Deliver Psychological First Aid with the Help of New Mobile App

By DCoE Strategic Communications

The new mobile app “Psychological First Aid” or “PFA Mobile,” supports providers and other response workers who provide psychological care to adults, families and children affected by natural or man-made disasters and emergencies. Developed through a collaborative effort among the Department of Veterans Affairs National Center for PTSD, National Child Traumatic Stress Network and National Center for Telehealth and Technology (T2), the app was designed to meet the challenges faced by first responders by making information and resources associated with response efforts readily accessible to them.

Materials in this application are adapted from the Psychological First Aid Field Operations Guide (2nd Edition), which has been used for successful disaster response around the world for the past six years.

Features of the app include:

■Summaries of psychological first aid fundamentals

■Intervention strategies for specific concerns and needs of survivors

■Mentor tips for applying psychological first aid in the field

■A self-assessment tool

■Easy forms for collecting data and making referrals

“PFA Mobile,” is free and currently only available for Apple users (iPhone, iPad and iPod touch). It will be available for Android devices in 2013. To learn more, read this article written by Dr. Julie Kinn, a clinical and research psychologist with T2 who leads the center’s mobile health application development.

T2 is a Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury center and serves as the primary Department of Defense office for cutting-edge approaches in applying technology to psychological health. Information about other mobile apps available for health professionals and the military community is at t2health.org.

PE COACH Mobile App Supports Prolonged Exposure Therapy

By Robyn Mincher

DCOE Strategic Communications

The Departments of Defense and Veterans Affairs (DoD/VA) have released “PE Coach,” a smartphone mobile application for use with posttraumatic stress disorder (PTSD) treatment.

PE Coach is a form of “prolonged exposure” therapy available to all past and present service members — including the more than 10,000 Wisconsin Soldiers and Airmen who have deployed since 9/11 — as a way to help diagnos and treat symptoms of PTSD.

“As technology grows – our ability to find new ways to get information out to our service members and their families needs to grow as well. This new technology is another great tool for our service members and their families to use while transitioning back into their normal routines following a mobilization.” said Vicki Cushman Edgren, director of the Wisconsin National Guard Badger Yellow Ribbon program.

“In addition to our three phases of reintegration, PE Coach can be a valuable tool for our Soldiers and Airmen to use when returning from deployment and beyond. It especially speaks to the younger generation who already utilize phone apps in many other areas of their lives,” she continued.

Both the DoD and DVA use prolonged exposure (PE) therapy as an effective treatment for PTSD.

Psychologists at the Defense Department’s National Center for Telehealth and Technology, known as T2, and VA National Center for PTSD, developed the mobile app to specifically help patients with their therapy.

“‘PE Coach’ is a helpful tool that assists our service members and veterans who are between visits and in treatment for posttraumatic stress disorder,” said Dr. Jonathon Woodson, assistant secretary of defense for health affairs. “We have shared this app with our military health care providers as well, and hope that many individuals who are receiving PE therapy will find it useful.”

Prolonged exposure therapy helps a patient process a trauma memory to reduce the distress and avoidance caused by the trauma. The patient revisits the memory with a therapist and as the memory is emotionally processed, anxiety decreases. The therapy also helps the patient confront avoided situations that trigger memories of the trauma.

“We worked with a broad and diverse group of psychologists in the DoD and VA who are treating PTSD patients with prolonged exposure therapy,” said Dr. Greg Reger, clinical psychologist with the T2 Innovative Technology Applications division. “We wanted to help our patients in the therapy and make it easier for providers to deliver this treatment. PE Coach does both.”

Many psychologists who provide prolonged exposure therapy acknowledge it could be more effective if patients could better adhere to their assignments between sessions.

The patient installs “PE Coach” on their smartphone and can record the therapy session for playback between sessions. The app also provides an explanation of exposure therapy, assignments, explanations of PTSD and its symptoms, and a convenient way to write notes about typically avoided locations, situations and events for later discussions with their therapist.

Reger said that writing in a notebook in public places may make people feel uncomfortable. However, tapping a note on a smartphone is much easier and a more personal way to capture those in-the-moment feelings.

