leslie Josling, Joanna
Bedggood, and Margaret Zaczek
This article is available at Scholars Commons @ Laurier: http://scholars.wlu.ca/scwk_faculty/16
WALK-INCOUNSELLINGVSTRADITIONAL
Thisisthepre-peer-reviewedversionofthefollowingarticle:
StalkerC.A.,Riemer,M.,Cait,C.A.,Horton,S.,Booton,J.,Josling,L.,Bedggood,J.&Zaczek
M.(2015).Acomparisonofwalk-incounsellingandthewaitlistmodelfordelivering
counsellingservices.JournalofMentalHealth.DOI:10.3109/09638237.2015.1101417,
whichwaspublishedon-lineonDecember15,2015.See
http://www.tandfonline.com/doi/full/10.3109/09638237.2015.1101417
ThisstudywasfundedbyCanadianInstitutesofHealthResearch(CIHR)FRN
119528.
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WALK-INCOUNSELLINGVSTRADITIONAL
Runninghead:WALK-INCOUNSELLINGVSTRADITIONAL
Acomparisonofsingle-sessionwalk-incounsellingandthe
traditionalmodelfordeliveringcounsellingservices
CarolA.Stalker1,ManuelRiemer2,Cheryl-AnneCait3,SusanHorton4,
JocelynBooton5,LeslieJosling6,JoannaBedggood7andMargaret
Zaczek8
1Professor,FacultyofSocialWork,WilfridLaurierUniversity
2AssociateProfessor,DepartmentofPsychology,WilfridLaurierUniversity
3AssociateProfessor,FacultyofSocialWork,WilfridLaurierUniversity
4Professor,CentreforInternationalGovernanceInnovation,ChairinGlobalHealth
Economics,UniversityofWaterloo
5ResearchCoordinator,FacultyofSocialWork,WilfridLaurierUniversity
6ExecutiveDirector,KWCounsellingServices,Kitchener,Ontario
7ClinicalDirector,KWCounsellingServices,Kitchener,Ontario
8DirectorofCommunityCounsellingProgram,FamilyServiceThamesValley,London,
Ontario
ThestudywasconductedatKWCounsellingServices,Kitchener,OntarioandFamily
ServiceThamesValley,London,Ontario.
WordCount:3,969wordsexcludingAbstract,References,TablesandFigure.
*RequestsforreprintsshouldbeaddressedtoCarolStalker,FacultyofSocialWork,WilfridLaurier
University,120DukeSt.W.,Kitchener,OntarioN2P2B3Canada.E-mail:cstalker@wlu.ca
Telephone:519-896-7585.Fax:519-888-9732.
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WALK-INCOUNSELLINGVSTRADITIONAL
AComparisonofSingle-SessionWalk-inCounsellingandtheTraditionalModelfor
DeliveringCounsellingServices
Abstract
Background:Walk-incounsellinghasbeenusedtoreducewaittimesbuttherearefew
controlledstudiestocompareoutcomesbetweenwalk-inandthetraditionalmodelof
servicedelivery.
Aims:Tocomparechangeinpsychologicaldistressbyclientsreceivingservicesfromtwo
modelsofservicedelivery,awalk-incounsellingmodelandatraditionalcounsellingmodel
involvingawaitlist
Method:Mixedmethodssequentialexplanatorydesignincludingquantitativecomparison
ofgroupswithonepre-testandtwofollowups,andqualitativeanalysisofinterviewswith
asubsample.524participants16yearsandolderwererecruitedfromtwoFamily
CounsellingAgencies;theGeneralHealthQuestionnaireassessedchangeinpsychological
distress;prioruseofothermentalhealthandinstrumentalserviceswasalsoreported.
Results:Hierarchicallinearmodellingrevealedclientsofthewalk-inmodelimproved
fasterandwerelessdistressedatthe4-weekfollow-upcomparedtothetraditionalservice
deliverymodel.Atthe10-weekfollow-up,bothgroupshadimprovedandweresimilar.
Participantsreceivinginstrumentalservicespriortobaselineimprovedmoreslowly.
Qualitativeinterviewsconfirmedparticipantsvaluedtheaccessibilityofthewalk-inmodel.
