Gaming, Wearables and Big Data: Psychology’s Hi-Tech Future

Simulated therapy training. Apps that monitor behavior and stand-in therapy. Vast streams of data shaped into undeniable patterns. According to a report by psychologists on the cutting edge of technology development, these could be familiar practice adds in the not-distant future.

Jason Satterfield, PhD, director of behavioral medicine UCSF Medical Center spoke of how hi-tech training could help equip clinicians to help meet the demands of truly integrated behavioral health care, otherwise known as the patient-centered medical home.

“The average primary care physician has a panel of 2,500 patients … [and] would need to work 21.7 hours per day just to do [treatments], and 7.4 hours per day for prevention, to deliver best standards of care,” he said. Meanwhile, 70 percent of of health care expenditures are due to chronic illness, and one in four of those patients will have diagnosable mental illness.

Newer tools may help clinicians to treat more people more efficiently and effectively. These include social networking using podcasts and online discussion panels, MOOCs (massive open online courses), and e-mentoring and supervision. “Smart care” tools might remind clinicians when it’s time to do a test or when a patient’s record indicates an intervention. Actors could play patients in simulated online scenarios.

To further help access, “extender and augmenter” apps can that help boost the lessons of cognitive behavioral therapy between sessions. For example, one mobile phone app called Addiction CHESS, currently in development, helps people in recovery for substance abuse, buzzing if they’re approaching a behavioral trigger and delivering appropriate messages. There’s also a “panic button” to call for help and therapists after hours.

That said, “There are lots of studies on digital health and ehealth tools, but if you build it, it doesn’t mean people will use it. Folks are too overwhelmed; there are too many choices and too many things to do. As psychologists we need to think about motivation,” Satterfield said.

One way may be through gamification of virtual therapy. People get drawn into games because they’re tapping into the psychology of motivation and rewards, like badges and scores, limiting play time and setting challenges just above your level of ability to add just enough fun.

“What if we had our training programs set up that way? Not to make light of them, but if they were fun and easy to use, and  where people were bored and could take out a pad and do their CBT exercises — how awesome would that be?” he said.

Assessment is critical to helping clinicians and supervisors of care managers make decisions, but can take up much of the time they have with patients, said Patricia Areán, PhD, of the University of Washington.

“We don’t know how our patient is doing until they walk into our office, and [sometimes] don’t even see patients once a week. We also have to rely on self report, which is guided by how person feels that day,” she said. “What if we could capture all of this information before you see your patient? Data collected in real time and presented in a really efficient way gives us the time to do treatments we need to do to make our patients feel better.”

Mobile phones and wearables may be the vehicles. Smartphone apps can give clinicians clues as to how patients are faring by collecting activity and social data, listening for voice data and changes, looking for typing errors and giving quick mood surveys or memory tests, and being on the lookout for texts and emails that get no response. Plus, they could help reach groups that currently lack access; minorities use mobile health apps more than Caucasians, according to Pew surveys, she said. Wearable sensors have grown 110 percent since 2011, and older adults are more likely to use these devices than any other demographic.

“It’s a combination of data points that will really come up with a signal for people on whether they are really doing better or worse,” Areán said.

All of this personal and public health data and electronic health records are generating enormous amounts of useful information, said Kari Stephens, PhD, who teaches biomedical informatics at the University of Washington, but the challenge lies in ” getting this data wrangled and unburying ourselves,” she said.

Government and other groups are spending millions of dollars to create information-sharing networks that have great value for behavioral scientists, she said, including the National Institutes of Health BD2K (big-data-to-knowledge) project,  the Patient-Centered Outcomes Research Institute’s clinical data repository network, the research-focused NIH Collaboratory, and the FDA’s Mini-Sentinel, which monitors the safety of medical products.

“Big data is correlational, not causal. … and messy and that’s OK, as long it’s mediated by human interpretation,” she said. “Lots of reporting pieces can help us figure out how behavioral health specialists are supporting evidence-based care. Imaging mapping a patient to providers to see how well each provider consults across a team. We also need to be thinking out of the box when we pioneer new ways to do research” with data.

