Henry M. Jackson Foundation (HJF). Brain Injury Monitoring and Treatment Application (DTx).

The Henry Jackson Foundation has funded a project to develop a new smartphone application that will provide intervention for service members and veterans with symptoms of depression and a history of concussive TBI (cTBI). The application will provide computerized Cognitive Behavioral Treatment (CBT) services for users which has been found to be effective in reducing depressive symptoms.

The application will provide users with a 12 week program where they will participate in regular activities and journaling to help track their progress. Additionally, there will be a control app that only includes content that can be read to learn about depression but will not include the activities included in the 12 week program.

Our task was to provide a mobile application for iPhone and Android that will allow users to read about depression and participate in a 12 week study. Metrics will be collected for each user to be stored in a HIPAA compliant database so that clinicians can study the data. There will also be a control app where users can read about their symptoms but not participate in the 12 week program.

A. Business Requirements (Therapeutic App)

Once the user has registered, signed up, and have gone through the terms and conditions, the customer user is immediately taken to start with an overview module (session 0). This is where they are introduced to cognitive-behavioral therapy, which will also include video contents. The user is to participate in a 12 week treatment course for depression associated with concussive traumatic brain injury. The course will include the following weekly activities:

1. a)  Ability to see a daily to-do list upon logging in to the application (See appendix B for weekly breakdown of daily to-do lists).

2. b)  Ability to answer questions or enter in free text in response to questions posed by application in sessions (See appendix C for sample questions/free text from overview (session 0), and session

3. c)  The application shall provide branching logic based on the answers provided to questions by the user. (Need to get branch logic for all questions).

We also wanted to incorporate the ability to bookmark pages they’d like to review later (to be accessed in the menu) along with the ability for users to schedule events or sessions for themselves that can be accessed in their phones calendar or a calendar within the app. The ability to personalize reminder notifications to complete tasks within the app based on a defined time period (example: remind weekly, daily, or on specific days) is also an important component of this healing protocol. We added an emergency button to be available and give access to the user’s safety plan, contact the Military/Veterans’ Crisis Line, or dial 911. Within certain handicaps in mind, we added the ability to use speech to text functions to complete text input questions (provided by the device operating system).

• Ability by user to delay a weekly lesson in a planned calendar week and complete it in a subsequent week (skip weeks).

• Ability to ensure that users cannot complete a subsequent week's lesson until the previous week has been completed. Note that homework assignments can be skipped but lessons cannot be skipped.

• Ability for a user to stream videos or request that they be downloaded to the user's device.

• Ability to write in a daily journal.

• Ability to view graphs of kQOL scores over time.

• Ability to view a graphic of how far along the user is in the 12 week program.

• Ability to view a library of videos so that they can be accessed at anytime.

B. Control App

Once the user (service provider) has registered, signed up, and have gone through the terms and conditions, the customer user is immediately taken to see a list of topics related to depression and concussive traumatic brain injury, which they can click to read articles within the application.

• Ability to view indicators of which articles have been read by the user and which still need to be read.

• Ability to search documents based on document title.

• Ability to personalize reminder notifications to use the application based on a defined time period (example: remind weekly, daily, or on specific days).

• Emergency button available to contact the Military/Veterans’ Crisis Line or dial 911

User Requirements

The way we set this up was for the user to be able to login with an email address and password provided by an HJF administrator when the account is setup. Then, we had the user be directed to either the Therapeutic, 12-week program app or the Control App based on a setting provided by the administrator when the user was set up. The control app user would only be able to read informational content in the control app and the same goes for the therapeutic app - they would be able to read the same informational content. The user that is online will be able to stream or download videos and will be presented with a weekly program where they can read a to-do list, answer questions, and input text in a journal. They are also able to use chat to text features on their device to populate any text field. As for the administrator, see below:

• An administrator user will be able to login and search and select a user.

• An administrator user will be able to view all metrics for that user.

• An Administrator user will be able to export all metrics for a selected user (in some cases multiple users).

In Conclusion

When I was first presented to take on this project, I was quite honored, because the problem we were solving was something near and dear to my heart. I happened to have a vast knowledge on the area of trauma (and trauma release) and many other forms of mental illness / disorders. I had first-hand experience with it in my younger days and have gone through different medications that didn’t work (but made things worst) and experimented with the many different protocols and approaches that I’ve studied throughout the years. The project was quite personal for me to some extent, since I understood many of the ins-and outs of trauma and the different forms of mental illness that tend to manifest through various dark experiences. For years, I’ve studied endless books on this topic and even read ancient texts that talks about the various types of the human condition pointing to this form of mental suffering. Since I have taken the deep dives and investigations on the subject-matter ranging from the western approaches all the way to the eastern methodologies and modalities, I realized that by opening up with the client of my discoveries and how I approached my own healing journey, it allowed them to take into account the feminine principle of healing. The DTx app focuses more on the masculine side of healing and in many cases uses the analytical side of the brain.

During my discussions, brainstorming sessions, and review sessions with the doctors (therapists) I had the chance to share the deeper aspects and benefits of entering altered states of consciousness through intense breath-work, meditation, plant medicine, deep self observation, and inquiry. The spiritual path is the way for some and for others it is not - and both are fine depending on which works best for that person at that time. Through shared stories based on personal experiences, we were able to come up with something quite wonderful as you’ll see below. I was able to share and address the many subtle symptoms, triggers, and the emotional spirals / patterns one enters in these conditions. It was an amazing experience to be part of something wonderful like this. Shortly after, the discovery sessions started to mold into an application that was more personalized to each user, more inviting, and more intuitive. We were able to tackle the major challenges of getting users to truly engage more consistently in the platform to heal themselves, by making the app rhythmically flow on all their tasks and assignments as well as making it slightly gamified to get rid of the monotonous feeling of certain tasks.

From here, we came up with various scenarios so we can provide the proper user-flow for that user. We kept doing this until we covered the main scenarios. Once we nailed down the entire UX flow, we jumped right into the visuals, user interface, branding, and organizing a beautiful design system for them. After some branding explorations and finalizing that, we wrapped up the clickable prototypes and handed it over for development. In the end, all was a success and was quite a service to humanity. Alleviating people’s mental suffering is one of my passions in life through various techniques I’ve learned overtime. And to have the opportunity to work with the Henry M. Jackson Foundation for the Advancement of Military Medicine for this cause was a great honor. The studies done on mental illness and trauma was quite massive. We realize that many people walking around in this world that deals with this mental prison are mostly in hiding or self-medicating with harmful substance - there is another way and it starts with platforms like this or the modalities I’ve listed above.