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Introducing Apps to Patients (Next Generation Behavioral Health Podcast)

Introducing Apps to Patients (Next Generation Behavioral Health Podcast)


[Dr. Christy Armstrong] Hello, and welcome
to Next Generation Behavioral Health. [Dr. Julie Kinn] 10-minute tips for modernizing
patient care. [music]
[Dr. Christy Armstrong] Hi. I’m Dr. Christina Armstrong. [Dr. Julie Kinn] And I’m Dr. Julie Kinn. We develop health technology for military,
veterans and their families. [Dr. Christy Armstrong] We also travel around
the country training military providers on the core competencies of how to integrate
mobile health into clinical care. And in this podcast, we’re going to answer
some of the most common questions we hear. [Dr. Julie Kinn] Yeah. And last time, we talked about safely using
apps. So this time, I want to ask you, Christy,
how do you prescribe an app to a patient? [Dr. Christy Armstrong] This is really one
of the most common questions I get. The providers we train are behavioral health
providers. They are not accustomed to prescribing anything. So what’s been your experience with that? [Dr. Julie Kinn] Well, I really do like the
word prescription because it implies something a little bit more formal than just, “Oh hey,
I used this mobile app. I liked it. You should try it too.” And you made a really good point which is
most of the folks who we’ve trained in the past have been behavioral healthcare providers,
but that’s not the entire scope. More and more we’re learning that primary
care providers, nurses, the whole range of our military care teams are interested in
using technology to help their patients. So I might not have answered your question. What was it again [laughter]? [Dr. Christy Armstrong] I was curious of what
your thoughts and your experience has been. I mean the thing about a prescription is the
specificity involved is really going to help patients to remember what parts of the treatment
that they’re going to be in charge of doing in between sessions, so that’s what’s so important
to me. [Dr. Julie Kinn] It really engages them and
it’s collaborative. Okay, so I do have disagree with one thing
you said. I think we are used to prescribing– we as
behavioral healthcare providers, we are used to prescribing homework, but we don’t really
talk about it as a prescription. Again it’s not that formal word. I know it’s very common to assign automatic
thought records or regular assessments, so I like to think of mobile apps as something
that in the first couple of sessions, I’ve always got on hand to recommend. Especially after an intake, I like recommending
T2 Mood Tracker, which we talked a little bit about last time. And we’re going to dive into that one a little
bit more deeply in a couple more episodes. I like them to be getting started on tracking
and getting used to the idea of building that insight. And also Virtual Hope Box is a good standby
one because it’s a general mood elevation app. And we know that sometimes coming in for the
first session can be a bit of a letdown because it is so intake interview-focused that if
you have a client or a patient who hasn’t experienced therapy before, they are coming
in that first time hoping they’re going to leave feeling better. And sometimes talking about your presenting
issue for 90 minutes doesn’t help you feel a lot better, so I like to have a tangible
tool I can recommend in the intervening weeks. [Dr. Christy Armstrong] Absolutely. [Dr. Julie Kinn] What about you? What do you prescribe most often, and how
do you prescribe it? [Dr. Christy Armstrong] First of all, I’ll
answer your first question. So the tools that I find just are the go-to
tools for me– I mean of course we’re military providers, so I stick with tools developed
by the Department of the Defense and VA. So my top go-to tools are Breathe2Relax, which
is breathing training mood tracker which, like you said, allows our patients to track
their moods, which almost any patient I’ve ever had that’s been a key feature of the
symptoms that they have. And the other, my most favorite app is Virtual
Hope Box. But the second part of the question, the question
is how do you prescribe it? What parts of the prescription are involved? What’s sufficient for a prescription? So I think it’s important to be specific,
but not too specific. So what I want patients to know is what tool’s
going to be used, how it’s going to fit into treatment, and frequency of the expected use. And I know if I’m not specific about that
like, “I want you to track your mood one time a day,” they’re either going to not do it
at all, or I’m going to have a couple patients that are going to get a little too obsessed
about it and maybe do it 20 times a day. And either one can happen, and I think it’s
