Episode 148 Transcription

Welcome to episode 148 of Behind The Mission, a show that sparks conversation with PsychArmor's trusted partners in educational experts. My name is Duane France, and each week I'll be having conversations with podcast guests that will equip you with tools and resources to effectively engage with and support military service members, Veterans and their families. Find the show on all the podcast players or by going to www.psycharmor.org/podcast.

 Thanks again for joining us on Behind The Mission. Our work and mission are supported by the generous partnerships and sponsors, who also believe that education changes lives. This episode is brought to you by PsychArmor, the premier education and learning ecosystem, specializing in military cultural content. PsychArmor offers an online e-learning laboratory that's free to individual learners as well as custom training options for organizations. You can find out more about PsychArmor at www.psycharmor.org. 

On today's episode, I'm having a conversation with Dr. Christina Armstrong, a clinical psychologist at the office of connected care and the department of veterans affairs central office. The office of connected care focuses on improving healthcare through technology. Uh, connected cares programs include my healthy vet. Via telehealth services via mobile and more. You can find out more about Dr. Armstrong by checking out our bio in our show notes, let's get into my conversation with her and come back afterwards to talk about some of the key points. 

duane----he-him-_65_11-04-2023_120006 (1): Dr. Armstrong. So glad to see you again, excited to share the work that you're doing with the audience. The intersection between technology and health is becoming more and more important, but before we get into that, I'd like to provide you an opportunity to talk a bit about yourself and why this work is so important to you.

christina-armstrong--ph-d--_1_11-04-2023_110010 (1): Oh, thank you, Dwayne. Thank you so much for having me. It's a pleasure. I would be happy to talk about that. I guess it's a bit of an origin story in a way. I've always been very interested in mental health. And, so that, of course, led me, as it will, to, graduate training to be a clinical psychologist.

And when I was going through that training, I became very interested in, technologies. My specialization is neuropsychology, so in that, it really is all about, measurement of cognitive functions and trying to often get to the point of rehabilitation, right? So when I was in my graduate training, I really became very interested in computer adaptive testing, eye tracking software, and also Developing cognitive assessments to look at different aspects of cognition and emotional functioning that we really haven't been able to measure in the traditional methods.

So that was really exciting for me and led me down a sort of, a path in a lot of ways that really began to join technology and mental health in a unique way. Then of course, I went along to, my, postdoctoral studies and, training. And so that led me to the department of defense, which I am so thankful because that ended up being just this perfect opportunity.

And so when I started with my postdoctoral fellowship in the department of defense, it was with this, perfect, amazing group called the national center for telehealth and technology. And they were at a Of course, Washington, D. C. area and Joint Base Lewis McChord in Tacoma, Washington. And so I was at, the Fort Lewis, the Joint Base Lewis McChord location, and there was about 150 of us at that time.

we were really absolutely on the cutting edge. I didn't realize I had walked into this, absolute, almost like disruptor of industries and many industries. I was just lucky to be at, A part of the heart of what was happening at that time. So we're talking all the mobile app development, telehealth.

this is back in 2010, and, all the virtual reality work, augmented reality, artificial intelligence, big data sensors, wearables, remote patient monitoring. we were just creating and building all of this and doing really excellent research in those areas too.

so each step along the way really sparked something for me. And I said, wow, we have a lot of potential here. Let's keep going. And so then I was with the department of defense for almost 10 years. And so we just really leaned into every single aspect of, really how can we change healthcare and how can we increase the efficiency and effectiveness and access to healthcare through.

All technology related things. although my background is clinical psychology, really, I see how this can be generalized, across all healthcare. So whether it's diabetes or traumatic brain injury, or, hypertension. so now, and of course, I work with all of my, nursing and, medical, physician colleagues that, have that subject matter expertise, but we really can apply these, technologies in all these realms.

And so it's been delightful. I was with the, defense health agency in the Department of Defense, which is really their medical headquarters. And after about 10 years there, I then transferred over about four and a half years ago to the, VA central office in Washington, DC, where I work at office of connected care.

And we're doing many of the same things. We're trying to really increase the efficiency effectiveness of this healthcare system. And so we can provide the best care possible. that's my end goal.

duane----he-him-_65_11-04-2023_120006 (1): it's interesting as you talk about sort of that trajectory and as you were talking, I was thinking the department of defense might've been really the best place for that because it is so well resourced and even the department of veterans affairs, but also, and I was in the army at in 2010, if my company commander or my sergeant major said, put this on and go do whatever you need to do, like the military is almost a really.

almost a test bed, right? but we see those kind of technologies. We see the same kind of thing that technologies that are developed within the Department of Veterans Affairs. There is an identifiable population. It's resourced. The development is there. and then those technologies go on to, to support the general population.

