In this presentation Dr. Robert Ciulla and Dr. Julie Kinn discuss why technology is effective in supporting behavioral health care and how the National Center for Telehealth & Technology is leveraging it.

1. Providing Behavioral Resources to
the Military Community: Mobile and
Web-based Applications
Julie Kinn, Ph.D. and Robert Ciulla, Ph.D.
National Center For Telehealth & Technology
Joint Base Lewis-McChord/ Tacoma, WA
American Telemedicine Association (ATA)
2012 Annual International Meeting & Expo

2. Agenda
• Military Behavioral Health
– Needs
– Challenges
• Why Telehealth in Addition to TAU
• National Center for Telehealth & Technology
– Approach to Development
– Current Tools for Military Behavioral Health
• Future Development
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3. Military Behavioral Health
• Needs
– Care for service members and families
– Access to resources for providers
– Agility to respond to emergent crises
• Challenges
– Costs
– Distance
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4. Why Use Technology in
Military Health Care?
• Overcome barriers to care (e.g., Hoge et al.,
2004)
– Stigma:
• Web-based and mobile apps are anonymous
• User interfaces/ platforms familiar to service
members
– Logistics:
• “Hip pocket” availability
• 24/7 access to care, 365 days a year

5. National Center for
Telehealth & Technology (T2)
Mission: Lead the
development of telehealth
and technology solutions Research what works,
what doesn‟t, and why
for Psychological Health
and Traumatic Brain Injury Create and adapt Provide operational and
technology administrative support
to improve the lives of our
Nation‟s Warriors,
Veterans, and their Integrate technology
with health care and
Families. health promotion
Vision: Technology to
Pilot innovative Deliver population level
Make People Healthy – technologies behavior change
technologies
Leading the greater
Connect patients with
military community to providers & providers
with consultants
improved health through
evidence-informed
technology innovation.
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6. MHS Quadruple Aim
EXPERIENCE OF CARE
 Providing a care experience that is patient and family centered, compassionate, convenient,
equitable, safe and consistently of the highest quality
 Access, clinical telehealth, clinical support tools, integrated, comprehensive care
POPULATION HEALTH
 Reducing the generators of ill health by encouraging healthy behaviors and decreasing the
likelihood of illness through focused prevention and the development of increased resilience
 Improving health, prevention, self-help, medical management, registries, health psychology
and lifestyle behavior change
READINESS
 Ready Force: Ensuring that the total military force is medically ready to deploy
 Screening, surveillance, family support, stress inoculation, reintegration, suicide prevention
 Ready Medics: Ensuring that the medical force is ready to deliver the full spectrum of healthcare
anywhere – currency and competency
 Professional development, education and training, currency and competency, telehealth
standards and training, access to telehealth sub-specialty care and consultation
PER CAPITA COST
 Creating value by focusing on quality, eliminating waste and reducing unwarranted variation;
considering the total cost of care over time, not just the cost of an individual health care activity;
providing value for healthcare funding
 Efficacy, evaluation, research, data-based decisions, culture of innovation to improve
healthcare operations
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7. T2 Approach to Development
• Assessment at every stage
– Focus Group
– Usability
– Efficacy
– Effectiveness
• Collaborations
– Department of Veterans Affairs (VA)
– Non-profit organizations
– Universities

8. T2’s Current Tools for
Military Behavioral Healthcare
• Web-based applications
– AfterDeployment.org
– MilitaryKidsConnect.org
• Mobile applications
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9. AfterDeployment.org
• 18 Topics
• 29 Self-Assessments
• Multiple Media Libraries
• Self-Paced Workshops
• Video-Based Personal Stories
• Community Forums
• Expert Blogs
• Links to Hotlines
• Links to Other Sites/Content
• Provider Locator Tool
• Provider Portal
• Podcasts
• RSS Feeds
• Polls and Quick Health Tips
• Social Media Links
• Daily Quotes
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10. Self-Assessments
• Twenty-nine standardized self-assessments
across eighteen modules
• Results are reflected along an acuity continuum,
from low to moderate to high
• Users receive immediate feedback on results and
recommendations within a structured Learning
Management System (LMS)
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11. Interactive Workshops
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12. Provider Education

13. MilitaryKidsConnect.org
• Launched January 2012
• Interactive map, personal
stories, games, message
boards, online scrapbook.
• Separate content for
children (6-8), tweens (9-12)
and teens (13-17).
• Resources for parents and
educators of military kids.
• Addresses each stage of the
deployment cycle.

