Lessons Learned from a Secret Facebook

Support Group
Debra Parker Oliver, Karla Washington, Elaine Wittenberg-Lyles, Ashley Gage,
Megan Mooney, and George Demiris

The National Association of Social Workers developed practice standards for social workers
using technology in their practice. These standards were derived from the foundation of the
social work code of ethics and are helpful as social workers explore the use of new tools for
the benefit of their clients. Hospice caregivers, both active and bereaved, are in great need
of support but are often unable to attend traditional support groups. Facebook secret groups
offer social workers a potential tool, given the geographic barriers that exist for traditional
face-to-face support groups. The authors’ experience with a secret Facebook group indicates
that the technology can be useful when managed by a social worker facilitator. As social
workers continue to explore helpful ways to use technology with clients, it is critical that they
evaluate that practice and assess the clinical outcomes to establish an evidence base behind this
practice.

KEY WORDS: caring; Facebook; hospice; social support

I n 2005 the National Association of Social

Workers (NASW) published standards for social
workers integrating technology into their prac-
tice. These standards, which were derived from the
NASW Code of Ethics (­NASW, 2008), address both
to find creative ways to manage caregiving demands
while attending such groups. Given these barriers,
some social workers have turned to technology to
make support for hospice families more accessible.

the administrative and clinical use of technology LITERATURE REVIEW

with the goal of assuring good practice using elec-
tronically mediated activity. Although the use of
technology is not new to the social work profession,
social workers are not traditionally early adopters, es-
pecially if the technology replaces face-to-face inter-
action with clients (­Parker-Oliver & Demiris, 2006).
Social workers value nonverbal behavior, interview
techniques that include silent pauses, and the im-
portance of relationship in the clinical encounter.
The purpose of this article is to discuss a pilot study
that used technology as a way to support informal
family caregivers who had assisted their dying loved
ones while in hospice.
In hospice, the patients and families served by so-
cial workers are often homebound, socially isolated,
and in need of psychosocial support. Although sup-
port groups are key tools, they are challenging to
use in a hospice or palliative care setting. Traditional
in-person or face-to-face support groups often
flounder due to lack of attendance. Patients are fre-
quently too ill to participate, and family members
who are actively involved in caregiving often need
Numerous interventions have been tested using the
telephone as a means of support (­Bank, Arguelles,
Rubert, Eisdorfer, & Czaja, 2006; ­Carr, Lhussier,
& Wilcockson, 2008; ­Dansky & Bowles, 2002;
­Finf­geld-Connett, 2005; ­Goelitz, 2003). Likewise,
interventions have tested the use of the Internet for
online support groups or dissemination of important
educational material (­Barak & Dolev-Cohen, 2006;
­Barak & Gluck-Ofri, 2007; ­Chen, 2012). Many of
these approaches relied on individuals coming to-
gether at a pre-established time to interact. Given
the many challenges faced with schedules and geo-
graphic distance for families receiving hospice ser-
vices, including those who are bereaved, scheduling
and committing to specific times are not easy tasks.
Most important, support is often needed in the
middle of long lonely nights, a time when the pro-
fessionals are sleeping and the only designated con-
tact is the on-call nurse.
The Pew Foundation recently delivered a report
on family caregiving and online behavior. This ­report
indicated that nearly 80 percent of family caregivers

