clinical psychology internships training

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Clinical Psychology Internships Walter Reed National Military Medical Center 3 February 2012

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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.

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Page 1: Clinical Psychology Internships Training

Clinical Psychology InternshipsWalter Reed National Military

Medical Center

3 February 2012

Page 2: Clinical Psychology Internships Training

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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

[email protected]

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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

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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

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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

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[email protected]

National Center for Telehealth & Technology9933C West Hayes Street

Joint Base Lewis-McChord, WA 98431