Text Message Adjunct to Helpline



Project to Incorporate Mobile Phone Text Messaging Into Helpline Operations

Executive Summary

NCPG staff propose a project to enhance the existing National Helpline Network voice platform by adding the ability to communicate with callers via text message[1]. The project will take place in two phases. Phase 1 has two components: The first is to provide text message access to the Helpline via the HELP short code.[2] The second component is a pilot project to evaluate a subscription-based Prevention Daily Text (PDT) message. Phase 2 would implement the PDT project based on the results of the pilot study.

Phase 1 will:

• Establish the HELP short code allowing easy access to the Helpline via text message.

• Launch an academic evaluation of clinical impact and revenue potential for subscription-based Prevention Daily Text (PDT) messages.

Phase 2 will:

• Launch the PDT service, based on the results from the pilot project evaluation.

Project Highlights:

• Will increase accessibility to the helpline, especially for younger callers in the 12-17 and 18-24 high risk groups, and may help mitigate problem gambling behavior.

• Will provide opportunities to sell subscriptions, generate fees by providing text access to other call centers, and gain sponsors.

Fiscal Impact:

• PDT Pilot: The six month PDT pilot project will cost $29,500, with $10,000 incurred in FY 2008 and the remainder required to be budgeted for FY 2009.

• HELP short code: A total of $1,500 plus 1 cent per message in FY 2008 as it utilizes the same equipment covered in the PDT pilot. There are possible sponsorship and fee revenue opportunities to offset these costs.

• Total Phase 1 FY 2008 fiscal impact for HELP short code and PDT pilot: $11,500. Funds are not budgeted but could be allocated from surplus conference revenue.

Recommended Resolution:

To approve Phase 1 of the Project, implementing the PDT Pilot and HELP short code.

Upon a review of the results of the PDT Pilot, staff will make a recommendation to the Board in FY 2009 regarding Phase 2, the implementation of the PDT project.

Project Background

For over a decade NCPG has partnered with the telecom industry to deliver national helpline services—we routed over 243,000 voice calls to 28 different call centers last year alone. Access to the Helpline may be improved by taking advantage of new communications technologies and evolving consumer practices, such as mobile phone use and text messaging.

There are approximately 263 million cell phone subscribers in the U.S. More than 10 percent of U.S. households have only a mobile phone and 75 percent of mobile phone owners use text messaging. Users send nearly one and a half billion text messages every month. Text message and mobile phone technology are being utilized to assist clients in meeting smoking cessation and weight loss goals—and also to deliver lottery results and bet on sports.

We began working with Media5, a text message company, in July 2007 to develop this project as part of our ongoing efforts to accomplish Strategic Plan Goal 1 (provide core programs to ensure availability of services for problem gamblers) and Board 2007/2008 Goal 3 (promote the National Helpline) and specifically 2008 Goal 3D (to develop bids on new technology pilot projects for Board approval). The current proposal is based on extensive feedback from the Executive Committee over the past year.

PHASE 1

I. PDT Pilot Study: Efficacy of Text Messages in Mitigating Problem Gambling Behavior

This six month study is a collaboration between NCPG, Media5 and Dr. Lia Nower to provide an empirical basis for designing mobile phone-based access and brief interventions for problem gamblers. The purpose of the study is to investigate the efficacy of daily telephone text messages on relapse prevention and decreases in problem gambling behavior. The study will:

a) Investigate the effectiveness of daily prevention messages in decreasing the urge to gamble and overall problem gambling behavior;

b) Evaluate the relative effectiveness of text message versus no intervention versus text message with interactive capability in decreasing urges to gamble and gambling problem severity.

c) Evaluate the relative demand for such services and explore pricing options.

d) Evaluate impact on call center costs in association with the project.

