Clinical Services

Oral Presentation

(CS1-01) Serving Veterans Where They Live: Implementing Video Telehealth to Deliver Evidence-Based Psychotherapy

Sunday, April 23
10:15 AM - 10:34 AM
Location: W224 AB

Objectives
Mental health (MH) treatment is one of the most prevalent, costly conditions for the Veterans Health Administration. Logistical and sociocultural barriers limit access to MH care for rural patients needing treatment. VA Video, which enables the connection between a VA provider and a Veteran over videoconferencing technology in their home or other remote, secure location, effectively increases Veterans’ access to care, especially delivery of MH care. Disseminating telehealth in a complex healthcare system such as the VA is challenging, and development of specific implementation strategies is necessary to overcome the difficulty of bringing evidence-based treatments and new technologies that support patient care into standard practice. The overall goal of this project was to implement a VA Video to Home program to increase access to mental health care for under served rural Veterans seeking care at the Jackson, Mississippi VA and its associated community-based outpatient clinics (CBOCs).


Methods
This project was guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework and employed Implementation Facilitation (IF) strategies to establish a sustainable, effective home telehealth service designed to deliver EBPs, specifically to rural Veterans. The project was conducted at a VA medical center in the South Central United States, which serves a large proportion of rural Veterans. To evaluate the effectiveness of our implementation intervention, we collected patient encounter and demographics data from the national telehealth database. We calculated the slopes to capture the growth over time for the site receiving the implementation intervention and compared it to the national average.

Results
Over an 18-month period, a robust video telehealth into the home service was established to provide greater access to EBPs, including Cognitive Processing Therapy, Prolonged Exposure therapy, Interpersonal Therapy, and Cognitive-Behavioral Therapy for depression, anxiety, and insomnia are among the evidence-based psychotherapies being conducted via VA Video. Eighty-seven Veterans (85% rural) received mental health treatment via VA Video for nearly 500 visits. We were able to reach a diverse population, including women (29%), a broad range of ages (21-72) and more than 50% ethnic minority Veterans. Compared to national average, the growth in VA Video to the Home visits was 5-times greater (p < .0001).

Conclusion
To our knowledge, this is the first prospective study of facilitation as an implementation strategy for telehealth into the home. Our findings suggest that implementation facilitation is an effective and acceptable strategy to support providers as they establish clinics and make complex practice changes, such as implementing video telehealth to deliver psychotherapy.

Jan A. Lindsay

Assistant Professor
Baylor College of Medicine

Jan Lindsay, PhD is an Assistant Professor at Baylor College of Medicine and a Clinical Research Psychologist at the Michael E. DeBakey VA Medical Center in Houston. She is also an Investigator at the SC MIRECC and Houston's HSR&D Center of Innovation. Dr. Lindsay focuses on the implementation of telehealth to increase access to evidence-based behavioral health treatments. Her research and clinical work leverages innovative technologies to improve effectiveness of mental health treatment, specifically video telehealth, web-based programs, and mobile applications.

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