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The National Center for Telehealth & Technology (T2) is one of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE), a part of the Military Health System (MHS). T2 was originally established to lead the integration of behavioural sciences with technology to provide solutions for psychological health and traumatic brain injury (TBI). T2 is a principal coordinator of United States Department of Defense (DoD) initiatives involving telehealth, online health tools, suicide surveillance and prevention, and information technology. [1]
T2 was established as a Department of Defense organization at Joint Base Lewis-McChord in 2008. It was developed out of the Army Behavioral Health Technology Office at Madigan Army Medical Center.
T2 is staffed by clinical psychologists, researchers, technical specialists, project managers, and communication experts who develop assessment, screening, reference, and treatment tools for the military community. The organization is tasked with identifying, developing treatments for, and minimize or eliminate the short-term and long-term adverse effects of TBI and deployment-related psychological health issues.
T2’s key objectives include:
T2 is headquartered at Joint Base Lewis-McChord near Tacoma, Washington and has an office in Crystal City, Virginia. T2 is organized into six distinct but collaborative divisions:
THP applies communication solutions known as telemental health, such as video teleconferencing and mobile video calling, to deliver mental health services to military personnel in physically remote locations. Principal THP projects include the Integrated Mental Health Strategy (IMHS), [2] deployable telehealth centers, and the Telemental Health Training Program.
ITA develops virtual reality, virtual world, and augmented reality programs designed to improve psychological health and wellness. Its principal projects focus on treating post-traumatic stress disorder (PTSD) and include the Virtual PTSD Experience in Second Life [3] and Virtual Reality Exposure Therapy (VRET) for PTSD. ITA also tests and validates T2 products through the usability lab of its Technology Enhancement Center (TEC).
Responsible for the daily operations of T2, the Ops division provides general administration, human resources, finance, logistics, and public affairs.[ citation needed ]
P3 develops online and mobile applications providing self-service support products to end users (service members, veterans, and military families) and diagnostic and clinical resources to health care providers. P3's Web-based applications include AfterDeployment.org, [4] MilitaryKidsConnect.org, [5] and SuicideOutreach.org and mobile applications for iOS and Android include Breathe2Relax, [6] PTSD Coach, Tactical Breather, and T2 MoodTracker.
ROSE develops and conducts testing and evaluation routines for all T2 applications and programs prior to their release for general use. ROSE conducts a comprehensive ongoing suicide surveillance program for the DoD and disseminates the data annually. [7] Principle projects include DoD Suicide Event Report (DoDSER), Personal Technology (PTEC) Study, Web-Based Care Survey, and Stigma Survey.
TS is the technology development component of T2 and is responsible for the building, testing and deployment of software-based and systems-based solutions. [ citation needed ]
Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.
A veteran is a person who has significant experience and expertise in an occupation or field.
Polytrauma and multiple trauma are medical terms describing the condition of a person who has been subjected to multiple traumatic injuries, such as a serious head injury in addition to a serious burn. The term is defined via an Injury Severity Score (ISS) equal to or greater than 16. It has become a commonly applied term by US military physicians in describing the seriously injured soldiers returning from Operation Iraqi Freedom in Iraq and Operation Enduring Freedom in Afghanistan. The term is generic, however, and has been in use for a long time for any case involving multiple trauma.
The Madigan Army Medical Center, located on Joint Base Lewis-McChord just outside Lakewood, Washington, is a key component of the Madigan Healthcare System and one of the largest military hospitals on the West Coast of the United States.
As defined by the United States Department of Veterans Affairs, military sexual trauma (MST) are experiences of sexual assault, or repeated threatening sexual harassment that occurred while a person was in the United States Armed Forces.
Military psychology is a specialization within psychology that applies psychological science to promote the readiness of military members, organizations, and operations. Military psychologists provide support to the military in many ways, including through direct clinical care, consultation to military commanders, teaching others and supporting military training, and through research relevant to military operations and personnel. Military psychology as a field has been growing since the early 20th century, evidence that the demands and needs for psychological clinical and operational application is continuing to grow steadily. There are many stressors associated with military service, including exposure to high-risk training and combat. As such, psychologists are critical support components that assist military leaders in designing appropriate training programs, providing oversight to those programs, and assisting military members as they navigate the challenges of military training and their new lifestyle. Military psychology covers a wide range of fields throughout the military including operational, tactical, and occupational psychology. Gender differences between military-trained personnel who seek mental health assistance have been extensively studied. Specific examples include post traumatic stress disorder (PTSD) associated with combat, or guilt and family/partner difficulties accompanying extended or frequent deployments due to separation. Clinical providers in military psychology are often focused on the treatment of stress, fatigue, and other personal readiness issues. Previous wars such as the Korean war, Vietnam war, and WW 2 provide great insight to the workings and practices of military psychology and how the practices have changed and assisted the military over the years.
The President's Commission on Care for America's Returning Wounded Warriors, also known as the Dole-Shalala Commission, was established on March 6, 2007, when U.S. President George W. Bush signed Executive Order 13426. The Commission was established to examine and recommend improvements to the effectiveness and quality of transition from returning to military service or civilian society, health care, benefits, outreach to service members, and awareness among service members of healthcare and benefits programs.
The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) is a United States Department of Defense (DoD) organization that provides guidance across DoD programs related to psychological health (PH) and traumatic brain injury (TBI) issues. The organization's official mission is to "improve the lives of our nation’s service members, families and veterans by advancing excellence in psychological health and traumatic brain injury prevention and care."