Do you see that that was the, the case really in the 2000s?

christina-armstrong--ph-d--_1_11-04-2023_110010 (1): That was absolutely the case. It was very interesting in the early 2000s because part of the dynamic in the Department of Defense is we have, two thirds are very young, so 30 and under, right? We have a lot of very young folks there and, most of the service members I've met, even the ones that are over 30, over 40, over 50, they tend to be very, tech savvy in many ways, right?

They're very interested in figuring out how things work and how to make things better. And so when we were on that side and also the group I was with in the department of defense, they also built the first DoD usability lab too. So it was a test bed in many ways, but it wasn't a, a vol and told situation like it sometimes is in the RV.

It was more like we had this huge, Group of service members that were very eager to let us know what they want, how they want it and how they want it to be done, which was for us because we really wanted to listen and really meet those needs. So it was a perfect combination.

So we had, trying to of court, huge, so many, service members go through there. And so we had, A lot of people be able to come through the our usability lab and say, no, not like that. Oh, don't do that. And so you'll notice a lot of the products that we created, were, you might say, why did you name it that?

And often it was because we had service members that told us to do it that way. and so sometimes somebody outside of that culture will think. Huh, that's not hitting right for me, but it's supposed to hit for service members and veterans. That's why we're doing this. so that's why we do what we do to serve.

We're here to serve.

duane----he-him-_65_11-04-2023_120006 (1): Yeah, no, I think it's really interesting sort of that idea of, being able to develop these things for the betterment of those who are serving, but also having the resource to be able to do that. As time goes on, accessing health support, either physical health or mental health is becoming increasingly integrated with and even influenced by technology.

How do you see veterans using technology to their benefit when accessing health care and maybe what are some of the barriers?

christina-armstrong--ph-d--_1_11-04-2023_110010 (1): Yeah. What a great question. So it's interesting. Cause so the department of, veterans health administration serves about 9 million veterans. we're the largest healthcare system in the United States. And and of course, there's a lot more veterans that are not receiving care through the VA.

So there's 20, about 20 million veterans in the United, that have served in the United States. across this, these 9 million patients that come here, there's a whole range of technology interest, technology experience. And so really when it comes down and there are a lot of barriers to access to, the heart of my approach is to meet the patient wherever they are at to, to support their needs.

so it's really up to us as a healthcare system and healthcare staff to be able to know how to ask the right questions to see where they are to meet those needs, right? Whether it be technology access. or not. It's not up to us to force it, right? And so, when it comes to barriers. So with, within that range of meeting patients, where they're at, there are patients that say, you know what?

I want to log my sleep on piece of paper. Fantastic. I'm not going to push something on that person. And then we have patients that are saying, Hey, look, I don't want to drive two hours to my follow up appointment for a procedure that I had, right? again, we're not going to make that person drive in if they don't want to, right?

We're going to provide them access they need, even if they don't exactly know how to do it. That's up to us. That's on us as a healthcare system to meet that need, right? To be listening and not pushing either way, because maybe it's more convenient to the person scheduling that or whatever it may be.

And so everything I do stems from that, trying to break down those barriers, not my perceived barriers, the actual barriers, any individual patient may have. And so some of the revolutionary ways that we've done that is, we're now in the process of building. in a way, essentially like a genius bar of support at every single VA medical center.

We call them virtual health resource centers. And so in these locations, we already have 31 that have done their ribbon cutting and are alive. And we have 50 more that are in the process today, getting ready to do their ribbon cutting. So pretty soon we'll have 80 of these live. and we've already met with.

About 180 VA medical centers, that are in our, VA healthcare system, we've spoken with and have received a huge amount of interest from about 155. So the vast majority of VA medical centers are already on the road of adopting this. So within about five years, you'll see virtual health resource centers at every single place.

So the services that veterans. their family members, their caregivers, and more importantly, healthcare staff can receive in these places is help with whatever, whether it's VA video connect to do a telehealth appointment with their provider. If they need, an iPad, because they want to be able to do those telehealth visits, but maybe they can't afford.

An iPad or a smartphone or whatever it may be. Maybe they have a smartphone, but now they don't have Wi Fi because maybe there was a challenge in paying that bill or whatever it may be. We're here to meet you where you're at and provide you the access to the resources you need to be able to get the health care resources that you really need.

