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Consumer evaluation of mental health and substance abuse providers - sharing experiences on the web
Jun 7

Written by: Matthew Hile
6/7/2007 1:43 PM

Recently I received a set of questions about one of the web sites we have created to support a Robert Woods Johnson funded project to implement a mental health system change process to implement evidence based practices in substance abuse treatment providers in Missouri. Because these were “lessons learned” questions I thought others might find these responses useful.

Q - Is the entire website using DotNetNuke? Are you doing it alone?

R – The site, supporting Missouri’s Advancing Recovery project, was built entirely with DotNetNuke (DNN) an open source web application framework based on Microsoft’s .NET platform. It uses many of the standard modules (e.g., Photo Gallery, HTML pages, Documents) and a couple of independently create ones (viz., Ktomics WWWiki, DNNstuff SQLView).

Q - How much time does it take you to initially develop the website?

R – Using DNN the initial site creation is quite easy to accomplish. Since the Institute has been using it for a number of sites (including our home site MIMH.EDU) once we have the content we can get a basic site up and onto the web in a day. My general approach is to get a site posted quickly then continue to add information, features, and organizational structures as time goes on.

Q - How much time does it take you to maintain the website?

R - Maintenance includes a variety of tasks. Because much of the site is private (available only to the project’s participants) I need to evaluate all new registration requests and decide it they are to have access. Actually approving them takes only a moment but often I need to check with others to see if they are valid participants. Also, I have gotten a number of requests from folks who are not part of our specific project (e.g., evaluators and RWJ staff). To accommodate their legitimate requests to view the site I needed to modify our initial security model granting these users “read only access” to many of the private pages and denying them access to one (viz., the contact information of all of the participants). This fine grained security tailoring is supported by DNN but it a couple of days to conceptualize, setup, and test.

Another maintenance task is to keep the base DNN software up-to-date. Because we support a number of sites, using modules developed by others and custom modules created by our staff it is a time consuming task to make major changes and to test all of the applications. This is not unique to DNN but is something that needs to occur with all software upgrades.

Q - How much time does it take you to update the website?

R - Updating the site refers to adding new content. Again, because of the DNN framework the mechanics of this are relatively simple. I receive, find, or create the content, decide where it should be placed, format it appropriately and add it to the site. For some information, like a RWJ project newsletter, this takes 10 minutes. Creating other materials take longer depending on what needs to occur. For example, there was a recent article about medication assisted treatments for substance abusers in the St. Louis paper that I wanted to site. Because I was afraid that the link to the original article could disappear I wanted a copy of the article on one of our pages. It took about an hour from start to final formatted and linked web page.

Another important feature of updating the site is to let user know what has changed. Since our user base is not sophisticated what I do is to send them a weekly email newsletter (through the DNN application) that lists what has been added and changed. Obviously the actual time I spend doing this varies based on how much material is added. It has ranged from 1-16 hours a week but is most often only a few hours.

Q - Is anyone else in addition to you adding information to the wiki or the forum or any other tab? Are any providers adding directly?

R – DNN supports participant contributions in many of its modules. In my mind that is one of the most compelling aspects of the application. However, our site participants are not accustomed to adding information to a web site and, to date, I have been unsuccessful in getting that to happen. What I have done it to continually solicit information from the participants. They email me the information and I put it onto the site. This has not become habitual on that part – I still need to ask people to send me this or that for the site – but when asked the information is readily provided.

Q - Has the wiki caught on/been used as much as you would like? Why or why not?

R – I am a huge fan of wiki supported collaborative writing. Basically a wiki allows any authorized user to easily edit current pages and to create new pages. However, for the reasons described above, our users are not actively using this to share their information.

The other problem with a wiki is organization. While it is easy to create additional pages it is difficult to keep up with an organically growing structure. And, because users need to have mental models about a site that they use, this makes the totally free form approach we adopted difficult is multiple individuals are making structural changes. Wikis that have an inherent structure (e.g., Wikipedia), or a commonly agreed upon structure, may be a better bet for this technology.

Q - I see you use both the wiki and a repository page to place documents. How do you decide which to use?

R – I have experimented with a number of ways to provide documents to our users and have yet to hit on one that I think really works. The basic issue is discoverability; users must be able to find what is on the site. Both the wiki and repository are searchable so that users can enter appropriate search terms and find pages containing that information. However, with the repository users have the additional advantage of going to a single page to scan the available documents which have names, categories, and descriptions. As time has gone on I have gravitated toward adding files to the repository pages.

Q - Has the forum caught on? Why or why not?

R – The forums have not. I have added a few questions and a high percentage of our users have viewed those posts but there have been essentially no comments or discussion. I think there are at least two reasons. First, we have not created a culture within our project for using this as a way to ask questions and receive support. Second, as mentioned above, I think that providing contributions on a web site is a new concept that has yet to attract our users. It might be possible to jump start this process by getting a few participants to use this area extensively and by example demonstrate to others its value. To date, we have not done this.

Q - Can you tell who is accessing the website and how they are using it? What do you see?

R - For the private sections of the site we have a total of 27 users. In the last two months 18 of those folks accessed the site. The most frequently visited pages are our wiki (304 requests), news page (144 requests), forum (109 requests), and medication assisted treatment documents (105 requests). For our publicly available pages we had the most hits on the home page (380 requests) and consumer/family information page (105 requests).

Q - What do you think is the primary value of the website to providers? To the state?

R - For both I think it is the one shared place where all of the project materials are available. Additionally, it provides a public face for the project which is often not done for many grant efforts.

Q - The providers identify the website as a strength of the project. What are three of the reasons?

R - The providers have liked having one place where all of the relevant information is stored and shared, the weekly updates on what is new, and the information created specifically for consumers and their families. They may be able to give additional reasons but these are things that I have heard.

Q - Is there anything you would do differently, either at the start or now?

R – Work more aggressively to develop a sense of a web based shared community. The participants seem to have a strong bond with each other in this project learning and sharing freely of their knowledge and experience. But that has not been successfully translated to their direct contributions to the web site.

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