Teen Hotlines

Teen Hotlines: iOS iPhone/iPod (Free)

http://teenhealthandwellness.com/

Many of us wish for a good, thorough database of hotlines. The best-organized therapists that I know have a database somewhere, either on a spreadsheet or on their phone. However, I often find myself searching in session for a website or hotline number that best fits my particular client’s needs and demographic. For example, the last hotline I searched for was a suicide/help line for veterans. Adolescents are an excellent demographic, especially as cellphone and smartphone penetration among teens gets higher. (on a side note, this cellphone penetration lends itself to some interesting uses of text messaging as a therapy/homework tool.)

Teen Hotlines is one such resource; it actually has two main functions. First, it is designed as a comprehensive portable database of support and informational numbers for adolescents. There are many, many topics on their list, including resources for suicide, bullying, depression, sex, sexuality, domestic violence, and more. Now, I have not by any means vetted all of the organizations listed in this app, but (for example) the numbers listed under sexuality are free from references to unsubstantiated and genuinely harmful things like “reparative therapy.”

The app also functions as a gateway to the Teen Health and Wellness website, which is a resource with message boards, literature on a broad range of teen mental health issues. You’ll note upon going there that it asks for a login and mentions a “30 day free trial.” Obtaining access to the full site is a kind of unique process, as it is typically made available through local libraries, schools, or similar institutions. I was able to “join” via my local library membership (in fact, I learned about this app from a news post on my library’s homepage). From within the app, the “login” link opens the full website in Safari after obtaining your login info. I only had to enter my library card number once; the app remembers it; this is good, because I don’t want a teen in crisis to have to go through any extra steps to get the information. You can use the hotline portion of the app without a login or without interacting with the website at all.

The UI is easy enough to navigate, and the links to phone numbers work properly. Numbers are listed by category. One thing I like is that every time the app opens, there is a message suggesting that you skip the hotline and call 911 if you are in an immediate emergency or danger. In terms of security, this app doesn’t keep any information aside from library card or other login. However, calls will of course end up in the call log on the phone; given the delicacy of confidentiality issues with teens, you probably don’t want parents finding out sensitive information by accident.

Opening screen with 911 instruction

Partial list of categories

A tangential final tip: if a child has a deactivated iPhone that they are using as an iPod, it can still dial 911 just like any deactivated cellphone (but only if it has a SIM card in for AT&T or TMobile, as far as I know; deactivated phones on Sprint and Verizon should be able to call 911).

Content: 5/5 – a good reference list, no blatant missing categories, references appear to be appropriately neutral/nonjudgmental

User Interface/Experience – 4/5 – login process is a little clunky, and accessing the information on the website is extremely obscure unless someone at your school or library advertises it. No such problems if you are only using it as a hotline reference.

** Disclaimer: While some of these apps may be helpful to you, NOTHING that I review is a replacement for therapy services from a qualified, licensed psychotherapist. If you are reading this because you or someone you care for needs it for mental health reasons, get them live help ASAP. Also, if you haven’t yet, read A Few Words on Security, which contains tips on keeping your and your client’s smartphone data safe from unwanted eyes.

Square Diary

Square Diary/Square Diary DX: iOS iPhone/iPod (free/$0.99)

Square Diary HD: iOS iPad ($1.99)

http://9squareworkshop.webs.com/9squarediary.htm

Note: this review is of the iPad version. Functionality of small screen version is similar.

A search for “journal” in the iOS App Store yields 923 hits for iPad and 1726 hits for iPhone/iPod (as of July 7, 2012; a search for “diary” gives you similar numbers). Journaling has been shown to be helpful with a number of mental health concerns, ranging from depression to eating disorders to anxiety. Many of these, both the paid ones and the free ones, could be helpful in therapy in any number of ways. I picked this one to review because it is designed to be a quick and easy daily journal of literally anything you want. That’s because it is extremely customizable based on specific things that you might want your client to keep track of.

