There is a high incidence of Post-Traumatic Stress Disorder (PTSD) among veterans of the current conflicts in Iraq and Afghanistan. The United States' all-volunteer forces have been engaged in combat for ten years and many military members have completed multiple tours. Some individuals are more susceptible than others (Corbett, 2002). Although sufferers of PTSD are in the minority of those returning from war zones, numbers are still sufficiently high to tax the military's health care system. There are simply not enough mental health professionals to meet the need.
Online counseling and special PTSD apps for smart phones and tablet computers have been demonstrated as effective solutions, at least in part. Military officials stress that neither online counseling nor apps replace one-on-one treatment in a clinical care setting. However, they can be beneficial to sufferers and provide some intermediate relief until actual treatment can be provided.
Project Proposal for the Central New York Veterans Outreach Center
The Central New York Veterans Outreach Center (CNYVOC) has provided comfort and guidance to military veterans and their families for over thirty-one years. The center offers transitional and low-income housing solutions, a food pantry, benefits advisory, and a dedicated team of professionals on staff during regular business hours to address veterans' questions and concerns. Three mental health counselors and four case managers regularly meet with clients to help them develop the skills needed to return to a self-sufficient, independent lifestyle. The case managers and two of the mental health counselors also provide mobile counseling for veterans unable to travel to the center.
Funding for the proposed project would enable the center to purchase iPads for the center's staff, as well as a limited number for client use. Staff would have ready access to forms and information needed for home visits with clients. Clients would use various apps and internet access to augment treatment for mental health issues. The executive director ultimately has the authority to purchase the iPads. The proposal will have to meet approval of the 10-member Board of Directors who have demonstrated in the past that they are open to new ideas that will aid the population served by the center.
Pending Board approval, the Executive Director (ED) plans to purchase seven iPads, one for himself and one for each of the other personnel who provide mobile services: two benefits counselors, two case managers, and two licensed mental health counselors. The ED will ask for volunteers from the mobile service team to do some research about the iPads before the purchase is made. It is generally agreed that the Center will purchase iPads for use with Verizon's 3G network. The ED wants some feedback about the amount of storage sought and ideas about applications (apps) the staff would like to purchase. In addition to doing some research via the internet, the ED will authorize staff members to visit an Apple Retail Store to talk with experts about the devices, accessories and apps that will best meet the Center's needs. The ED plans to discuss staff's findings and recommendations within two weeks of the Board's approval.
Funding for the project will be provided by the local Veterans of Foreign Wars (VFW) post. The post sponsors an annual classic car show that traditionally draws a large number of enthusiasts from the region. Each year, the post donates a portion of the proceeds to a different charity or non-profit it selects before the event. For this year, the post has chosen the Central New York Veterans Outreach Center. In recent years the post has donated between six and seven thousand dollars to the cause of its choice; CNYVOC can therefore reasonably assume it will receive a donation of similar size. The sum will be sufficient to purchase the iPads and cases. The ED is prepared to ask the Board to allocate monies for any additional spending that the VFW's donation does not cover. Such items may include wireless keyboards, apps, and portable printers. The Board will also have to approve the recurring monthly expense for the data plan, since the iPads will be used in locations where wi-fi is unavailable.
After the iPads are purchased, CNYVOC will conduct training. Two staff members -- one of the benefits counselors and one mental health counselor -- already have personal iPads and have indicated they are willing to provide instruction to their co-workers. Staff members will schedule one-on-one training sessions that will last about an hour each. This will minimize disruption to the Center, which can thus remain open during training and continue to meet the needs of clients. With individualized training sessions, staff members can work at their own pace and can be freer to ask questions than they might be in a group setting. After the training sessions, the ED would like staff members to spend a week using the iPads in office to gain facility before taking them into the field.
In addition to the built-in apps with which the staff is to become familiar, they will learn to use a free app called PTSD Coach. The app was developed through a collaborative effort between the Veterans Administration National Center for PTSD and the Department of Defense National Center for Telehealth and Technology (Mobile app: PTSD Coach, 2011, n.p.). PTSD affects some combat veterans and has been associated with strained marital and family relations as well as parenting difficulties (Hayes, Wakefield, Andresen, Scherrer, Traylor, Wiegmann, Denmark & DeSouza, 2010, p. 826).
There are four components to the app: Learn, Self-Assessment, Manage Symptoms, and Find Support. Under the "Learn" component, one can get basic information about PTSD and about options for professional care. The information is organized in a question-and-answer format for ease of use. The assessment component contains seventeen questions that individuals can use to rate their current level of anxiety. The self-assessment automatically graphs an individual's score and the person can track results over time. It is an opportunity to get feedback on the severity of one's symptoms and see whether they are getting better or worse. There is also an option to schedule assessments weekly, bi-weekly, monthly, or every three months.
Under a component titled "Manage," one can select from eight symptoms, including "sad/hopeless," "angry," and "unable to sleep." Tapping on any of these symptoms brings up information about what can do to manage them.
Finally, a component called "Find Support" displays "911" and an 800 number to the Veterans Crisis Line. There is also space where one can enter phone numbers of local support contacts. (The calls cannot be made directly from the iPad.) There are also links so the user can locate a mental health care provider through the VA, the Department of Defense Outreach Center for Psychological Health and Traumatic Brain Injury, Military OneSource, Mental Health Services Locator, and the Substance Abuse Treatment Locator.
As has been discussed, the app is not intended to replace the services of a mental health professional but to serve as a bridge between the need for care and the availability of a provider. A study by the Veterans Administration showed that PTSD diagnoses can be overlooked in primary care (Gravely, Cutting, Nugent, Grill, Carlson, & Spoont, 2011, p. 27).
The mental health counselors at NYCVOC currently meet with PTSD sufferers individually as well as facilitate a weekly group meeting. The counselors will instruct clients in the use of the app during these sessions and allow clients to use them in the Center. At the present time, the Center does not have sufficient funds to purchase mobile devices for its clients to use outside the Center.
Staff members will also be able to use PTSD Coach with clients when conducting home visits. Additionally, staff will be able to use the iPads to take case notes, help clients use the internet for research, and…