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Changing Practice: How Domestic Violence Advocates Use Internet and Wireless Communication Technologies

Ann L. Kranz

Director Violence Against Women Online Resources akranz@che.umn.edu

Abstract

This research report describes how and why two Midwestern domestic violence organizations use Internet and wireless communication technologies. The data is derived from interviews that were conducted with Executive Directors and select staff from two such organizations in December 2001. The report describes the organizations' technology usage and their understanding of the implications of their organizational practices. Major findings of the study reveal a need for more awareness and technical assistance regarding safe and ethical Internet and wireless communication service delivery. The author recommends the development of a "domestic violence and technology" training center to address both real and virtual challenges that result from the digital revolution.

Introduction

Internet and wireless communication technologies have permeated contemporary American culture. Over 168 million United States households currently have Internet access ( Nielsen/Netratings, 2001 ) and more than 50% of households in the 25 largest U.S. cities use a wireless phone ( J.D. Power and Associates, 2001 ). These new communication technologies have changed the way some people seek resources and have motivated some domestic violence organizations to re-think ways in which they deliver information and services, but little has been written to document their change in practice.

This research report describes how and why two Midwestern domestic violence organizations use Internet and wireless communication technologies. The data is derived from interviews that were conducted with Executive Directors and select staff from two domestic violence organizations in December 2001. While the small sample does not yield data that can be applied generally, it does describe some organizations' technology usage, their similarities and differences, and their understanding of the implications of their organizational practices.

As Program Director of the Minnesota Center Against Violence and Abuse (MINCAVA), School of Social Work, University of Minnesota, I oversee Violence Against Women Online Resources, a web site that provides technical assistance and online resources related to violence against women. Violence Against Women Online Resources was developed in 1997 and its growth has been tremendous. The site currently supports approximately 1,000 users per day and receives about 700 email requests for assistance a year.

Violence Against Women Online Resources site staff have been inundated with an increasing number of help-seeking requests. In 2000, victims of intimate violence were the largest group of individuals (35%) seeking assistance through the site's email address ( Kranz, 2001a ). We have wrestled with the most appropriate ways to respond requests without endangering victims, who may be unaware of privacy and safety risks associated with Internet communication, and without jeopardizing the liability of our organization.

We have sought training and information to implement safe and effective Internet practices and have found it difficult to locate resources to meet this need. Therefore, I set off to study a few other organizations and share my findings, believing that if we need this information to do our job well, perhaps there might be others who could also benefit from learning about organizations' technology practices. It is my hope that these case studies will raise awareness about other organizational practices and that they may be a springboard for further research in this area. Ideally, such research may lead to the development of a "promising practices" guide that educates domestic violence programs about effective and safe Internet and wireless service delivery.

Literature Review

Researchers in both social work and psychology have chronicled the prevalence of online human service delivery ( Banach & Bernat, 2000 ; Finn, 2000 ; Levine, 2000 ; Maheu & Gordon, 2000 ; Meier, 2000 ; Sampson, Jr., 2000 ; Schoech, Hoover, & Betts, 1993 ; and Waldron, Lavitt & Kelley, 2000 ). These reports have shed light on the types of services available online ( Finn, 2000b ; Waldron, Lavitt & Kelley, 2000 ), a description of who's offering these services ( Maheu & Gordon, 2000 ; Sampson, Jr., 2000 ), and the benefits and risks associated with this form of service delivery ( Meier, 2000 ; Schoech, Hoover, & Betts, 1993 ; Waldron, Lavitt & Kelley, 2000 ;).

Primary risks of online service delivery include threats to personal safety, liability to the service provider, confidentiality breaches, lack of privacy, and ineffective service delivery ( Banach & Bernat, 2000 ; Finn, 2001 ; Levine, 2000 ; Meier, 2000 ; Sampson, Jr., 2000 ; and Waldron, Lavitt & Kelley, 2000 ).

Waldron, Lavitt and Kelley (2000) perhaps most clearly articulate how online communication can cause potential harm at individual, relational, and group levels, which includes: a) violations of privacy; b) misunderstood communications; c) disinhibited communication and premature intimacy; d) rapid and wide spread inaccurate information; e) cyber-addiction; f) misrepresentation of identity; g) unanticipated and burdensome obligations; h) lack of procedures and rules; i) online harassment and stalking; and j) a lack of knowledge about technology.