And so in these, so it could be veterans that are enrolled in the VA or not enrolled in the VA. doesn't matter. We're not discriminating. We want to. Provide equal access to help, but it's for mobile health apps. It's for telehealth. It's for Sensors wearables remote patient monitoring devices activity trackers whether you own it or it's the VA's that issued it to you We're gonna help you.

We're gonna help you sync those devices. We're gonna help Talk through what might be the best for you. And all of these people, part of this infrastructure that's going to help support is, it offloads the sort of burden on many health care staff. So one of the biggest barriers to this is health care staff don't know what's available.

Even though we're in the healthcare system, it's we're busy, right? And so we, there's no way for us to always know every single technology that's available. And there's absolutely no way for us to be experts in all of them, right? And so often the challenge has been, there's an unintentional gate gating system that happens.

So you as a patient come in and say, Hey, you know, I really, I've got this problem. I don't know what it is, or, I think this is it, can we track this for a while? and for the healthcare staff, they are going to go on often, unfortunately what they were trained on in their graduate training, Which is, fine. That's standard of care. It's great, but we can do better. We can do better and we have access to the resources to do better. But we also know that putting that burden on that every single healthcare staff member in the VA to know all of it. that's a barrier we've been trying to break down for 15 years, in the DOD and VA.

And we realize that's that's just the bridge too far and it's unfair to put that burden. So creating these virtual health resource centers right in the hospital in every single hospital, then you as a clinician can say, Hey, whatever your patient's name is. I can see you want to do telehealth.

I see you want to track your sleep in this way. these are the things that I think you can do. How about you go down to the virtual resource center and they're going to Walk you through it. They're going to walk you through how to download that app, how to sync your device, all of that.

They're going to be great. They're going to help you. And then you have this entire, group of people in all these virtual resource centers across the VA healthcare system that are all trained the same way. We've created the entire training infrastructure for them too. So those people serving in those virtual health resources centers can also, have all the information they, they need to serve the patient and their family members, right?

Cause there's caregivers that are also like. Hey, I don't know how to sync this. how do I wasn't even at the appointment, right? What do I do? And so we see where we're there to meet the need, really the really meet the need wherever it is at. So what we've seen now, cause we've been doing this for four and a half years, we have a huge amount of data.

So those VA medical centers, those 31 that already have this live ribbon cutting, providing these services. we see virtual care utilization, increase at this way higher rate than all those VA medical centers that don't have one. So we can tell, and there's one that, and they'll have thousands and thousands of patients, not in one day, but over the course of the time.

And so what we're seeing is, oh, That's where people were falling through the cracks before. now we're starting to meet a need that was always there. and then we see that virtual care utilization increase. So it wasn't that people didn't want to use these things. It wasn't that people didn't, that they really wanted to drive three or four hours to the VA medical center and try to park in one.

That's not what they wanted to do, but that's what 

they were comfortable with. Right.

duane----he-him-_65_11-04-2023_120006 (1): Or, or there was no other option or that was really the

christina-armstrong--ph-d--_1_11-04-2023_110010 (1): no, I gotcha. Yeah. Or, if that healthcare staff member said, Hey, yeah, we do telehealth, but I'm not comfortable with it, so then we're there to meet that need.

duane----he-him-_65_11-04-2023_120006 (1): and as you're talking, it puts me in mind. and here we are, as we're having this conversation, three years after the onset of COVID, but you were doing this work for a full 10 years before COVID. and there was, it was much more difficult for both patients and clinicians to adapt technology pre COVID.

I'm curious how, we're not saying that silver linings come out of COVID, but from my perspective, that's one thing is telehealth has taken almost an exponential leap forward, due to the advent of COVID.

christina-armstrong--ph-d--_1_11-04-2023_110010 (1): Absolutely. So what we saw before that this should always be an option provided to patients to any patient, unless, of course, they need a blood draw or a surgery right where we need to put hands on most of the appointments, the health care appointments we have really could be done in other ways if we provide the infrastructure to do it conveniently.

And so what we saw as a need before, And especially the Department of Defense. we know better, right? We know we are worldwide as a health care system in, in the Department of Defense, and we know people move all the time. So we need to be flexible and to meet people really wherever geographically that they are.

We know that. And so we were, I was again, very thankful to be in the setting that had that mindset, right? Our goal is to help people. Service members and their families be ready, resilient, wherever they are. Technology had a played a big part of that. And we saw that need then, and a lot of times it was almost like hypothetical, right?

so in the department of defense, we're really, really good at prepping for emergencies, prepping for potential crises, right? Because in the military, often it isn't hypothetical, things you really do go into battle and you really do need to be prepared. but. Because we saw this, we knew there was a potential for a pandemic.

