This training was presented to the Clinical Psychology Internships at the Walter Reed National Military Medical Center on the use of technology to address deployment related psychological health issues.
Android or Apple phones/tablets, leave them on if you wish. BB, turn it off. Feel free to download our apps if you wish while we are talking.
At the end of the workshop, you should be able to do these 9 things.You can see from this slide and the next that we have a large number of teaching goals for a relatively short workshop. In many ways, with both the number of participants and the time for a workshop, we have limited expectations about turning everyone into a Technology Ranger. However, we hope to open doors for you and point you in the directions you may want to follow. We do not anticipate that we can get you all the way down the path toward integration of technology into clinical practice but think that this workshop can provide a good start, at least.
Our view is that there is a good range of opportunities to integrate technology into psychological health and traumatic brain injury care. That is what this workshop is all about.
I will start with just a little essential background.Let me start by telling you something that you know. There is a real supply and demand problem. While the precise epidemiological statistics vary from report to report and study to study, there is no disagreement that there is plenty of work for mental health providers and not enough of them to go around – not enough to meet the need. The services and VA are hiring mental health providers in record numbers. Despite that, there are still not enough providers to address the needs of Service Members returning from OIF and OEF alone. Never mind the Viet Nam veterans and the other Service Members and Veterans who have not deployed in the last 10 years.
The gap between Demand and Supply – Needs and Resources - is huge!This slide carries a lot of information. For now, I’ll note that the first pie chart makes it clear that, at least in 2004, over half – approaching 2/3’s – of the Service members who had diagnosable problems did not want to receive formal help. Why do you think? [STIGMA AND DISTANCE/TIME] Did you know that approximately 40% of recent returnees are returning to rural locations where care may be difficult to access. A second point this slide makes is that less than 1/3 of patient with diagnosable problems – even those within range of good medical and BH care – actually received help. Why do you think? [as nust noted: treatment AVAILABILITY issues both because of the MASSIVE NUMBER of individuals who need coupled with the FINITE NUMBER OF providers, SHORT APPOINTMENT TIMES in key clinics due to productivity demands, TRANSPORTATION, CLINIC HOURS, CONFLICT WITH WORK/FAMILY NEEDS]. These factors impact service members but also impact providers who have top-down pressure within their healthcare systems to provide care within certain constraints. For example, while PCPs may be expected to fit care within very short appointment times but are also expected to go through a whole lot of required screenings, and have little time to provide education and motivate reluctant consumers to take referrals. Stigma has been shown to be a factor for service members as well as their families (families won’t seek care because they don’t want to bring their SM into question) and although gains in this area have been made, the reality is that mental health care is still not without discrimination and stigma.
So, these are the problems. Is technology the solution? Maybe but it is still a somewhat unproven proposition.However, we believe various kinds of technology can help providers meet more of the demand while remaining comfortable that they are providing effective,quality care. We also believe that in many cases technology-based approaches can provide pathways to prevention and self-care goals. IT IS POSSIBLE, even likely, that technology-based approaches may be the only ones that some service members and veterans will accept.