There are only a handful of researchers who have specifically addressed the prevalence of domestic violence online service delivery and its inherent risks ( Banach & Bernat, 2000 ; Finn, 2000 ; and Waldron, Lavitt & Kelley, 2000 ). Finn is the only researcher to date that has documented the growth of domestic violence materials on the world wide web. Finn (2000a) noted a 37% increase in web-based resources about family violence between September 1998 and February 1999. Finn (2000b) then surveyed 166 domestic violence organizations with a web presence and found that organizations used the Internet to achieve: (1) agency visibility; (2) direct service; (3) community education; (4) advocacy; and (5) financial resources.

Finn's (2000b) research also reported that domestic violence organizations delivered direct services via the Internet. They provided: (1) online assessments of violent relationships; (2) outreach to survivors; (3) information and referral; (4) direct service through email; (5) links to monitored online chat rooms; (6) online support groups; and (7) art and stories by survivors.

Only one study to date specifically addresses liability issues for online service delivery by domestic violence organizations. In that study, Finn (2001) reveals that no legal precedent has been established regarding these matters.

No empirical studies to date have examined batterers' misuses of technology, but advocates who work with battered women are reporting anecdotal accounts of batterers using surveillance equipment, covert web monitoring software, caller ID and other devices to locate, harass, and stalk their victims (Kranz, 2001b ). These accounts indicate that batterers are using Internet and wireless technologies to commit high-tech eavesdropping, tamper with email, monitor home and Internet activities, engage in "cyberstalking" and track the locations of their victims.

Recognizing a need for specific information about organizational practices, this study provides concrete examples of how two domestic violence organizations use Internet and wireless technology in their work with survivors. It demonstrates in tangible terms, how change in practices due to innovations in communication technologies have created both benefits and risks for victims of intimate violence. This study also raises awareness about the training and technical assistance needs of advocates.

Design and Method

The purpose of this study was to gain a better understanding of how and why domestic violence organizations use Internet and wireless technologies (i.e. web sites, email, instant messages, electronic bulletin boards, pagers, cellular, digital, and cordless phones, etc.) to conduct outreach and advocacy with survivors of intimate violence. This study examined how and why some programs choose to utilize these technologies and attempted to answer the following questions:

1) Are organizations utilizing these technologies in response to battered women's requests? 2) Is the use of technology intended to make advocacy more convenient for advocates? 3) Is it a more efficient use of staff resources? 4) Are funders requesting or requiring the integration of technology? 5) Why are some organizations choosing not use use information technology? 6) Are organizations concerned about liability issues? 7) Are programs facing ethical dilemmas and/or safety risks? 8) In general, are organizations aware of various technologies' capabilities and do they understand how to safeguard against negative unintended consequences?

The case study method was used to gather qualitative data for this study. The organizations were selected based on a prior relationship with the Principal Investigator (PI). The PI made initial contact with the organization's executive directors through a letter and followed up with a telephone call. A total of five subjects from two domestic violence organizations were interviewed.

Subjects were executive directors, advocates, and technology experts of domestic violence organizations. The executive directors were asked to invite two other staff members to the interview: 1) an advocate who could discuss how she uses technology in her job; and 2) an in-house "technology expert" (the person whom other staff seek out when they have a technology-related need). A 90-minute, face-to-face interview was held with each organization. The interview consisted of multiple-choice and opened-ended questions regarding the organizations' Internet and wireless technology usage.

The study was voluntary and confidential. Participants were assured their identities would not be revealed in order to encourage a candid discussion about organizational practices. Participants described in the report are not identified by name and organizations are not identified. Participants are described by title (i.e. advocate or director) and the organizations are described generally (i.e. a battered women's shelter in a rural, Midwest community).

Results

The first program, identified here as the "urban program," is a non-profit organization that was founded in the late 70's. This urban program provides legal advocacy; community education and outreach; groups for survivors, batterers and child witnesses of domestic violence; training and systems advocacy; technical assistance; and research and evaluation.

The program is located in a city with an approximate population of 350,000 residents. The program serves about 8,000 people per year, who represent diverse racial backgrounds, are primarily 20-54 years old, and earn less than $10,000 per year.

The urban program has approximately 25 full-time equivalent staff. Four staff participated in the interview, which was held off-site at the organization's request.