Conclusions:Thisstudyimprovesmethodologicallyonpreviousstudiesofwalk-in
counselling,anapproachtoservicedeliverythatisnotconducivetorandomizedcontrolled
trials.
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WALK-INCOUNSELLINGVSTRADITIONAL
Declarationofinterest:None.
Keywords:single-sessiontherapy;walk-incounselling;outcomes;hierarchicallinear
modeling;mentalhealthtreatment;servicedeliverymodels;mixedmethods;brieftherapy
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WALK-INCOUNSELLINGVSTRADITIONAL
Longwaitinglistsformentalhealthservicesarecommon.Community-basedmental
healthandfamilycounsellingagencieshaveincreasinglyturnedtothewalk-incounselling
(WIC)modeltoreducewaittimesandimproveaccessibility.Mostwalk-incounselling
servicesprovidesinglesessiontherapy(SST),whichhasbeendefinedas“anyone-visit
treatmentthatisintendedtobepotentiallycompleteuntoitself”(Hoyt,1994,p.141).SST
canbeofferedbyappointmentorwithinawalk-incounsellingprogram.
NosingletheoreticalframeworkguidesSST;however,itisbasedonprinciplesof
brieftherapythatencouragetherapiststolistencarefullytotheclient’sgoalsandto
emphasizetheclient’sstrengthsandresources.Systemic,narrative,solution-focusedand
cognitivebehavioralapproachesarefrequentlyusedinSST(Campbell,2012;Clements,
McElheran,Hackney,&Park,2011;Young,2011).OrganizationsofferingWICusually
provideadditionalcounsellingtoclientswhorequestitorareassessedbythetherapistto
requireit.
AlthoughSSThasbeenemployedtocopewithwaitlistsformanyyears(Denner&
Reeves,1997;Clementsetal.2011),andafewdescriptivestudiesofwalk-incounselling
servicesthatemploySSThavebeenpublished(authors,2013),wefoundonlyoneprevious
studyofWICwithastandardizedmeasureofclinicaloutcomeandacomparisongroup
(withawaitlist)(Barwicketal.,2013).ChildrenandtheirfamiliesusingWIChad“steeper
ratesofimprovementcomparedtousualcareclientsdespiteequivalenceinpsychosocial
functioningatbaseline”(p.339).
OnestudyofSSTbyappointmentwasfoundwitharandomizedcontrolgroupanda
standardizedoutcomemeasure(Perkins,2006).Youthandtheirparentswhoattendeda
scheduledsinglesessionwithintwoweeksoftheirrequestinanoutpatientmentalhealth
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WALK-INCOUNSELLINGVSTRADITIONAL
clinicinAustralia,werecomparedwithcontrolswhoreceivedtheSSTsessionaftera6weekwait.Significantimprovementinseverityandfrequencyofpresentingproblemfor
thetreatmentgroupwasreportedcomparedtothecontrolafter6weeks.Reviewsofthese
studieshaveconcludedthatSSTmaybehelpfulforsomeclients,butmorerigorous
researchisneeded(Bloom,2001;Cameron,2007;Campbell,2012;authors,2013;Hurn,
2005).
Recruitmentandretentioninnaturalisticstudiesofclientsseekingpsychotherapy
aredifficult(Staines&Cleland,2007),butthecharacteristicsofWICmayexacerbatethis
challenge.Designingstudieswithcontrolorcomparisongroupsthataresimilartoclients
whoattendWICisdifficult,inpart,becauseofthelikelihoodthatclientsself-selectwhen
bothwalk-incounsellingclinicsandtraditionalservicemodelsareavailable.Givenachoice,
individualsandfamilieswhoarehighlydistressedwouldbeexpectedtoattendawalk-in
counsellingserviceratherthanseekserviceswherewaitlistsarethenorm.
WeaimedtocomparepsychologicaloutcomesforclientsofaWICserviceoffering
SST,withclientsonawaitlistfortraditionalcounseling.Wehypothesizedthatclientswho
accessedtheWICmodelwouldshowfasterimprovementinpsychologicaldistressthan
thosewhoaccessedthetraditionalservicedeliverymodelusuallyinvolvingawaitlist.A
secondobjectivewastounderstandwhomaybenefitmostfromthismodel.