Other big data boons on the horizon: cloud services, actigraphy, consumer data clouds, genomic profiling, and discovering new neurocognitive measures. Psychologists are integral to designing and implementing these tools, and supervising real world change in practice and policy, she said.

 

Health service psychologists wanted! How do we get there?

Thanks to the Affordable Care Act (ACA), there is a greater need than ever for psychologists in integrated health care. But what is integrated health care? A comprehensive definition from APA is here, but basically it reflects the growing interdisciplinary nature of the health-care system and recognizes the need to develop  comprehensive treatment — and prevention — plans to meet patients’ psychological, social and medical needs.

Many psychologists are interested in working collaboratively in a medical setting, but how do we ensure that psychologists are ready upon graduation?

A symposium panel, chaired by Dr. Emil Rodolfa, answered that question by discussing several important areas. The first was competencies. Dr. Stephanie Wood of Alliant International University outlined the competencies health service psychologists need. These include:

  • Interprofessionalism: The ability to work collaboratively with others in a medical team, including speaking the same language (e.g., what is a electronic medical record?)
  • Leadership: Positioning psychologists to be in an ideal situation to lead effectively in medical settings. This includes not being afraid to ask physicians questions and working to ensure psychology remains an integral part of integrated care teams.
  • Cultural competence: Raising the level of knowledge around who seeks care and why.
  • Use of evidence-based interventions: Teaching psychologists to effectively review the literature and implement only interventions that have a robust evidence base.

The good news is that there are already programs in place for this sort of health services training, particularly at the clinical internship level.

Dr. Jeffrey Baker, the executive director of APPIC, reported there are 226 internship programs that provide experiences in integrated primary health care. Others provide more specialized training. Also, there are as many as 63 APPIC postdoctoral programs that offer ample experience. Check out the APPIC website for more details.

The medical system is changing and there is a true need for trained psychologists that can navigate health care and deliver psychological treatments to those in need.

We Need to Teach the Teachers: Training for the Future of Psychology – An Integrated Primary Care Curriculum.

IMG_0454It’s almost impossible these days to discuss psychological clinical work in the United States without also discussing how it fits into an integrated health care model. Luckily, the Div. 38 (Health Psychology) Clinical Services Counsel (CSC) is on the job. In the dark corridors of the Toronto Convention Centre, a few psychologists presented their proposed primary care curriculum to a clutch of students, faculty and clinicians.

They described a critical problem in psychological training programs: Students need to learn how to work in integrated health care, but we don’t have anyone to teach them — at least not on the mass scale necessary to train a generation of clinicians for a rapidly changing health care model. Most faculty in psychological training programs do not have experience or training in this type of treatment.

Essentially, we need to teach the teachers to teach the future of psychology.

How do we do this? Shanda Wells PsyD, described a curriculum the CSC is developing. It includes a plethora of materials that have been produced to help graduate faculty to teach integrated health care psychology — “beautiful Powerpoints, like you have never seen before,” plus handouts, pictures/models, videos, and even pre/post tests that have been produced by the committee to help develop teachers in graduate schools. She emphasized and repeated one point: “The materials are free and flexible”

IMG_0456

She and her colleagues showed a few of the videos, which featured high-quality cinematography and great use of diverse actors in real world settings. One video shows a psychologist in a “doctor’s office” talking to a man about behavior interventions for sleep. The video feels real and the acting is solid. It doesn’t feel like a generic psychology training video made in the 1980s. It feels current and relevant.

It feels like something students will respond to.

Nancy Ruddy, PhD, spoke of  the importance of setting expectations for the future of psychology for both students and faculty. The days are gone of “solo practice where you sit alone in a room with a box of Kleenex and a lamp,” she said. She described the importance of seeing ourselves as a component of treatment in holistic health care as opposed to islands off by ourselves.

In addition, committee members plan to make themselves available for consultation about the curriculum. They described the importance of allowing an “ongoing discussion” around this type of training experience. And they said they are excited to see how these materials get used in training settings and want to hear feedback on how they can improve them.

IMG_0457

The materials will be available for mass consumption soon. For more information, contact the Div. 38 (Health Psychology) Clinical Services Counsel (CSC).