“PE Coach” will help users successfully adhere to PE treatment, which could improve the quality of treatment. Reger said it was not designed to be used as a self-help tool and should not replace professional counseling.

The Defense Department and VA released a similar mobile app last year; “PTSD Coach” is a reference tool for education, tracking symptoms, self-assessments and connections to support individuals with PTSD.

“PE Coach” is available for Apple and Android mobile devices. Find more information about the app at t2health.org/apps/pe-coach.

The National Center for Telehealth and Technology, located at Joint Base Lewis-McChord, Wash., serves as the primary Department of Defense office for cutting-edge approaches in applying technology to psychological health. More information about T2 is at t2health.org.

T2, a Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury center, designs, tests and evaluates available and emerging technologies in support of psychological health and traumatic brain injury recovery for service members, veterans and their families. To learn more, read “About T2.”

DCoE Seeks Feedback on Mild TBI Pocket Guide

By Corina Notyce, DCoE Strategic Communications

We want to hear from you! Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) encourages health care professionals to share their thoughts on the Mild Traumatic Brain Injury Pocket Guide and corresponding mobile app. Your feedback will help us make improvements to the pocket guide and other traumatic brain injury-related products.

How often do you refer to the pocket guide? What aspect of it do you find most useful? Based on your experience with the pocket guide, tell us everything from advantages and disadvantages to recommendations and suggestions for future traumatic brain injury (TBI) clinical resources and tools.

The pocket guide, developed by DCoE, is an all-encompassing, quick reference clinical guidance tool to help primary care providers assess and treat service members and veterans who have sustained a concussion. It includes a summary of the clinical practice guidelines and recommendations from the Defense Department and Department of Veterans Affairs on the management of mild TBI and provides information on treating common mild TBI symptoms; coding guidance; clinical recommendations for cognitive rehabilitation and driving following TBI; patient education materials; and additional clinical tools and resources related to TBI prevention and care.

You can also access the pocket guide from your smartphone with the free mobile app developed by National Center for Telehealth and Technology, a DCoE center. The mobile app was created to help providers conveniently access the latest evidence-based clinical guidelines for concussion care and enhance provider-patient interactions.

Hard copies of the pocket guide are available from Defense and Veterans Brain Injury Center. Call 800-870-9244 or email for details. To download an electronic version and other TBI clinical resources, visit the Health Professionals section of the DCoE website.

Take the online survey today — it only takes a few minutes. Participation is voluntary and responses will remain anonymous.

New Mobile App Offers “Jackpot” of Stress-Relieving Activities

By Robyn Mincher, DCoE Strategic Communications

The newest mobile application from National Center for Telehealth and Technology (T2) encourages you to get moving.

Designed for those experiencing post-combat stress, “Positive Activity Jackpot,” available for Android systems, helps users creatively plan fun activities using “pleasant events scheduling,” a behavioral health therapy used to help regulate emotions and cope with stress.

“If you have enough positive events in your week, you’re just going to feel better,” said Dr. Amanda Edwards Stewart, T2 clinical psychologist. “With this therapy, we say ‘what can you do today to make yourself feel better?’ and go through a list [of activities]. The cool thing about a mobile app is that your phone has so much more functionality than sitting with a clinician.”

The app offers many ways to find activities in your community using the phone’s GPS navigation feature. Users can use a step-by-step search function to choose an activity based on its distance, cost or one that just suits their current mood. They can also search through the app’s “Jackpot!” game-like feature where users can pull a lever on a slot-machine screen to flip through a random list of local activities in their area found by the GPS.

“If a user wants a water activity, it pairs them up with the location and contact information of a place that rents boats. They can also contact people to come with them, either through their phone contact list or social media,” said Stewart.

After they participate in an activity, one can rate it to record how it helped their mood. If they don’t want to partake in an activity at the moment, users can schedule a future event on the app’s calendar. The app also links directly to contact information for the 24/7 National Suicide Prevention Lifeline in case a user wants to talk to a trained professional.

While the app isn’t intended to replace provider treatment, it encourages positive thinking and promotes resilience by being proactive.