Method
Weemployedamixedmethodssequentialexplanatorydesign(Ivankova,Creswell,
&Stick,2006)collectingquantitativedatainthefirstphase,andqualitativedatainthe
secondphase.TheUniversityResearchEthicsBoardapprovedthestudy.
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WALK-INCOUNSELLINGVSTRADITIONAL
AgencySettings
DatawerecollectedfromtwoFamilyCounsellingagenciesintwourbanareas
located97kilometresapartandsimilarintermsofpopulation.FamilyServiceAgencyA
introducedaWalk-inCounsellingClinic(WICC)in2007.Theclinicisopenonedayper
weekfromnoonuntil6:00p.m.withthelastclientdepartingatapproximately8:00p.m.
ThenumberofpeopleattendingtheWICCeachdayrangesfrom29to75;40to50people
perdayismostcommon.Anyindividual,coupleorfamilymayattendwithoutan
appointment.Clientsregisterwiththereceptionistandpayafee,whichisonaslidingscale
gearedtoincomerangingfromnochargetoCA$187.50($125.00perhour).Theintake
workerwhoscreensforrisktoselforothers,addictionsandintimatepartnerviolence,sees
theclient(s)briefly.Theclient(s)seesatherapistforasessionnormallylastingupto90
minutes.Thetherapistemploysastrengths-basedapproachthatinvolvescollaboration
withtheclient(s)todevelopawrittenplan.Clientsareencouragedto“worktheplan”and
toreturntotheWICC(orrequestongoingcounselling)ifneeded.
AtFamilyServiceAgencyB,whichdoesnothaveawalk-incounsellingclinic,
betweeneightand15peoplenormallytelephoneeachbusinessdayrequestingcounselling,
buttheagencyisonlyabletoprovidethreetofivetelephoneintakeappointmentsperday.
Individualswhocallearlyenoughtobeincludedinthedailyquotaaregivenatelephone
appointmentwithanIntakeWorker,normallywithinafewdays.TheIntakeWorker
determinestheserviceoffered,usuallyplacingthecalleronawaitlist.TheIntakeworker
alsoinformscallersaboutothercommunityservicesthatmaybehelpfultothem.People
callingafterthedailyquotahasbeenreachedareaskedtocallbackthenextbusinessday.
Whengivenanappointmentforongoingcounselling,thecosttotheclientisgearedto
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WALK-INCOUNSELLINGVSTRADITIONAL
incomeandrangesbetweennochargeandCA$115.00perone-hoursession.Noother
agencyinthatcityofferedWICatthattime.
Priortodatacollection,wedeterminedthatclientswhoattendedtheWICCand
thosewhorequestedcounsellingfromthecomparisonagencywereareasonablematch
demographically,andthetwoagenciesofferedasimilarrangeofotherservices.
RecruitmentProcedure
Phase1
AttheWICC,everyoneaged16yearsandolderwhorequestedservicewasinvited
bythereceptioniststoparticipateinthestudy,andgiventheBaselineQuestionnaire.
ResearchAssistants(RAs)presentinthewaitingroomofferedtoassistifaclientneeded
helptocompletethequestionnaire.Participantsprovidedcontactinformationandconsent
forfollow-upbytelephonealongwiththecompletedquestionnaire.
Atthecomparisonagency,thereceptionistswhoreceivedcallsrequesting
counsellingrespondedasusual;beforeterminatingthecalltheyinvitedcallers16yearsor
oldertoparticipateintheresearch.Severalmonthsintothestudy,tobesurethatall
clientswereinformedaboutthestudy,weintroducedasupplementarystep.TheIntake
Worker,whencallingbackinresponsetotheinitialrequest,wasalsoaskedtoexplainthe
studyandinvitethecallertoparticipate.CallersconsentingtospeakwiththeRAwere
eithertransferredimmediatelytotheon-siteRAoraskedforcontactinformationsotheRA
couldcallthemlater.TheRAsexplainedthestudyandthecaller’srightsandrequested
verbalconsenttoparticipateinthestudy.Forthosewhoconsented,theRArecordedthe
participant’sanswerstothebaselinequestions.