doi: 10.1093/hsw/hlv007  © 2015 National Association of Social Workers 125

have Internet access and use it frequently to find
health care information and to increase their social
network (­Fox & Brenner, 2012). The report further
noted that 28 percent of caregivers who use social
networking sites like Facebook have followed their
friends’ personal health experiences or health up-
dates online, compared with 21 percent of noncare-
givers who use such sites (­Fox & Brenner, 2012). In
addition, the report indicated that nearly 70 percent
of family caregivers report that they have turned to
friends and family members for information, care,
or support (­Fox & Brenner, 2012). Although these
statistics do not specifically address bereaved family
members who are no longer actively providing care
for their deceased loved one, it is clear that most
bereaved caregivers possess the knowledge and skills
necessary to access support online, having done so
while actively caregiving.
Facebook has been studied as a platform for
the provision of social support (­Bender, Jimenez-­
Marroquin, & Jadad, 2011; ­Bull et al., 2011; ­De la
Torre-Díez, Díaz-Pernas, & Antón-Rodríguez, 2012)
and, although the evidence is in its infancy, the find-
ings do indicate promise. Recently we conducted a
support group for bereaved hospice caregivers using
Facebook as a platform. The specific purpose of this
article is to share what we have learned with secret
Facebook groups, assess the usefulness and ease of
using secret Facebook groups as a tool, and examine
the use of these groups in the context of the NASW
standards for technology in practice.
TECHNOLOGY ACCEPTANCE MODEL
The technology acceptance model (TAM) devel-
oped by ­Davis (1986, 1989) proved a useful frame-
work for considering the likelihood that social
work clients would accept technology-facilitated
interventions. Developed from the theory of rea-
soned action, TAM holds that beliefs affect actions.
TAM identifies two categories of beliefs: (1) per-
ceived usefulness and (2) perceived ease of use. Per-
ceived usefulness refers to how strongly an individual
feels that the technology would be helpful. Per-
ceived ease of use is how strongly a person feels that
the technology would be easy to use (­Davis, 1986,
­1989). TAM contends that technologies are more
likely to be accepted if they are seen as both useful
and easy to use.
Facebook accommodates three types of social net-
work groups on special group pages: (1) an open
group that can be searched and anyone can join, (2)
126
a closed group that can be searched but not partici-
pated in by outsiders, and (3) a secret group that
involves only those an administrator allows to par-
ticipate (­Facebook, 2013). The secret Facebook
group offers the most privacy and allows an admin-
istrator control over who is in the group and how
the group interacts. The secret group setting does
not allow nonmembers access to see who is in the
group, nor does it allow members to distribute or
share content with their personal network. The
only way information can be shared is through
members copying content and pasting it to their
personal walls. The secret page offers the greatest
privacy and was therefore the type of group we
selected for the support group; however, all par-
ticipants were informed that the ultimate protection
of their privacy was dependent on all members
honoring one another’s privacy, as it would be in a
face-to-face support group.
METHOD
Participants in the group were bereaved family
members who had provided informal caregiving
(medication management, personal care, and so
forth) for their loved one while enrolled in one of
three hospice programs. Staff members of the hos-
pice referred the bereaved caregivers to our study,
based on the staff assessment that the caregiver could
benefit from such support. Group membership
­required prior enrollment in one of the hospices
and  verbal consent, including consent for the
group guidelines (see Table 1). These guidelines were
modi­fied from traditional group work practice and
a review of several guidelines from public online
support groups. Participants were not required to
post to the Facebook group page. Participants were
informed that the group was not a substitute for
bereavement counseling; rather, it was an opportu-
nity for interaction with others facing a similar situ-
ation. Upon enrollment we advised participants that
if we became concerned about any one individual’s
need for additional counseling we would refer him
or her to their hospice bereavement coordinator for
follow-up. This project was approved by a university
institutional review board.
Participants were trained on the use of Facebook
upon giving consent. Instructional documents were
shared with group members both upon enrollment
and in response to queries. The documents included
screenshots and an explanation of the different
­aspects of Facebook and the secret group. These
Health & Social Work  Volume 40, Number 2  May 2015
 Table 1:  Rules of Conduct for Participation in Secret Facebook Groups
The following rules of conduct have been developed to ensure the safe and smooth conduct of conversation between individuals
from various backgrounds and to ensure clarity in the expectations of the goals for the group. By requesting membership in the
group, you are agreeing to abide by these expectations.
• Respect your fellow Facebook group members. Comments of a disparaging nature directed at other members or the research staff
cannot be tolerated.
• Strong language and vulgarity are prohibited. Use a similar standard of language to what you might hear on major network TV,
on the radio, or in any other public forum. Crude sex words are strictly prohibited. Using asterisks or other symbols in place of
letters generally does not make a word okay to use. Please use common sense and courtesy. If you wouldn’t say it in polite
company you shouldn’t say it here.
• No personal insults to others.
• If you don’t like what someone has to say, we suggest you ignore their posts. Facebook allows you to hide the posts of individuals.
If you aren’t sure how to do this, ask the research staff.
• Members have the right to refuse to give out any and all personal details.
• We request that you refrain from topics that can be difficult for others to respond to. These topics include—but are not limited
to—suicide, self-injury, rape, sexual abuse, drug or alcohol abuse, and domestic violence.
• Cybersex and picking up “dates” is not allowed in this Facebook group. If a member of the group requests to be “friends”
through the regular Facebook forums then it is the right of any member to decide to accept or ignore this request.
• You may be asked to change topics if the topic is controversial and is creating a great deal of arguing in the group. Religion is one
example of such a topic.
• Jokes that are off-color, racist, homophobic, or otherwise offensive are not permitted.
• All caps are considered to be shouting. Please don’t use them.
• Our Facebook group is a support and information group only. We are not a suicide hotline. Please contact one of the suicide
hotlines, your personal physician, a hospital emergency room, or your local 911 or emergency contact number for professional
assistance.
• If a member is deemed to have such complicated grief that it is unhelpful to the rest of the group we will privately talk to him or
her and refer him or her for additional assistance, and we have the right to protect the rest of the group by revoking his or her
group access.
• If you give your personal information to the research staff or other member and later threaten suicide we reserve the right to
contact appropriate authorities, including your hospice bereavement services; however, no guarantee is made that someone will
contact emergency personnel for you.
• Discussion of alcohol or drug use is prohibited. Members who make it known that they are using alcohol or drugs—either
through their behavior or a statement to that effect—will be subject to having their access revoked. Discussion about recovery
from alcohol or drug abuse is, however, permitted.

