Julia Hoffman, Psy.D. Mobile Apps Lead | Clinical Psychologist - National Center for PTSD (VA) Faculty Affiliate - National Center for Telehealth & Technology (DoD)

1. VA Mobile Applications for Mental Health:
Designing a Patient-Centered User Experience
Julia Hoffman, Psy.D.
Mobile Apps Lead | Clinical Psychologist
National Center for PTSD (VA)
Faculty Affiliate
National Center for Telehealth & Technology (DoD)

2. Problem Statement
(Barriers and Needs)
Veterans
• Stigma
• Logistics (Geographic distance,
busy schedules, etc.)
• Intermittent symptoms / Sub-
threshold or non-disorder
specific problems
• Engagement, retention, and
implementation problems
• Need to address whole person
with various co-occurring
problems
• Risk of relapse
VA Services
• Finite resources throughout
system ( staffing, appointments,
non-standard times)
• Differing quality of services
available in different areas + lack
of specialty services
• Competing demands on
Providers’ time
• Need to establish outcomes
monitoring
• Limited opportunities to engage
families and communities

3. Mobile Applications as a Solution?
• The recent
emergence and
pervasiveness of
mobile devices
has led to
innovations in
clinical care that
address some of
these challenges.
The ultimate goals:
Improve treatment
delivery
By increasing efficiency,
accessibility, and alleviating
implementation challenges.
Increase treatment
effectiveness
Effective tools to provide
psychoeducation, develop
treatment strategies, practice
invaluable skills introduced in
therapy, improve tracking and
monitoring capabilities
(including in-the-moment
assessment), and improve
upon risk mitigation.

4. Applicable Characteristics of
Mobile Technology
Anonymous
and Safe
Accessible
and
Immediate
Targeted /
Patient-
Centered
Connected

5. Mobile App Target Users
Healthcare Providers
VA
Providers
Community
Providers
Concerned Significant
Others
Children Adults
Care-
givers
Veterans &
Service
Members
VA Patients
Patients
Enrolled in
Evidence-Based
Psychotherapies

6. The PTSD Coach Timeline

7. PTSD Coach

8. PTSD Coach Screenshots

9. Tool Examples

10. Metrics of Success: Reach
• Increased usage of
Veterans Crisis Line
• Versioning for Canada,
Israel, Australia and for
inner-city violence and
cancer
• 2011 Winner FCC
Chairman’s Award for
Advancements in
Accessibility
• 2012 Winner ATA
President’s Innovation
Award
• 2011 Nextgov.com Best
Government App
• 2011 Yahoo’s Top 10
Health Apps

11. Evaluation of PTSD Coach
(Kuhn et al, in submission)
• Purpose: Feasibility,
acceptability,
perceived helpfulness
• Sample: 54 PTSD
Residential Patients
– 40 men, 12 women
– Age ranges from 24-
69 (mean of 45)
– 48% white, 17% AA,
and 15% Hispanic
• Method
– Patients used app
over 3-days
(weekend)
– Post-use survey and
focus group
*% endorsed at “moderately” to “extremely helpful”

12. Mobile App Evaluation
Usability/
Feasibility
Validation
Clinical
Outcomes
Implementation
&
Dissemination

13. PE Coach
PE Coach is a fully 508 compliant
smartphone application for iOS and
Android devices. The app is designed to
be used in the context of face-to-face
clinical care with a trained PE provider.
PE Coach:
• Replaces workbook, photocopies, tape
recorder to increase adherence and
decrease implementation challenges
• Adds rich media psychoeducation
• Allows various customizations to directly
correlate to VA and DoD roll outs

14. PFA Mobile Overview
PFA Mobile, is a fully 508 compliant
smartphone application for mobile Apple
products. The app is designed to assist
responders who provide Psychological
First Aid (PFA) to adults, families, and
children as part of an organized
response effort.
PFA Mobile includes:
• Summaries of PFA fundamentals
• PFA interventions matched to specific
concerns and needs of survivors
• Mentor tips for applying PFA in the field
• A self-assessment tool for readiness to
conduct PFA
• A survivors' needs form for simplified
data collection and easy referral

15. UX in a Nutshell
Solve exactly the problem you need to solve,
for a specific audience,
using only the tools you need to solve it.

16. mUX Commandments
• Solve a specific clinical or implementation challenge.
• Know (and constrain if necessary) your audience.
• Include no more than 5 major functions. This focus on parsimony should
be applied at every level.
• Use the language of the target audience and imagery that they can relate
to (or, at least, will not reject). All labels should be self-evident.
• Understand the science. Know what you don’t know. Map the intervention
on to the platform accordingly.
• Focus on motivation. Understand where it comes from. Learn how to
increase it. Use game mechanics, freedom of choice, interactivity, and
personalization where possible to drive continued engagement.
• Understand and accept constraints.
• Separate content from structure and function as much as possible.
• Outsource and consult as much as possible to those with “boots on the
ground” to resolve real-world implementation challenges.
• Plan for iterative design.

17. Questions?
Julia E. Hoffman, Psy.D.
julia.hoffman@va.gov
Email to be added to distribution list to try new apps.