Technology andPsychology

FEATURE

Making the Most of MobileTechnology in Private PracticeYvette N. Tazeau. PhD

t comes as little surprise that the evolution of health care, includ-ing mental health, now includes an increasingly prominent rolefor technology. Mobile technology, in particular, is making strides

because of its potenrial for tech-cenrered, multimodal clinical servicesfor practitioners and clients alike (Luxron, McCann, Bush, Mishkind,& Reger, 2011). For clinical practices, the portability and immediacythat mobile technology affords makes for on-the-go access ro informa-tion, multimedia (audio/video) recordings, and skills practice, as wellas provide for creative ways to update traditional clinical methodolo-gles.

Explosive Growth of Mobile TechnologyMobile cechnology takes many forms. The "platforms" by which it

is available include handheld mobile devices such as smartohones and

tablets. To say that mobile technology has witnessed an explosion ofuse is not hyperbole. Perez (2012) nored that the networking com-pany, Cisco Systems, report of the massive demands for mobile datawill have the number of mobile devices exceeding the world's popula-tion by the end of2012. Indeed, the advent ofsmartphones represen$the largest technology migration in global history and with a record300% annual growth rate, smartphones are the fastest consumer tech-nology adoption on record (MobiSource, 2011). Eighty-five percencof the U.S. population uses smartphones, representedby 48o/o iPhone(an Apple, Inc. product) users (Cuevas, et al, 201 1).

For the 6rst time ever,2012 smartphone shipments outpaced thesale of traditional personal compurers (Kain, 2012). According to An-derson and Volff (2010), 6y 2A14, mobile phones/smartphones willbe the dominant method by which people access the Interner, and mo-bile software programs, "appsi'will replace the tVeb with its download-able format, and websites will be mostly for desktop/laptop use.

In 201l, Apple's App Store had sold more than $4.3 billlon in apps(Burrows, 2011). In March2012, the store recorded with much fan-fare its 25 billionrh apps download (www.apple.com). \(ith its multi-Iingual and multicultural reach in 85 countries, Applet iOS softwaretechnology and its App Store center lead the field of mobile app de-velopment and distribution for iPhone, iPad, and iTouch users. Othercompetitors are nor far behind, with Research in Motion Blackberryand Google's Android fighting for a place at the center of the appssurge.

Early Adopters of Mobile Technology: Educationand Medicine

In the U.S., no sector has seen greater use and early adoption ofappsthan education (Barber, 2012). Public and private schools alike areincreasingly switching to classroom delivery of learning in the formof mobile technologies, such as tablets (e.g., iPads), thereby traininga new generation of students and learners in the use of apps. In medi-cine, the prediction is that by 2015, 500 million people will be usinghealthcare apps (Mikalajunaite, 2010). Psychology is catching up andthe prediction is that that mobile apps may be the new way psychologyreaches the masses (Leis-Newman, 2011). According to a recenr surveyofperceptions ofhow the field ofclinical psychology may change overthe next twenty years, psychologists will be engaged in much moretechnology-assisted clinical services (M. Prinstein, personal commu-nication, January 8, 20 I I ) .

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Security Issues ofMobile Technology Use inClinical Practice

How can the use of apps in private practice settings enhance theclinical experience of clients and provide greater benefits for theirffeatment goals ? Before conside ring the possibilicies, ir is imporrant torealize the pocential challenges and barriers that can preclude an effec-tive implementation of mobile technology ideas. For example, privacy,confidentiality, data security, and risk management are all cornerstoneissues to consider before integrating mobile technology into clinicalwork. A concise review of rhese issues is provided by Yuen, Goetter,Herbert, and Forman (2012). Because this technology is relatively new,work is still being done ro provide professional guidelines, regulatorydirection, and risk manag€ment principles. Telepsychology is a broadterm encompassing not only apps, buc also phone therapy, telehealththerapy (via Internet video), electronic medical records, r€xr messag-ing, virtual therapy, etc. A Joint Task Force for the Development ofTelepsychology Guidelines for Psychologists, with an emphasis onstandards and protocols (DeAngelis, 2012) is underway and readersare encouraged to participate in the spring 20 I 2 draft that will providefor a commentary period.

Integrating Mobile Technology in Clinical Practice'W'hen

considering incorporating mobile technology in clinicalpractice, a first step is askingwhat guides apps usage. In identifying thestrategic objectives for adopting technology, is ir for accessing informa-tion, recording data, or practicing skills ? The nexr srep is to develop aplan bywhich to select the necessary technology tools to implement inthe practice. Questions to consider include the role of the app vis-)-visthe client, how the app can enhance client learning and goal achieve-ment, the app's functionality in these roles, and the quality of a free vs.paid app.