documents were pinned to the group for continued
access and e-mailed to individual members. In our
instructional document both a “newsfeed” and a
“timeline” are explained and a screenshot provided.
The level of privacy for each component was empha-
sized in the explanations.
Each week an educational link or material related
to coping with grief was posted on the group Face-
book page, followed by a discussion question from
the social worker facilitator (SWF). Twelve topics
were chosen before the initiation of the group,
based on common concerns with grieving caregiv-
ers as identified in the literature (see Table 2). Fol-
lowing the use of the predetermined material,
topics were selected based on the observation of the
discussions by the SWF. Information and resources
were carefully vetted to ensure appropriate credit
was given, copyrights respected, and information
accurate. Criteria were developed to determine the
trustworthiness of all resources and included con-
sideration of the source (government, university,
medical center, and so forth) and the author (pro-
fessional credentials). Two social workers (one pri-
marily a facilitator and her social work supervisor)
reviewed postings daily and responded when ap-
propriate (clarifying, answering questions, offering
encouragement, or asking additional facilitating
questions). Involvement by the social workers was
triggered by notifications received on their smart-
phones. These notifications were received and re-
viewed at all times of the day and night; however,
group participants were aware that the social work-
ers would not necessarily provide an immediate
response.
RESULTS
A total of 16 participants joined the secret Facebook
group. These participants were predominantly fe-
male (n = 11), and ranged in ages between 22 and
82 years. The majority (n = 7) were spouses of the