There are two broad questions that we are going to address as we me move through this workshop
There are often questions about why would we want to do this – to develop and even emphasize use of technology for behavioral health problems? After all, isn’t much of mental health treatment about the therapeutic relationship? Who really wants an intimate relationship with their computer or smart phone. Well, not many of us here – some of the developers and techies might think about it but most wouldn’t. These are some of the broad-brush answers to the question WHY. We won’t be taking time to thoroughly and directly support these answers to these questions about why use technology. But the answers are embedded in what we will cover and may be part of the final exam. You got a note taking device. Please note your support for these advantages as we come to them and hold on to them. Also there is more specific support for these advantages in the slide deck that we have included in the Toolkit CD for this conference.Note that not all of these points or advantages refer to all technologies; some only make sense for web-based tools or for mobile apps.For the modeling bullet, my point is that they can get the info about others without needing to talk to others directly – that’s why I put it under anonymous & safeANSWERS:Anonymous and safe:Avoid stigma (and/or actual discrimination resulting from acknowledging problem)Social media provides an opportunity to feel less isolated but remain anonymous (e.g. forums)See modeling e.g. videos or educational materials about what others are going throughAccessible and Immediate:DoD/VA care may be impossible to get due to ineligibility or inaccessibility (e.g. rural location)Low/no cost in most casesProvides interventions or resources (e.g. hotlines) in the moment even when clinics aren’t openOpportunities to record and address challenges between appointmentsExpectation of digital access and flexibility among younger generationFamilies/other military community members can also get access even if ineligible for formal servicesTargeted:Opportunity to provide necessary skills training including basic psychoeducation“Stepped care model” that addresses the user at the level needed, even if sub-syndromalHighly personalized solutions allow for user to get care in ways that are optimized for him/herAllows intervention on secondary issues not addressed in active careBenefits to the System:Creates a “force multiplier” for stretched systemsCost effective – does not require a clinician or clinic administrative infrastructurePatients perceive system as current and flexibleIncreases coverage of patients without increasing demand on cliniciansProvide tools to providers that will decrease turn-over and burnoutBenefits to non-BH providers (e.g., primary care):Allows non-specialty providers easy to prescribe BH tools and vetted assessmentsPotentially increases likelihood of reluctant consumers taking up needed specialty careEasy way to track patient progress over time (plus accurate in-the-moment assessment)Possible risk management (e.g. hotlines are in the hands of patients)Learning opportunities outside of standard trainings that can have high time costBenefits to BH providers:Allows outsourcing of less provider-dependent elements of treatment (e.g. education)Easy way to track patient progress over time (plus accurate in-the-moment assessment)Possible risk management (e.g. hotlines are in the hands of patients)Aimed at increasing compliance with face-to-face therapy goals (e.g. homework in PE Coach)Opportunity to provide care for issues that are not a target of treatment (e.g. relationships)
That’s as much time as we are going to spend explicitly on WHY use technology. The rest of our time will be spent on how.
With that as a short preamble, I’m going to start telling you a fictional story about Carson B. It is a composite of many service member stories.We are going to follow Carson’s experience across the continuum of care and we will be thinking about what technology solutions can be helpful and in what ways. What do you think are some of the issues Carson would possibly be facing if he showed up in your office – or more likely in a Primary Care office?
EBP is Evidence Based PracticeBeyond the continuum of care, I would also point out that we will at least touch all of the various target groups where technology solutions are intended to be used. This picture presents a nice visual summary of targets for help through leveraging of technology.We will at least touch on all of the various target groups where technology solutions are intended to be used.
Here we are going to pick up the story of Carson B. You recall he deployed first to Iraq. Despite seeing intense combat including in Fallujah, he came home without physical injuries. Indeed, the reception at home was pretty good. This short video, while part of a commercial, does capture the positive reception that many, if not most, Service Members received. So things seemed good but he started having symptomsyou would recognize as post-traumatic stress. He got lucky and ran across a flier for www.afterdeployment.org and he decided to spend some time on the website. The simple reassurance that he got helped him feel better. His wife spent some time with him on the afterdeployment website and found it helped her. (Parenthetically, I’ll add that here is an actual quote from wife that we got as feedback to our website. I’ll let you read it.) As Carson was getting ready for the second deployment, he got back on AfterDeployment and spent time adding to his resilience and stress management skills. But I’m getting ahead of myself.
T2’s flagship website, afterdeployment.org, has been online since late in 2008. it has evolved through 3 updates and will be moving into the Next Generation over this next year. Right now it’s center is a selection of 18 topic areas. Each one offers an assessment, a workshop if the assessment suggests it may be of benefit, and easily accessible additional resources. Predictably, one topic area is Post Traumatic Stress. Others include depression, angers and relationships – both family and friends. However, there are also topics like resilience, stress management and sleep as well as Health and wellness, work adjustment and spirituality. During the next year we will be adding three more topic areas (CLICK)A congressionally-mandated website aimed at providing recent returnees with self-guided tools for managing postdeployment challenges. Overall: huge depth of information formed by SMEs around the country since 2006 and launched initially in 2008.Features of AD:18 program areas, described in next slideEach program has workshops, assessments, modeling videos, lengthy psychoeducation documents that can be printed, and lists of resources.Expert blogCommunity features for social interactionDirect access to urgent care by phone or chatForthcoming documentary videos and workbooksTabs for providers and families
Recognizing that it is essential to have a well-trained cadre of professionals to provide evidenced-based care in order to meet the behavioral health needs of the military and VA, T2 developed a “provider portal” which contains many features. There are descriptions and scoring info for the site’s self-assessments; quick facts about PTSD and TBI; client handouts; clinical practice guidelines; topical briefings; links to continuing education materials; and a section on secondary trauma and provider burnout. Clinicians will also find value in reviewing the interactive multi-session workshops available within various topic modules on the site’s home page to use in ways like or similar to what the DC VA has done. The portal, which was launched in December 2010, has recently been updated and refreshed.