The flexibility of this app is pretty incredible. You can have four, six, or nine categories, each of which can be labeled as anything you want. The wallpaper can be changed to any photo on the device. The screenshot shows a sample six-square grid. For each section, you put in a brief entry, and you can do a voice entry as well. You could also have a client pick a song for the day if that appeals to them (you start to see why I love the way that the app can be structured for many different clients). The app also allows you to put pictures in each section, which could be helpful in many ways; in my example below (iPad entry page), I have added a screenshot within the self-care section from my sample page with a guide to unhelpful thinking styles. A client could use this as a guide for logging a stressful event (it’s from the Centre for Clinical Interventions, a great resource).

iPad home page

iPad entry page

iPad Settings Page

In therapy, I might use the different categories for logging specific types of cognitive errors, events that cause stressful reactions in different life roles (e.g., work or home), body image concerns along with daily food intake, or anything specific to your client. It doesn’t give you the flowing narrative style that you might want with some clients, but it is great for anyone who might need a little more structure with their journaling.

Regarding data security, there is a passcode lock if you do not want anyone else to be able to access the diary, separate from the passcode lock of the device itself. It does not automatically share on social networks. Each day can be emailed if your client feels okay with this and you think that check-ins prior to the next session may be helpful. App data can be backed up via iCloud, manually via iTunes, or via wifi onto a computer.

There are a few quibbles with the app UI. You can’t replace the location/weather square with anything else, although the little smiley could be used to give a day an overall rating. Picking the date requires a couple of taps more than it should. However, it does not seem to be crash-prone (0 crashes in a two-week test). These little issues don’t really seem to interfere with the functioning of the app.

Ratings:

Content: 5/5

User Interface: 4/5

Disclosure: Author downloaded the app when it was free on iTunes Store.

** Disclaimer: While some of these apps may be helpful to you, NOTHING that I review is a replacement for therapy services from a qualified, licensed psychotherapist. If you are reading this because you or someone you care for needs it for mental health reasons, get them live help ASAP. Also, if you haven’t yet, read A Few Words on Security, which contains tips on keeping your and your client’s smartphone data safe from unwanted eyes.

ePocrates

ePocrates: iOS/Android/Blackberry; Drug reference is free, but requires creating an account

www.epocrates.com/mobile

ePocrates may be an app with which many of you are already familiar, and one that’s been a commonly used reference for me for many years. Its primary function is as a drug reference, although it has a number of other associated tools such as dosage calculators, medical reference tables, and many other things that I’m not trained or qualified to use.

Some of you may be stopping to wonder why I’m starting with a drug app. The short version (and an interesting discussion to me) is that I believe that medications are becoming so much more important in mental health treatment that our clients are very poorly served if we do not have a basic awareness of psychopharmacological treatment. Since we as therapists often have more consistent interactions with a client than their prescribing physician, we at minimum need to be aware of what questions to ask about side effects, how to determine whether the medications are helping their psychological symptoms, and so on. I agree with (probably) most readers that medications can be overprescribed and poorly managed. However, we will gain our clients nothing if we keep our heads in the sand [steps off soapbox].

ePocrates has become something of a standard in the medical community; I personally have used it as a reference for at least ten years and I understand that it is required in some medical schools. It covers all drugs, including available psychopharmacological drugs. You can look up a drug by class, but you will probably usually be looking it up by name when you are presented with an unfamiliar name. The app itself is easy to use on any mobile operating system. The menus are pretty easy to navigate, offering information about common dosage levels for adults and children, side effects to watch for, and basic pharmacology information such as metabolism, half-life, and (when available) mechanism of action.At the end of an entry are pictures of the medicine. It also has a pill ID tool where you put in some descriptives and it attempts to tell you what the medicine is. In my experience, this feature has been kind of hit and miss.

Android Home Screen

Android Pharmacology

Android Dosage

iOS Home

iOS Pill Pictures

ePocrates is an easy to use app that has more information than will be needed by most therapists. I will often refer to it if my client mentions that they have been started on a medication, or if I hear that from their prescribing doctor.

