Smart phones could help bridge treatment gap - Army News | News from Afghanistan & Iraq - Army Times

Smart phones could help bridge treatment gap

Soldiers who lack access to mental health care providers because they are too far away from each other could one day speak to a doctor on a screen in the palm of the hand or inside a converted shipping container.

Researchers with the National Center for Telemedicine and Telehealth are exploring how smart phones and cargo containers equipped with two-way video technology can link soldiers to care across long distances. Tests are underway for smart phones, and the first converted cargo container is already in use.

“We at T2 continue to focus on expanding access to care to our service members, veterans and families, and one of the ways is through two-way audio-visual interactions,” said Matt Mishkind, chief of T2’s clinical telehealth division. “Our big focus is to make sure we get care to people anywhere it’s needed, anytime that it’s needed, that it’s as close to patients as possible in places where people feel comfortable receiving the care.”

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“It’s hard to get more comfortable than the palm of your hand,” he said. “You can have health care delivery 24/7, and that’s where we see the future of mental health care going.”

Mishkind said the Army has been particularly receptive to working this application of two-way video conferencing, both for using the Transportable Telehealth Unit for mass post-deployment screenings and for avoiding the expense of transporting providers.

“We’re working with [the Army] a lot to come up with new ideas,” Mishkind said.

The proliferation of smart phones equipped with two-way video technology in recent years drove T2 researchers to explore their use. Because the technology is relatively new, there is little information about how well it might work, but they have great potential, said David Luxton, a research psychologist and program manager at T2.

“The thing about smart phones is that they aren’t tethered to a hard-wired network, so they’re highly mobile.” Luxton said. “It works anywhere a service member can get access to a WiFi connection, and it’s affordable technology. A lot of people, if they don’t have a smart phone, they’re getting one.”

T2, a component center of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE), is based at Joint Base Lewis-McChord, Wash. T2 has set up laboratory-based usability tests as part of a study to examine the iPhone 4’s FaceTime application, and other platforms in the future. T2 is exploring how the application can be used and how well it can connect.

Overcoming a stigma

Researchers believe the use of smart phones will help soldiers get information and counseling without the perceived stigma of going to a therapist or mental health clinic.

Volunteer soldiers, who are patients at the Sleep and Pulmonary Clinic at Madigan Army Medical Center, Wash., will be employed to conduct mock sessions. Those sessions will influence researchers who are planning more tests for South Korea and Afghanistan that will be focused on connectivity.

In mid-February, researchers for the first time tested how well the technology worked in a call to Iraq. The test included a 22-minute session in which the researchers in the U.S. used the communications application Skype on a smart phone, and their counterpart in Iraq used Skype on a desktop computer.

The top challenge, Luxton said, is the reliance on network connectivity, which could be spotty, particularly in a war zone.

The tests so far are evaluating the quality of the video and the audio, and the potential for dropped calls.

“If we’re going to use it for a therapy session, the audio and video have to be of a certain quality to be effective,” Luxton said. “We want to see that it’s reliable enough to see facial expressions and see what’s going on in the room.”

Luxton declined to name which of the three cell networks researchers used worked the best because, he said, the results were biased by the varying proximities to individual cell towers.

Researchers are also keeping in mind privacy, data security and encryption standards endorsed by the Defense Department and American Telemedicine Association, he said.

Luxton said he was unaware of any studies where the technology has been explored this way.

T2 will also look at the effectiveness of an iPhone app it offers called “Tactical Breathing Trainer,” which guides the user through a stress-reducing breathing technique. A second app, T2 Mood Tracker, allows personnel to self-report their emotional well-being for themselves or a therapist.

The container initiative

T2’s other main effort is the Transportable Telehealth Unit, at work in isolated American Samoa since June. At T2 headquarters, there are several containers waiting to be shipped for mass redeployments. In such cases, installations either lack the clinic space to treat large numbers of returning troops or providers at the installations lack the providers.

The TTU is a modified cargo container in which soldiers consult via webcam with mental health professionals thousands of miles away at Tripler Army Medical Center in Honolulu.

The 80-foot container, outfitted with three telehealth booths, connects via a T1 fiber optic line to Tripler providers. That enables three of the four clinic spaces in a TTU to operate at once.

American Samoa in the Pacific, home to a Reserve unit from the 100th Infantry Battalion, lacks broad access to mental health care because of its remote location, Mishkind said. Located west of the island of Tonga, the South Pacific territory is 2,300 miles from Hawaii.

Between October and January, the TTU had 88 clinical visits, 85 percent of which were repeat visitors. The units are used for screenings, assessments and some regular clinical services.

“Whereas before some people would have to be flown back [to Tripler] to get their clinical visits, now they are getting their care from Hawaii from this unit in American Samoa,” Mishkind said.

Mishkind said because service members do not have to fly to Tripler, they are taking advantage of the care. “Anecdotally, we’re hearing that people who had never been seen before or would never seek care are now coming out to seek care,” he said.

Like in American Samoa, the TTU’s would allow providers to stay where they are and connect via fiber optics. The bandwidth allows for mass post-deployment screenings.

Mishkind said he envisions being able to place TTUs at other isolated locations around the country, such as armories and Reserve centers, when units are placed there for limited periods.

T2 also envisions a recreational vehicle equipped with telehealth booths. The vehicle would travel on a rotational basis along a circuit of Reserve installations, for example. In contrast with the cargo containers, which would be more stationary, the RVs would allow more mobility.

As with smart phones, researchers hope their work leads to advances in policies, which have been outstripped by technology. For example, providers are restricted from counseling soldiers from across state lines unless both the soldier and the provider are on federal property.

“Policy does not allow us to provide care in some of the ways that technology does,” Mishkind said. “So if we show the technologies work appropriately, if we show there are no connectivity issues, that then leads us down the path of speaking to the policies.”