Unlike other health care systems, the Military Health System must deliver world-class service across its continuum of care around the world, including providing well-calibrated behavioral health resources that address the psychological impact of combat and deployments overseas.
Ongoing health care models must consider the immediate and long-term effects of multiple deployments and the limited resources and intensified operational tempo of combat environments. Other potential deterrents to obtaining care include scheduling barriers, transportation difficulties, and concerns about privacy. Care models that do not consider these concerns, as well as the stigma associated with seeking face-to-face mental health care, may deter warfighters from obtaining much-needed support.
New health care technology such as Internet-based applications bypass common barriers to care, facilitating 24/7 communication and access. Downloaded in one’s home, Web-based applications support confidential, non-stigmatizing use. With the implementation of these tools, Department of Defense beneficiaries no longer need to wait for scheduled appointments and can exercise greater control over when and where to seek help.
Since its initial launch in August 2008, the DOD Web application afterdeployment.org has received nearly 154,000 visitors. Throughout the website’s development, several core features have characterized the application. Credible and comprehensive content allows users to access educational and behavioral-change tools independent of a health care provider. The site offers a sophisticated interface, an intuitive navigation scheme, multimedia content, self-guided and self-paced tools and, most importantly, privacy.
Users who log on to afterdeployment.org discover a wide spectrum of offerings. Educational libraries span 18 topics including depression, anxiety, families and friendships, and spirituality. The site also offers 29 standardized self-assessments where users can receive immediate feedback and recommendations tailored to their scores. Text-based materials are complemented by a range of interactive exercises. Users obtain ‘hands-on’ guidance with various self-management strategies such as deep-breathing exercises and formats that allow for personalized tracking of problem areas.
Afterdeployment.org also has a substantial library of video-based presentations featuring Service and family members describing their own post-deployment adjustment challenges and successful coping strategies. Content is updated regularly, and continually highlights new psychological health information through interactive polls, daily quotes and health tips.
In addition, audio podcasts act as an ‘on-the-go’ resource. The site’s community forums and expert-written blogs encourage social networking, while the resources list references community support programs and additional Web resources.
In the event that ‘self-care’ needs to be supplemented by traditional provider-interaction, a user can call the site’s telephone hotlines or by chat with providers via instant-messaging. The site’s geospatial locator connects Service members with local providers and a partner library highlights other programs available to service members, such as the Real Warriors Campaign, Sesame Workshop, Myhealthevet and the National Center for Post Traumtic Stress Disorder).
Recognizing the importance of offering a variety of tools for Service members and their families in one single website, afterdeployment.org has assembled a cadre of mental health care providers, and an array of materials such as the self-assessments, PTSD and TBI fact sheets, clinical practice guidelines and links to continuing education materials.
By Dr. Robert Ciulla, Chief, Population and Prevention Programs, National Center for Telehealth and Technology