The second program, which will be identified as the "rural program," is a non-profit organization that was also founded in the late 70's. It provides shelter; legal advocacy; community education and outreach; children's advocacy and supervised visitation; job training; training and systems advocacy; pro bono legal services; parenting classes; and community services (i.e. food shelf). The rural program also offers services specifically for gay, lesbian, bi-sexual, and transgender people.

The city in which this program is located has a population of 50,000 residents and a defined service area of several outlying rural counties. The program serves over 500 people per year who are primarily white, 18-34 years old, and earn less than $12,000 per year.

It has approximately 30 full-time equivalent staff, plus around 90 volunteers. Two staff participated in the interview, which was held at the rural program's offices.

Internet Related Technology Usage

The urban program is networked, owns a server, and uses the most current software on the market. Every manager has her own computer and there are several other computer workstations available for staff use, which is encouraged. Each staff has an email account that is provided by the organization. Email is used internally as well as externally with other professionals. The urban program's general email address is published on materials (e.g. program brochures) and on the organization's web site.

The urban program developed a web site in December 1998 because the organization wanted another means to disseminate information and saw the Internet as a means to communicate to the widest possible audience. They were aware of other national domestic violence programs with web sites, but did not know of other organizations at the local level with a web presence. The urban program primarily uses their web site to communicate with other professionals (i.e. marketing publications and trainings). However, in March 2001, they began posting orientation materials and dates about client groups. They immediately began to receive responses from it. As a result, some batterers are using email to sign up for groups. This practice marked a shift from how clients typically access the program. While the majority of batterers are referred to the program by the criminal justice system (i.e. probation officers), the material on the web site provides batterers an opportunity to access information and services without the aid of an intermediary. Thus, creating a more client-driven service.

The urban program's communications director serves as webmaster and notes that the organization primarily receives emails requesting technical assistance, relaying personal accounts of abuse, and expressing appreciation for the agency's services. At this point, she does not track incoming email messages, but estimates that the organization receives approximately 15 emails from the web site per month and estimates that roughly 20% of those messages are client related.

A man who is deaf contacted the urban program through the email address listed on their web site. He said he was unable to access services in other places. This helped the organization to recognize how the Internet can alleviate certain barriers to clients with disabilities. The urban program formerly provided a face-to-face group for deaf clients but the interpreter costs became too prohibitive. County probation officers used to refer batterers who were deaf to the group, but the county would not compensate for the added interpreter costs. After learning from the webmaster that a person who was deaf emailed the agency, the Executive Director recommended to her staff members during our interview that "we should consider hosting an online group for deaf clients."

The urban program also relayed an example of a message received via the Internet that was disconcerting to staff. Once a client from one of their groups sent an Instant Message to the group's facilitator who was at home using her computer under her personal account. The facilitator immediately informed the client that the communication was inappropriate and asked her not to do it again. Sometime later, months after the group was completed, the client emailed the facilitator to her personal email account again. The facilitator felt uncomfortable with both situations and was unclear how the client discovered her personal contact information. A written policy addressing online communication may have been helpful for both parties in this situation. If such a policy was given to both staff and clients, the client may have better understood appropriate (and therefore inappropriate) methods to communicate with her facilitator and the facilitator may have better understood the protocol to follow when such an event occurs.

The urban program identified their local United Way as leader in the push for organizations to use technology. They offer seminars and technology funds to help organizations create client-focused online services. The United Way offered the urban program an opportunity to participate in a pilot project in which the United Way underwrote the start-up costs of transferring client records onto a secure (encrypted) server with a web interface. As a result, the urban program is in the process of developing a database of all client records that will be viewed through a web browser and accessible to all staff.

In a similar fashion, the rural program reported that a funding agency played a critical role in their technology acquisitions. The rural program went online after their primary government funder gave them a computer technology grant. It was a one-time award of approximately $6,000. They purchased four computers and a contract with an Internet Service Provider. All staff members at the rural program have access to a computer, but the organization is not networked office-wide and only a few computers have Internet access.

Rural program staff use the Internet to conduct web searches for job related research and to provide supporting material for presentations. Women staying in the shelter also have access to the web and shelter residents receive some web training as a component of the job-training program. The Executive Director said that she was aware of residents who informed staff that batterers "would check everywhere she's been on the computer." She also said that women staying in the shelter would teach each other how to check if her partner was using the Internet to view pornography.