Parker Oliver et al. / Lessons Learned from a Secret Facebook Support Group 127
 Table 2:  Secret Facebook Group Topics, Participants, and Responses
Number of Number of Number of
Group Member Member
Week Topic Membersa Postsb Commentsc
1 Grief—myths and facts 5 8 0
2 Five stages of grief 6 2 0
3 Common symptoms of grief 6 3 0
4 Support and coping with grief 6 2 0
5 Self-care 9 1 0
6 Complicated grief 9 6 10
7 Reminders of loss and coping  10 11 8
8 The journey of grief 13 3 0
9 Holiday memories 13 4 6
10 Grief and painful emotions 13 0 0
11 Online resources 14 4 4
12 The effects of losing a loved one 15 5 0
13 Remembering the holidays 15 9 11
14 Commonly asked questions 15 2 0
15 Five stages of grief 15 8 20
16 Poetry and grief 16 8 2
17 Financial issues 16 4 7
18 Anticipatory grief 16 7 16
19 Anger and guilt 16 4 5
20 Valentine’s day 16 8 4
21 Experiencing positive emotions 16 7 10
22 Positive emotions of grief 16 5 6
23 Engaging with life after a loss 16 3 6
24 After caregiving ends 16 5 11
25 Grief dreams 16 5 11
26 Dealing with belongings 16 5 7
27 Isolation and grief 16 8 18
28 Challenging grief myths 16 3 2
29 Gauging progress in grieving 16 2 4
30 Dealing with triggers 16 4 2
31 Loved one’s impact on the living 16 0 0
32 Spirituality and grief 16 6 6
33 Frequently asked questions 16 2 3
34 Topics from the group 16 10 5
35 Defining when grief should end 16 2 0
36 Transitions for the group 16 7 4
37 No topic. “Check in” post 16 2 0
38 Reflection on group termination 16 8 8
39 Reflection on group termination 16 4 16
40 Final thoughts 16 7 15
Total 175 247
aTotal number of members enrolled in the Facebook group that week.
bTotal number of member posts made related to the topic.
cTotal number of comments made in response to the post that week.

deceased hospice patient; others were adult children
(n = 6), in-laws (n = 2), or grandchildren (n = 1). All
but one participant were white (the other Native
American); half had a college degree, and half
were high school graduates. The participants’ loved
ones had died between two weeks and four months
before the caregiver enrolled in the study. All but
one participant had used Facebook.
Lessons on Perceived Usefulness
The idea of using Facebook for support was well
received, and no participant expressed concern

