The National Center for Telehealth & Technology (T2)
The National Center for Telehealth & Technology (T2) is a component center of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE). DCoE is a principal component of the Healthcare Operations Directorate under the Defense Health Agency.
The mission of T2 is to lead the innovation of health technology solutions for psychological health and traumatic brain injury, and deliver tested, valued health solutions that improve the lives of our nation’s warriors, veterans, and their families.
The vision is world-class health care and optimized health in the DoD through effective leveraging of behavioral science and technology.
T2’s advanced health technology solutions are user-friendly, valued by our warriors, and cost-effective. These qualities align with the Military Health System Quadruple Aim to ensure readiness, population health, experience of care, and responsible management of the total cost of health care. T2 also supports the DoD’s goals of increasing access to care, establishing best practices and quality standards for health technology and telehealth, and reducing both military suicide rates and the prevalence of stigma associated with seeking behavioral health services.
The products developed by T2 meet the needs and requirements of the DoD and its beneficiaries. DCoE provides requirements to T2 based on guidance from various sources that include:
T2 leads the DoD in applying existing and emerging technologies for delivering psychological health care options to the military community. As the benefits of these services grow, the need will continue.
T2 is organized into Mobile Health and Telehealth programs, which are supported by the Technology, Operations, National Capital Region, and Research, Outcomes and Investigations divisions.
T2 is located on Joint Base Lewis-McChord near Tacoma, Washington, with an office in the National Capitol Region that represents and coordinates T2’s program activities with DCoE and partners in the Military Health System.
Link: http://t2health.dcoe.mil/about.html
T2 Programs Overview
At T2, teams of leaders, researchers, clinical psychologists, technical and administrative staff work together to promote resilience, recovery and reintegration so that our Warriors, Veterans and Families can thrive in their communities of choice.
Using the latest technology, T2 seeks to identify, treat and minimize or eliminate the short- and long-term adverse effects of war. The Center’s research and outreach programs support the following major initiatives:
As a leader in military mobile health, T2 seeks to improve patient outcomes. As one way to reach patients, we offer training for military providers on how to use mobile health to integrate best practices, evidence-based research and other resources into clinical care. T2 offers the following free resources:
Technology Enhancement Center
Usability testing is a critical step in the production of mobile apps, websites, and virtual reality tools. By applying rigorous and repeated instrumented testing in a controlled environment, usability testing is the most effective way to be certain that users will understand, interact with, and benefit from technology as designed.
T2’s new Technology Enhancement Center (TEC) enhances our development of accessible and effective technologies targeting PTSD, traumatic brain injury as well as suicide reporting and prevention within the military community.
The TEC allows testing and evaluation at every stage of the development lifecycle and helps developers optimize the user experience through input from representative end-users. In this way, technology development is more efficient and the end product is more useful to the Warrior and Veteran populations we support.
Optimizing Next-Generation Technologies
T2 consulted with some of the industry’s most accomplished design engineers to ensure the utility, flexibility and longevity of the new facility. The result is a state-of-the-art facility encompassing 4,260 square feet of testing, observation, and monitoring facilities, as well as meeting rooms and offices for the comfort of participants and visiting observers. Through this service, T2 is delivering technological solutions using industry-standard best practices.
Testing and observation rooms are equipped with a wide array of technologies to allow developers and other observer-stakeholders to track and record virtually every aspect of user interaction:
What to Expect when Participating in a TEC Test
If you are participating in a usability test session at T2’s TEC, you will be greeted by TEC staff, including the usability specialist you will be working with, in the reception area and guide to a testing room.
Testing rooms accommodate one to 15 participants, depending on the technology to be tested. Testing will generally involve reviewing websites or mobile applications either individually or in groups.
Testing typically consists of “trying out” an app or website on an instrumented mobile device or computer that tracks and records how you navigate the screens. While reviewing this technology, a usability specialist will ask you questions about your experience with the technology tested. The total time spent in a test session is typically one to two hours.
You may also participate in a “focus group,” or guided discussion about your experience with technology in general. Developers use focus groups to guide them in creating new technologies or making changes to existing technologies.
Telehealth Program
Telehealth is the use of technology to provide health care consultation, education, assessment, treatment, care coordination and support for health care providers and patients separated by distance. In the area of behavioral health care, the wide dispersal of the Military Health System’s beneficiaries creates challenges. According to a 2015 RAND report, more than 300,000 U.S. military service members in geographically remote locations may benefit from telehealth services, which:
Supporting the growth of telehealth within the DoD has always been a core objective for T2. The successful integration of telehealth into the overall DoD health services system requires enterprise-wide strategies, policies and guidance. T2 has led telehealth growth efforts by leveraging partnerships with the Services, VA, TRICARE and civilian providers. These efforts include:
Telemental Health Education and Training
T2 offers the following telemental health (TMH) training and tools (available here for download) to provide military behavioral health clinicians and administrators with the clinical and technical skills required to understand and deliver health services in this way:
T2 Clinical Programs
T2’s clinical programs focus on innovative approaches to providing health care to warriors and their families. These approaches include Web-based tools, Virtual Reality and Virtual Worlds technologies.