A. Pilot Study Methods

During the three-month study, all incoming callers to the National Helpline default call center from at least 10 different states will be asked if they are willing to participate in a study, designed to monitor their progress in controlling problem gambling behavior. Participants who agree will be randomly allocated to one of three groups: Group 1 (control, N=50), Group 2 (cell phone text message only, N=50), and Group 3 (interactive text messaging, N=50). All participants will be screened at intake by helpline workers for gambling problem severity according to DSM-IV criteria and asked to provide a cell-phone contact number for follow-up. Participants in Group 1 will receive a follow-up call only at 30 days to evaluate level of problem gambling severity and the desire for additional referrals. Participants in Group 2 will receive daily prevention text messages for 28 days and a follow-up evaluation call at 30 days. Participants in Group 3 will receive the same prevention messages with the added option of exchanging messages with the hotline staff as well as a follow-up evaluation call at 30 days. Statistical comparisons will determine whether either of the treatment conditions resulted in significant differences in urges to gamble or gambling problem severity.

B. Pilot Study Budget:

Media5 will be responsible for securing and overseeing the hosting of the mobile services, using a short code and all text message fees, completing all Carrier Approval Forms (CAFs), assist drafting certain message flows and terms and conditions for mobile alerts, etc.; reviewing for adherence to content standards; interfacing with the wireless carriers and third parties on programming, customer service, billing, and accounting functions; assist in developing sales and advertising materials for mobile services; assist in identifying most promising customers for mobile services; assist in selling mobile services to agreed upon potential customers; and providing expertise as to the best methods for maximizing participation and success of the mobile services. $10,000

Travel for Dr. Nower to train hotline workers. $1,500

Consulting for Dr. Nower to author the messages, set up computerized content for delivery, and conduct follow-up assessments and statistical analysis, prepare a final report for NCPG and submit to an academic journal. $18,000

Total: $29,500

II. HELP Short Code

A. Operation:

The HELP short code will provide help seekers with a quick and easy way to reach the Helpline via text message. Mobile Aggregator (MA) text messaging software program is installed at the Helpline call center on a standard PC with internet connection. The helpline specialist receives the text message on their screen. The specialist determines an appropriate response—generally to switch to a voice call for a more comprehensive intake or crisis counseling—either by using a template of responses to frequently asked questions or manually typing a reply, and the text is delivered instantaneously.

B. Costs:

The cost per message (determined by the user’s cell phone plan) will be assigned to NCPG to preserve the traditional toll-free nature of the Helpline, although surcharges could be added for the user. All billing is done by the phone company, just as with traditional voice calls. Corporations, state agencies and treatment centers could be solicited to sponsor the service, and other call centers could contract with us to receive similar short code access for callers in their area codes. Once the MA software is installed the maintenance fee is $1,500 per month. The only additional costs are message charges (1 cent per incoming text/3.5 cents per outgoing text) and any costs to equip and train helpline staff at the NCPG contracted-call center in Louisiana.

PHASE 2

III. Prevention Daily Text (PDT)

The Prevention Daily Text (PDT) subscription service will a daily positive text message and/or wallpaper images delivered conveniently to their cell phone or other messaging device. Studies have shown mobile technology and text message programs of support, encouragement and reminders to be successful in smoking cessation and weight loss programs.

A. Operation:

The PDT program is a discrete, subscription-based service. Subscribers will receive one text message per day with a positive theme (the subscriber can indicate on the website the exact time each day they wish to receive the incoming message) and other helpful information, such as the Helpline number. Users would sign up through the NCPG website, Helpline or by dialing the short code. Only the cell phone number is needed to sign up. Potential subscribers would receive a text message stating: “Thank you for your interest in getting a daily message. Reply YES to confirm your request.” They would have to affirmatively text back “yes”, or the service will not be initiated. The charge is then added onto their bill and is automatically handled through the phone company. After 30 days they would receive a renewal message and again would have to respond affirmatively to continue for another month. Wallpaper for mobile phone screens can be purchased with a similar double opt-in process. The PDT operations would utilize the same MA program as with the HELP short code.

B. Costs:

Implementation for the PDT project would begin in FY 2009. The monthly fee is $1,500 for the MA program. Additional costs are limited staff time to compose a bank of daily messages and message fees.