The Naval Center for Combat and Operational Stress Control (NCCOSC) is a U.S. Navy Medicine organization established to promote psychological health in the U.S. Navy and Marine Corps. It is a culturally relevant center that leverages sound medical knowledge to improve resilience, preserve psychological health, improve care for sailors, marines and their families and facilitate Navy Medicine research efforts on psychological health and traumatic brain injury.
PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.
The Military Acute Concussion Evaluation (MACE) is an American medical screening and documentation measure that is used to gauge the severity of symptoms and cognitive deficits after a diagnosis of a concussion has been made. Taking less than 15 minutes to administer, it involves collecting a history of the injury event and the symptoms experienced at that time, followed by a brief neurological screening, and a similarly short cognitive test. The score is presented with a listing of symptoms endorsed and a red or green light regarding the neurological screen. All cases of a concussion result in mandatory restricted duty for 24 hours followed by immediate reevaluation via the MACE. Similarly, the MACE is most effective if given within 24 hours of the injury event to fully gauge the level of possible brain injury. The MACE has been distributed to all branches of the US military. It is currently used in DVBIC and the US Department of Veterans Affairs (VA) Veterans Health Administration are partners in clinical care, education, research and care coordination for veterans and active-duty service members who have sustained a traumatic brain injury.
The Center for Deployment Psychology (CDP) is an organization offering training for behavioral health professionals who provide mental health services unique to the experience of deployment in the United States Armed Forces for active-duty military service members, veterans and their families. CDP is headquartered at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Maryland, and is funded by the United States Department of Defense.
The Chronic Effects of Neurotrauma Consortium (CENC) is a federally funded research project devised to address the long-term effects of mild traumatic brain injury in military service personnel (SMs) and Veterans. Announced by President Barack Obama on August 20, 2013, the CENC was one of two major initiatives developed in response to the injuries incurred by U.S. service personnel during Operation Enduring Freedom and Operation Iraqi Freedom. The project is jointly funded in the amount of $62.175 million by the Department of Defense (DoD) and the Department of Veterans Affairs (VA). The CENC is led by Dr. David X. Cifu of the Virginia Commonwealth University.
A moral injury is an injury to an individual's moral conscience and values resulting from an act of perceived moral transgression on the part of themselves or others. It produces profound feelings of guilt or shame, moral disorientation, and societal alienation. In some cases it may cause a sense of betrayal and anger toward colleagues, commanders, the organization, politics, or society at large.
United States military veteran suicide is an ongoing phenomenon regarding the high rate of suicide among U.S. military veterans in comparison to the general civilian public. A focus on preventing veteran suicide began in 1958 with the opening of the first suicide prevention center in the United States. During the mid-1990s, a paradigm shift in addressing veteran suicide occurred with the development of a national strategy which included several Congressional Resolutions. More advancements were made in 2007, when the Joshua Omvig Veterans Suicide Prevention Act created a comprehensive program including outreach at each Veterans Affairs Office (VA) and the implementation of a 24-hour crisis hotline. PTSD, depression, and combat-related guilt in veterans are often related to suicide as it can be difficult for veterans to transition to civilian life.
Operational stress injury or OSI is a non-clinical, non-medical term referring to a persistent psychological difficulty caused by traumatic experiences or prolonged high stress or fatigue during service as a military member or first responder. The term does not replace any individual diagnoses or disorders, but rather describes a category of mental health concerns linked to the particular challenges that these military members or first responders encounter in their service. There is not yet a single fixed definition. The term was first conceptualized within the Canadian Armed Forces to help foster understanding of the broader mental health challenges faced by military members who have been impacted by traumatic experiences and who face difficulty as a result. OSI encompasses a number of the diagnoses found in the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification system, with the common thread being a linkage to the operational experiences of the afflicted. The term has gained traction outside of the military community as an appropriate way to describe similar challenges suffered by those whose work regularly exposes them to trauma, particularly front line emergency first responders such as but not limited to police, firefighters, paramedics, correctional officers, and emergency dispatchers. The term, at present mostly used within Canada, is increasingly significant in the development of legislation, policy, treatments and benefits in the military and first responder communities.
Warrior Care Network is a mental health program that provides care, travel, and accommodations at no cost for United States veterans and their families. Treatment options consist of intensive outpatient care, mainly focusing on post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), military sexual trauma (MST), and related conditions such as anxiety and depression. Warrior Care Network began accepting veterans into the program on January 15, 2016. It was created by a joint effort between Wounded Warrior Project, the U.S. Department of Veterans Affairs and partners consisting of four academic medical research hospitals located throughout the United States. The four programs are Operation Mend at UCLA Health, the Veterans Program at Emory Healthcare, Road Home at Rush University Medical Center, and Home Base, a Red Sox Foundation and Massachusetts General Hospital Program.
Alison Nenos Cernich is an American neuropsychologist specializing in traumatic brain injury and computerized neuropsychological assessment. She is the deputy director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Cernich was previously deputy director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, assistant professor of neurology at University of Maryland School of Medicine, and chief of neuropsychology at the VA Maryland Health Care System.
Internet-based treatments for trauma survivors is a growing class of online treatments that allow for an individual who has experienced trauma to seek and receive treatment without needing to attend psychotherapy in person. The progressive movement to online resources and the need for more accessible mental health services has given rise to the creation of online-based interventions aimed to help those who have experienced traumatic events. Cognitive behavioral therapy (CBT) has shown to be particularly effective in the treatment of trauma-related disorders and adapting CBT to an online format has been shown to be as effective as in-person CBT in the treatment of trauma. Due to its positive outcomes, CBT-based internet treatment options for trauma survivors has been an expanding field in both research and clinical settings.
Marlene M. Maheu is an American clinical psychologist who is the author of Infidelity on the Internet.