AfterDeployment was designed in response to Congressional language calling for web-based help for Warriors and Veterans. The website was produced so that it could be used anonymously at any time by any individuals who felt they might need help with re-integration or something else related to their deployment. We met Elsbeth Fast at the VA’s Mental Health conference in August, 2011 and are genuinely impressed with her work. She has found a way for using afterdeployment that greatly impresses and pleases us, in part because it seems to work really well. Other VA CBOCs and Medical Centers are picking up on this and a research study has begun to evaluate the effectiveness and outcomes of this as an interventional tool.
MKC is our newest website and is out now public facing and freely available. This website was released in November 2011 and announced at a White House meeting on January 11, 2012. Important to note that some providers may never see children but do see their patients who will know that their kids are perhaps needing some support. This is a resource for kids 6-17 plus parents and educators.MilitaryKidsConnect is intended to provide a community of support for military kids from ages 6 to 17. It is designed to provide peer-to-peer support and to help build resilience skills.
This remarkable site addresses three developmental age groups: kids (6-8), tweens (9-12), and teens (13-17). Unlike many similar sites, it is intended for military off spring of all ages. And it also has sections for parents/guardians and for educators. There is an animated guide. [CLICK] A range of selectable activities. [CLICK] Some relevant games. [CLICK] A peer-to-peer Forum. [CLICK] And age appropriate coping tips. [CLICK] As you look through the site, you will notice that an underlying purpose is to build resilience through both a community of support and development of resilience enhancing skills.
I’m going to take just a couple of moments to talk about the common features of web-based Self-change programs. Our websites tend to be designed for multiple visits or sessions. Perhaps in the course of completing a specific workshop or perhaps coming back for information on new topics, areas or concerns as time goes on. Our websites have multiple components or features. For instance, topic coverage includes assessments, workshops and resource suggestions as well as interactive possibilities such as chat and games, videos for instruction as well as for endorsement of getting help and modeling of healthy behavior. Our websites are designed as standalone resources that can be used if, when, and where a person wants to. But also, our websites can be used in conjunction with a provider who may assign homework of various kinds that will move therapy along more quickly and/or effectively.
We have talked about a couple of websites that are helpful with the education and prevention parts of the continuum of care. These don’t have a surveillance function. The can be helpful with treatment.We do have a website with a surveillance function that is important. I will describe it but as I doing that I would like you to see if : you can think of ways this could be used to plan for suicide risk reduction?Though it probably is not of immediate clinical utility. The DoDSER collects 250 data points on every suicide in the services and the reserve component. Results are available to the services but not necessarily to providers. However, providers may get involved in providing reports of suicides and suicide attempts. These are important for prevention as well as from a treatment perspective. It allows us to better understand what are the risk factors and what are the protective factors. - For example, DoDSER data demonstrated that deployments do not predict suicides. More sucides have been completed by service members who have never deployed.
It’s probably obvious that risk for PTSD and TBI increases as the number of deployments increases. So for the fictional case example we have been following we will say that on his second deployment in Afghanistan, Carson’s unit got pretty beat up a number of times and, unlike Iraq, he was injured himself. One possible example could be this. An explosion just on the other side of a vehicle blew the vehicle into him and knocked him down. His helmet protected his head but he hit the ground hard rolled several times and he was momentarily dazed. These additional events would move things along the continuum of care.