A Few Words on Security

Technology is an amazing and wonderful thing. Stop for a minute and think about the fact that the computer (smartphone) you’re holding in the palm of your hand probably has more processing power, RAM, and storage than the eight pound laptop you had 10 years ago. I was just thinking the other day that my 20 month old son no longer needs the motor coordination to use a mouse in order to master the use of a computer – he can turn on an iPad and pick his app, at least when he can get one finger to the screen instead of his whole hand. The potential of these devices as the use of a tool in therapy is amazing.

However, think about the last time you or a colleague lost a smartphone or tablet – even for a minute. Then think about how much worse it would feel if there was any sort of client information accessible on that device. Always keep in mind that the combination of tiny, fragile computers, HIPAA, and ethics can make these devices a significant liability if they are not managed properly. Many of the apps I talk about here keep some sort of data on your device; most of them only allow you to manually wipe data. There are some otherwise secure ways to access client files on your phone or tablet if you are out of the office – but if any random person can access your phone, then you can be in significant trouble.

You’ll need to remember one rule: there is no electronic security that is ever 100% risk-free. Every day we see about a shopping site, or a bank, or a gaming company that gets hacked. It’s just a reality that we have to account for, and in an odd turn of events, both ethics and law understand that electronic security is never going to be an absolute thing. There are three things that you need to do in order to limit the dangers to confidentiality and privacy inherent in these devices:

1. Implement a device-level passcode of some sort. Apple products allow you to create a PIN that is required to access the device. Android products also let you use a PIN. Most Android products also have the ability to create a pattern-based passcode that even the FBI can’t crack. (UPDATE August 2012: Not anymore).
2. Disable auto-login on any software that can access data that is best kept private (yours or the client’s. It’s just good practice).
3. Make sure that clients are aware of the unique risks of lugging around data on their phone that they might want to keep private, and advise them of these security features. While paper homework that you give clients might be pretty safe, kids, friends, and partners regularly pick up someone else’s phone. (Keep in mind that a partner could become worried if a person suddenly puts a passcode on their phone, and be ready to defuse that).

A final important point: neither law or ethics codes have kept up with the fast pace of technology or the widespread use of insecure communication tools. SMS (text messaging) is a currently relevant example. If you are going to use SMS or similarly insecure methods to communicate with a client (like some really cool recent research in the medical and mental health fields), make sure that they are aware of the risks involved. Most likely, they’ll want to have these tools available to them anyway.

An Introduction

Hi there!

While this blog is conceptualized as a resource for professionals, I understand that a number of non-professional individuals are going to happen across this site, either by chance, or because they want to find a review of an app that they found on the iTunes or Play store. That’s great, and I’m happy to see all of you!

For those of you who are not mental health professionals: before you get too far into the other material on this site, I want to make something clear. One of the things that I teach my graduate students is that they should never say anything to a client without knowing why they are saying it. Put briefly, this means that there is a combination of science and art behind successful therapy, and there is no science to using any self-help tool on its own.

Don’t  get me wrong – I believe that there are many excellent self-help tools, and sometimes all you need is a little self-organized kick to right the ship. However, some people are looking for tools like this because they are desperate or in another way genuinely need help. I also believe that these tools work exponentially better when there is a professional to help frame the use of these tools. As I try to remind my readers as often as possible, nothing that I review here is a replacement for help from a qualified, licensed professional.

For mental health professionals: I decided to start this blog one day when I was demonstrating a cool CBT-based Android app to a colleague. After this, I searched for a blog like this and found that while there are many standalone stories on blogs and other websites about “therapy apps,” there is no single repository to seek opinions about this or that tool on any app store. I have long used a blog like this to find apps for my young son to play with, and thought it would be useful to have a similar tool for mental health practitioners.

As I noted above to the non-professionals, it’s important to remember that there is little or no science behind the use of these tools in therapy. I don’t see anything that I will ever review as being a standalone treatment tool, or even a replacement for a treatment manual if you tend to use that sort of thing. I see these apps as modern homework rather than anything else (although I view homework as a central piece of treatment).