NYC use of virtual patient avatars to train PCPs on managing treatments of patients with trauma-related mental health disorders

Every year, more than 57 million American adults suffer from a diagnosable mental disorder, yet 62% of them go untreated, creating a significant public health challenge. This challenge is exacerbated following large-scale traumatic events, such as 9/11 or, most recently, Hurricane Sandy that can lead to a surge in the number of patients seeking help for physical ailments, which, in fact, may be masking underlying mental health disorders. Primary care providers (PCP), acting as the first point-of-care for nearly half of the U.S. patient population, are in a unique position to change this paradigm by identifying patients with mental health disorders and developing treatment plans that integrates mental health treatment.

To address the need for better detection and referral, the New York City Department of Health and Mental Hygiene developed in collaboration with a simulation company, an online role-playing training simulation to train PCPs in identifying and managing the treatment of patients with the four most common trauma-related mental health disorders: Post-Traumatic Stress Disorder, depression, substance and alcohol abuse disorders, and Generalized Anxiety Disorder. In addition to learning to identify warning signs and discuss treatment options, PCPs are taught how to engage in collaborative decision-making, conduct follow-up care, and apply effective conversation tactics to increase patient engagement, trust, and adherence to treatment plans. This is accomplished by the providers interacting and role-playing in conversations with emotionally responsive, fully animated patient avatars that act and respond like real patients in distress.

The simulation was launched in 01/13 and is currently disseminated in NYC through partnerships with hospital and healthcare networks. Data is being collected on the effectiveness of the training. On a small matched sample (n = 8 pairs) all measures are trending towards significance. A power analysis was conducted with the criterion for significance of alpha=0.05. The analysis revealed that with a sample size of 30 pairs, the study will have power of 89.5% to yield statistically significant results. Thus, in comparing pre/post training differences we expect significant increases in the PCP's ability to 1) identify risk factors and warning signs of trauma-related mental health disorders, 2) screen patients for trauma-related mental health disorders, 3) discuss treatment options, 4) engage in collaborative decision-making about treatment plans, and 5) build intrinsic motivation in patients to adhere to a suggested treatment plan.