128 Health & Social Work  Volume 40, Number 2  May 2015
r­egarding the group’s usefulness. All participants
agreed to the established rules (see Table 1), and no
concerns were raised regarding any of the content
of those rules. Upon enrollment, several participants
told the SWF that they valued the privacy of their
postings and were happy the group was designated
as a secret group. The Facebook group page was
accessed from computers and mobile technologies
(tablets and smartphones) by both the bereaved par-
ticipants and the SWF.
The SWF found that, as with face-to-face groups,
the introduction of new group members was im-
portant. It was helpful for the social worker to assist
participants in thinking about introductory posts so
other group members could “know” one another’s
stories. Upon introduction to the group, the new
member often received a welcome message from other
members. The topics chosen for discussion were also
important. The specific topic seemed to have a direct
relationship on the number of responses by partici-
pants (see Table 2). Some topics, such as complicated
grief, did not elicit discussion, despite ongoing
questions from the SWF. In contrast, other posts,
such as remembering the holidays, resulted in a sig-
nificant number of comments and follow-up posts.
Posts bringing the greatest response and indicat-
ing the most support were those related to common
experiences and feelings regarding holidays, anni-
versaries, and other special occasions. Members
shared posts about the ways they honored their de-
ceased loved one or described the former rituals of
the special occasion. These posts explained why the
loss felt more difficult at a particular time (for example,
Valentine’s Day) and brought many supportive com-
ments from members. The shared experiences were
often remembered by someone in the group when
the special occasion arrived (such as “Bill, I’m think-
ing of you today as I know Valentine’s Day was
special for you and Amy”). Although some partici-
pants mentioned to the SWF that it was useful to
watch the healing journey of other participants, it
also appeared to create challenges if the participants
were in different places in their grief journeys. For
example, when a husband who had been bereaved
only a few weeks posted comments reflecting his
“fresh grief ” experiences, both the responses and
page views of members with “older grief ” decreased
as seen in participant posts in week 12 when com-
ments went to zero and posts were down to five
following the husband’s enrollment (see Table 2).
In this particular case one participant e-mailed the
Parker Oliver et al. / Lessons Learned from a Secret Facebook Support Group
social worker and told her that she could not read
the posts by that husband as they were too painful
for her. Interestingly, there were also recently be-
reaved participants who posted that they had not yet
begun to grieve. Regardless of where in the grief
journey members were, their progress and coping
was observable over time by all members and re-
sulted in the building of trust and confidence as
noted in positive comments by others in the group.
The perceived usefulness of the group also seemed
to vary depending on the relationship of the be-
reaved caregiver to the deceased (wife, son, grand-
child, and so forth). In our small group, we observed
that spouses were the most likely to share a post.
Interestingly, members’ relationship to their deceased
loved one also appeared to influence the group’s re-
sponses. For example, when someone who had lost
a parent tried to reach out to someone who had lost
a spouse, the effort went unacknowledged; however,
when bereaved spouses offered support to one an-
other, it was typically acknowledged and in some
cases resulted in a lengthy exchange.
One of the useful aspects of the Facebook group
was the group members’ ability to express them-
selves with a “post,” “comment,” or “like” and read
others’ shared information any time of the day and
any day of the week. Original statements that were
typically self-prompted and consisted of new topics
are referred to as “postings” or “posts.” Comments
were defined as remarks made in response to material
posted by the social worker or another bereaved care-
giver. A like is when someone clicks on the “like”
button under a post or comment. There were 175
total posts and 247 comments (see Table 2) made in
response to posts by bereaved caregivers. In addition,
there were 315 “likes” to the posts or comments.
Many participants made comments late at night
when professional help was not available and when
they were experiencing particularly difficult or
lonely times. Similarly, it was not uncommon to find
posts made very early in the morning, as though
participants were thinking about their loved one as
their day began. Similar to face-to-face groups, the
number of participants was an important consider-
ation for our support group. In our experience, 10
seemed to be an ideal number of participants to
generate discussion. Once 10 participants (between
weeks 6 and 7) had joined the group, posts and
comments among all participants appeared to in-
crease (see Table 2, week 7). A group with at least
10 participants held enough diversity of experience
129
and interest to allow the traditional roles to be filled
(observer, leader, information provider, and so forth)
and lessened the discussion burdens shared among
individual participants.
Perceived Ease of Use
Many lessons learned related to how to use the Face-
book platform and how to improve the ease of use.
The first lesson involved the vocabulary of Face-
book. This special language can be somewhat con-
fusing to those unfamiliar with it. Developing a user
guide was very important for improving commu-
nication and increasing posting by participants.
Especially difficult for participants was the under-
standing of the difference between their “wall” or
“timeline” and the “news feed.” There were occa-
sions when individuals were concerned that their
privacy was not honored as they reported seeing a
member’s post on their Facebook page (rather than
the “group” page). However, on inquiry by the SWF,
we learned that the post was appearing on the par-
ticipant’s news feed. The news feed is a private page
for participants and cannot be seen by anyone but
the individual. Unless set up with the strictest privacy
settings, the wall or timeline can, on the other hand,
be viewed by any of the individual’s “friends.” It was
critical that the social worker continually inform
participants that what they saw on a news feed was
not the same as what appeared on a wall or timeline.
In every case in which a privacy concern was voiced,
it was because a member had seen a status post on his
or her private news feed and feared it had appeared
on his or her public wall or timeline. When these
differences were explained, or in some cases demon-
strated, the privacy concerns for participants eased.
One of the most helpful aspects of the experience
involved the notifications that were automatically
made when someone posted to the group. The SWF
and all group members were notified via e-mail
when someone initiated a post, when a new member
joined the group, or when settings were changed.
Although these notifications were helpful to the
social workers, they were at times confusing to the
group members who were not familiar with Face-
book. It was very helpful when these notifications
were given via e-mail so the social worker could see
them immediately, even if not working on a com-
puter, through the application on her smartphone.
This allowed for very timely follow-up and problem
solving when necessary. Finally, one of the most sig-
nificant ease-of-use features was that the SWF was
130
able to monitor how many people viewed specific
posts. It was clear from monitoring the “views” of
