A better kind of selfie: veteran-directed digital for mental health

Rebecca Stoeckle rstoeckle@edc.org


With the implementation of the ACA requirements for mental health parity, the increase in mental health, trauma, and substance abuse diagnoses in a range of populations, and the relative paucity of mental health clinicians trained to deliver evidence-based therapies, the gap between demand and supply of mental health care has arguably never been higher.  This gap is especially apparent among veterans, who face additional, sometimes self-imposed, barriers to accessing mental health care: the perception that mental health treatment is poorly aligned with the Veteran’s needs and experiences, as well as logistical or psychological challenges that arise between treatment sessions and foster attrition. The urgent need for new approaches to effectively mitigate these barriers is driven in part by the size of the population in need.  Approximately 1 in 4 Veterans who receive care in VHA have a confirmed diagnosis of a mental disorder.[i] After more than three years, 75% of OEF/OIF/OND Veterans with psychiatric diagnoses had not engaged in minimally adequate mental health treatment in VHA. E-tools for patient self-management are rapidly emerging, but have typically been designed for empowered, techno-literate users and focus on wellness issues such as diet and fitness.  Fewer digital self-management tools specifically designed for challenging populations and difficult conditions have been tested. In light of these realities, EDC in collaboration with Boston University and VA’s NCPTSD developed a novel, veteran-centric digital tool, VetChange; a veteran-directed adaptation of an evidence-based therapy for co-occurring PTSD and problem drinking.  VetChange extends and applies promising approaches to patient self-management in a novel design, using the virtuous cycle of “hook-actions-rewards-investment”[ii] demonstrated in technology product development, and applying innovative persuasive technology techniques to deliver triggers for behavior change when motivation is high and the threshold for action is low. In this presentation we will show how the introduction of a nodal dashboard allows users to record, monitor, and self-regulate problem behaviors and to access psychotherapy modules on demand, and discuss how e-tools can successfully adapt linear clinic-based therapies to formats that allow for self-directed non-linear exploration that aligns with how users organically interact with web-based resources.  We will also explicate the use of various UI strategies (including audio and video narratives from veterans, clinician coaching, goal-setting, reminders and incentives) to foster engagement and reduce attrition, and present early data on uptake, use, and outcomes.  VetChange represents a promising model for scalable, effective tools that can empower hard-to-reach mental health consumers to access and “own” evidenced-based therapy outside the clinical setting.

[i] Department of Veterans Affairs. (2014). Analysis of VA Health Care Utilization among Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn Veterans, from 1st Qtr FY 2002 through 1st Qtr FY 2014. Washington, DC: Author. Retrieved from http://www.publichealth.va.gov/docs/epidemiology/healthcare-utilization-report-fy2014-qtr1.pdf

[ii] Eyal, N., & Hoover, R. (2013). Hooked: How to build habit-forming products. Nir Eyal. 

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