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WALK-INCOUNSELLINGVSTRADITIONAL
Bothgroupswerere-interviewedbytelephonefourand10weeksaftertheinitial
questionnaire.Asanexpressionofappreciation,participantsweremaileda$10coffeeshop
giftcardwhentheycompletedthe4-weekfollow-uptelephoneinterviewsandagainafter
the10-weekfollow-uptelephoneinterviews.Afterthe10-weekfollow-up,consenting
participantswereconsideredforinclusioninrecruitmentforthesecondphaseofthestudy.
Phase2
Thequalitativecomponentwasdirectedbyamultiplecasestudyapproach
comparingtwodifferentmodelsofserviceprovision(Drisko,2004,Stake,1995,Yin,2003).
Thecasestudysoughttounderstandaspectsoftheservicedeliverymodelsclientsfound
bothhelpfulandunhelpful. Participantswereselectedaccordingtothreecategorieswith
respecttotheirscoresovertimeontheoutcomemeasure(GeneralHealthQuestionnaire12(GHQ-12)(Goldberg,1972);becausetheoveralltrendforparticipantsfrombothsites
wasimprovementontheGHQ-12,thethreecategorieswere“trend(improvement)”,“nontrend(nochange)”and“non-trend(deterioration)”.Atotalof48interviewswere
conducted.Participantsreceivedanother$10giftcardwhentheycompletedthequalitative
interview.
Measures
Participantsprovideddemographicinformationandselectedpresentingproblem(s)
fromalistofcommonconcernsthatleadadultstoseekmentalhealthcounselling.The
GHQ-12isa12-itemscaledevelopedasaself-administeredscreeninginstrumentto
identifypsychologicaldistress.Itwasdesignedforuseingeneralpopulationsurveysorin
clinicalsettings(McDowell,2006).Ithasbeentranslatedintomanylanguagesandfound
tobereliableandvalidthroughouttheworld.Itcorrelateshighlywithmeasuresofwell-
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WALK-INCOUNSELLINGVSTRADITIONAL
beingandothermeasuresofdistress,andhasdemonstratedabilitytopredictphysician
visitsandpsychiatricconsultations.Sensitivitytochangeisgood(Goldberg,1972).We
usedtheLikert-typescalescores(1-4)becausetheyhavebetterdistributionalproperties
forlongitudinalstudiesofchangecomparedtothemorecommonGHQscoring,developed
primarilyforscreeningpurposes.Scoresrangefrom0-36.
Tomeasureprioruseofsocialandmentalhealthservices,inconsultationwiththe
agencypartners,wedevelopedameasuretailoredtotheuniquecontextofeachagency.
Thismeasurelistedlocalagenciesprovidingmentalhealthcounsellingandinstrumental
support.Thelatterincludedagenciesprovidingassistancerelatedtohousing,employment,
familyviolence(e.g.women’sshelters)andlegalissues.Participantswereaskedtoindicate
thosewithwhichtheyhadcontactandthenumberofvisitsorcontactsintheprevious
month.Theywereinvitedtoaddanyagenciesthatwerenotinthelist.Thisformat
followedrecommendationsofresearcherswhohavestudiedreliablewaystocollectthis
typeofdata(Reid,Toban&Shanley,2007).
Toestimatethecost-effectivenessofthetwomodelsofservicedelivery,participants
wereaskedabouttheirabilitytoparticipateindailyactivities/workandabouttheiruseof
formalhealthservicesinthepreviousmonth.Thefindingsrelatedtocost-effectivenessare
reportedinaseparatepaper.
Anoriginalsemi-structuredinterviewguidewasdevelopedforthequalitative
telephoneinterviews,whichlasted20to30minutes.Theinterviewgathered
comprehensiveinformationabouttheparticipants,includingpresentingproblem,natureof
psychologicaldistress,thecounsellortheymetwith,howeachservicehadorhadnotbeen
helpful,otherservicesused(ornot)andreasonsforalternativeserviceuse.Itincluded
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open-endedquestionsandplannedpromptstomeettheneedsforbothstructureand
consistencyintheinterview(McCracken,1988).