The rural program does not provide email accounts for each staff member. In fact, they reported that there is not a local Internet Service Provider that covers their entire nine-county service area. The organization has a total of seven email accounts: each of the rural program's five outreach offices in the outlying counties has their own email address and two addresses are provided for use by main office staff. Their various email addresses are printed on agency brochures and business cards and are linked from other websites (i.e. state coalition, United Way, Womandom.com). The Executive Director checks email, prints messages, and places printed copies in the recipients' mailboxes. The rural program staff members exchange email with clients. The Executive Director speculates that staff probably use personal email accounts for work related matters and feels that the organization's email usage with clients is driven by client request. She has not been aware of any resistance or hesitation from staff about their email practices.

Since 1995, the rural program has had a web site that provides a basic description of the agency's services. The Executive Director is currently working with some college students who have volunteered to redesign the agency's web site. The new web site will have more information about staying at the shelter, obtaining a protection order, and developing a safety plan.

Wireless Phone Related Technology Usage

The urban program provides wireless phones (i.e. cellular or digital) for advocacy and research staff. Advocates use wireless phones to respond to victims' calls. Researchers use them to conduct follow-up calls with clients who complete batterer and survivor groups. The urban program began using wireless phones about one year ago as a result of advocates' request to be able to be more accessible to victims. Advocates were concerned that victims were too frequently getting voicemail instead of an advocate and sometimes calls were not returned for hours because advocates were not at their desks. There were additional concerns that a delayed return call further endangered victims and that it was best to return calls as near to when a victim left a message as possible because the victim must have identified the time as a safe opportunity to talk.

Victims are given advocates' wireless phone numbers. All wireless phones have voicemail. Advocates are discouraged from using the phones for internal and personal uses due to prohibitive costs. The urban program managers call wireless phone numbers when they need to communicate with advocates, but other staff and external professionals are asked to reach advocates through their office phone numbers. The organization would prefer to use the phones more if cost was not a factor.

Regardless of the type of phone used, the urban program trains advocates to inform victims about ways to safeguard against batterers who use CallerID, Last Number ReDial, or *69 (last call return) to track communication. The urban program's advocates recommend that victims call a common place like the grocery store after placing a call to them to ensure that if the batterer hits an auto-redial function, he reaches somewhere other than the domestic violence organization.

The urban program has encountered two situations in which problems with phone technology has caused serious safety concerns for victims of intimate violence. One time, the phone company mistakenly removed the program's Caller ID block. The urban program was not sure how long that went undetected or how that may have negatively impacted the victims to whom they placed calls.

The other situation involved the county's automated victim notification process. When an offender is being released, a county computer automatically calls the victim if she has requested to be notified. The computer makes three attempts to call and leaves a message if the victim has voicemail or an answering machine. The automated voice states when the offender is being released and a number to call with questions. It broke down for a week and went undetected until a victim called to complain that she was not notified of her abuser's release.

The rural program uses both cordless and regular phones. They use a cordless phone (not a wireless phone, but a regular phone that has no cord -- commonly found in households) for the crisis line in the advocates' station in the shelter. It is a "scout" phone that has more than one line with range limited to the building. The Executive Director is not sure if the phone is encrypted or otherwise secure.

The rural program advocates use wireless phones (again, cellular or digital) for emergency purposes only. The Executive Director considers these phones as a means to increase safety, but not necessarily efficiency. The Fiscal Manager explains that it can be difficult and frustrating to use pagers and cell phones in rural areas because there are fewer towers than metro areas and coverage is spotty. She also notes that not one company covers the entire service area so the organization must purchase different plans from different vendors, which increases costs.

The rural program finds that wireless phones are cost prohibitive for regular usage. Outreach staff use wireless phones more frequently than advocates in the shelter because they spend more time en route traveling between appointments in the outlying counties. Shelter staff use a wireless phone when running errands and accompanying residents to appointments.

Wireless phones are given to women leaving the rural program's shelter as an added measure of protection. Wireless phone companies donate both new and old phones. The phones are pre-programmed to dial either 911 or the shelter. Victims can have the phone as long as they need it and then return it to the shelter.