IV. Marketing Plan

Upon Board approval of Phase 1, staff will begin to promote the project throughout NCPG communications channels over the next six months. Other call centers on the Helpline Network, especially those who utilize the Louisiana call center, will be contacted to solicit help with recruitment for the PDT pilot and possible interest in the HELP short code. The program may also be utilized to solicit new and renewed corporate sponsorship, including from outside the gaming industry. Media5 will promote project to telecom industry media. No new materials or paid advertising are envisioned, so staff time will be the primary cost for the promotional effort. The goals for Phase 1 marketing are to provide general public awareness of the project and to communicate with potential partners and sponsors. We estimate HELP short code will receive 100 texts in the first month, increasing by 100 each month to 1,200 at year end.

Phase 2 is also primarily marketing and public awareness, likely to launch at the NCPG national conference in June 2009. The goal over the following 12 months is to recruit a total of 600 PDT participants, secure two call center partners and three sponsors. We estimate beginning with 50 subscribers the first month and increasing by 50 per month, for 600 by year end.

A. Projected Revenue and Expense Streams:

Market research on other text subscription plans finds a wide range of pricing. Again, these assumptions may be adjusted based on findings from the pilot, but we suggest a monthly fee of $5.99/month to subscribe to the PDT service. 300 PDT subscriptions at $5.99 would cover PDT and HELP short code costs. All subscriber billing is handled by the telecom, and revenues will be split approximately 50% to the telecom company, and the first $10,000 in net revenue be apportioned as 75% NCPG and 25% Media5; all subsequent net revenue split equally.  Net revenues include all revenue generated from sponsors of the mobile services and products and messages and calls to the short code or use of the short code minus actual fees paid to wireless carriers or any other third parties.  

B. Other Call Centers:

We would charge a one-time set up fee plus a monthly hosting & support fee, and possibly a percentage of revenue to participate in the subscription service. Each participating call center would also be charged the cost of any HELP text messages.

C. Sponsors:

A number of different options are available, one large sponsor could cover the entire project as Harrah’s used to support the Helpline, or several smaller sponsors could be enlisted. Different pricing structures could be developed if sponsors wanted to subsidize the cost of HELP short code and/or PDT to callers from their area.

HELP & PDT Monthly Revenue and Expense Projections at 1, 6 and 12 Months

| |Month 1 |Month 6 |Month 12 |

|Revenues |

|NCPG PDT Revenue |$112 |$675 |$1,350 |

|Call Center Fees |0 |$1,000 |$2,000 |

|Total |$112 |$1,675 |$3,350 |

|Expenses |

|Maintenance |$1,500 |$1,500 |$1,500 |

|PDT Messages Sent ($.01) |1,500 |9,000 |18,000 |

|PDT Message Fees |$15 |$90 |$180 |

|HELP Message Received ($.035) |100 |600 |1,200 |

|HELP Message Fees |$3 |$21 |$42 |

|Total |$1,518 |$1,611 |$1,722 |

|NET |-$1,406 |$59 |$1,628 |

Additional considerations:

Privacy and confidentiality concerns are the same for voice call information as for text message information. The wireless carriers treat their subscribers and phone numbers as their most valuable asset and, as a result, zealously guard them and their privacy. In addition, there are federal and state regulations that prohibit commercial entities from sending unsolicited text messages to wireless users.  Under the Telephone Consumer Protection Act a wireless subscriber may file suit to recover $500 in damages for each such violation. The wireless industry also has a third party company who monitors all the programs and reports any violations. Enforceable legal agreements will ensure that Media5 stringently protects confidentiality and access.

V. Background Information on Text Messages and Health Promotion

1) TVNZ.CO.NZ “Gambling Helpline Gets Text-Wise” August 14, 2007

2) “Text Messages Double Chances of Giving Up Smoking, July 10, 2007

3) “What Can I Expect?” (accessed September 20, 2007)

1) Gambling helpline leads the way with new text service

The Gambling Helpline New Zealand has introduced what is thought to be a first for gambling help services with problem gamblers now able to seek help via text message.

Krista Ferguson, chief executive officer of the Gambling Helpline, said the new text message service is about offering more choices to problem gamblers as well as friends and family affected by problem gamblers. “We know from talking with our clients that they often have pre-paid mobile phones rather than land lines. By offering them the invitation to text, they are being provided with another option to reach out for help,” she said.