DataAnalysis
Phase1QuantitativeDataAnalysis
Totestthemainhypothesis,weusedhierarchical,longitudinal,slopes-asoutcome
modelsthatusedrandomcoefficientstoestimatewhetherthewalk-inmodelhada
differentialeffectonindividuals’trajectories.Inthishierarchicallinearmodel(HLM;also
referredtoasmultilevelmodelormixedeffectsmodel),repeatedmeasureswerenested
withinparticipantsandtheeffectofthewalk-inmodelwasestimatedasasecondlevel
dummyvariable(Singer&Willet,2003;Raudenbush&Bryk,2002).Whilesomestudies
alsoincludetheclinicianasalevelintheHLMmodel,thiswasnotfeasibleinthisstudy
becausenotallclientsinthecomparisongroupsawaclinicianduringthestudyperiod.We
usedSAS,ProcMixedV9.2,toestimatethemodelbyusingrestrictedmaximumlikelihood
(RML)estimationasrecommendedformulti-levelmodelsifrepeatedmeasuresarenot
equallyspaced(Singer&Willet,2003).
HLMsofferimportantadvantagescomparedtooldermodels,suchasbetter
handlingofmissingvaluesandunequaltimeintervalsbetweenandwithinparticipant
responses(Hedeker&Gibbons,1997;Nich&Carroll,1997).Repeatedmeasurementsalso
increasethestatisticalpower,describetheshapeofchangeovertime,andavoidthe
psychometricproblemsassociatedwithchangesinscoresbeforeandafteranintervention.
Indevelopingthefinalmodelpresentedbelow,age,genderandpriorserviceuse
(mentalhealthandinstrumentalservices)duringthefourweekspriortothebaseline
assessmentwereenteredintothemodelascontrolvariableswiththeGHQ-12scoreasthe
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WALK-INCOUNSELLINGVSTRADITIONAL
dependentvariable.Theagevariableiscenteredontheaverageageof35whilegenderis
representedasadummyvariable(Female=1;MaleorTransgender=0).Priormentalhealth
serviceuserepresentsthenumberofreportedmentalhealthservicesreceivedorattempts
ataccessingtheseservices(e.g.,counsellingsessionsorcallstoacrisisservice)inthe
monthpriortobaseline.Whileonlythegendervariablewassignificantlydifferentbetween
thegroupsatbaseline,themaineffectsofallcontrolvariableswereretainedinthemodel
fortheoreticalreasons.Theindividualtrajectoryismodeledasaquadraticgrowthmodel
includingbothalinearcomponentrepresentingtheinitialslopeatbaselineandaquadratic
componentrepresentingthecurvatureoraccelerationineachtrajectory(Raudenbush&
Bryk,2002).Group(1=WICC)wasenteredasasecondleveldummyvariabletoaccountfor
theeffectofthewalk-inmodelrelativetoatraditionalmodel.
Phase2QualitativeAnalysis
Transcriptionsofthetelephoneinterviewswerereviewedforaccuracybefore
analysisbegan.Amultiplecasestudyapproachinvolvesanalysisbothwithineachcase
(model)andacrosscases(models)(Stake,1995,Yin,2003).Athematicanalysiswas
conducted,organizingdataintopatterns/themes,andincludingacross-thematicanalysis.
Codinginvolvedfivephases:becomingfamiliarwiththedata,creatinginitialcodes,
assemblingcodesintothemes,naminganddefiningthemes,andfinally,integrating
qualitativefindingswithquantitativefindingstoanswertheresearchquestions(Lofland&
Lofland,1984).Themeswereidentifiedbothinductivelyanddeductively.Trustworthiness,
credibilityandverificationofdatawereestablishedthroughintercoderagreement(3
coders),lengthyandrigorousdiscussionsidentifyingareasofdifferencetoreachclarityon
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WALK-INCOUNSELLINGVSTRADITIONAL
codes,memo-takingandfurthersampling(interviewing)(Miles&Huberman,1994).