“When you don’t have enough that is positive in your day-to-day life, it can impact your mood,” Stewart said. “In order to help build resilience to face tough times and keep your mood up during stress, you need enough positive events in your week. It helps you cope with stress easier and keeps your mood up.”

The app is the latest mobile resource that T2, a Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury center, developed using unique technology to advance psychological health in the military community. These apps not only make resources more accessible, they encourage help-seeking behavior.

“We’re providing ways people can get mental health care that minimize stigma,” Stewart said. “Putting this app in a service member’s hands gives them tools to help themselves and helps connects them to providers when needed.”

T2 offers a clinician’s guide for the “Positive Activity Jackpot” mobile app that explains pleasant events scheduling therapy and helps navigate through the app’s features. Download the app and let us know what you think.

DCoE February Webinar – Treating Sleep Problems in PTSD and TBI

The Defense Centers of Excellence (DCoE) presents:

Title: DCoE February Webinar – Treating Sleep Problems in PTSD and TBI

Date: Feb. 23, 2012, 1-2:30 p.m. (EST)

Purpose: The DCoE February webinar will focus on evidence-based and empirically-supported treatments for sleep problems (e.g., trouble getting to sleep, trouble staying asleep, nightmares and excessive daytime sleepiness) that are common in patients with post-traumatic stress disorder (PTSD) and/or traumatic brain injury (TBI). Both behavioral and pharmacological treatments will be presented, with a special emphasis on prazosin. Prazosin is a medication that has been found to be effective in reducing combat-related nightmares.

Presenters: 

 ■Anthony Panettiere, MD

 National Intrepid Center of Excellence

■Murray Raskind, MD

 VA Puget Sound Health Care System

Continuing education units (CEUs) and continuing medical education (CMEs) credits from Saint Louis University will be available for this webinar. Pre-registration is required to receive CEUs/CMEs.

Now available through Adobe Connect and Defense Connect Online

In an effort to support all guests whose network security settings may limit access to various internet sites, we are simultaneously hosting this webinar via two technical platforms. The primary site is via Adobe Connect and Defense Connect Online is the optional site. You need only to sign on to either one of the sites to fully participate in the webinar.

To register, please visit: http://es.adobeconnect.com/dcoewebinar/event/registration.html. Please note, if you would like to obtain CEUs/CMEs, you must register. Some network security settings (e.g., Department of Veterans Affairs) limit access to the registration page. If this occurs, please access the registration page from a different network.

View the webinar

The webinar will be simultaneously hosted on two technical platforms. The primary site is via Adobe Connect and Defense Connect Online is the optional site. You need only to sign on to either one of the sites to fully participate in the webinar. Visithttp://www.dcoe.health.mil/Training/MonthlyWebinars.aspx for instructions on how to access the webinar room and dial-in information for the audio portion of the webinar. Audio will not be provided via Adobe Connect or DCO.

If you have any questions, please email DCoE.MonthlyWebinar@tma.osd.mil

Fort Campbell Makes Advances in TBI Evaluation

By Kathy Helmick, DCoE deputy director for traumatic brain injury

In December, I had the opportunity to visit Fort Campbell, Ky., to learn more about their Military Functional Assessment Program. Maj. Sarah Goldman, Army Office of the Surgeon General, traumatic brain injury (TBI) program manager, and I were invited to see this comprehensive, advanced five-day assessment, which is part of a 12-week program designed to treat service members with TBIs.

This evaluation does not rely on a pen and paper test or a computer assessment. It takes place on post and in the program’s simulation lab, exposing service members to realistic combat scenarios while allowing a team of medical and rehabilitation providers the opportunity to evaluate their responses. Service members are observed on camera while combat-related decision-making functions are tested, such as how long it takes a service member to come to the aid of a fallen comrade, identify a threat, plan a course of action, or radio call into a command center. If they perform tasks in simulated combat situations in accordance to Army standards, then this information helps guide return-to-duty decision-making.

Additionally, the lab tests how the service member performs under environmental stressors, such as lack of light or loud sounds, to approximate scenarios encountered in combat zones.