And there still is now, right? So what are we going to do when that happens? And so we saw that and we prepared for that. And also thankfully the VA did too. So actually out of all healthcare systems, the VA was more prepared than any other to really switch to telehealth. So we were able to maintain, this continuity of services that.

No other health care system was really able to do. And so we saw that and we were able to shift quickly when that happened. And you're right, when the pandemic happened, and it really started to, the weight of it and how long this was potentially going to last, we really realized this is our opportunity.

We've already built. This for decades. We've been working on this. I at that time had been working on it for, over a decade. And so you said, now let's make this real. Let's really double down, provide this to everybody. And so that's what we did the first six months. Really? I don't know one other myself and all my colleagues.

I think we worked, 70 or 80 hours a week for those first, yeah. Four to six months, we said, okay, let's meet the need. The need is here. It's arrived. Let's make sure every healthcare staff member is trained and has everything they need. Let's make sure that every, veteran that needs, an iPad or smartphone or whatever it is, let's make sure.

We provide that and we already have the logistics infrastructure in place to do it. So it was finally, it was, we wanted to, make hay while the sun was shining, right? And so we, that's even though the sun wasn't shining at that point, but that's we said, okay, let's, let's see this as an opportunity and provide, now that we really, people are seeing the need.

We saw this need a long time ago

duane----he-him-_65_11-04-2023_120006 (1): Yeah, and I think that was, as you said, a lot of veterans that I know were appreciative of being able to at least continue that. And I think that there was, it's almost this is something, like you said, we've been saying for years, here is this thing. Now let's use it. so you are a clinical psychologist with the VA's Office of Connected Care.

That encompasses a lot of things. things. if folks want, like if they wanted to learn more about the Office of Connected Care or what are some of the programs that the Office of Connected Care supports?

christina-armstrong--ph-d--_1_11-04-2023_110010 (1): Yeah, so the Office of Connected Care is in VA's central office, so VA's, headquarters, and we are, really, it's this kind of umbrella, office that oversees all of VA's telehealth programs, all of VA's, mobile web solutions, all of VA's, Like my health vet, which is the VA's, patient health portal, and sensors, wearables, remote patient monitoring, all of the help desks that are associated with all of these.

so we run all of those things, all the devices. So if someone were to, have diabetes and need a, like a glucose monitor, all of those devices that go out for all of those things are off, are under our office. And so it really is this, it's good because, because there's so many things, but they're all very interconnected in, in many ways.

So it's great. And all of us across these sort of teams, work really well together. The group I'm with, which is Connected Health Implementation, we sort of. wrap around in a way all of these groups, and work. So I work, whether it's a mobile app or, whether it's a, activity tracker, whether it's, whatever it is, that's, we're really about the big picture, increasing the adoption of all these virtual care tools and programs.

duane----he-him-_65_11-04-2023_120006 (1): You know, I, I think that's great. and even as you said, the office itself is interconnected and it's not just really about technological connection. So if people wanted to find out more about the VA's Office of Connected Care, how can they do that?

christina-armstrong--ph-d--_1_11-04-2023_110010 (1): Yeah, so connect to care dot va dot gov there they can find out about virtual health resource centers. Also at connect to care dot va dot gov forward slash VHRC they can find out more about that and also well, we have a map we have a filterable Interactive map there that shows what about my VA?

Do I have a virtual three source center there? You may be asking that and that'll, that, that'll be something that'll be rolling out over the next five years too. And if you don't see one, you'll see an email address on there and you'll be able to email us. at VHA VHRC at va. gov.

And so you say, Hey, I want one at ours or whatever it may be. Ask us questions, whatever it may be in that. And I'm the national lead for that whole program. but we're doing a lot of wonderful things, but I connect to care. va. gov. You'll be able to find all the. Amazing things. And also another place, that people I think can learn a lot about what we're doing is mobile.va.gov.

That's our VA app store where you can see all the different, mobile and web apps that you have access to. Many of these, oh, all of them are free of course, to, patients and, healthcare staff, but there's a lot of 'em that anybody in the world can download and use. Although we make them for veterans and service members and their families, a lot of them, they're all built on evidence based foundation.

This is, we know this works for mental health or, all these other, issues. And so people can use this. We just, the VA out of the national center for PTSD is a group within the VA. They just launched really one of my favorite apps that the VA has launched. It's called safety plan. And so it's really about suicide safety planning, and it is an app.