Themesrepresentrepeatedinstancesofsimilarresponsesacrossthedata.
Results
Participants
AttheWICC,outofanestimated729individualswhoattended,359(49%)
completedthebaselinequestionnaire;307ofthe359(85.5%)consentedtofollow-up.Of
these,221(72%ofthoseconsentingtofollow-up)completeddatacollectionatthe4-week
follow-up,and229(75%)completedthedatacollectionatthe10-weekfollow-up.Atthe
comparisonagency,outofanestimated532eligibleindividualswhorequestedcounselling,
151individuals(28%)completedthebaselinedatacollectionandalloftheseagreedto
follow-up.At4weeksfollow-up,146ofthe151(97%)completedthedatacollectionandat
10weeks,142(94%)completedthedatacollection.
[Table1approximatelyhere]
Table1illustratesdemographicandothercharacteristicsoftheparticipantsfrom
eachresearchsite.Thetwosamplesweresimilarwithrespecttotheproportionbornin
CanadaandtheproportionforwhichEnglishwasthefirstlanguage.Theparticipants
attendingtheWICCweremorelikelytobemale,andslightlyyoungerthanthecomparison
group.Similarproportionsatbothsiteswereemployedfull-timeorunemployed,butthose
attendingtheWICCweremorelikelytoreportattendingschoolandlesslikelytoreport
beingoneitherSocialAssistanceortheprovincialdisabilitysupportprogram.
ThemeanGHQ-12scorefortheWICCparticipantsatbaselinewasslightlyhigher
thanforthecomparisongroup.Reporteduseofmentalhealthandinstrumentalsupport
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WALK-INCOUNSELLINGVSTRADITIONAL
servicesinthefourweekspriortobaselinewassimilar,althoughthecomparisonagency
participantsreportedslightlymorepriorcontactswithothermentalhealthorganizations.
FormalmentalhealthservicesincludevisitstotheEmergencyRoomand/oradmissionsto
hospitalformentalhealthreasons.
HierarchicalLinearModelling
[Table2approximatelyhere]
TheestimatesforthefinalmodelcanbeseeninTable2.TheHLManalysisconfirms
ourhypothesisthatparticipantsintheWICCgroupimprovedfasterthanparticipantsinthe
comparisongroup.Thereisasignificantmaineffectofgroup(2.05),suggestingthat,on
average,participantsintheWICCgroupweremoredistressedatbaseline.Theslope
coefficientfortime(-1.61)indicatesthatimmediatelyafterthebaselineassessment,
participantsinthecomparisongroupimprove,onaverage,1.61pointsontheGHQ-12per
week.Thesignificantinteractioneffectofgroupandtime,however,suggeststhatthesame
rateforparticipantsintheWICCgroupis-3.05,almostdoubletherateofthecomparison
group.However,overtime,thisdifferenceingrowthratesbecomeslesspronounced(see
Figure1).Throughaseriesofmodelcomparisonsitwasdeterminedthatinadditionto
group(walk-invs.traditional),instrumentalsupportserviceusepriortobaselinewas
relatedtoindividualchangesinGHQ-12scoresovertimebuttheinteractionforageand
genderwasnotsignificant.Noneofthethree-wayinteractionswithtime,groupandthe
controlvariablesweresignificant.
[Figure1approximatelyhere]
Figure1depictsthedifferencebygroupinGHQ-12scoresovertime(Week0-10)as
predictedbythestatisticalmodelforfemaleclientsattheaverageageof35withno
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WALK-INCOUNSELLINGVSTRADITIONAL
instrumentalserviceuseinthefourweekspriortobaseline.Theseconditionswere
selectedtorepresentthemosttypicalcases.ThemodelpredictsthattheWICCgroup
participants,onaverage,wouldtransitionfromaclinicalseverityleveltoanormalor
nonclinicalrange(i.e.,aGHQ-12scoreof13orless)afterfiveweekswhiletheaverageof
thecomparisongroupwouldnotreachthisclinicalthresholduntilweek10.Forthetypical
casesdescribedabove,theestimatedeffectsizeatfourweeksis0.24,whichisconsidereda
smalleffect(Cohen,1992).At10weeks,theeffectsizeisonly0.05.Effectsizeswere
calculatedusingthepooledstandarddeviationoftherawscoresassuggestedforgrowth
models(Feingold,2009).