After Deployment offers modularized content across a spectrum of post-deployment conditions (combat stress and triggers; conflict at work; re-connecting with family and friends; depression; anger; sleep problems; substance abuse; stress management; kids and deployment; spiritual guidance; living with physical injuries; health and wellness).
The web resource provides an interactive self-care solution: users can take assessments, view video-based testimonials, and access narrator-guided workshops. Accessing online resources from the comfort of one’s home eliminates concerns about stigma associated with in-person care. Along with anonymity, online resources offer the following benefits:
Mobile Technologies
Smart phones, and other portable devices, provide new opportunities for the development of the next-generation of psychological health content. The fit between health-related content and handheld devices is particularly applicable within the military community. Age groups using such devices are well-represented in the military. Interventional tools available on smart devices can provide “always-on” support for highly mobile, on-the-go individuals. Users receive evidence-based tools via standardized content and would have immediate two-way contact with support systems during a crisis or to manage unexpected acute symptoms.
Creating self-assessment software for a handheld device would offer a number of advantages. Significantly, real-time assessments (rather than retrospective assessments) would be possible. Handheld devices would provide un-tethered portability and facile data transmission to a central server available to the provider. A “virtual handheld clinic” would allow the user to personalize content and access hotline links, psychological tools (e.g., relaxation exercises), and appointment reminders.
Mobile Applications
ACT Coach is designed for service members, veterans and others to use along with face-to-face treatment with a mental health professional in Acceptance and Commitment Therapy (ACT). ACT Coach incorporates mindfulness and acceptance strategies to help people cope with unpleasant emotions and symptoms of mental health conditions including post-traumatic stress disorder (PTSD), depression, anxiety, chronic pain and other trauma-related difficulties. ACT Coach helps you live with unpleasant thoughts and feelings without avoiding them or being controlled by them.
Biozen® Mobile Application was developed as a pilot project to study the feasibility of using smartphones to receive signals from biosensor devices and display the information in a usable graphic. The National Center for Telehealth & Technology (T2) is a Department of Defense organization that evaluates new technologies for telemental health. BioZen represents an approach to mobile monitoring of biosensor devices that may be further developed to support future projects. No further development or enhancements to BioZen are planned.
Breathe2Relax is a portable stress management tool. Breathe2Relax is a hands-on diaphragmatic breathing exercise. Breathing exercises have been documented to decrease the body's 'fight-or-flight' (stress) response, and help with mood stabilization, anger control, and anxiety management.
CBT-i Coach is for people engaged in cognitive behavioral therapy for insomnia (CBT-i) with a health provider, or those who have experienced symptoms of insomnia and would like to improve their sleep habits. The app guides users through the process of learning about sleep, developing positive sleep routines and improving their sleep environments. It provides a structured program that teaches strategies proven to improve sleep and help alleviate symptoms of insomnia.
Concussion Coach is a mobile app for veterans, service members and others who have symptoms of a concussion or mild-to-moderate traumatic brain injury (TBI). This app is intended to support face-to-face treatment with a health provider and provides portable, convenient tools for the patient to assess symptoms and cope with TBI related problems. It is not intended to replace professional diagnosis, medical treatment, or rehabilitation therapies.
The CPT Coach mobile application is for people participating in cognitive processing therapy (CPT), an evidence-based psychotherapy for posttraumatic stress disorder (PTSD). For patients, this app is designed to improve engagement and participation in CPT and enhance treatment outcomes. It is also intended to help CPT providers better adhere to the treatment protocol.
Dream EZ is a smartphone app designed to help a person “rewrite” their nightmares to make them diminish in intensity and frequency. The app uses principles from Imagery Rehearsal Therapy (IRT) for nightmare reduction to help users change their nightmares into less disturbing dreams so they can get a better night’s sleep. Although Dream EZ can be used on its own, this app was designed to be used along with a health care provider trained in IRT.
Life Armor Mobile Application. Touch-screen technology allows the user to browse information on 17 topics, including sleep, depression, relationship issues, and post-traumatic stress. Brief self-assessments help the user measure and track their symptoms, and tools are available to assist with managing specific problems. Videos relevant to each topic provide personal stories from other service members, veterans, and military family members.
