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

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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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Military Behavioral Health

• Needs– Care for service members and families– Access to resources for providers– Agility to respond to emergent crises

• Challenges– Costs– Distance

Why Use Technology inMilitary 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

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Integrate technology with health care and

health promotion

Create and adapt technology

Connect patients with providers & providers

with consultants

Pilot innovative technologies

National Center for Telehealth & Technology (T2)

Research what works, what doesn’t,

and why

Deliver population level behavior change

technologies

Provide operational and administrative support

Mission: Lead the

development of telehealth

and technology solutions

for Psychological Health

and Traumatic Brain Injury

to improve the lives of our

Nation’s Warriors,

Veterans, and their

Families.

Vision: Technology to

Make People Healthy –

Leading the greater

military community to

improved health through

evidence-informed

technology innovation.

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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T2 Approach to Development

• Assessment at every stage– Focus Group– Usability– Efficacy– Effectiveness

• Collaborations– Department of Veterans Affairs (VA)– Non-profit organizations– Universities

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T2’s Current Tools for Military Behavioral Healthcare

• Web-based applications– AfterDeployment.org– MilitaryKidsConnect.org

• Mobile applications

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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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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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Interactive Workshops

Provider Education

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.

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MilitaryKidsConnect.org

Passport “gamification”

Stampy the Global Guide

Features identified by text

and graphics

Age-differentiated message boards

Site tailored depending on identified

deployment location

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T2 Mobile Applications

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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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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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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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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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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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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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Provider Resilience

Deploying Summer 2012Currently 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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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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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

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

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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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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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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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