Palliative Care

Psychotherapy Telemental Health Center and Regional Pilot

Fed Pract. 2015 July;32(7):48-55

References

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The various steps necessary to address TMH clinical issues are summarized in Table 2.

VISIN 22 Pilot Project

The VISN 22 EBP TMH Center and Regional Pilot, based at the VA San Diego Healthcare System, was tasked with developing and providing TMH EBP services for PTSD across VISN 22 and adjacent West Coast VISNs. In addition to creating standardized procedures, troubleshooting guides were established to assist other programs with implementation. The primary focus was to increase access to EBPs for veterans with PTSD in areas where there was either no available trained providers or delays for specific services. The program established 16 clinics as well as in-home
services in VISN 22, VISN 21, and VISN 20. In fiscal year (FY) 2013, the VISN 22 EBP TMH Center and Regional Pilot provided 1,657 EBP encounters via TMH to 234 unique veterans with PTSD (Table 3).

The pilot project collected data to evaluate program effectiveness. The data were de-identified before being sent to the VA Central Office (VACO) TMH program manager. The following items were collected for the pilot: (1) clinical information; (2) consent to engage in treatment and telehealth; (3) release of information to share de-identified data to VACO for program monitoring; (4) demographic form; (5) Beck Depression Inventory-II (every other week); (6) PTSD Checklist (every other week); (7) World Health Organization Quality of Life (sessions 1, 7, final); (8) Wechsler Adult Intelligence Scale-Revised (sessions 3, 7, final); (9) satisfaction survey (final); (10) mileage not driven by veterans who receive TMH services; (11) travel pay saved by VA; (12) no-show rates; and (13) veteran, TMH provider, and referral provider satisfaction.

The growth in number of encounters and number of unique veterans has increased steadily from the first quarter of FY14 through the second quarter of FY15 (Figure 1).

In January 2013, in-home TMH services were piloted. Although occasional technical difficulties occurred, 143 EBP encounters via TMH were provided to 42 unique veterans in 2013. The service has continued to expand, and in the first half of FY14, services were provided to 64 unique veterans for a total of 278 encounters, saving veterans 3,220 travel miles and saving the VA $1,336 in travel reimbursement. In-home TMH services will continue to expand as more providers in a variety of programs are being trained by the San Diego staff on how to provide these services to veterans in their homes. In addition to decreasing mileage and travel pay, the no-show rates are lower for TMH appointments in general (averaged 8%-10% vs facility no-show rate average of 13.5%) and with the use of inhome TMH, no-show rates were kept to 2%. The growth in the number of in-home encounters and the number of unique veterans has also increased steadily from the first quarter of FY14 thru the second quarter of FY15 (Figure 2).

In-Home TMH Services

The VISN 22 EBP TMH Center and Regional Pilot often requests to have an in-person meeting with a veteran before starting TMH services in order to complete a waiver to download the software used by the VA for real-time video in-home services, a Release of Information for a Primary Support Person form, and an emergency plan.