It is also recommended that information about the veteran’s Internet connection, type of computer, type of software, presence of a camera and speakers, e-mail address, and access to secure messaging are obtained. During the initial contact with a veteran, the provider will discuss the rules and requirements to ensure HIPAA compliance. The veteran will need to have a private area for the call (not a restaurant, car, or other place where Wi-Fi is offered). Even with these discussions, some veterans will initiate services from a public place or a room in their home where family members will enter and exit frequently.
Although not required, it is recommended to have the veteran identify a primary support person and complete a release form to allow the TMH provider to contact that person in an emergency. The support person may be a person in the home (adult family member or caregiver) or someone nearby (neighbor, friend, or family member) who can contact emergency services if needed. After the necessary information is gathered and the veteran agrees to the conditions of participation, a test call will be completed. The TMH provider is often the person to conduct this call, but if available, a telehealth technician or facility telehealth coordinator may assist. The TMH provider may help the veteran download the appropriate software that is sent from the VA Scheduler software. The veteran initiates the call with the provider. Once the connection is made, the session may begin. Sites that are currently conducting in-home services have provided guides to veterans and newer TMH providers to outline the necessary steps for initiating services.
It is recommended that any provider interested in providing in-home TMH services use the Office of Technological Services help desk to assist in troubleshooting difficulties with connectivity. Challenges have included the software used for in-home TMH, periodic Internet outages, and compatibility issues.
Veteran Satisfaction
Veteran satisfaction was measured through a self-report satisfaction survey. The survey included 12 questions assessing overall experience in using TMH services. Eleven of the 12 questions included a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree); the last question was openended for additional comments.
A summary of the survey response of the initial 29 veterans who received TMH services suggested the following: (1) Veterans felt comfortable with using the TMH equipment and were able to see their clinician clearly; (2) Technical assistance was sufficient; (3) During the TMH session, they related to the provider as if it were a face-to-face meeting and that their needs were met; and (4) Veterans reported extremely high satisfaction with TMH and would refer TMH care to other veterans. Veterans found clinic locations very convenient and preferred the TMH modality of mental health services delivery to the alternative of travelling a long distance to see their provider (Table 4).
Written comments and recommendations from veterans supported the survey results. Most reported that they saved time and the convenience of the clinic allowed them to receive the treatment they need without interfering with their work schedule. However, some veterans still experienced trouble with travel to the remote clinic. Others felt their experience was different from the one they expected or they had a good experience via TMH but preferred face-to-face care.