Current Practices, Perceptions and Challenges of Telehealth in the Treatment of Mental Health in the U.S. Department of Veterans Affairs

Currently there are 17,964,242 million Veterans living in the U.S. Around 50% of these Veterans are over 65 years of age. Many U.S. service members – both active and retired, experience trauma and dysfunction in restructuring their lives. Mental health problems are reported in over 50% of Veterans both in active service and retired. According to the U.S. Department of Veterans Affairs (VA), ten times more suicides are reported among Veterans who did not register with the VA compared to those who do register. Longer deployments, shorter times at home between the deployments and combat exposure are the greatest contributors of physical and psychological health problems. Combat exposure has been linked with most cases of PSTD. This creates a greater need for mental health services to Veterans than any other forms of treatment. Due to the complex nature of Veterans population, characterized by an aging majority and location of many Veterans in rural areas, delivering mental health services is a huge challenge for the VA. The VA has been making efforts to ensure that all Veterans can access mental health services from where they are. Out of these efforts, integration of telehealth services to improve access to mental health care services has yielded promising results but this is not without challenges. This dissertation explores the current practices, perceptions and challenges of telehealth in the treatment of mental health in the U.S. Department of Veterans Affairs (VA)

Achieving Behavioral Health Care Integration in Rural America

Integrating primary care services and treatment for mental health and substance use conditions not only enhances patients' access to needed care but also improves health outcomes in a cost-effective way. Yet the barriers to integrated care are substantial, and it is even more difficult to achieve in rural and frontier communities, which are home to 1 in 7 Americans.Our current work focuses on breaking down the barriers to integration in rural America, where the health care infrastructure and provider composition vary in distinct ways from urban and suburban areas. Americans in rural areas face significant shortages of psychiatrists, psychologists, clinical social workers, and other behavioral health specialists. More than 60% of nonmetropolitan counties lack a psychiatrist, and almost half of nonmetropolitan counties do not have a psychologist, compared with 27% and 19% of urban counties, respectively. These gaps in specialty care force rural residents to rely heavily on primary providers for much of their care

Treating Invisible Wounds: Improving The Cultural Competency Of Non-Va Providers Treating Rural Veterans Through Telepsychiatry

Addressing the mental health needs of veterans is a national priority, especially with respect to rural veterans. There is a compendium of literature that exists in regard to medical providers becoming culturally competent in treating veteran populations. Similarly, much literature also exists on the use of telemedicine, or more specifically, telepsychiatry in healthcare. However, there is a dearth of literature that examines the relationship between providers practicing telepsychiatry and their competency to treat veteran populations, specifically veterans in rural settings. Rural veterans are especially vulnerable to mental health difficulties due to the unique disadvantages they experience in comparison to their urban counterparts. This project aimed to evaluate how an educational curriculum could increase the cultural competency of mental health clinicians towards veteran populations practicing via telepsychiatry in a non-VA organization

Factors Affecting Blood Pressure Target Outcomes for Veterans Using Home Telehealth

Hypertension is the most common diagnosis among Veterans, contributing to approximately 15,000 veterans hospitalized for stroke every year. The high prevalence of hypertension found in the Veteran population suggests a need to better define the risks and benefits associated with the diagnosis and treatment of hypertension. The U. S. Department of Veteran Affairs (VA) home telehealth program provides chronic care management for hypertension to facilitate Veteran access to care. Existing evidence suggests Veterans’ monitoring of blood pressure at home may selectively assist in managing hypertension. This secondary analysis of data used a self-management lens to assign meaning to traditionally demographic variables from a primary study. The purpose of this study was to explore whether the risk and protective factors of age, ethnicity/race, marital status, living arrangement, number of diagnosed chronic illnesses, and number of instrumental activities of daily living impairments, along with the self-management behavior home telehealth utilization rate, contribute to predicting success in maintaining blood pressure targets by Veterans who are participating in home telehealth services to manage hypertension. The sample was 107 Veterans with a mean age of 73.97, years with few participants below the age of 60. The majority of participants were married and living with their spouse or in a living arrangement with others. Most participants were white. Results from this study indicated that success in both outcomes home telehealth utilization rate and maintaining blood pressure targets were partially predicted by age. Age and number of chronic conditions explained 15% of the variance with home telehealth utilization rate and explained 14.4% of the variance with maintaining blood pressure targets. Results also indicated that the outcomes home telehealth utilization and maintaining blood pressure targets were not related; therefore, home telehealth utilization rate was most likely not a mediator between age and maintaining blood pressure targets. Tailored interventions based on age and chronic conditions may impact outcomes for Veterans self-managing blood pressure through VA home telehealth services