posts that nearly all individuals read all posts. It is
also noteworthy that new participants usually read
former posts after enrolling in the group.
The platform had some challenges that hampered
the ease of use. The convenience of accessing the
Facebook group on mobile devices presented a few
challenges. On several occasions posts made from a
mobile device were delayed before appearing on the
group page. This delay was frustrating and some-
times confusing for participants. In addition, poten-
tial privacy problems occurred when a new member
joined the group, if the joining was not handled
carefully. To access the group, joining members had
to be able to search for and find the group and then
request that they be permitted to join. This search
required the group settings to be changed from se-
cret to closed. Although it never occurred, it was
briefly possible that someone other than a desired
group member could have searched for and found
the group and seen the membership list. To address
this concern, the SWF prearranged an appointment
time for the searching and membership requests,
which prevented the lowering of the security for
more than a few minutes. Although moderating the
group was not a full-time endeavor, it did require
that the SWF or her supervisor be readily available
to check updates. In our case the SWF, at her earli-
est convenience, would glance at the status posts and
comments using her smartphone to ensure there was
not a crisis event or inappropriate statement made.
DISCUSSION
These lessons were the result of experience with
a small number of participants and a single social
worker facilitating the group with a social work
­supervisor assisting with the project and, thus, gen-
eralization is not possible. The size of the interven-
tion prevents adequate assessment of any clinical
­outcomes; however, assessment of the overall expe-
rience and refinement of the group protocols,
­observations, and informal feedback from partici-
pants were possible.
This experience has found the secret group Face-
book platform to be a usable tool for social work
practice. Education is necessary for all participants.
The measurement of the perceived usefulness of an
individual post or comment is an interesting chal-
lenge. Often posts seemed useful because they were
read by participants; however, they did not always
Health & Social Work  Volume 40, Number 2  May 2015
 Table 3:  NASW & ASWB Technology Standards and Secret Facebook Group Protocol
Standard
Ethics and Values
Access
Cultural Competence and
Vulnerable Populations
Technical Competencies
Regulatory Competencies
Identification and Verification
Privacy, Confidentiality,
Documentation, and
Security
Risk Management
Practice Competencies
  Advocacy and Social Action
  Community Practice
  Administrative Practice
Parker Oliver et al. / Lessons Learned from a Secret Facebook Support Group
Explanation of Standard
Social workers providing services via the
telephone or other electronic means shall act
ethically, ensure professional competence,
protect clients, and uphold the values of the
profession.
Social workers shall have access to technology
and appropriate support systems to ensure
competent practice, and shall take action to
ensure client access to technology.
Social workers shall select and develop appropriate Educational material for clients must be
online methods, skills, and techniques that are
attuned to their clients’ cultural, bicultural, or environment, including literacy and
marginalized experiences. Social workers shall
have the skills to work with people who are
culturally different or a member of a vulnerable
population.
Social workers shall be proficient in the
technological skills and tools required and
for seeking appropriate training and
consultation to stay current with emerging
technologies.
Social workers who use electronic means
to provide services shall understand that
their practice may be subject to regulation
in both the jurisdiction in which the
client receives services and the jurisdiction in
which the social worker provides services.
Social workers shall represent themselves to the
public with accuracy and verify client identity
and contact information.
Social workers shall protect client privacy and
document all services, protecting client
information.
Social workers shall ensure high-quality practices
and procedures that are legally sound and
ethical to protect clients and safeguard against
litigation.
Social workers shall use technology to inform and
mobilize communities and to provide tools,
opportunities, and information so that clients
are able to advocate directly for their own
interests.
Social workers shall advocate for the adoption
and use of relevant technologies that will
enhance the well-being of communities.
Social workers shall keep themselves informed
about technology that will advance quality
program operations and service delivery,
invest in and maintain such systems, and
establish policies to ensure access, appropriate
security, and privacy in agency information
systems.
Protocol
The secret setting allows the greatest privacy.
Assisting with individual privacy settings
is important. Supervision is appropriate as
well.
Facebook improves access for those whose
geographic distance or travel is a barrier.
Access can be via mobile technology or
computer.
sensitive to the clients’ culture and
language. Rules of conduct must ensure
respect and safety between participants.
Requires understanding of the different types
of groups, the privacy settings for
Facebook, and the structure of the
platform.
Protocols were approved by institutional
review board (IRB) to ensure ethical social
work research.
Rules of conduct clarified expectations.
Enrollment into the group required
referral. 
The secret setting protected client identity
and posts.
Plans for referral for follow-up to minimize
risk of harm for those experiencing
complicated grief.
Resources posted were vetted to ensure
respect for and accuracy of copyright.
Criteria were established to ensure
trustworthiness of all resources.
The Facebook group is a community itself,
and the rules of conduct were developed
to protect all.
Protocols allowed for use of all technology
for participation and for facilitation of
the group. A protocol was developed for
group members to submit technical or
security issues or questions they wanted
addressed.
(continued )
131
 Table 3: Continued
Standard Explanation of Standard
Clinical Competencies  Social workers shall be knowledgeable about
online relationships, the advantages and
drawbacks of non-face-to-face interactions,
and the ways in which technology-based social
work practice can be safely and appropriately
conducted.
Research Social workers shall ensure ethical credibility and
ensure the informed consent of the participant.
Supervision Social work supervisors and supervisees shall follow
the standards applied to a face-to-face
supervisory relationship and shall be competent
in the technologies used.
Standard 10: Continuing Social workers shall adhere to the NASW Standards
Education for Continuing Professional Education and follow
applicable licensing laws regarding continuing
education delivered via electronic means.
Source: ­National Association of Social Workers & Association of Social Work Boards. (2005). NASW & ASWB standards for technology and social work practice. Washington, DC: Author.
Protocol
Social workers used their intervention group
skills and were sensitive to what
information is seen and how each
participant interacts.
Continued research is needed for an evidence
base. IRB approval is mandatory.
Supervision of online group practice is
necessary, and backup support for online
practice is needed to ensure coverage when
the social worker is unavailable.
Continuing education needs to address the
unique aspects of providing online support
to ensure the best evidence-based practice.