Using Mobile Technology in the CommunityAs a practitioner ofclinical neuropsychology and Cognitive-Behav-

ioral Therapy (CBT), my practice has been enhanced by the afford-ability, adaptabiliry, and portabiliry of mobile cechnologies. Vith theclinical neuropsychology work, an important role in the provision ofevaluation services is the explanation of testing results to individualsof differing knowledge base and professional backgrounds. In pastyears, when attending school meerings for srudent disability services, itwould be with a laptop and DVDs and CDs in tow if it were imporrantto illustrate a concussion with a video, or have the teaching staffview aclip ofan national expert speaker addressing the educational and learn-ing impacts of Tourette's Disorder.

rJ7ith the advent ofthe iPad. the device can be handed around theroom for viewing by individuals, as well as connected ro a projector forgroup viewing. An excellent app for brain anatomy and brain injury in-formation is FINR Brain Atlas 3 (Florida Institute for Neurologic Re-habilitation, Inc.). Also, being able to transfer DVDs ro an iPad worksseamlessly with DVD to iPad Converter for Mac software (Tipard). Ihave attended other meetings whereby (with proper authorizations)preschool teachers have presented school videos ofrecess play in orderto highlight for team discussion aspecrs ofchild play interactions thatmay not appear to be neurotypical. Vhen consultingwith other healrhand education providers, I often introduce apps for them to use in theirwork. Athletic trainers who manage concussion issues have been inter-

12 Tbe California Pslchologist c May/June 2012

esred in PAR, Inc.'s Care Sporr Concussion Assessment & Responseapp for irc ability to provide information guiding quick responsivenessto a head injury situation.

Using Mobile Technology at the OfficeAt the office for psychotherapy, mobile technology provides an

additional source ofbibliotherapy. A tabler like the iPad can containmany child therapy books (Virtual Help, Inc.). Many children alreadyhave familiarity wirh mobile technology through the use of games andrelate readily to the elecrronic medium. Therapy with children can alsoinclude drawings. \fhen drawings are not on paper but on a white-board, preserving the information can be challenging if the therapiscdoes not have sufficient time to hand-copy rhe informarion before rhenext client appointment. A smartphone or tabler can take a picture ofthe whiteboard and send it ro print on the local, office printer direct-ly chrough a secure wireless Internet connection (\fi-Fi) (e.g., PrintMagic app by'W'ellala, Inc.). In rhis way, the young parienr can takehome their drawing.

In providing CBT to adults, traditionally a piece of paper was themethod by which clienrs tracked their automatic negative thoughtsand challenged them. Several CBT apps, such as iCBT (Bonfire De-velopment Advisors), are now available for adults to use any time asituation arises that could be helped by the CBT approach. The iCBTapp provides for saving the information or sharing ir by way of e-mail.The convenience and portability of the app helps maximize compli-ance with assigned homework as there is greater chanbe it will be re-membered and not lost as can occur with a paper verslon.

Tablets can be connected to television screens so that CBT appwork can be done collaboratively between client and therapisc, muchas it has been done raditionally on a piece of paper or whiteboard.Inreracrive therapeuric apps for childrent social skills such as The So-cial Express (Language Express, Inc.) can also be viewed on a screenin the office. For example, in working wich developmentally disabledchildren, teaching them and their parents in the use of electronic ver-sions of Picture Exchange Communication Systems (PECS), e.g.,Communicating Basic Needs app (Special Learning, lnc.), connectingthe iPad to the TV. screen helps to learn how to use the app. W'ithmobile devices, reaching relaxation with audio tracks can be streamedvia Bluetooth to speakers in the office during the session.

Staying Up to Date with Advances in Mobile Technologyand Psychology

Mobile rechnology's application to psychology is still in its infancybuc holds great promise.

'W'ith the increase in app use in the field, it

will be important to study and me asure if the availability of differenttherapy tools' delivery formats makes a difference regarding the use-fulness of treatment services, what is the impact of apps on achieve-ment of treatment goals, and client reporrs of effectiveness. Findingapps can be a challenge when so many have been created to date. Auseful app for finding apps is Chomp. For reviews on psychology apps,readers can join Sylvain Roy, PhD's Linkedln group, Mobile Apps forPsychologists, and for sraying abreasr ofrhis evolving field, the journalTelemedicine and e-Heahh is available. M

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ReferencesAnderson, C., & !7'o1fl, M. (2010, Seprember). The \W'eb is dead. Long live

the Internet. V[/ire d Magazi ne. Retrieved from http : //www.wired.com/ maga-zine I 20 1 0 / 08 / ff _webrip/ all/ l

Barber, D. A. (2012,January).5K-IZ Ed Tech Tiends for 2012. TbeJour-nal.ketrieved,from htrp://rhejournal.com/Arri cles/2012/01/lO l5,K-lZ-Ed-Tech-for-20l2.aspx ?p= l.