QualitativeFindings
Participants’narrativesabouttheirexperienceswithwalk-inand/ortraditional
counsellinghelpedusbetterunderstandfindingsfromthequantitativedata,inparticular
differencesbetweenthetwomodelsintherateofchangeandforwhomwalk-in
counsellingishelpful.Aparticipant’sjourneythroughandexperiencewithbothmodelsof
counsellingwascharacterizedinfourinterconnectedways.Oneofthese,Accessibility
(barriersand/orfacilitatorsinfluencingaperson’sabilitytoreceiveandobtainservices)is
mostsalientinunderstandingthedifferenceinrateofchange.Beingabletoaccessservice
quicklyandeasilywasveryimportanttoparticipantswhoutilizedtheWICC:“Itwas
definitelysomethingIliked.Iamgladthiswasanoptionforme.FromhowitwasbeforeI
hadtokeeplookingtofindacounsellor”.AnotherWICCparticipantexplained,“itwasnice,
because...whenyouhavethesethingsonyourmindyoukindofwanttogetitoffright
away.”Thisstandsindirectcontrasttoaparticipantattemptingtoaccessservicesforboth
herselfandheradolescentdaughterfromthetraditionalmodel,“Imean,shewasinthe
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WALK-INCOUNSELLINGVSTRADITIONAL
mindsettogoandprobablyifwehadbeenabletogetanappointmentthatweek,yesit
probablywouldhavemadeadifferencebecauseshewasgoingtogo,...Ican’tremember
exactlywhattranspiredinthatperiodoftime(whileonawaitlist),butshechangedher
mind.”
AccessibilityislinkedtoMeaningofService,aparticipant’swayofmakingsenseof
theirexperienceandunderstandingoftheservicereceived.Thefollowingparticipant
explainshowtheeaseofaccessibilityfortheWICChelpedtomobilizeherandthisledtoa
senseofselfefficacy:“SoImeanIhavealotofissues.Idon’tknowifanyonecan
really…youknowsaytheperfectthingthatisgoingtomakethemgoaway…whetherit’s
fatiguefromMS(MultipleSclerosis)orpainfromwhateverorjustfeelinganxietyandjust
depressionandworthlessness.Idon’twanttogooutside…justgoingoutofthehousethat
dayIfeltreallygood…So,I’m,like,okay,I’mgoingtodothisandIwasscaredasshit
leavingbutIfeltgoodaboutitforjustthat.Gettingthatdone,no,IfeltalotbetterafterIleft
[theWICC].Ifeltlikeshe[counsellor]wasveryhelpfulandgavemeencouragementtodo
thingsandthatiskindofhardforme.So,tosaythatshehelpedmewiththat,thatwas
prettycool.”
ReadinessforService,thedegreetowhichtheparticipantfeelsmotivatedandableto
committoandengageincounselling,helpsusunderstandtheeffectivenessoftheWICC
andforwhomitisbeneficial:“ItrunsinmyfamilythereisalotofpeoplewhohavebipolarandalotofdepressionandanxietyandIjust,...IfiguredI’mnotgoingtotakea
chanceI’mgoingtodoitmyselfandIwantedtoseeifIcouldgetsomeadvicefrom
somebodyelseandseeiftheycouldoffersomesortofcopingmethodsthatIcouldutilize
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WALK-INCOUNSELLINGVSTRADITIONAL
tocopewhenIfindmyselfstressingout.So,Idecidedtowalk-inandsee,Iguess,whatI
couldlearnandwhatIcouldapply.”
Discussion
ThisstudyadvancesresearchontheWICservicedeliverymodelbyemployinga
comparisongroup,usingastandardizedmeasure,recruitinglargersamples,including
follow-upto10weeks,usingHLMtoanalyzethequantitativedataandusingamixed
methodsdesign.Anotherstrengthistherelativelyhighparticipantretentionrateacross
thefollow-uppoints.
