What is The Online Advocate?
The Online Advocate (www.onlineadvocate.org) is a web-based tool designed to screen individuals and families
for health-related social problems, determine the areas in which they need and desire assistance, and help them select specific referrals to nearby agencies that provide appropriate services.
The Online Advocate’s purpose is to assist health care providers and other organizations identify and address key thth-6 grade reading level. The unmet needs in their target population, using a user-friendly system operating at a 5
system can take advantage of waiting room time to engage individuals and expand an organization’s ability to
screen universally. In addition, The Online Advocate can provide the benefit of serving as a robust research and
tracking tool which can analyze the social needs in whole communities, if desired.
Who should use The Online Advocate and where should it be used?
The Online Advocate targets problems that affect everyone. While many of these social problems occur more commonly in lower income families, they cross all socioeconomic and racial/ethnic boundaries. The program is designed to accommodate multiple languages (once the information is translated).
The tool can be used in multiple settings including primary care and specialty clinics, emergency department waiting rooms, social service agencies, schools, and other locations where individuals and families may desire assistance with social problems. Specific surveys have been developed for adults/families and for adolescents.
What does the survey assess and how does it work?
The Online Advocate has the capabilities to screen individuals in eleven social domains:
1. Access to health care (medical, dental, 7. Safety equipment use (car seats, helmets
insurance, prescriptions) smoke alarms, etc.)
2. Housing (availability, utilities, structural 8. Exercise/Nutrition
problems)
3. Food security 9. Education/After-schools programs
4. Income security (job, income, education) 10. Mental health
5. Violence (intimate partner and violence risk 11. Sexual activity/Birth control/Sexually
factors) transmitted infections testing
6. Substance abuse (tobacco, alcohol, drugs)
The questionnaire currently supports several question formats including: multiple choice, yes/no, check all that
apply, Likert-style questions, dropdown menus, number entry, date entry, text entry, and address entry. A percent
completed bar tracks progress for the user. Pre-programmed logic is used to determine skip patterns in the questionnaire based on combinations of responses to earlier questions. This process is invisible to the user.
How does the evaluation and referral system work?
Evaluations and Calculations: The evaluation system assesses survey responses to determine both the user’s need
and eligibility for services. The system can: (1) evaluate single or multiple responses from the questionnaire; (2) perform calculations to use as a part of the evaluation (such as family’s income as a percentage of the federal
poverty level); and (3) use answers from previously completed questionnaires as part of the evaluation process. This process helps to identify and provide the most appropriate referrals for each user.
Strengths and Problems Display: Once the evaluation process is complete, the system generates a new webpage that displays two lists: (1) a list of social domains where the user is doing well, and (2) a list of areas where the user might want to receive assistance. The second list includes a check-box next to each item. The user is instructed to select those areas that they want a referral for assistance. Once those selections are made, the system transfers the user to the additional services page.
Additional Services: Once the user has selected the computer-identified problems for which they would like help, they are brought to a page that lists additional services, categorized by domain, that they can choose from to receive help. Some of the services listed on this page are not screened for by the computer system.
Eric Fleegler, MD, MPH ? eric.fleegler@onlineadvocate.org ? Last Updated June 9, 2009
Agency Selection and Printed Referrals: The Online Advocate program is designed to select and present to the
user a list of agencies that have the best chance of providing the user with meaningful assistance. The agencies are selected using a formula based on the number of relevant services provided by the agency as well as the agency’s distance from the family’s location.
Clicking on an agency name brings up a detailed description of the agency, including a map, a description of services, a list of requested services offered, and eligibility requirements. The user then selects those agencies they are interested in pursuing. If the suggested agencies do not meet the user’s needs, more agency
suggestions can be provided.
After the user has selected the desired referral agencies, The Online Advocate prints the referrals for the user as
a PDF (portable document format) file. The referral contains information about each of the selected agencies including: details about relevant service, contact data, transportation options, and other information. An optional second PDF may be generated for the provider (doctor, nurse, social worker, etc.) that contains a brief summary of the screening process, evaluation results, and agencies selected. This PDF also contains “alerts” for problems
that need immediate attention such as homelessness, domestic violence and food insecurity. This second document is only made available if appropriate for the setting.
Agency Database: Our Greater Boston agency database is comprised of approximately 470 health and human service agencies. These agencies were selected based both on the services they offer and the populations they serve. Each agency has been contacted to obtain extensive information including: contact information; exact services provided (>70 specific services queried); transportation availability (nearby bus and train stops, parking); eligibility requirements; hours of operation; languages spoken; and other information.
A separate tool was designed to facilitate the easy development of health and human service databases for other cities as well as an automated system for tracking when agencies need to be updated/re-verified.
What type of administrative system is available?
The administrative system contains a set of tools designed for primary investigators, study coordinators, researchers, and other staff. These tools facilitate the design, development, implementation, and management of research studies using The Online Advocate. The Online Advocate has the current functional tools:
Questionnaire Viewer: This tool allows study personnel to view and print the study's questionnaire in four different formats to optimize display of questions, answers, and flow of the questionnaire. This flexibility is ideal to review questions and aid in submission for grants or institutional review boards.
Participant Management: Study administrators can enter tracking information for participants, such as a medical record number or a study ID number. This process either creates a new participant record or signs in a returning participant (who can then complete unfinished questionnaires or take follow-up surveys).
What types of research tools are available?
Follow-up Generator and Data Entry System: The follow-up system is comprised of a follow-up form generator, a
data entry system and a tracking tool. The follow-up generator creates a PDF file that resembles a typical paper-based questionnaire based on user responses to a previous questionnaire(s), evaluations of those responses, and additional questions stored in the follow-up database. The PDF is designed to be printed out and used with telephone follow-up calls. The data collected on the form can then be entered back into the system using the data entry tool. The administrative system tracks who needs to be screened and notifies administrators when required.
Storage, Downloading and Analyzing Data: There are two paired databases for each study/implementation. The
first is the questionnaire responses database which collects the user responses to the survey. The second is the identifier database, which stores HIPAA-sensitive identifying information (name, address, date of birth, etc.). The two databases are stored separately and linked via a unique identification number. Each set of databases is secure and firewall protected.
In the future, The Online Advocate will allow investigators to perform basic summary calculations on the entire study population or subsets of the population. The system currently exports data in CSV format; support for other formats (including Excel, SPSS, SAS, and others) will be developed in the near future.
Future Tools: Additional tools in development include a randomizer, a questionnaire builder, and more detailed research tools. Suggestions for additional features are always welcome and will be developed as needed.
Eric Fleegler, MD, MPH ? eric.fleegler@onlineadvocate.org ? Last Updated June 9, 2009
Do I need special computer hardware or software to use The Online Advocate?
The Online Advocate can be used by any computer system that connects to the internet. The Online Advocate
has been developed as an entirely open-source project; all of the applications, platforms, and other software needed to run the program are freely available. We will work with each outside institution to customize the
platform as needed.
Eric Fleegler, MD, MPH ? eric.fleegler@onlineadvocate.org ? Last Updated June 9, 2009