Technology-Mediated Case Management to Enhance Community Reintegration Among Veterans with Mental Health Risks

Purpose: Military personnel serving in today's conflicts are returning from combat with increased rates of posttraumatic stress disorder, traumatic brain injury, and polytrauma which may hinder their efforts to engage in desired life trajectories. Geographically dispersed National Guard and Reserve components deployed to combat theaters have challenged the military's and community's delivery of accessible post-deployment and post-military treatment, case management, and support services to these wounded warriors. The military has recently implemented mobile phone reminders to augment treatment services available to Community Based Warriors in Transition Units and to the Polytrauma Centers. Text messages have been used previously as treatment adherence and reinforcers in behavioral interventions for health behaviors and as case management tools to enhance medication adherence in the treatment of chronic conditions. The use of these technological tools has shown promising results in enhancing treatment engagement and adherence. However, there is a need for investigation of these tools to support service delivery to veterans in community-based settings. To explore the impact of this type of technology-augmented case management for veterans in a community setting, this study investigates use of a cell texting service for veterans enrolled in a supported education intervention trial.

Method: Within a thirty-month active intervention period in a clinical trial of supported education services for veterans, four months of technology-augmented case management services were provided. This study utilized a sequential, mixed methods cross-sectional case study series design to explore the following research questions about the augmented services: • Do veterans in a randomized clinical trial of supported education find mobile phone texting messages an acceptable and helpful augmentation to their case management service? • Do participants receiving more messages through the service (“higher dosage”) complete more intervention sessions with their supported education counselor than those receiving fewer messages? • Do participants receiving more messages through the service (“higher dosage”) utilize more types of services available through the clinical trial than those receiving fewer messages? The first research question was investigated through telephone interviews conducted with nine trial participants concurrently with the pilot phase of technology implementation. The second and third research questions were addressed through descriptive and correlation analysis of service utilization data for clinical trial eight participants. Results: Interviewees in the pilot phase endorsed the acceptability and helpfulness of messages received, both appointment reminders and general motivational and informational messages. In the trial phase, numbers of reminder text messages the day before were significantly associated with number of sessions (r = .92; p = .002). Improved GPA at the end of the active service period was significantly associated with texted reminders the day before a supported education intervention sessions (r = .83; p = .04). Implications: Increasing numbers of persons among diverse client groups are gaining access to mobile phones, and the enhanced communication options and connectivity they represent. Social workers can utilize this trend to initiate innovative technology-augmented case management strategies which can improve client outcomes. This study suggests that such technology may enhance community-based psychosocial rehabilitation and support networks.