That, anyone can use, anyone can download and it's free and it's also self contained. although you can use it, download it. the VA, we can't see anything that's in it. So you can, so that I know that's really important to people, what can the VA see or not see? I cannot see a thing that you put in there and it has access to resources and you can put down, you can work right along with your, with your clinician, your counselor, with this, but you can also do it on your own too.

And there's, you can export data to share, or you can say, you know what, I'm going to be working on this on my own and that's So safety plan. I'm just so thrilled that finally was able to come out

duane----he-him-_65_11-04-2023_120006 (1): And that's great. And I'll make sure that all of the links, that you just mentioned are gonna be in the show notes. Thank you so much for coming on the show today.

christina-armstrong--ph-d--_1_11-04-2023_110010 (1): to Wayne. It's such a pleasure. You are doing such incredible work and I'm just grateful to have this time with you.

duane----he-him-_65_11-04-2023_120006 (1): appreciate it. 

 Once again, we would like to thank this week's sponsor, PsychArmor. PsychArmor is the premier education and learning ecosystem specializing in military culture content. PsychArmor offers an online e-learning laboratory. That's free to individual learners as well as custom training options for organizations. And you can find more about PsychArmor at www.psycharmor.org.

 I've had the pleasure of connecting with Dr. Armstrong before, and I've always appreciated her expertise and her passion related to the intersection of behavioral health and technology. One of the first reflections I'd like to share Is how far we've come in healthcare. 

And of course, society in general, related to technology in the past 30 years. I'm sure you've heard it before, but the advancement of technology since the 1960s is occurring at an extremely accelerated pace computers, the internet telecommunications are all making it easier to connect and share information. 

And of course the adaptation of technology for military purposes has advanced in an equal and perhaps even more accelerated rate. Back in the day story warning here, but I can remember my first duty station in Germany in the early nineties, there was only one computer in the entire company and that was down in the motor pool. 

So the maintenance team could order parts. Even the late nineties when I was an 82nd airborne division, we use grease pencils and document protectors. Uh, to update our daily personnel status. And the first time I ever saw any kind of GPS device was when my Lieutenant pulled it out to keep us from getting lost in 

the middle of the national training center at Fort Irwin. Spoiler alert. It didn't work. We were still lost. But advancing through my career. By the end of 2014, we had pinpoint accuracy of locations of vehicles and troops, an instant communication with people, 10 feet away and thousands of miles away. That's almost mind blowing. But then to realize that the adaptation of that technology was not just for the communication, the military objectives, But now to see that kind of adaptation in the department of veterans affairs to advance healthcare, for those who served is also surprising. Along the same timeline. 

I remember going with my father to local VA hospital when I was home on leave during that first duty station. and the VA hospital in the early nineties was everything that you might expect. It was a hospital first and foremost, and a government hospital at that. Lots of cinder blocks. I always say, and my father said it to the VA of today is not my father's VA. 

And I think that's nowhere more evident than with the adaptation and use of technology through the office of connected care. The other thing that I'd like to briefly point out is how Dr. Armstrong emphasized that the adaptation of technology in healthcare is not just for the benefit of the patient or even the responsibility of the patient, but it is the responsibility and to the benefit of the provider as well. Uh, someone who attended their graduate studies in the 1990s or earlier is a highly sought after an experienced individual with decades of deep experience in their specialty. That experience in their field, however, may not come with an equal level of experience when it comes to trying new technology to enhance the care for their patient. I've seen it, especially in mental health care. For therapists. 

I see that my profession has offered a second or even a third career. It certainly my second after my military career and I didn't start in the mental health care industry until I was in my forties. And there's nothing wrong with that. I've heard it often from clients that they find it comforting to see a therapist who is older, because there's the idea that with age comes wisdom and experience. I can tell you from experience That's certainly not the case, but it seems to make the client feel better anyway. But again, with older generations of healthcare providers, there is a larger barrier to the adaptation of new technology. And a greater responsibility to overcome those barriers, like in the VA To be able to provide veterans with the best service possible. And it know that the VA has consolidated all of its programs into the office of connected care is helpful to ensure that these services are being provided, not just to patients, but providers as well across the agency. So I hope you appreciated this conversation with Dr. Armstrong. If you did, we'd appreciate hearing from you. so if you do have some feedback, let us know, drop a review in your podcast player of choice, send us an email info@psycharmor.org. We're always glad to hear from listeners, both feedback on the show and suggestions for future guests. But this week, psychomotor resource, the week I'd like to share the PsychArmor course tele-health services. And this course you can learn how tele-health brings medical and mental health services directly to veterans by using your computer or smartphone. To find a link to the resource in our show notes.