DoD Mobile App Helps Healthcare Providers Track Own Resilience

by U.S. Medicine

June 8, 2013

Tool Can Help Prevent Compassion Fatigue or ‘Secondary Traumatic Stress’

By Stephen Spotswood

JOINT BASE LEWIS-MCHORD, WA— One of the most insidious things about trauma is that its effects can spread far beyond the initial event. A traumatic event can echo and reverberate into every corner of victims’ lives, the lives of their family and friends, and, though it is not frequently acknowledged, the lives of their physicians.

Screenshot of T2’s Provider Reilience App which was launched last September

Physicians treating patients with PTSD — especially psychologists and therapists who spend hours with patients helping them work through and overcome trauma — can, little by little, be overwhelmed by the stories they hear. And this can happen so slowly that physicians often do not recognize the issue begins to seriously affect their work or home life.

In recognition of this, DoD health technology specialists have engineered a new mobile application physicians will be able to access from their phones to track their own resilience as they are helping others reclaim their lives.

“While in most cases, healthcare workers don’t experience the same kind of combat-related trauma, that worker is exposed to the trauma through the retelling of the servicemember,” explained Robert Ciulla, MD, psychologist and director of the mobile health program at DoD’s National Center for Telehealth and Technology (T2).

“They’re sitting in the same room, day after day, hour after hour, with the kind of suffering servicemembers experience. And they put the patients first and don’t think about the effect of this on themselves,” he said.

Experiencing stress from working with trauma victims is completely natural, Ciulla said. Compassion fatigue — or “secondary traumatic stress” — is common among those working with trauma victims and is characterized by a gradual lessening of compassion over time.

Moving Quickly On Mobile Health

One striking aspect of the project is how quickly the app went from conception to fruition. It was launched for iPhone on Sept. 20 and Android on Sept. 27 but was conceived only about six months before that, Ciulla said.

“It’s about six months to develop the concept, do business case analysis, scope it, write up requirements and specifications, and then run it through a lot of testing,” he explained.

In the testing phase, the T2 team, composed of psychologists, project managers, Web designers, and 3-D animators, went through the nuts and bolts of the application to ensure that it functioned on the two mobile platforms. Now that the application is available free to the public, the team can obtain user feedback to help improve the usability of future iterations.

“Users can go to the app store and give feedback that way,” Ciulla said. “There’s also a mechanism that can drive questions directly to our team.”

As of April, the application had been downloaded approximately 2,500 times from the iPhone and Android sites and had been used about 13,000 times. The latter number is the most informative, Ciulla said, because it shows that providers — or at least a portion of them — are using the application more than once, as it was intended.

Formal studies using the application also are being developed, Ciulla said.

The Provider Resilience App is the latest in a series of mobile applications T2 has developed targeting PTSD and its effects. They partnered with VA to create PTSD Coach — an application for servicemembers suffering from PTSD — and are working on a companion piece called PTSD Family Coach.

Ciulla said he does not expect this newest app, directed at a much smaller audience, to be as popular as PTSD Coach, which had 100,000 downloads in its first year.

It is no less important, however, he said, explaining,. “Supporting a well-educated cadre of providers that do this work is as important as creating applications targeted at stress for servicemembers.”

Gauging Resilience

T2’s Provider Resilience App was launched last September to allow healthcare providers to track how they’re feeling, offering a quotient that shows them what their resilience rating is from one day to the next. The app’s dashboard resembles a vehicle gauge, with a needle that can swing 180 degrees from green (very resilient) to red (heavily fatigued).

Where that gauge lands is determined by a short series of questions answered by the app user. For example, in a professional quality-of-life survey, providers are asked to check one of five boxes from “Never” to “Very Often” to describe the statement, “I am preoccupied with more than one person I treat.” They do the same for “I get satisfaction from being able to help people” and “I feel trapped by my job as a therapist/healthcare provider.”

Providers also are asked to keep track of Resilience Builders and Resilience Killers. Builders include taking short walks, exercising and taking a day off in the past 60 working days. Killers include skipping lunch or eating lunch at the desk, working weekends and reporting to work sick.

One prominent feature of the app is tracking how long it has been since a provider’s last vacation. A digital clock display in the middle of the app dashboard counts continually up, showing a provider to the minute how long they’ve gone without a meaningful break.

Ciulla admitted these might seem like very basic things for providers to keep in mind, but professional and emotional necessities are exactly the kinds of things that get lost in the day-to-day work of treating servicemembers.

“We knew we wanted to foster resilience in providers, so we broke it down and looked at what would be the ingredients in that,” he said. “Those include relaxation exercises, not eating lunch at your desk, taking leave time and not overworking.”

“Also, we knew humor worked,” Ciulla added. “So we built in the Dilbert cartoon. A provider, if they need a quick laugh, can access the resilience app and walk through a Dilbert cartoon.”

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