Evaluating the Effectiveness of Concurrent Sessions and Counselors' Attention Allocation in Online Counseling.

Objective: With its anonymity and accessibility, text-based online counseling has shown great potential in reaching people with mental health needs. One strategy adopted to meet the service gap is concurrent counseling, that is, each counselor attending to more than one client at a time. To date, there is no reported evidence supporting its rationality and effectiveness. This study investigated the potential opportunities, effectiveness, and caveats in concurrent service delivery and identified the optimal cutoff number of concurrent sessions while maintaining the quality of service at or above a set threshold. Method: We analyzed the transcript of 54,716 online counseling sessions from Open Up, a free, 24/7 text-based counseling service, to develop an attention score that measures the attention allocation of counselors and examined the impact of the counselor's attention allocation on client satisfaction and service outcomes. Results: On average, compared to nonconcurrent sessions, concurrent sessions were longer, more likely to end prematurely, and had lower client satisfaction. We also identified an optimal attention score of approximately 0.4 (out of 1.0, which denotes full attention), which translates to two to three concurrent sessions. Conclusions: This study provides empirical evidence for the feasibility of conducting multiple text-based sessions concurrently without compromising service quality and client experience. Our method of measuring the counselor attention allocation offers a way to systematically assess and evaluate concurrent sessions. What is the public health significance of this article?: The rapid increase in the availability of online counseling services continues to be outpaced by the growth in their demand. This study is the first to provide evidence for the possibility and effectiveness of concurrent counseling, that is, treating more than one client at a time. It highlights the feasibility of reaching more people with psychological distress without substantially sacrificing the service quality. The resulting attention score calculation is potentially relevant to a wide range of contexts. [ABSTRACT FROM AUTHOR]