One of the program’s best practices relates to integrating the expertise of a non-commissioned officer (NCO) to evaluate the ability of the soldier to perform the tasks to established Army standards. In the assessment we saw, the NCO was instrumental in educating medical providers about Army standards and describing combat scenarios. Leveraging the knowledge of a qualified NCO helps the medical provider offer a comprehensive evaluation of the service member’s impairments associated with TBI and the injury’s effects on their ability to perform military duties on the battlefield to standard.

I was also impressed with how this program focused on function; instead of clicking a dot on a computer test or circling a multiple choice question, service members with TBI are put in an environment to test their performance and capabilities. Some service members may perform well in a controlled rehabilitation environment, but may not be able to perform as well when multitasking during a high-pressure combat scenario. It was clear that the service members appreciated this type of evaluation and gained more confidence, whether they transitioned back to duty, or out of the military into civilian life.

In continuing to follow this advanced program, I hope that we can identify key outcomes that predict return-to-duty success, or help service members return back home.

8th Annual Blast Injury Conference Discusses New Technology, Continuum of Care

By Robyn Mincher, DCoE Strategic Communications

Defense and Veterans Brain Injury Center (DVBIC), a center of Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE), hosted the 8th Annual Blast Injury Conference Dec. 14, 2011, in Tampa, Fla. The event covered topics such as current care efforts of blast injury, new technology to improve treatment of traumatic brain injury (TBI), blast testing methods and how families can be affected by TBI.

Dr. Steven Scott, medical director of James A. Haley Veterans’ Hospital’s Polytrauma Rehabilitation Center in Tampa, gave opening remarks and helped organize the conference. Scott has been integral to the annual event since it began as a session at the Special Operations Medical Association conference in 2004. It has since grown to a full-day event, bringing together TBI and psychological health care experts from around the world, as well as those invested in TBI and psychological care and treatment in the military community.

“When the conference first originated eight years ago, we were seeing injuries from the wars, but recognized that the community and providers often didn’t really know what blast injury was,” he said. “Realizing the uniqueness of this injury, we made the conference a one-day event so we can educate our people working in care settings on advanced knowledge on blast injury.”

In her presentation “Mild Traumatic Brain Injury: Continuum of Care,” Army Col. Jamie Grimes, DVBIC director, discussed pre-deployment prevention and education training for service members on concussion, such as an Army campaign to teach soldiers and units how to identify, care for and track cases of mild TBI, which includes mandatory classes on the basics of the injury.

New technology was the focus of the presentation “Improving Function through Use of the Functional Electrical Stimulation Hand Glove 200.” Scott and a team of researchers from Haley Veterans’ Hospital discussed how the electrical glove delivered electrical stimulation to finger extensors and flexors attached to parts of the hand. The glove, invented by a scientist who spent 10 years as a robotic engineer for films, strengthened muscle, reduced spasticity, pain and swelling in hands that have decreased function as a result of TBI.

Dr. Jeanette Betancourt, vice president of outreach and educational practices with Sesame Workshop, the nonprofit organization behind Sesame Street, discussed the impact of TBI on military families. She listed their resources to help military families communicate when there is a psychological health care issue, such as their website www.familiesnearandfar.org.

The conference marked another year where top minds in TBI furthered knowledge on the many concerns surrounding the injury in the military.

“There’s a lot we’re learning every day about blast injuries. This injury has a significant effect on the whole person and their family, and it needs a whole team community behind rehabilitation,” said Scott.

T2 Launches Online Community for Military Mental Health Professionals

National Center for Telehealth and Technology (T2) invites military mental health professionals to join “Psychological Health Providers for the Military Community,” a new group the center manages on LinkedIn. This initiative creates additional opportunities for providers to share information and best practices for treating psychological health or traumatic brain injury.

 “Our vision for this group is to offer an engaging environment where mental health providers can share knowledge, exchange ideas and collaborate to help provide the highest level of support and care for service members, veterans and military families,” said Dr. Greg Gahm, executive director of T2.

Members of the group will have centralized access to deployment-related behavioral health resources from the Departments of Defense and Veterans Affairs as well as other government and civilian organizations. Additionally, they can access unique content and receive previews of new resources, tools and technologies focused on the provider community.