Another area of activity along the continuum of care is assessment. So to continue to describe a typical story: Upon returning from Afghanistan, Carson encountered a new set of PTS problems. He decided to visit the sleep topic on afterdeployment.org to see if it would offer anything useful in terms of understanding his sleep problems. It did but even more to the point, he spent some time with in the Post-traumatic Stress topic area and based on the assessment there (PCL-M) decided he needed to see his primary care provider. During the appointment, the Nurse Practitioner he saw became suspicious that the symptoms Carson was describing could also be attributed to a traumatic brain injury – he had several hard falls while deployed that had shaken him up but did not seem to have immediate significant effects. TBIs were not really the PCM’s specialty or even a diagnostic question that he encountered frequently. So, he got out his mobile device to use the mTBI Pocket Guide and administered the assessments on dizziness, sleepiness, and multi-dimensional assessment of fatigue. Each one further reinforced the concern about the possibility of a previously undiagnosed TBI. An appropriate referral was made for further evaluation. The Nurse Practitioner also suggested that Carson visit the DVBIC website, which was noted on the apps resources page.
Hands OnAcross the bottom of the screen you will find selection buttons – they may be easier for you to use in the horizontal orientation.Home button: DoD definintion and diagnostic criteriaCPG button OR VA/DoD CPG: Provides clinical practice guidelines including for RTD and when to apply duty restrictions. Under the summary of algorithms, Algorithms A is maybe most helpful for Primary Care or consultation in an ERYou will notice that there are selections for: ICD 9 coding (next on the Android and later on the Apple. ICD-9 button: Provides coding guidance, including for V-codes, E&M coding for TBI care and Procedure codes for TBI care. Sticking with the APPLE, for symptom management Symptom (management) button on the Android leads to both Headaches a Other Symptoms: Lists the symptoms to considerHeadache is probably the most common symptom--Prevalence information--H&P – Note medication reviewReferral--ER or NeurologyPatient Education--Look at the neck stretches or the sleep position – mostly for treating muscle problems Treatment--Pharmacologic Treatment – Post-concussive – pick which ever seems closer (Migraine vs Tension)----If the medicines reported are not listed or the doses being take are different, consider referral to PCP or prescribing physician--Non-pharmacologic Treatment – not this is pretty standard cognitive-behavioral treatment for stress, anxiety, anger.
What factors affect the effectiveness of computer-aided psychological treatment? Marks & Cavanaugh identify these
Your patients may be concerned about how their private information is protected on these apps. Even though all but mobile screener do not transmit any data, there is still the possibility of data loss if a person misplaced their phone.
PTSD Coach has been one of our most downloaded applications. It has consistently received good reviews including by the FCC, which presented an award for it’s well designed accessibility features.When you first sign on, you are prompted to identify some of your favorite pictures, some of your favorite music and some personal contacts that you might want to call if you are really distressed. You can change these selections if you subsequently want to make changes. The screen is divided into four sections. The first is the one that leads to the opportunities to simply learn more about PTSD. Tap Learn. Tap a question you would like to read or hear read to you. The upper right corner takes you to assessment. Tap that. Go ahead and answer the questions – you can pretend you are your most difficult PTSD patient if you wish or pretend to be your favorite PTSD patient. The app will give you feed back but does not give a diagnosis. In fact, it will state straight forwardly that it is not a giver of diagnoses.The lower left corner will offer the opportunity for managing a symptom. Tap the Manage Box. Tap a symptom. Let’s pick sleep. The app will talk you through an approach that may help. If it does not or you do not want to do what is suggested, you can pick another one. The lower right corner provides contact for emergencies, crisis, just wanting to talk, and ways to find a provider to see in person. If there is time, small groups can talk among themselves to discuss ways this application might be used.