BonfireDevelopmentAdvisorsiCBT(Version3.0.1) [CompurerSoftware].Retrieved from htrp ://itunes.apple.corn/us/app / ic& / id355021834?mt= 8.

Burrows, P. (201 l, June). How Apple feeds ics army of app makers. Bloom-berg Businessweek Rerrieved from htrp://wwwbusinessweek.co m/ magazine /content/ I 1 25 / b423303933637 4.html

Chomp [Computer Software]. Retrieved from hnp://chomp.com/.

Cuevas, L., Galvan, C., Smirh, E., Arguello, J., Romano, R., Larco, V., &Dines, A. (June,2011). Larinas in rech. In L. Cuevas (Moderator),2 atino 2 allthings Latino in tbe digital age. Symposium conducred at The California Tourmeeting of Larinos in Social Media (LAIISM), Mountain View, CA.

DeAngelis, T. (2012, March). Practicing discance rherapy, legally andethically: Psychology is developing guidelines for practitioners in this rapidlychanging area. Monitor on Psychology, 43(3), 52.

Florida Institure for Neurologic Rehabilitation, Inc. FINR Brain Arlas 3[Compurer Software]. Rerrieved from hrrp://www.fi nr.net/educational-re-sources/fi nr-educarional-marerials/3d-brain/.

Kain, E. D. (2012, February). Smarrphone shipmens top PCs for thefirst time ever. Forbes. Rerrieved from htrp://www.forbes.com/sites/erik-kajn I 2012 / 02 /04lsmartphone-shipmenrs-rop-pcs-for-the-fi rst-dme-ever/.

Language Express, Inc. The Social Express IComputer Software]. RerrievedFrom http ://rhesocialexpress.com/.

Leis-Newman, E. (2011, June). Unhappy? There's an app for that: Mobileapplications have become a new way to bring psychology r o rhe rnasses. Moni-tor on Psychologl, 42(6),31.

Luxron, D. D., McCann, R. A., Bush, N. E., Mishkind, M. C., & Reger, G.M. (2011). mHealch for menral health: Inregraring smartphone technologyin behaviorai healthcare. Professional Psychology: Research and Practice, 42(6),505-512.

Mikalajunaite, E. (2010, November). 500m people will be using heahhcaremobile applicarions in 20 I 5. Rerrieved from hrrp://www.research2guidance.com/500m-people-will-be-using-heahhcare-mobile-application s-in-2015/ .

MobiSource. (2011). \7hy Mobile? Retrieved from http://www.mobi-source.com/aboutus.php.

PAR, Inc. Care Sport Concussion Assessmenr & Response IComputerSoftwarel. Retrieved from http://www4.parinc.com/Producrs/Product.aspx ?ProductID =CARE_AP P.

Perez, S. (2012). Tbe nurnber of mobile d.euices will exceed tbe worldi popu-lation b1 2012 (6other shockingfgures). Retrieved from http://techcrunch.com/2012/02114lthe-number-of-mobile-devices-will exceed-worlds-popula-tion-by-20 I 2-orher-shocking-6gures/.

Special Learning, Inc. Communicating Basic Needs fComputer Soft-warel. Retrieved from hnp://itunes.apple.com/ph/artist/special-learning-inc./id442992037.

Telemedicine and e-Health. Reuieved from hrrp://www.liebenpub.com/overview/telemedicine-and-e-h eahh/ 54 / .

Tipard DVD to iPad Converter for Mac software fCompurer Software].Retrieved from http://www.ripard.com/dvd-to-ipad-converter-for-mac.html.

Virtual Help, Inc.: Ifhere Mental Health Meets Technology, iPad counsel-ing srory books. Retrieved lrom hrrp://www.virtualhelpinc.com/ipad-coun-seling-story-books.hrml.

'Wellala, Inc. Prinr Magic (Version 2.3.2) [Compurer Software]. Retrieved

from http ://itunes.apple.com/us/app/print-ma gic / id3325 16694?mc=8.Yuen, E. K., Goetter, E. M., Herberr,J.D., & Forman, E. M. (2012). Chal-

lenges and opportunities in Internet-mediared telemental health. ProfessionalPsychologl : Research and Practice, 43(l), 1 -8.

Yuette Tazeau, PhD, is the CEO and Founder of TikalBayTek, Inc., aSilicon Talley colnpdn! that applies behaaioral sciences to mobile tech-nology (www.tikalbaytek.com). 7he cornpany reates apps and proaidesconsubing seruices to dssist clinicians in adding technolog! to tbeir prac-tices. Dr Tazeau is ako a licensed psychohgist specializi.ng in ClinicalNeuropsychohgy and Cognitiae-Behaaioral Therapy (CBT) (wwu.drtazeaa.com), She ako practices as a Management Consuhant (wwu.lntconsultin&com). Her e-mail addras is info@ti.kalbaytek.corn.

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