TheresultsoftheHLManalysisconfirmourhypothesisthatparticipantsinthe
WICCgroupimprovedfasterthanparticipantsinthecomparisongroup.Theimprovements
inseverityofdistressaresignificantlydifferentinthefirstfewweeksfollowingtheinitial
contactwiththeagencies.Towardtheendofthetenweeks,themeanGHQ-12scoresfor
bothgroupsaresimilareventhoughtheinitialconditionalmeanGHQ-12scoreforthe
WICCgroupwas2.05pointshigher.Thestudysupportsthefindingsofless
methodologicallyrigorousstudiesofsinglesessiontherapyandwalk-incounsellingthat
reportedimprovementinthepresentingproblemfollowingeitherascheduledsingle
sessionorvisittoawalk-incounsellingservice(Authors,2013).
Clientswhowerereceivingmoreinstrumentalsupportservicesinthefourweeks
priortorequestinghelpatbothagenciesimprovedataslightlyslowerratethanthosenot
reportinginstrumentalsupportservicesatbaseline.Peoplewhoarereceivinghelpwith
problemslikehousingorfamilyviolencemaybelesslikelytoimprovequicklybecause,for
example,itnormallytakessomeperiodoftimetofindsuitablehousing,andthecomplexity
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WALK-INCOUNSELLINGVSTRADITIONAL
ofdecisionsinvolvingfamilyviolencearewellknown.Prioruseofinstrumentalsupport
servicesmayalsobeanindicatorofpoverty,arecognizedsocialdeterminantofhealth.
Findingsfromtheinterviewsindicatethatforsomeclientsofthewalk-inmodel,
mentalhealthdifficultiesareanongoingpartoftheirlifeexperience,somethingtheyneed
tonegotiateandadapttoatdifferentlifestages.Forthesepeople,beingabletohavea
“booster”intheformofaneasilyaccessiblewalk-insessionisnotonlyhelpfulintermsof
relievingdistress,butalsoagoodfitforthosenotinterestedinongoingcounselling.The
interviewsalsorevealedthathowparticipantsmakesenseoftheirexperienceandhow
readytheyaretousecounsellingservicesmayinfluencewhobenefitsmostfromwalk-in
counselling.
ThefindingthatproportionatelymoremenaccessedtheWICCissimilartofindings
fromBarwicketal.’s(2013)studyofchildrenandyouthattendingwalk-incounselling;
theyreportedmoremalesweretheinformantsforchildrenseeninthewalk-inclinicthan
intheusualcarecondition.Futureresearchcouldclarifywhetherthewalk-incounselling
modelisabettermatchthanthetraditionalmodelwiththehelp-seekingneedsofsome
men(Evans,Frank,Oliffe&Gregory,2011).
Limitationsofthestudyincludethedissimilarmodeofdatacollectionbetweenthe
sitesatbaseline(self-reportvstelephoneinterview)anddifferentialparticipationrates.
Althoughmulti-levelmodelingenabledustocontrolforthedifferencebetweensitesinthe
meanGHQ-12scoreatbaseline,moresimilarityintermsofinitiallevelofdistressand
genderwouldstrengthenthestudy.
Thestudydemonstratesthatindividualsattendingwalk-incounsellingservicesare
willingtoparticipateinoutcomeresearch,andwithsufficientresourcesandadequate
18
WALK-INCOUNSELLINGVSTRADITIONAL
trainingofresearchstaff,itispossibletoachieveagoodresponserate.Moreresearch
involvingmultiplewalk-incounsellingservicesandadditionalcomparisonservicesis
neededtoconfirmthefindingsofthisstudyandtounderstandinmoredetailtheessential
componentsofaneffectivewalk-incounsellingservice.
19
WALK-INCOUNSELLINGVSTRADITIONAL
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Figure1
EstimatedGHQ-12ScoresforEachGroupOverTime(for35yearoldfemaleclientswithno
priorserviceuse)
35
30
25
GHQ12Scores
Transitionfromclinicalto
normalrange
20
15
10
Comparison
5
Walk-In
Treshold
0
0
1
2
3
4
5
6
7
8
9
10
Weeks
23