This toolkit does not educate on how to make these diagnoses, but rather, on how to further evaluate what conditions may be resulting in the presenting symptoms. It was developed to give guidance to primary care providers on the assessment and management of these patients, synthesizing the information of the above CPGs. Evidenced-based approaches to the management of co-occurring disorders are emerging but have not reached fruition. To that end, SMEs from the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE), the Center for Deployment Psychology (CDP), the Center for the Study of Traumatic Stress (CSTS), the Defense and Veterans Brain Injury Center (DVBIC), the Deployment Health Clinical Center (DHCC), the National Center for Telehealth and Technology (T2) and the National Intrepid Center of Excellence (NICoE) gathered to provide expert opinion to address these gaps. As the science emerges, this toolkit will be revised to reflect the evidence. Given the occurrence of co-occurring conditions, a holistic approach that works to incorporate all spheres of the patient's life is essential to include family and spiritual aspects. While medications can be very effective, this patient population is at high risk for polypharmacy which may lead to significant drug-drug interactions. Utilizing non-pharmacological approaches where indicated and appropriate is critical. Emerging research in the area of complimentary treatments in this population may indicate therapeutic alternatives in the near future. Diagnostic criteria for the conditions are listed under the Provider Resources tab for reference. However, this guide is not intended to be used as a diagnostic tool. Rather, it is assumed that diagnoses have already been determined. Furthermore, this guide is designed to provide information and assist decision-making. It is not intended to define a standard of care and should not be construed as one. It should not be interpreted as prescribing an exclusive course of management and should not replace clinical judgment or consultation with a specialist when deemed appropriate. Every healthcare professional making use of this guide is responsible for evaluating the appropriateness of applying the recommendations in the clinical setting.In the primary care setting, even the initialappointment time is typically limited. Therefore, this section attempts to highlight areas that need to be addressed immediately. When seeing a post-deployment service member with a history of concussion and ongoing symptoms, a screening for potential co-occurring psychological health (PH) concerns should take place. In addition, several key areas of safety and symptoms should be addressed. General questions regarding the below topic areas should be followed up with specific questions to maximize clinical data. 1. Difficulty with sleep 7. New or worsening headaches 2. Nightmares 8. Violence Changes in mood (depression, anger, irritability) 9. Substance use (alcohol, drugs, supplements) 4. Suicidal or homicidal ideation 10. Difficulties with relationships5. Changes in cognitive function, attention 11. Difficulties at work6. Chronic pain 12. Medications used (includes over-the-counter)
I’ll mention quickly here that T2 is releasing a mobile application on the Android platform that makes the afterdeployment assessments, workshops, and reference material available on your smart phone.
Introductory Slide; Click to Add Specific Title
Clinical Psychology Internships Training
Clinical Psychology Internships Walter Reed National Military Medical Center 3 February 2012
Desired Learning Outcomes• Able to state at least 3 roles that IT technology can play in psychological health and traumatic brain injury (PH/TBI) care• Able to state why leveraging technology makes sense in today’s culture• Able to describe 1 way that websites may be helpful in PH/TBI care• Able to describe 1 way that a smart phone application can be helpful in PH/TBI care• Able to describe 1 way that a Virtual World site might be used in PH/TBI care• Able to describe how to implement an afterdeployment.org group• Able to identify the clinical need/benefits of using clinical video teleconferencing (CVT) modality for PTSD services• Able to identify research on clinical effectiveness of using CVT modality for evidence-based practice (EBP) for PTSD• Able to identify at least 3 VA training resources to support implementing a CVT clinical programs for PTSD EBP 2
Continuum of Care and Technology Assessment & Education Prevention Surveillance Diagnosis Treatment Rehabilitation Reintegration ScreeningEducation Screening T2 Virtual PTSD Experience Mobile ScreenerPopulation and Prevention Assessment Websites Virtual Reality Cognitive Performance MiltaryKidsConnect.org Assessment Test AD.org (including VA application) Treatment Mobile Applications PTSD Coach Breath2Relax PE Coach Tactical Breather T2MoodTracker mTBI Virtual Reality Exposure TreatmentSurveillance DoD Suicide Event Report (DoDSER) 3