14. MilitaryKidsConnect.org
Site tailored depending
on identified
deployment location
Features
identified by text
and graphics
Passport
“gamification”
Age-differentiated
message boards
Stampy the
Global Guide
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15. T2 Mobile Applications
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16. PTSD Coach
T2 collaborated with the VA's National
Center for PTSD to develop this app to
assist veterans and active duty
personnel (and civilians) who are
experiencing symptoms of PTSD. It is
intended to be used as an adjunct to
psychological treatment but 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
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17. T2 Mood Tracker
Self-monitor, track and reference
emotional experiences over a period of
days, weeks and months.
Features:
• Self-rating on pre-populated categories
• Full note adding
• Graphed results
• Fully customizable categories
• User-set reminders for self-rating
• Send results to providers (upcoming)
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18. Breathe2Relax
Breathe2Relax is a portable stress
management tool utilizing hands-on
diaphragmatic breathing exercise.
Breathe2Relax uses state-of-the-art
graphics, animation, narration, and
videos to deliver a sophisticated,
immersive experience for the user.
Features:
• Setup guide to assist with tailoring app
• Customizable backgrounds and music
• Immersive tutorial videos
• Body scanner to display effects of stress
• Graphing to track effectiveness
• Audio narration
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19. mTBI Pocket Guide
Clinical Practice Guidelines for
treatment of mTBI
Features:
• Quick results with coding guidance
• Symptom management lists
• Summary of clinical recommendations
• Patient education resources
• Clinical tools and resources
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20. Co-occurring Conditions Toolkit
Co-occurring Conditions Toolkit:
Mild Traumatic Brain Injury and
Psychological Health
Features:
• 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
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21. LifeArmor
Currently in beta version (soft release)
A multi-topic application derived from
AfterDeployment.org to provide the
user with knowledge and tools to cope
with the many challenges 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
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22. Provider Resilience
Deploying Summer 2012
Currently field testing downrange
Self-care tool for health care
providers who work with service
members and who may need
support coping with burnout or
compassion fatigue
Features:
• Quick dashboard view
• Graphing to track resilience progress
• Tools to assist increasing resilience
• Inspirational value cards
• User-set reminders to update
assessments
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23. Positive Activities Jackpot
Currently in beta version (soft release)
Provides suggestions for daily positive
activities. Based on positive event
scheduling, the active component of
Behavior Activation. Helps with
depression, self-harming behaviors,
and individuals without any mental
health difficulties.
Features:
• “Jackpot” suggests random activities
• Users select from 376+ possible activities
• Augmented reality technology to identify
activities in immediate surroundings
• Ability to invite friends or post chosen
activity to social media
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24. PTSD Family Coach
Deploying Summer 2012
T2 collaborated with the VA's
National Center for PTSD to create
the PTSD Family Coach. This app
provides support to families of
Veterans and Active Duty personnel
(and civilians) who are experiencing
symptoms of PTSD.
Features:
• Education about PTSD
• Coping tools to help manage stress
• Guided deep breathing and progressive
muscle relaxation
• Assistance in finding immediate
support and resources
• Customized support information
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25. Telehealth Clinical Coach
In Development
Provides information and interactive
tools to assist in the design of telemental
health systems and guidance for
conducting telemental health sessions.
Features:
• Interactive tools to assist with clinic set-
up and maintenance
• Instructional content to educate users
about telemental health (TMH)
• Interactive VTC back panel and remote
control images
• Graphical demonstration of effects of
bandwidth on video quality
• Decibel reader for measuring sound
levels
• Email and print capabilities

26. Virtual Hope Box
In Development
Self-care tool for patients. Helps the user
cope with suicidal ideation and other
symptoms of depression by providing a
customizable, virtual “hope box” containing
reminders for living, distraction tools,
relaxation tools, coping cards, and other
symptom management tools.
Features:
• Customizable pictures, video, and music
to remind user of reasons for living
• Word games, photo puzzles, and other
distraction tools
• Guides user in controlled breathing and
progressive muscle relaxation
• Inspiring quotes
• Crisis lines and customizable contact
information for immediate support
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27. Future Development
Focus On:
• Efficiency:
– Content should be created once and applied across platforms
– Applications and generic modules shared via
library/repository
• Security:
– Address linkage of devices to Electronic Health Record (EHR)
– Support mobile health in deployed settings, for reservists, etc.
• Forward-thinking policy:
– Identify and share best practices (“share first”)
– Work to create an environment that supports the evolution of
the Patient Centered Medical Home model across the MHS
spectrum („participatory medicine‟)
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28. Contact Information
Julie Kinn, Ph.D.
Mobile Applications Program Manager | Research Psychologist
Population and Prevention Programs |P3|
National Center for Telehealth & Technology |T2|
TEL: (253) 320-5718 | FAX: (253) 968-4192
www.t2health.org | julie.kinn@us.army.mil
Robert Ciulla, Ph.D.
Chief
Population and Prevention Programs |P3|
National Center for Telehealth & Technology |T2|
TEL: (253) 968-2849 | FAX: (253) 968-4192
www.t2health.org | robert.ciulla@us.army.mil
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