An Internet Intervention as Adjunctive Therapy for Pediatric Encopresis
Lee M. Ritterband, Ph.D., University of Virginia Health System, Daniel J. Cox, Ph.D., University of Virginia Health System; Lynn S. Walker, Ph.D., University of Vanderbilt; Boris Kovatchev, Ph.D., University of Virginia Health System; Lela McKnight, Ph.D., University of Miami; Kushal Patel, M.A., University of Vanderbilt; Stephen Borowitz, MD, University of Virginia Health System; James Sutphen, MD, Ph.D., University of Virginia Health System

Findings Summary
Although use of the Internet to deliver behavioral health interventions is in its infancy, research findings are providing tantalizing results. One particularly successful application is “U-CAN-POOP-TOO,” an Internet treatment for encopresis funded by the National Institutes of Health. Encopresis affects 500,000 to 2.5 million school aged children in the US, and can become overwhelming to children/families struggling with it. An intervention incorporating behavioral treatment, education, and medical management, effective as a face-to-face intervention, was transformed into an Internet intervention to test the feasibility and effectiveness of this treatment. Twenty-four children with encopresis were randomly assigned to the web intervention group (Web) or no web intervention group (No-Web). All subjects received care from their physician. The Web participants, who received a computer and Internet access from their home, decreased accidents by 93%, increased number of bowel movements (BMs) in the toilet by 152%, and increased bathroom trips without parental prompt by 109%. The No-Web children decreased accidents by 31%, number of BMs in the toilet by 16%, and bathroom trips without parental prompt by 37% (all p’s < .02). Internet interventions may be an
effective way of delivering sophisticated behavioral interventions to a large and dispersed population in a convenient format.

Learning Objective 1
Recognize and appreciate the utility of an Internet intervention such as U-CAN-POOP-TOO

Learning Objective 2
Examine the findings of the U-CAN-POOP-TOO Internet intervention and understand the importance of empirically testing this type of application

Learning Objective 3
Have a greater awareness for the use of the Internet as a medium for delivering behavioral health treatments

Dissemination Plan
Results of the outcome study utilizing the U-CAN-POOP-TOO Internet program will be published in a peer-reviewed academic journal. Subsequent funding has been obtained from NIH to revise the program and conduct a national trial and disseminate the program. Also, this program prompted development/testing of several other behavioral Internet interventions.