Why We Are Doing This• Numerous challenges in delivery of mental health care to Service Members and Veterans Only 38 to 45 percent of diagnosed OEF/OIF including: service members indicated – Treatment availability interest in receiving help and only 23 to 40 percent – Implementation problems for reporting receiving help EBP’s due to individual and within the past year. systemic constraints Logistical barriers to care – Paucity of resources (e.g. and concern about stigmatization were the providers with adequate largest causes of this training) phenomenon. – Logistical barriers (Hoge, et al., 2004 – Stigma 4
Bridging the Gap Diagnosed OEF/OIF Service MembersSoldiers who want help Soldiers who received help Want Help Received help 41.5% 31.5% Dont want help Didnt receive 58.5% help 68.5%Only 38 to 45 percent indicated interest in receiving help and,only 23 to 40 percent reporting receiving help within the past year.(Hoge, 2004) 5
Technology as a Solution?The recent emergence and pervasiveness oftechnologies including websites, mobile devices andother technologies has led to innovations in clinicalcare that address some of these challenges. The ultimate goals: Improve treatment Increase treatment delivery effectiveness By increasing efficiency, accessibility, and Effective tools to provide alleviating implementation psychoeducation, develop challenges. treatment strategies, practice invaluable skills introduced in therapy, improve tracking and monitoring capabilities, and improve upon risk mitigation. 6
Technology as a SolutionTwo broad questions: – Why would you use more technology in a behavioral health practice? – How would you use more technology in a behavioral health practice. 7
Why is Technology Valuable for Veterans and Service Members? Anonymous and Safe Accessible and Immediate TargetedWhy is Technology Valuable for Providers and Health Care Systems? Benefits to the System Benefits to Non-BH Providers (e.g. Primary Care) Benefits to BH Providers 8
Prevention and Population Work Assessment & Education Prevention Surveillance Diagnosis Treatment Rehabilitation Reintegration Screening• Technology can be used across the continuum of care from education, skill building and inoculation to assessment, treatment, and follow-up monitoring.• The most commonly used technology solutions are web-based and mobile applications. 9
A Case Study: Carson B.• 25 year old activated Active Duty E4• Married 5 years with two children• 2 Deployments – Saw combat in around Fallujah – Saw more combat in Afghanistan• Now assigned to garrison duty 10
Types of Technology Solutions Support Provision of EBP Recommended Provider Oversight Provider Provider Support Self-Help Support Improve Unit Assisted Provider Apps/Web Provision of Systems Adults Children Members, NC Apps/ Web Growth/ sites EBP* O Commander Sites Resilience a Service Member / Vet / Concerned & Significant Others Patient*Evidence Based Practice 11
Carson B.“Afterdeployment.org is an amazing and helpful site!I recently used it to determine whether or not I reallyneeded to seek counseling after my husband camehome from deployment.....turns out--I do, and I am incounseling now. Great site for private assessments!” 12
Provider Portal • Launched December 2010 • Technical info about assessments • Client Handouts • Clinical Practice Guidelines • Topical Briefings • Links to Continuing Education • Resilience/ Self-Care re: Secondary Trauma • “AD Clinic” will allow providers to tailor content to individual users • New Look (to the left) Fall 2011 14
MilitaryKidsConnect.org • A web-based service aimed at enhancing resilience and coping skills of military youth and improving family readiness throughout the deployment cycle. www.MilitaryKidsConnect. org“Deployment from a kid’s point of view” • Five tracks: Kids (6- 8), Tweens (9-12), Teens (13- 17), Parents, Educators 16
Age-Specific Landing Page www.MilitaryKidsConnect.org Selectable Activities Passport Gamification Deployment Experiences with Helpful Tips For Coping Forum-Based Peer-to-Peer Support Animated Global Guide Selectable Videos 17
Web-Based Self-Change Programs• Common features • Multiple sessions/workshops • Multiple components • Stand alone components • Can be used as an adjunct to face-to-face therapy. • Assign on-line homework assignments • Track patient progress • Email contact with provider 18
Continuum of Care AssessmentEducation Prevention Surveillance Diagnosis Treatment Rehabilitation Reintegration & Screening SurveillanceDoD Suicide Event Report- Very complete data base for all services plus the Reserve Component.- Model for VA- Linkable to VA- Linkable to CDC National Violent Death Reporting System 19
Carson B.• During his second deployment, Carson again saw much combat• Some injuries and saw a lot of casualties 20
Assessment Assessment & Education Prevention Surveillance Diagnosis Treatment Rehabilitation Reintegration Screening Screen shot of Virtual Reality Cognitive Assessment P Test• “Signature wounds” of today’s wars – Post-traumatic Stress – Traumatic Brain Injury• Efforts to improve both treatment & assessment 21
mTBI Pocket GuideFeatures:• Quick results with coding guidance• Symptom management lists• Summary of clinical recommendations• Patient education resources• Clinical tools and resources Availability: NOW NOW 22