result in comments. Deciding how to define and
measure usefulness is challenging but important.
The lessons learned in this experience speak to
the practice standards from NASW on use of tech-
nology. Table 3 identifies the standard and the com-
ponent of the intervention that allowed compliance
with the NASW guideline. These experiences and
lessons should encourage further social work use of
social media platforms with appropriate attention to
the NASW guidelines, including attention to re-
search in this area as we understand ethical issues,
clinical outcomes, and issues of use fulness and ease
of use in practice.
RECOMMENDATIONS AND CONCLUSION
Facebook secret groups offer social workers an ad-
ditional tool to enhance support to patients and
families given the geographic barriers that exist for
traditional face-to-face support. Whereas this proj-
ect focused on caregivers in bereavement, similar
strategies should apply to active caregivers. Obser-
vation and participant comments indicate that the
Facebook support group was perceived as useful
and that concerns related to perceived ease of use
were manageable by the SWF. Understanding the
language and technical functioning of the Facebook
platform is necessary, and one can ­expect that it
will be necessary to help group ­participants manage
these issues. Further research is necessary to deter-
mine whether specific types of groups are helpful
based on specific needs (­diagnosis, relationship, and
so forth). In addition, research is needed to determine
the effect of these groups on clinical outcomes such
as anxiety and depression.
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Debra Parker Oliver, PhD, is professor, and Karla

­Washington, PhD, MSW, is assistant professor, Family and
Community Medicine, University of Missouri, Columbia.
Elaine W ­ ittenberg-Lyles, PhD, is associate professor, City
of Hope, Nursing Research, Durante, CA. Ashley Gage, PhD,
is a­ ssistant professor, Department of Social Work, University of
Nebraska at Kearney. Megan Mooney, MSW, is research spe-
cialist, Department of Family Medicine, University of Missouri,
Columbia. George Demiris, PhD, is professor, School of
Nursing, University of Washington, Seattle. Address correspon-
dence to Debra Parker Oliver, Department of Family Medicine,
University of Missouri, One Hospital Drive, MA 306,
­Columbia, MO 65212; e-mail: oliverdr@missouri.edu.
Original manuscript received July 17, 2013
Final revision received December 11, 2013
Accepted January 16, 2014
Advance Access Publication February 18, 2015

Parker Oliver et al. / Lessons Learned from a Secret Facebook Support Group 133
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