This article describes the development and evaluation of a training program for behavioral health providers on the integration of mobile health applications (health apps) in clinical care. The purpose was to train military and Department of Veterans Affairs (VA) providers in the use and current research of various behavioral health apps. The training focused on 5 core competencies: gaining knowledge on the evidence base for using mobile apps in behavioral health practice, effective integration of mobile technologies into traditional treatment settings, security and privacy issues involved with digital data, ethical issues, and cultural considerations. During a 3-year span (October 2014 -September 2017), the training program delivered 20 one-day workshops at 15 military or VA locations, reaching 760 Department of Defense and VA clinicians (psychologists, social workers, physicians, and nurses) on best practices for health apps in clinical care. Prior to the training, less than half of the providers who attended the workshop (41.1%) reported that they were using health apps during treatment. Just following the training, 93.7% of the trainees indicated their intent to use health apps during patient care. At the 3-month posttraining interval, provider-reported use of health apps in treatment was 90.8%. Results demonstrated the impact of a mobile apps provider training program to deliver a relevant, feasible, and impactful approach to educating providers regarding mobile health best practices. Data collected also provided valuable insight into military provider technology use over a 3-year period. Public Significance StatementIn order for clinicians to leverage mobile health technology to best serve their patients, training on best practices is necessary. This article describes the results of an education and training program that successfully trained 760 clinicians over the course of a 3-year period on best practices for mobile health in clinical care.
Practicing psycbologists and otber bealtb professionals are facing a growing patient population of United States military service members witb significant psycbological and behavioral bealtb concems retuming from war zones in Afgbanistan and Iraq. Some of these issues are new and unfamiliar to many bealtb providers. Furtbermore, because of a military culture of self-reliance, strengtb, and tbe perceived stigma of seeking mental bealtb services, a second and substantial population of service members-in-need is cboosing not to consult bealtb professionals at all. Tbe Intemet and otber networked multimedia tecbnologies now offer a deb expert resource for providers, and an anonymous, less stigmatizing venue for self-management for service members and tbeir families. Over tbe last 2 years tbe U.S. Defense Department's National Center for Telebealtb & Tecbnology bas developed afterdeployment.org, a Web-based set of resources, tools, and aids for service members, veterans, and tbeir families, afterdeployment.org provides education and skills-development exercises aimed at overcoming cballenges to tbe adjustment process after a deployment. Tbe Website also provides bealtb professionals witb a comprebensive resource to serve as an adjunct to face to face treatment of individuals in tbe military community.
Mental health problems pose challenges for military veterans, returning service members, and military family members including spouses and children. Challenges to meeting mental health needs include improving access to care and improving quality of care. Mobile Health, or "mHealth," can help meet these needs in the garrison and civilian environments. mHealth brings unique capabilities to health care provision through the use of mobile device technologies. This report identifies high-priority mHealth technology development considerations in two categories. First, priority considerations specific to mental health care provision include safety, privacy, evidence-based practice, efficacy studies, and temperament. Second, priority considerations broadly applicable to mHealth include security, outcomes, ease of use, carrier compliance, hardware, provider perspectives, data volume, population, regulation, command policy, and reimbursement. Strategic planning for the advancement of these priority considerations should be coordinated with stated Department of Defense capability needs to maximize likelihood of adoption. This report also summarizes three leading, military programs focused on mHealth projects in mental health, The Telemedicine and Advanced Technology Research Center, The Military Operational Medicine Research Program, United States Army Medical Research and Materiel Command, and The National Center for Telehealth and Technology.
BackgroundInternet-facilitated interventions may offer numerous advantages in reaching the large numbers of military service men and women exposed to traumatic events. The Internet is now a primary source of health-related information for consumers and research has shown the effectiveness of web-based interventions in addressing a range of mental health problems.ObjectiveClinicians can learn how to bring Internet education and intervention into routine care, to help clients better understand mental health issues and learn skills for self-management of problems.MethodThe Afterdeployment.org (AD) Internet site can be used by health care professionals serving U.S. military personnel returning from Iraq and Afghanistan, and their families. The site currently addresses 18 key domains of functioning, including post-traumatic stress, sleep, anger, alcohol and drugs, and military sexual trauma. It provides an extensive amount of client and family education that is suitable for immediate use by clients and providers, as well as the kinds of interactive workshop content and self-assessment tools that have been shown to be helpful in other treatment contexts.ResultsAD can be utilized in clinical practice in a variety of ways: as an adjunct to treatment for PTSD, to supplement existing treatments for a range of post-deployment problems, or as the primary focus of treatment for a client.ConclusionsAD represents a kind of service that is likely to become increasingly available in coming years and that is important for mental health providers to actively explore as a tool for extending their reach, improving their efficiency, and improving quality of care.
This pilot study employed a nonconcurrent, multiple-baseline single-case design to examine the impact of an online self-management posttraumatic stress (PTS) workshop on self-reported symptoms of PTS, depression, and functional impairment. Eleven student veterans with PTS first completed between three and five weekly baseline measures. Second, they took part in eight weekly online workshop sessions, each accompanied by symptom assessments. Third, they completed postintervention outcome measures. We found statistically significant reductions in PTS from baseline across workshop sessions for four of 11 participants, and significant overall reductions in PTS between enrollment and postintervention for five participants. One participant also demonstrated significantly reduced depressive symptoms from baseline across the intervention, and two evidenced significant overall reductions from enrollment to postintervention. Three student veterans showed significantly improved general functioning across the sessions and one reported significant overall functional increase. Finally, five of six participants who completed extended measures of educational function showed significant improvements from enrollment to postintervention. Among secondary outcomes, more than 80% of those taking part said they would recommend the online PTS workshop to a colleague or fellow student with PTS issues. These preliminary findings show that our online PTS workshop can be effective in reducing PTS symptoms in some cases, but also suggest that additional research is needed. With increasing numbers of service members and veterans using the Internet and many reluctant or unable to seek in-person care because of stigma or limited access, the time seems right to further examine the utility of networked PTS resources.
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