Evaluation of Technology

Both the urban and rural programs identified cost as one of the drawbacks of technology. However, the urban program said that technology is not any different than other money spending issues (i.e. hiring more staff or buying a new building). "Like anything else," the Operations Director explains, "it's just about leveraging resources for helping survivors." This is partly why the urban program agreed to participate in their local United Way's pilot project to move client files over to a web-based database. The United Way researched security issues, found a national vendor, and underwrote the start-up costs. The urban program saw the opportunity to leverage both their time and money and wanted to take advantage of it because they weren't sure when an offer like that would come their way again.

The rural program seemed to have fewer resources, and therefore, fewer opportunities available to them. As Edleson and Frank (1991) found in their study of rural interventions in woman battering, "These programs often confront greater obstacles than do programs in larger metropolitan areas, including (1) few resources for program innovations, (2) restricted access to services due to geographic and social isolation..." (p. 543). There was not one Internet Service Provider or wireless service carrier that covered rural program's entire service area. This means that the program must manage different plans with different vendors, which requires more time, effort, and ultimately, more money.

Overall, there also seemed to be a philosophical difference in how the two programs viewed technology. The urban program seemed to consider it an integral component of the organization and the rural program seemed to regard it as component of the organization that takes time away from other vital functions. The rural program staff expressed a frustration that it sometimes takes time away from client services, citing the re-design of their web site as a good example. Instead of spending time developing new programming, they find themselves meeting with college students to explain their web needs. They also noted that new technology requires training and that not all staff are computer literate.

However, the rural program Executive Director finds that email offers benefits for her role. "I can communicate with more people this way versus by phone. It's more efficient." She explains that she regularly uses email to communicate with attorneys from Legal Aid and can follow-up with them at any time of the day. She also said that they receive email as a result of their services for gay, lesbian, bi-sexual, and transgender people and finds it interesting that people from the urban area seek direct services from them. Domestic violence advocates also email the GLBT program for technical assistance because they are interested in replicating the model programming.

Both programs recognized that many of their clients do not possess the skills or necessary equipment to take advantage of services delivered via the Internet. They see technology as integral to streamlining their administrative processes, but not as a substitute for human interaction. "Technology is not a substitute for advocates, it's a substitute for pen and paper," said the urban program's Operations Director.

When evaluating technology expenditures and usage, the urban program adheres to the following criteria:

  • Does it add to our ability to serve more people? (i.e. Does it make us more efficient?)

  • Does it help us do our jobs better? (i.e. Does it make us more effective?)

  • Does it push our mission forward?

In the end, the urban program confessed that some decisions are just based on a gut feeling. They find it difficult to track clients' satisfaction level with technology-related practice changes. Their information is more anecdotal than statistical. "We would like to prove statistically versus just hearing stories, but for now, that's what we've got," said the Operations Director.

Conclusion

Much more empirical research is needed about technology and its benefits and drawbacks for survivors of intimate violence and the organizations serving them. In particular, information is needed about survivors' technology needs, batterers' misuses of technology, and domestic violence organizations' technology practices. The case studies presented in this report are helpful in illustrating two particular organizations' technology practices, but due to the small sample, they do not yield data that can be applied generally. Additional interviews with a wider variety of agencies would draw interesting information that might result in new insight of additional practices and concerns.

Written materials and training are also needed to increase organizations' awareness about safety, ethical and liability issues surrounding innovative communication technologies. Neither organization currently has a technology policy, but both organizations have web sites that provide information specifically targeted to clients; regularly exchange email with clients (sometimes using personal accounts); use wireless phones to communicate with clients; and one organization uses a cordless phone as its crisis line. Staff from both organizations expressed a desire to learn more about security implications of these practices and said that the discussion during our interview gave them a new understanding and concern for victims' safety.

Both executive directors requested an in-service for their staff about the implications of Internet and wireless service delivery. Until such training is available, organizations may find it helpful to institute Finn's recommendations that follow:

  • Email should be treated as formally as other client documentation.

  • Organizations should take steps to prevent unauthorized access to their electronic records through using password protection of their computer and maintaining storage of back-up files in a secure place.

  • Victims and Internet users should be informed if and for how long their messages are being preserved as part of their file, and organizations should obtain signed informed consent before any materials are forwarded to another party.

  • If messages are to be saved, there should be appropriate electronic and/or hard copy back up of all email messages. Alternatively, organizations may want to consider a policy in which all email from consumers is deleted after being read.