If you have questions about this new professional group, or would like more information, you can contact T2 via email at AskUs@T2Health.org. Please note that participation in the group requires that you have a LinkedIn account. You can learn more about LinkedIn and create an account by visiting their sign-up page.

A center of Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE), T2 designs, tests and evaluates available and emerging technologies in support of psychological health and traumatic brain injury recovery for service members, veterans and their families.

For more information about T2 and their provider resources, visit www.T2health.org. You can also connect with T2 on Facebook and Twitter.

By Corina Notyce for DCoE Strategic Communications

Annual Trauma Spectrum Conference Day One: TBI, Technology, Sleep Discussed

By Robyn Mincher and Emily Deck, DCoE Strategic Communications

Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) hosted the fourth annual Trauma Spectrum Conference at the National Institutes of Health (NIH) in Bethesda, Md., Dec. 8-9. The conference brought together top minds from DCoE, NIH, Department of Veterans Affairs (VA), health care providers and military health care advocates to discuss a key issue: how to bridge the gap between clinical research and military systems of care for psychological health and traumatic brain injury (TBI).

“This is an important conference because we have a lot of creative people out in the world doing excellent work,” said Navy Capt. Paul S. Hammer, DCoE director, who gave opening remarks. He stressed the need to provide greater care to wounded warriors by translating information from the research world into clinical reality, and reminded the audience of the importance of keeping the patient at the center of what they do every day.

After encouraging the audience to introduce themselves to neighboring attendees, Hammer remarked that one of the first steps in bridging this gap was to reach out “and get to know people from other agencies.”

Keynote speaker Dr. Ramon Diaz-Arrastia, Center for Neuroscience and Regenerative Medicine, Uniformed Services University for the Health Sciences, outlined the modern epidemiology of TBI and gave an overview of TBI in the military and modern battlefield. He discussed diffusion-tensor imaging, an advanced technique that scans white matter in the brain. The technique is valuable because it can help clinicians diagnose a TBI months after the trauma.

Technology to improve diagnosis and treatment became a focal point of the conference, as new imaging techniques and technology from National Center of Telehealth and Technology (T2) were presented.

Dr. Greg Gahm, T2 director, took the audience on a virtual tour of the center’s mobile applications, websites, telehealth units and the future of its efforts to help service members manage care.

He praised suicideoutreach.org and afterdeployment.org as key resources for improving military psychological health care and noted the success of the popular Mood Tracker mobile application. He also discussed the use of virtual worlds for treatment, including demonstrating the T2 Virtual PTSD Experience, which provides information about PTSD causes, symptoms and resources for care.

“We at T2 believe the best way to predict the future is to create it, and we will continue to do that,” Gahm said.

Dr. Anthony Panettiere, a neurology and sleep physician at National Intrepid Center of Excellence, talked about sleep concerns. The center treats service members with post-combat sleep disorders in its sleep lab.

“Most troops do not look forward to going to bed,” he said as he discussed ways the center treats a service member with wartime experiences that turn into nightmares.

“We have a patient take a dream or nightmare they’re having, write it down and then [encourage them to] change the beginning or the end to something less emotional,” said Panettiere.

Afternoon workshops provided attendees with opportunities to gain more information and resources and ask questions about psychological health topics such as co-occurring disorders, cognitive rehabilitation, substance use disorders, among other subjects.

Day one of the conference ended with encouragement for attendees to embrace what they learned to help improve the system of military health care.

“We can rapidly translate what we’re learning from our investment into clinical practice,” said Dr. Alison Cernich, VA Maryland Health Care System and VA senior liaison for TBI with DCoE. “Above all, the service member and veteran is our focus. For all of us, the responsibility, and the charge, is clear.”

A first-time poster session was held later that afternoon where 26 researchers highlighted current and emerging findings and best practices focused on bridging the gap between research and clinical practice of psychological health and TBI. Award recognition went to Susanne W. Gibbons, Ph.D., assistant professor, Graduate School of Nursing, Uniformed Services University of the Health Sciences, for her poster about “Gender Differences in Response to Deployment Among Military Healthcare Providers in Afghanistan and Iraq.”