Computer-aided Psychological Treatments: Effectiveness•The importance of screening patients for suitability for CP (simple screening can enhance uptake, motivation, and economies of scale)•The role of live human support for CP users (just a little human contact can go far to reduce attrition, improve uptake and pt outcomes)•The background of successful CP supporters (typically professional, paraprofessional or student CBT therapists)•The importance of routine monitoring of CP progress and live support (monitoring number of users, what sections they access, the goals they work on, their outcome ratings)•How CP can fit with (complement/augment) traditional face to face psychotherapy. Annu. Rev. Clin. Psychol. 2009.Isaac Marks and Kate Cavanaugh 23 5:121–41
Privacy and Technical Details• Phones have built-in security options (e.g. password protection)• Apps with sensitive data (e.g. PE Coach) have password protection on the app• Other than Mobile Screener, none of the apps transmit data to or from the phone. – Unfortunate due to lost clinical utility• Data can always be cleared; apps can be completely removed from the phone 24
Breathe2RelaxBreathe2Relax is a portable stress managementtool utilizing hands-on diaphragmatic breathingexercise. Breathe2Relax uses state-of-the-artgraphics, animation, narration, and videos todeliver a sophisticated, immersive experience forthe user.Features:• Initial setup guide to assist with tailoring application• Customizable backgrounds and music• Immersive tutorial videos• Body scanner to display effects of stress• Graphing to track effectiveness• Audio narration Availability: NOW NOW 25
PTSD CoachT2 collaborated with the VAs National Center forPTSD to develop this app to assist Veterans andActive Duty personnel (and civilians) who areexperiencing symptoms of PTSD. It is intended tobe used as an adjunct to psychological treatmentbut can also serve as a stand-alone education tool.Features:• Self-assessment of PTSD Symptoms• Tracking of changes in symptoms• Manage symptoms with coping tools• Assistance in finding immediate support• Customized support information Availability: NOW NOW 26
T2 Mood TrackerT2 Mood Tracker is a mobile application that allowsusers to self-monitor, track and reference theiremotional experience over a period of days, weeksand months using a visual analogue rating scale.Features:• Self-rating on pre-populated categories• Full note adding• Graphed results• Fully customizable categories• User set reminders for self-rating Availability: NOW NOW 27
Tactical BreatherUsing a four-count methodology, the TacticalBreather application can be used to gain controlover physiological and psychological responses tostress.Features:• Introduction Narrative to the Benefits of Tactical Breathing•Tutorial on how to use Tactical Breathing• Practice Mode to help you learn• Settings Page to change voice gender and graphics preferences• Excerpt Page provided by Lt. Col. Dave Grossman that displays several chapters from his book Availability: NOW NOW 28
mTBI Co-occurring Conditions ToolkitClinical Practice Guidelines for treatmentof mTBIFeatures:• Guidance to primary care providers on the assessment and management of patients synthesizes information from the following VA/DoD CPGS: mTBI, PTSD, depression, chronic opioid therapy and substance use disorder Availability: NOW NOW 29
Life ArmorA multi-topic application derived fromafterdeployment.org to provide the user withknowledge and tools to cope with the manychallenges faced by today’s service members.Features:• Multi-topic resource guide• Self-Assessments of topic symptoms• Ease to manage, customizable views and favorites• Manage symptoms with coping tools• Video resources on topics Availability: MAY 12 MAY 12 30
PE CoachPE Coach takes one of the most effectivetreatments for PTSD (Prolonged Exposure) andcreates an easily transportable tool to be usedduring treatment. The app leverages thesmartphone’s capabilities to improve the patient’sand the provider’s convenienceduring treatment sessions, and between treatmentsessions.Features:• Educational Materials• Homework assignments• Self-monitoring forms Availability: JUN 12 JUN 12 31
Provider ResilienceSelf-care tool for healthcare providers who workwith service members and who may need supportin coping with burnout or compassion fatigueFeatures:• Quick dashboard view• Graphing to track resilience progress• Tools to assist increasing resilience• Inspirational value cards• User set reminders to update assessments Availability: JUL 12 JUL 12 32
T2 Virtual PTSD Experience• T2 Virtual PTSD Experience: Second Life – “Public Access” Islands – Publically launched Jan 18, 2011 – Immersive, Experiential Education – Discuss Causes – Demonstrate Symptoms – Access to Care – Social Support http://www.t2health.org/vwproj 33
Technology: Next StepsWhat’s coming up? NEXT STEPS:• Increased use of technology to • HTML5 provide Evidence-based care• More deployable technology tools • mobileHealth• Greater access to information, assessment options, and guidelines • Multimodal Mobile • ‘Virtual Clinic’