PTSD Family Coach

1. PTSD Family Coach Application Overview Eric Kuhn, Ph.D. VA National Center for PT November 22, 2013D

2. Application Development Project Team Subject Matter Experts Steven L. Sayers, Ph.D. Katherine Iverson, Ph.D. C. Perry Bosmajian, Ph.D. Shirley Glynn, Ph.D. 5 VA Puget Sound Health Care System, MIRECC 6 University of Washington, School of Medicine 7Durham VA Medical Center, MIRECC 8 Duke University School of Medicine 9 VHA Office of Clinical Public Health • Julia E. Hoffman, Psy.D.1,3 • Eric Kuhn, Ph.D.1,2,4 • Laura H. Wald, Ph.D. 1 • Kelly M. Ramsey 1 • Josef I. Ruzek, Ph.D.1,4 1 VA National Center for Posttraumatic Stress Disorder 2 VA Sierra Pacific (VISN 21) Mental Illness Research, Education, & Clinical Center 3 DoD National Center for Telehealth & Technology (T2) 4 Stanford University School of Medicine (affiliated)

3. Need for PTSD Family Coach • Involvement of family members/loved ones is critical to treatment of someone with mental illness (e.g., Dausch et al., 2012) • PTSD symptoms such as anger, violence, numbing, and avoidance may negatively impact close relationships, including those with spouses and children (e.g., Galovski & Lyons, 2004; Sayers, 2011; Sayers, Farrow, Ross, & Oslin, 2009) • Family members and friends of someone with PTSD may experience distress as result of their interactions with that person (e.g., Dekel & Monson, 2010)

4. Promise of PTSD Family Coach Mobile Phone Intervention • Accessible • 56% of adults in the U.S. have smartphones(Pew Internet & American Life Project, 2013) • Evidence based features • Content developed by PTSD subject matter experts • Convenient • Can be used anytime & anywhere • Can be personalized with user’s own photos, music, & contacts • Discreet • Can be used in public spaces without drawing attention/notice • Cost-effective • App is free

5. PTSD Family Coach Overview • PTSD Family Coach is a mobile phone application for people who have a loved one with Posttraumatic Stress Disorder (PTSD) • This application provides: • education about PTSD • a self-assessment tool • portable skills to address acute symptoms • direct connection to crisis support • information about treatment aimed at guiding those who could benefit into care • Can be used as a stand-alone tool or to augment face-to-face care with a healthcare professional • Due to the application’s portability, these tools are easily accessible when they are needed most

6. PTSD Family Coach: 4 Main Components • From the Home screen users can choose to: • Learn • Self Assess • Get Support • Manage Stress • Personalizebutton can be used to customize app with user’s own photos, music, support contacts, & safety plan • The “?” button provides info about the app development team

7. (1) Learn About PTSD Provides user with information derived from PTSD experts about the following topics: • PTSD Basics • Symptomology, treatment, ways to support a loved one with PTSD • Self-Care • Overview of challenges that family members or friends may experience if a loved one has PTSD • Family Care • Impact of PTSD on children & parenting tips • Impact of PTSD on intimate partner relationships, communication tips, & addressing concerns about IPV • Getting Treatment • Communication tips for encouraging treatment, types of treatment providers, counseling options, & overcoming barriers to seeking care

8. (1) Learn about PTSD - Basics

9. (1) Learn about PTSD: Family Care

10. (2) Self-Assessment • Monitor distress levels • 10-item Perceived Stress Scale (PSS; Cohen, Kamarck, Mermelstein, 1983; Cohen & Williamson, 1988) • Item about stress related to loved one with PTSD • Item about perception of safety around loved one with PTSD • Track & view stress history over time • Schedule future assessments

11. (2) Self-Assessment Examples

12. (3) Get Support Users can locate resources for: • Immediate services in emergency situations • Loved ones with PTSD • Children or family members affected by PTSD • Veterans & Service Members

13. (3) Get Support - Examples

14. (4) Manage Stress • Identify problem areas & severity of distress related to: • General stress • Isolation/Loneliness • Anger/irritation • Sleeplessness • Parenting challenges • Safety concerns • Immediately access specific tools for coping • Determine preferred tools • Thumbs up – Tool is saved to “Favorites” List • Thumbs down – Tool is not suggested again

15. (4) Manage Stress - Process • User selects symptom area • User rates distress on 0 to 10 thermometer scale • Depending on problem & severity, user is routed to any of a number of cognitive-behavioral skills • After completing tool, user re-rates distress • User receives feedback on score • Option to give thumbs up/down

16. (4) Manage Stress – Process Example Users can determine which tools they like

17. (4) Manage Stress – Toolkit • All tools are based on Cognitive Behavioral Therapy and are empirically supported • Tools include: • Activity planning • Motivational messages • Mindfulness exercises • Positive imagery • Reframing techniques • Relaxation exercises • Sleep hygiene tips • Time outs • Also includes option to create personalized safety plans if user has safety concerns

18. (4) Manage Stress – Toolkit Examples

19. (4) Manage Stress – Toolkit Personalization • User can add personal photos, music, and contacts into the app for customized distress support

20. (4) Manage Stress – Personalized Safety Plan User can: • Access info about safety plans • Create a customized safety plan

21. (4) Manage Stress – Safety Planning User can: • Access info about safety plans, such as: • Who to contact • What to pack if leaving is necessary • Where to go • Create a customized safety plan • Specific contacts • Safe locations in the home • Safe locations outside the home

22. (4) Manage Stress – Safety Plan Access (3 Locations)

23. (4) Manage Stress – Customize Safety Plans

24. Tool Preference Removal • All tool preferences can be removed

25. Clearing All App Data • All data can be cleared from the app • Helps protects security of user • Allows for multiple users