Analyzing Veterans Affairs Telehealth Services Between Rural and Urban Centers in West Virginia

Veterans often have difficulty accessing health care within the Veterans Affairs (VA) system, contributing to the growing need for health care services in rural communities. The increasing demand for health care services in rural communities is driven by the aging population, an increase in life expectancy, and an increase in chronic disease. This quantitative study aimed to explore the relationship between the type of appointment and patient location on initial primary care and telehealth primary care wait times for veterans in West Virginia. The two research questions addressed the independent variables, type of appointment (telehealth or face to face) and patient location (urban vs. rural), and the impact, if any, on the dependent variables, initial primary care and telehealth primary care wait time. The independent t test and the Mann-Whitney U test analyzed the data. Secondary data were obtained from VA Informatics and Computing Infrastructure. Donabedian\u27s 1966 framework on structural, process, and outcomes standards applies to access to care and provided the theoretical framework for this quantitative study. Analyses indicated a significant relationship between the type of appointment and the average wait time, as well as patient location and type of appointment. The F2F initial primary care visits were higher than telehealth conducted via telephone visits, and the average wait time was lower in the F2F visits than in those conducted via telehealth/telephone. Also, the wait times were higher for rural patients than for urban patients. The results of this study may lead to positive social change by contributing to a more focused allocation of health care resources through considerations of innovative telehealth services in rural communities

Art Therapy for Veterans in the Military to Civilian Transition: A Literature Review

Although all U.S. military service members eventually return to civilian life, whether they serve 20 years and retire through the military or serve a few enlistments before making a career change, the unique challenges that come with the military to civilian transition are largely overlooked, particularly the accessibility of mental health services during this period. Commonly referred to as separating from the military or “getting out” amongst service members, this stage from active duty to veteran status involves a significant adjustment in lifestyle and responsibilities. Potential gaps in health insurance and income, relocating, supporting their family, and aligning with a new identity in an entirely different workforce are only a few stressors commonly experienced by those in the military to civilian transition. Further research focused on this transitional period, in addition to breaking the stigma on mental health will encourage veterans to seek mental health services if needed and help their families, coworkers, and clinicians learn how to best support them. This literature review explores the challenges and needs expressed by newly separated veterans, the attitude towards mental health in the military culture that consequently creates barriers in seeking care, and how nontraditional options such as teletherapy and art therapy can offer unique solutions for veterans who desire mental health services during civilian reintegration

Relationships Between Interprofessional Teamwork and Clinical Management of

Diabetes mellitus (DM) is a highly prevalent chronic disease that affects 29 million people in the United States including over 2 million veterans who receive care through the Veterans Administration. Patient-aligned care teams (PACTs) are an interprofessional teamwork system designed to improve outcomes of chronic illness, but empirical explorations of the efficacy of the PACTs have been insufficient. Utilizing the chronic care model, the purpose of this retrospective study was to determine if PACTs have been efficient in the diabetic management of veterans receiving care through a Southeastern VA. Medical records for 114 veterans with type 2 DM were randomly selected. A 1-way ANOVA was used to analyze outcomes for 5 evidence-based standards (SBP, DBP, BGL, A1C, & LDL) among 6 outpatient clinics. A repeated measures ANOVA was used for the same 5 evidence-based standards for the clinics to assess if there were any changes from FY2014 to FY2016. Results revealed that blood pressure readings and LDL levels met evidence-based standards, while A1C and BGL levels did not. No significant differences over the 3-year period were noted nor were there significant differences in patterns of performance between the clinics. The findings provide an essential basis for initiating a discussion on the potential of PACTs for the delivery of quality healthcare to U.S. veterans with diabetes and other chronic diseases. Positive social change can result from improving the delivery of healthcare using the PACT model to decrease morbidity, improve clinical outcomes, and increase the quality of life of U.S. veterans with type 2 DM. Future research that examines perceptions of clinical team members, team stability, and the delivery of shared care is warranted