really important to give them kind of right and left boundaries, and then they say, “Okay. I know the expectations,” and then they come
in ready, and then aren’t nervous with not knowing what to provide and what to do. [Dr. Julie Kinn] I like how you said you would
indicate how it fits into treatment. I think that’s really respectful. We wouldn’t want to give somebody the Beck
Depression Inventory, have them fill it out, and then never talk about those results, right? [Dr. Christy Armstrong] Absolutely. So for example, if I’m providing treatment
to a patient that’s suffering from insomnia and as a part of our treatment, I’m providing
cognitive behavioral therapy for insomnia, or we call it CBTi. It would make a lot of sense for me to prescribe
CBTi Coach, which is an outstanding mobile app developed by the VA and co-branded by
us with the DoD. So how I might prescribe that is I might let
them know, “Hey, this is a safe and secure app. Are you interested in integrating into care?” Because if they’re not, that’s okay. We can do everything paper-pencil too. That’s fine. But if they’re interested in doing the app,
I will be specific. I’ll let them know, “Hey, I want you to track
your sleep every day in the sleep diary, and I want you to do one sleep tool a day, and
once a week, I’m going to have you do the sleep assessment that’s embedded within that
mobile app.” And then the next piece is saying, “Hey, you
know what? And when you come next week, we’re going to
review that data together on your phone.” Let them know that. [Dr. Julie Kinn] And they know they’re going
to be held accountable. [Dr. Christy Armstrong] Absolutely. [Dr. Julie Kinn] So one thing a lot of our
providers have really liked is the prescription pads we make, and you can download these on
our website, and we’ll provide a link in the show notes. Our prescription pads show the pictures of
a lot of different mobile apps we’ve made, and ones made by the VA, and some really excellent
websites, and they briefly state what problem area they can help with. And you can actually circle for them the apps
you want them to go download, and there’s instructions on them, and then rip it off
and give it to them just like a regular prescription. And if you’re interested, you could always
order these from us on our website, and anything you order from us is free of course. Or you can print them yourself and have them
in your clinic, and sometimes it’s a nice, tangible thing for them to hold so they don’t
have to download something in the moment in front of you. Also many of us, especially in military treatment
facilities, don’t have Internet access in our offices. So we want to give them something to take
home with them. And again, I think that’s really helpful on
after a first session or intake. [Dr. Christy Armstrong] Julie, those prescription
pads – correct me if I’m wrong – they have been the absolute most popular thing for our
behavioral health providers. I mean, really, we get thousands ordered,
and people love them. [Dr. Julie Kinn] I think they’re tied with
the squishy hippos that we have [laughter] to advertise our Military Kids Connect website,
but it’s a close second. [Dr. Christy Armstrong] The same thing is
true for prescribing website. [Dr. Julie Kinn] Oh yeah, that’s true. [Dr. Christy Armstrong] Yeah. And so on the back of those prescription pads,
we have some of the top DoD websites. AfterDeployment, Military Kids Connect, and
Sesame Street for Military Families. [Dr. Julie Kinn] It goes back to that idea
of, “Let’s more formalize this. Let’s bring it into the next generation.” That’s the whole theme of this podcast, that
using mobile apps and websites and technology as part of your care doesn’t have to be a
weird little thing you do on the side. No, let’s make this part of treatment as usual. [Dr. Christy Armstrong] Completely. [Dr. Julie Kinn] Well, listeners, please let
us know what you think. Check out the prescription pads and tell us
how you think we could improve them for your practice, and tell us what questions you’d
like us to address in this series as we continue recording. [Dr. Christy Armstrong] So thank you so much
for joining us today while we talked about how to prescribe apps to patients. [Dr. Julie Kinn] Next Generation Behavioral
Health is produced by the Defense Health Agency. Learn about our other free health resources
like mobile apps, websites, and other podcasts on Facebook and Twitter, @MilitaryHealth. Thanks so much for subscribing and rating
us on iTunes or wherever you get podcasts. [music] And you know what, Christy? I think we did it in less than 10 minutes. [Dr. Christy Armstrong] Yes! [Dr. Julie Kinn] Yeah, we don’t have to refund
any money this time. [Dr. Christy Armstrong] Great [laughter]! [Dr. Julie Kinn] Talk to you all next time. Bye. [Dr. Christy Armstrong] Thank you. Bye.

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