Ms Ferguson added that the text message offering is also another way for clients to reach out discreetly.

“Stigma and shame are barriers to help-seeking with privacy being important to anyone contacting the Gambling Helpline. Mobile phones are a way people can get in touch with us more privately than other means, such as landlines. “Mobile phones are also a way, through texts, to provide information and schedule telephone calls privately,” said Ms Ferguson.

The new text-message offering has been launched with a billboard campaign in the three main centres Auckland, Wellington and Christchurch, aimed at targeting all people with a mobile phone experiencing gambling-related harm, not just the traditional youth market associated with text messaging.

Clients can send an anonymous free text to 8006, and immediately receive an automated response to confirm the Gambling Helpline has received the text, which also contains the free phone number. A counsellor will then send a personalised response, encouraging the texter to phone for help or to provide details so that an information pack can be sent.

Ms Ferguson said the new text-message service is part of Gambling Helpline’s commitment to be up-to-date with technology in order to deliver gambling support services to the widest audience possible.

“In the late nineties we launched an interactive self-help website and in 2001 we introduced an online message forum “Talking Point”. The website is proving to be extremely popular with a 52 per cent increase in use during 2006. The online forum has more than 11,400 posts, which illustrates alternative communication channels really appeal to our clients,” she said.

2) Text messages double the chances of patients giving up smoking

Smokers that used a text-messaging service to support smoking cessation were twice as likely to give up smoking, according to the findings of a UK pilot trial. The research, presented last week at the 36th annual conference for the Society of Academic Primary Care in West London, involved 200 participants who were randomised to intervention or control groups and followed up at six months.

Smokers who received advice via a text messaging service where found to be twice as likely to stop smoking in the short term than a control group who did not receive any texts.

[The pilot was a success. Follow up was excellent with 98% following up for the short term outcome and 92% follow up for the long term outcome. We demonstrated a statistically significant increase in self-reporting quitting at 4 weeks RR (95%CI) 2.02 (1.08 -3.76).]

Lead researcher Dr Cari Free, from the London School of Hygiene and Tropical Medicine, said: ‘Mobile phones provide a new channel for individualised smoking cessation advice.

‘It has the advantage of being able to reach people at all hours, unlike traditional counselling sessions.’

If someone is craving a cigarette, then they can send a text and receive advice as well as a distraction, she said. ‘There is also a ‘buddy up’ service whereby smokers can text each other for support.’

Dr Andrew Farmer, from the primary health care department at the University of Oxford, said that it was a nice use of technology, but warned: ‘the problem with technology is that it moves so rapidly, meaning that the text messaging system may have to become more sophisticated over time.’

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What can I expect?

...treat yourself today to something special...

The QuiText programme has been compiled by ex-smokers. People who have gone through the quitting process. Based on individual real life experiences, our message programme is designed to steer you through the physical and psychological stages of the quitting process. You will receive a daily SMS message to your phone providing support and encouragement about problems you will be facing at specific times. We will send you help and advice on dealing with cravings, habits and even how to start thinking about your smoke free future. With QuiText, it's one day at a time.

Wherever You Are

...training your mind to get through triggers...

Your support finds you wherever you go, world wide. At the shops, at work, or on holiday. Take your phone with you and have access to support every minute of every day. Found yourself in a trigger situation? Reach for you phone to remind yourself why quitting is important to you. With QuiText you don't need to change your routine and that means less stress for you.

Whenever You Want

Tell us what time of day you want to receive your messages, be it your morning coffee break or just after lunch and we will deliver support, direct to your phone daily, for six weeks.

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[1] Text messaging, or texting is the common term for the sending of "short" (160 characters or fewer, including spaces) text messages from mobile phones using the Short Message Service (SMS). It is available on most digital mobile phones. The most common application is person-to-person messaging, but text messages are also often used to interact with automated systems, such as ordering products and services or participating in contests.

[2] Short codes are special telephone numbers, significantly shorter than full telephone numbers, which can also be used to address text messages from mobile phones or fixed phones. They are designed to be shorter to read out and easier to remember than normal telephone numbers.

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