  • Encryption software programs should be used to prevent messages from being read by anyone but the intended receiver.

  • Victims and Internet users should receive education about online safety and privacy protection.

  • Staff should receive training about maintaining secure electronic communications.

  • To prevent access by hackers, electronic files containing victim or funder records should be kept on computers that are not connected to the Internet.

  • Organizations should not permit staff to access organization email from their home computer.

  • Finally, organizations should create written polices that establish how email is to be used, by whom, and what the sanctions are for violation of those policies."

( Finn, 2001 p. 5 ).

Due to continual upgrades and changes in technology, training and technical assistance needs will evolve with technology. An in-service training may be helpful as an initial step toward raising awareness, but ultimately, a training center is needed to meet the ongoing needs of these organizations. Such a center could offer face-to-face training; deliver online and telephone technical assistance; and develop and maintain written materials describing promising, and conversely, dangerous organizational practices to be avoided.

The domestic violence organizations interviewed expressed a desire for statistical information they could use when making decisions about technology expenditures. Particularly, they seek materials that will help them assess how technology will make their organizations more efficient, effective, and support their overall mission.

In closing, it behooves us to remember that the major focus of any domestic violence organization's mission is to keep women and children safe. In today's technological environment, this poses new virtual, and yet, real challenges. It is important that we work together and learn from each other as we cautiously move forward within this digital revolution. Remembering, that while our practices may evolve, the underlying needs of battered women and their children have not changed.

References

Banach, M. & Bernat, F. (2000). Liability and the Internet: Risks and Recommendations for Social Work Practice. Journal of Technology in Human Services. 17 (1). 153-173.

Edleson, J.L. & Frank, M. (1991). Rural Interventions in Woman Battering: One State's Strategies. Families in Society: The Journal of Contemporary Human Services. 72 . 543-551.

Finn, J. (2000a). Domestic Violence Organizations On The Web-A New Arena For Domestic Violence Services. Violence Against Women 6 (1). 80-102.

Finn, J. (2000b). A Survey Of Domestic Violence Organizations on the World Wide Web. Journal of Technology in Human Services 17 (1). 83-102.

Finn, J. (2001). Domestic Violence Organizations Online: Risks, Ethical Dilemmas, and Liability Issues. Violence Against Women Online Resources <http://www.vaw.umn.edu/documents/commissioned/online_liability/online_liability.pdf>.

J.D. Power and Associates. (2001). 2001 U.S. Wireless Industry Services Study. J.D. Power Consumer Center <http://www.jdpower.com/telecom/summary.asp?StudyID=561&CatID3>.

Kranz, A. (2001a). Survivors of Intimate Violence Seek Help Online: Implications of Responding to Increasing Requests. Violence Against Women Online Resources <http://www.vaw.umn.edu/documents/10vawpaper/10vawpaper.html>.

Kranz, A. (2001b). Helpful or Harmful? How Innovative Communication Technology Affects Survivors of Intimate Violence. Unpublished Manuscript, Minnesota Center Against Violence and Abuse, School of Social Work, University of Minnesota.

Levine, J. (2000). INTERNET: A Framework for Analyzing Online Human Service Practices. Journal of Technology in Human Services 17 (1). 173-193.

Maheu, Marlene M; Gordon, Barry. (2000) Professional Developments in Telehealth and Telepsychology Counseling and Therapy on the Internet. Professional Psychology, Research and Practice 31. 484-489.

Meier, A. (2000). Offering Social Support via the Internet: A Case Study of an Online Support Group for Social Workers. Journal of Technology in Human Services 17 (1) . 237-267.

Nielsen//Netratings. (2001) Global Internet Usage: Hot Off the Net. Milpitas, CA. <http://www.nielsen-netratings.com/hot_of_the_net_i.htm>.

Sampson, Jr., James P. (2000) Assessment & Diagnosis: Using the Internet to Enhance Testing in Counseling Journal of Counseling and Development78 (3). 348-357.

Schoech, Dick; Cavalier, Al R.; Hoover, Betts. (1993) Using Technology to Change the Human Services Delivery System. Administration in Social Work 17 . 31-52.

Waldron, V., Lavitt, M., & Kelley, D. (2000). The Nature and Prevention of Harm in Technology-Mediated Self-Help Settings: Three Exemplars. Journal of Technology in Human Services 17 (1). 267-295.