clinical psychology internships training
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Clinical Psychology InternshipsWalter Reed National Military
Medical Center
3 February 2012
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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
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Continuum of Care and Technology
EducationT2 Virtual PTSD Experience
Population and PreventionWebsites
MiltaryKidsConnect.orgAD.org (including VA application)
Mobile ApplicationsBreath2Relax Tactical BreathermTBI
SurveillanceDoD Suicide Event Report (DoDSER)
ScreeningMobile Screener
AssessmentVirtual Reality Cognitive Performance Assessment Test
TreatmentPTSD CoachPE CoachT2MoodTrackerVirtual Reality Exposure Treatment
Education Prevention Surveillance Assessment & Screening Diagnosis Treatment Rehabilitation Reintegration
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Why We Are Doing This
• Numerous challenges in delivery of mental health care to Service Members and Veterans including:– Treatment availability– Implementation problems for
EBP’s due to individual and systemic constraints
– Paucity of resources (e.g. providers with adequate training)
– Logistical barriers– Stigma
Only 38 to 45 percent of diagnosed OEF/OIF service members indicated interest in receiving help and only 23 to 40 percent reporting receiving help within the past year. Logistical barriers to care and concern about stigmatization were the largest causes of this phenomenon.
(Hoge, et al., 2004
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Bridging the Gap
Soldiers who want help
Want Help 41.5% Don't want help 58.5%
Soldiers who received help
Received help 31.5%Didn't receive 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)
Diagnosed OEF/OIF Service Members
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Technology as a Solution?
The recent emergence and pervasiveness of technologies including websites, mobile devices and other technologies 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, and
improve upon risk mitigation.
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Technology as a Solution
Two broad questions:– Why would you use more technology in a
behavioral health practice?– How would you use more technology in a
behavioral health practice.
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Why is Technology Valuable for Veterans and Service Members?
Anonymous and Safe
Accessible and Immediate
Targeted
Benefits to the System
Benefits to Non-BH Providers (e.g. Primary Care)
Benefits to BH Providers
Why is Technology Valuable for Providers and
Health Care Systems?
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Prevention and Population Work
• 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.
Education Prevention Surveillance Assessment & Screening Diagnosis Treatment Rehabilitation Reintegration
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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
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Types of Technology Solutions
aSelf-Help Apps/Web
sites
Provider Assisted
Apps/ Web Sites
SupportProvision of
EBP*
Support Provider Growth/
Resilience
ImproveSystems Adults Children
Concerned & Significant OthersService Member / Vet / Patient
Support Provision of EBP
Recommended Provider Oversight Provider
Unit Members, NCO
Commander
*Evidence Based Practice
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Carson B.
“Afterdeployment.org is an amazing and helpful site! I recently used it to determine whether or not I really needed to seek counseling after my husband came home from deployment.....turns out--I do, and I am in counseling now. Great site for private assessments!”
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afterdeployment.org
Pain
Finances
Suicide
www.afterdeployment.org
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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
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Elsbeth Fast
Elsbeth.Fast@va.gov
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MilitaryKidsConnect.org
• A web-based service aimed at enhancing resilience and coping skills of military youth and improving family readiness throughout the deployment cycle.
• Five tracks: Kids (6-8), Tweens (9-12), Teens (13-17), Parents, Educators
www.MilitaryKidsConnect. org“Deployment from a kid’s point of view”
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Age-Specific Landing Page
Selectable Activities
Passport Gamification
Deployment Experiences withHelpful Tips For Coping
Forum-Based Peer-to-Peer Support
Selectable Videos
Animated Global Guide
www.MilitaryKidsConnect.org
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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
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Continuum of Care
Education Prevention Surveillance Assessment & Screening Diagnosis Treatment Rehabilitation Reintegration
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
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Carson B.
• During his second deployment, Carson again saw much combat
• Some injuries and saw a lot of casualties
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Assessment
• “Signature wounds” of today’s wars – Post-traumatic Stress– Traumatic Brain Injury
• Efforts to improve both treatment & assessment
Screen shot of Virtual Reality Cognitive Assessment P Test
Education Prevention Surveillance Assessment & Screening Diagnosis Treatment Rehabilitation Reintegration
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mTBI Pocket Guide
Features:• Quick results with coding guidance• Symptom management lists• Summary of clinical recommendations• Patient education resources• Clinical tools and resources
Availability: NOW NOW
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Computer-aided Psychological Treatments: Effectiveness
Annu. Rev. Clin. Psychol. 2009. 5:121–41
•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.
Isaac Marks and Kate Cavanaugh
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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
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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:• 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
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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
Availability: NOW NOW
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T2 Mood Tracker
T2 Mood Tracker is a mobile application that allows users to self-monitor, track and reference their emotional experience over a period of days, weeks and 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
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Tactical Breather
Using a four-count methodology, the Tactical Breather application can be used to gain control over physiological and psychological responses to stress.
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
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mTBI Co-occurringConditions Toolkit
Clinical Practice Guidelines for treatment of mTBI
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
Availability: NOW NOW
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Life Armor
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
Availability: MAY 12 MAY 12
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PE Coach
PE Coach takes one of the most effective treatments for PTSD (Prolonged Exposure) and creates an easily transportable tool to be used during treatment. The app leverages the smartphone’s capabilities to improve the patient’s and the provider’s convenience during treatment sessions, and between treatment sessions.
Features:• Educational Materials• Homework assignments• Self-monitoring forms
Availability: JUN 12 JUN 12
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Provider Resilience
Self-care tool for healthcare providers who work with service members and who may need support in 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
Availability: JUL 12 JUL 12
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
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http://www.t2health.org/vwproj
Technology: Next Steps
NEXT STEPS:• HTML5
• mobileHealth
• Multimodal Mobile
• ‘Virtual Clinic’
What’s coming up? • Increased use of technology to
provide Evidence-based care• More deployable technology tools• Greater access to information,
assessment options, and guidelines
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Resources
www.t2health.org
Linkedin www.linkedin.com
FaceBook www.facebook.com/T2Health
Twitter www.twitter.com/T2Health
AskUs@t2health.org
National Center for Telehealth & Technology9933C West Hayes Street
Joint Base Lewis-McChord, WA 98431
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