Evaluation of the Department of Veterans Affairs Mental Health Services (2018) / Chapter Skim
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14 Health Technology for Mental Health Care
14 Health Technology for Mental Health Care
Pages 293-310
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This chapter describes the current state of health technology at the VA as well as some of the barriers throughout the system that may inhibit the wider use of health technology among veterans and providers. It also summarizes committee site visits and survey findings related to health technology.
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In its assessment of VA health IT, MITRE determined that the VistA Evolution program is "not adequately staffed or organized to successfully manage the development and integration of a such a large complex software program, which increases the risk of schedule delays or failed delivery of clinical IT capabilities" (MITRE Corporation, 2015, p.
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A majority of VA-delivered tele-mental health, however, is general or specialty mental health care delivered from a VAMC to a CBOC primarily via videoconference. In 2008 the VA created a comprehensive National Telemental Health Training Program to teach clinicians best practices in delivering tele-mental health (Godleski, 2012)
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. For PTSD treatment, the VA National Telemental Health Center is promoting the delivery of prolonged exposure therapy and cognitive processing therapy via tele-mental health, particularly to veterans in rural areas where these therapies may not be otherwise available (IOM, 2014)
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(2011) evaluated group cognitive processing therapy delivered to veterans via telehealth and found no significant differences in clinical or process outcome variables.
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The off-site collaborative PTSD specialist teams included a nurse care manager, clinical pharmacist, telepsychologist, and telepsychiatrist. While both treatment groups improved, veterans randomized to the TOP intervention experienced significantly greater improvement in PTSD and depression severity, albeit with small to medium effect sizes.
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, the VA's annual survey of veterans served by the VA, asks veterans to rate the statement, "I talk to my counselor/therapist by Telemental health," using a scale of 1 to 5, where 1 is strongly disagree, 5 is strongly agree, and 3 is neither. For FY 2016,1 the VA reported a mean rating of 2.27 (standard deviation = 1.33)
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In East Orange, New Jersey, the VAMC created a special women's telehealth initiative in 2012 explicitly to improve service access for women veterans, particularly those living in rural areas. Selfassessment data from the site visit indicated that in FY 2014, the New Jersey VAMC provided tele-mental health services to 107 unique women veterans.
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OTHER HEALTH TECHNOLOGY IN USE AT THE DEPARTMENT OF VETERANS AFFAIRS The use of technology by the VA to deliver and manage mental health treatment extends beyond tele-mental health. The VA is also using websites and mobile smartphone applications ("mHealth")
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Interestingly, 20 percent of Blue Button users shared their health information from Blue Button with their non-VA providers -- 87 percent of whom reported that their non-VA providers found this to be helpful. Veteran computer literacy was the greatest predictor of using Blue Button and sharing information with non-VA providers.
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. In a study of PE Coach, a smartphone app designed as a treatment companion for patients receiving prolonged exposure therapy, most providers agreed that using the app would offer a relative advantage compared to existing prolonged exposure (PE)
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Similarly, podcasting and e-mail outreach are ways to distribute information and reach at-risk populations. The authors also described smartphone apps that help users self-assess and monitor psychiatric symptoms, text messaging services that people in crisis can use to seek help or report incidents, and "virtual worlds" that allow users to interact with each other via avatars and provide suicide prevention information and support.
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. Site Visit and Survey Findings Interviewees described numerous technological and bureaucratic challenges regarding the implementation and use of telehealth services at the VA, and the committee's site visits revealed variability in the knowledge, use, and implementation of telemedicine across the VA system: One of the biggest challenges is some [veterans]
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SUMMARY This chapter describes the state of health technology at the VA as well as some of the barriers throughout the system that may inhibit the wider use of health technology among veterans and providers. It also summarizes committee site visits and survey findings related to health technology.
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2016. Centrally assisted collaborative telecare for posttraumatic stress disorder and depression among military personnel attending primary care: A randomized clinical trial.
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2014. Cognitive processing therapy for posttraumatic stress disorder delivered to rural veterans via telemental health: A randomized noninferiority clinical trial.
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2010. A pilot study of prolonged exposure therapy for posttraumatic stress disorder delivered via telehealth technology.
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2015. Randomized controlled trial of home-based telehealth versus in-person prolonged exposure for combat-related PTSD in veterans: Preliminary results.
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