Mindfulness is a term used to describe a set of several strategies which are designed to change the way people think about everyday life. By helping to focus attention on present experience and away from potentially distressing thoughts about the past or future, mindfulness meditation helps to reduce tension and worry and improve coping. The Mindfulness Coach mobile app was created to introduce the concept of mindfully focusing attention and to facilitate the acquisition of the skill through practice.
DCoE’s National Center for Telehealth & Technology and the VA Office of Mental Health Services developed the Moving Forward mobile app as part of the DoD/VA Integrated Mental Health Strategy (IMHS). The Moving Forward mobile app and the companion online course features problem-solving therapy (PST) tools designed to teach skills for overcoming life problems. PST is an evidence-based cognitive behavioral treatment for depression and other distress.
The Mild Traumatic Brain Injury Pocket Guide mobile application for health care providers gives instant access to a comprehensive quick-reference guide on improving care for mTBI patients. Designed to reflect current clinical standards of care, the mTBI Pocket Guide mobile application can help you improve quality of care and clinical outcomes for patients.
The Navy Leader’s Guide for Managing Sailors in Distress is your one-stop shop for information on issues that affect your sailors and guidance on what leaders like you can, or must, do. Based on the Navy & Marine Corps Public Health Center website of the same name, the Navy Leader’s Guide mobile app puts the resources you need to respond to almost any issue affecting sailors right in the palm of your hand.
DCoE’s National Center for Telehealth & Technology and the VA Office of Mental Health Services developed the Parenting2Go mobile app as part of the DoD/VA Integrated Mental Health Strategy (IMHS). Parenting2Go and the companion online course Parenting for Service Members and Veterans is for military and veteran parents with tools to help them reconnect with their families after a deployment and build closer relationships with their children anytime.
PE Coach Mobile Application is the first mobile app designed to support the tasks associated with prolonged exposure treatment for PTSD. Providing hip-pocket access to the necessary tools for successful PE participation, the app includes audio recording capability for easy playback after sessions; tools to support patient tasks between sessions; and visual displays of symptom reduction over time.
PFA Mobile was designed to assist responders who provide psychological first aid (PFA) to adults, families and children as part of an organized response following a disaster or emergency. This app is not intended to train responders nor meant to be a replacement for PFA training. It is a supplement to other resources that trained individuals utilize before, during and after a disaster response, allowing responders to review PFA guidelines and hear tips on putting PFA into practice in the field.
Positive Activity Jackpot Mobile App uses a professional behavioral health therapy called pleasant event scheduling (PES), which is used to overcome depression and build resilience. This app features augmented reality technology to help users find nearby enjoyable activities and makes activity suggestions with local options and the ability to invite friends. If you cannot make up your mind which fun thing to do, “pull the lever” and let the app’s jackpot function make the choice for you. While this app does not require clinical training to use, it should not be used as a substitute for treatment by a therapist. For more information, see the FAQ.
Provider Resilience gives health care providers tools to guard against burnout and compassion fatigue as they help service members, veterans, and their families.
PTSD Coach was developed by the Department of Veterans Affairs' National Center for PTSD(link is external) in collaboration with T2. The goal was to develop a mobile application to assist Veterans and Active Duty personnel (and civilians) who are experiencing symptoms of Post Traumatic Stress Disorder (PTSD).
The Stay Quit Coach mobile app helps you stay quit after you’ve quit smoking. This app is best used while in treatment with a therapist or to help prevent relapse after treatment. It is not meant to be a replacement for smoking cessation treatment.
T2 Mood Tracker is a mobile application that allows users to monitor and track emotional health. Originally developed as a tool for service members to easily record and review their behavior changes, particularly after combat deployments, it has now become very popular with many civilian users around the world.
The Tactical Breather application can be used to gain control over physiological and psychological responses to stress. Through repetitive practice and training, anyone can learn to gain control of your heart rate, emotions, concentration, and other physiological and psychological responses to your body during stressful situations.
The Virtual Hope Box mobile application received the 2014 Department of Defense Innovation Award for its unique application of technology in supporting behavioral health in service members and military families. The Virtual Hope Box (VHB) is a smartphone application designed for use by patients and their behavioral health providers as an accessory to treatment. The VHB contains simple tools to help patients with coping, relaxation, distraction, and positive thinking.
T2 Research
T2 is dedicated to coordinating and implementing cutting edge research to improve the psychological and traumatic brain injury healthcare of our Warfighters and their families. The T2 staff maintains an active internal research program and continues to develop collaborative research opportunities with a broad network of stakeholders. Recent projects have focused on the use of Virtual Reality (VR) in clinical practice; the detection of suicide risk factors; the impact of deployment on psychological health; the use of technology to improve health outcomes; and Service Member assessments of technology-based approaches to care.
T2’s research projects have been competitively funded by the Congressionally Directed Medical Research Programs (CDMRP) and the Telemedicine and Advanced Technologies Research Center (TATRC).