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Improving Access to Telemental Health Services for Veterans Residing in Rural Settings

The delivery of mental health services through telehealth is one of the top priorities for VA. Telemental health (TMH) offers an opportunity to increase access to mental healthcare, especially for Veterans living in rural settings, and has been shown to be effective in patients with a wide variety of mental conditions. It also addresses priorities in VA's Blueprint for Excellence by creating healthcare networks that improve access, timeliness, efficiency, and flexibility, while addressing Veteran demographics and preferences.

Currently, there is lack of standardization in the way telemental health services are implemented into VA community-based outpatient clinics (COBCs) located in rural settings. Lack of standardization makes the comparison of programs and collection of meaningful outcome information difficult. The National Telehealth Training and Resource Center (NTTRC) developed the Clinic-Based Telehealth Operations Manual and Tele-mental Health Supplement (CBT-OM) to help guide implementation of telehealth programs to meet national VA standards. All VA Telehealth programs are required to comply with this internal accreditation process.

VISN 20 leadership has requested help in developing a system that promotes systematized implementation of TMH services that meets the national VA standards. The QUERI for Team-Based Behavioral Health program will assist VISN 20 in implementing TMH programs in three rural CBOCs using an evidence-based, implementation facilitation model (external/internal facilitators) that complies with VA's telehealth accreditation process. In addition, this project will provide feedback to the NTTRC on how to update the CBT-OM for other VISNs interested in implementing telemental health services into CBOCs that serve Veterans in rural settings.

Project investigators will apply the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) analytic framework to determine the degree to which these quality improvement efforts have been successful. They also will measure baseline contextual factors at each site, as well as characteristics of CBOC and telemental health providers - both before and after implementation of this intervention. Most importantly, this project will improve access and engagement in mental healthcare for Veterans who might not otherwise be able to receive care. Moreover, this project will ensure implementation of telemental health services that are consistent with national VA recommendations. While this project will certainly advance the provision of this type of care in VISN 20, it may also have national impact, as investigators plan that the modified CBT-OM and Telemental Health Operations Manual supplement will be disseminated nationally through NTTRC training and dissemination.

For more information, please contact Principal Investigator, QUERI for Team-Based Behavioral Health, Bradford Felker, MD, at Bradford.Felker@va.gov , or Kathy Henderson, MD, at Kathy.Henderson@va.gov .