1. VA Mobile Applications for Mental Health: Designing a Patient-Centered User Experience Julia Hoffman, Psy.D. Mobile Apps Lead | Clinical Psychologist National Center for PTSD (VA) Faculty Affiliate National Center for Telehealth & Technology (DoD)

2. Problem Statement (Barriers and Needs) Veterans Stigma Logistics (Geographic distance, busy schedules, etc.) Intermittent symptoms / Sub- threshold or non-disorder specific problems Engagement, retention, and implementation problems Need to address whole person with various co-occurring problems Risk of relapse VA Services Finite resources throughout system ( staffing, appointments, non-standard times) Differing quality of services available in different areas + lack of specialty services Competing demands on Providers time Need to establish outcomes monitoring Limited opportunities to engage families and communities

3. Mobile Applications as a Solution? The recent emergence and pervasiveness of mobile devices 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 (including in-the-moment assessment), and improve upon risk mitigation.

4. Applicable Characteristics of Mobile Technology Anonymous and Safe Accessible and Immediate Targeted / Patient- Centered Connected

5. Mobile App Target Users Healthcare Providers VA Providers Community Providers Concerned Significant Others Children Adults Care- givers Veterans & Service Members VA Patients Patients Enrolled in Evidence-Based Psychotherapies

6. The PTSD Coach Timeline

7. PTSD Coach

8. PTSD Coach Screenshots

9. Tool Examples

10. Metrics of Success: Reach Increased usage of Veterans Crisis Line Versioning for Canada, Israel, Australia and for inner-city violence and cancer 2011 Winner FCC Chairmans Award for Advancements in Accessibility 2012 Winner ATA Presidents Innovation Award 2011 Nextgov.com Best Government App 2011 Yahoos Top 10 Health Apps

11. Evaluation of PTSD Coach (Kuhn et al, in submission) Purpose: Feasibility, acceptability, perceived helpfulness Sample: 54 PTSD Residential Patients 40 men, 12 women Age ranges from 24- 69 (mean of 45) 48% white, 17% AA, and 15% Hispanic Method Patients used app over 3-days (weekend) Post-use survey and focus group *% endorsed at moderately to extremely helpful

12. Mobile App Evaluation Usability/ Feasibility Validation Clinical Outcomes Implementation & Dissemination

13. PE Coach PE Coach is a fully 508 compliant smartphone application for iOS and Android devices. The app is designed to be used in the context of face-to-face clinical care with a trained PE provider. PE Coach: Replaces workbook, photocopies, tape recorder to increase adherence and decrease implementation challenges Adds rich media psychoeducation Allows various customizations to directly correlate to VA and DoD roll outs

14. PFA Mobile Overview PFA Mobile, is a fully 508 compliant smartphone application for mobile Apple products. The app is designed to assist responders who provide Psychological First Aid (PFA) to adults, families, and children as part of an organized response effort. PFA Mobile includes: Summaries of PFA fundamentals PFA interventions matched to specific concerns and needs of survivors Mentor tips for applying PFA in the field A self-assessment tool for readiness to conduct PFA A survivors' needs form for simplified data collection and easy referral

15. UX in a Nutshell Solve exactly the problem you need to solve, for a specific audience, using only the tools you need to solve it.

16. mUX Commandments Solve a specific clinical or implementation challenge. Know (and constrain if necessary) your audience. Include no more than 5 major functions. This focus on parsimony should be applied at every level. Use the language of the target audience and imagery that they can relate to (or, at least, will not reject). All labels should be self-evident. Understand the science. Know what you dont know. Map the intervention on to the platform accordingly. Focus on motivation. Understand where it comes from. Learn how to increase it. Use game mechanics, freedom of choice, interactivity, and personalization where possible to drive continued engagement. Understand and accept constraints. Separate content from structure and function as much as possible. Outsource and consult as much as possible to those with boots on the ground to resolve real-world implementation challenges. Plan for iterative design.

17. Questions? Julia E. Hoffman, Psy.D. julia.hoffman@va.gov Email to be added to distribution list to try new apps.