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Methodology for Evaluating Models of Telemental Health Delivery Against Population and Healthcare System Needs: Application to Telemental Healthcare for Rural Native Veterans.

https://arctichealth.org/en/permalink/ahliterature294503
Source
Telemed J E Health. 2018 Aug 21; :
Publication Type
Journal Article
Date
Aug-21-2018
Author
Jay H Shore
Cynthia W Goss
Nancy K Dailey
Byron D Bair
Author Affiliation
Veterans Rural Health Resource Center-Salt Lake City, Veterans Health Administration Office of Rural Health , Salt Lake City, Utah.
Source
Telemed J E Health. 2018 Aug 21; :
Date
Aug-21-2018
Language
English
Publication Type
Journal Article
Abstract
Rural American Indian and Alaska Native (AI/AN) Veterans face exceptional barriers to receiving quality mental healthcare. We aimed to identify models of in-person and telemental health service delivery with promise for adaptation and wide dissemination to rural AI/AN Veterans.
Our method for matching specific populations with models of care includes (1) selecting frameworks that represent the healthcare organization's goals, (2) identifying relevant service delivery models for the target population(s), (3) assessing models against the selected frameworks, and (4) summarizing findings across models. We applied this approach to rural AI/AN Veteran populations.
Searches identified 13 current models of service delivery for rural AI/AN Veteran, rural AI/AN, and general rural Veteran populations. These models were assessed against four frameworks-the U.S. Department of Veterans Affairs' Office of Rural Health's Promising Practices, Veterans Health Administration's Guide to Mental Health Services, the Institute for Healthcare Improvement's Triple Aim Framework, and the American Indian Telemental Health Clinic framework.
The one model used for service delivery for rural AI/AN Veterans increases access and is patient-centered but lacks operational feasibility. Models for rural AI/ANs also increase access and are patient-centered but generally lack effectiveness evaluations. Models for rural Veterans demonstrate beneficial effects on mental health outcomes but do not emphasize cultural adaptations to diverse populations.
Our approach to selecting models of service delivery considers the needs of operational partners as well as target populations and emphasizes large-scale implementation alongside effectiveness. Pending further testing, this approach holds promise for wider application.
PubMed ID
30129880 View in PubMed
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Outcomes and Lessons Learned from the Tribal Veterans Representative Program: A Model for System Engagement.

https://arctichealth.org/en/permalink/ahliterature301305
Source
J Community Health. 2019 Jun 21; :
Publication Type
Journal Article
Date
Jun-21-2019
Author
Cynthia W Goss
W J Richardson
Jay H Shore
Author Affiliation
U.S. Department of Veterans Affairs (VA) Office of Rural Health's (ORH), Veterans Rural Health Resource Center in Salt Lake City, Salt Lake City, Utah, USA. cynthia.goss@ucdenver.edu.
Source
J Community Health. 2019 Jun 21; :
Date
Jun-21-2019
Language
English
Publication Type
Journal Article
Abstract
American Indian and Alaska Native Veterans are more rural than Veterans of any other race or ethnicity and face significant barriers to accessing care. Since 2001, the Tribal Veterans Representative (TVR) Program, a partnership between the U.S. Department of Veterans Affairs (VA) and tribal nations, has trained liaisons from tribal communities to facilitate access to VA benefits and services. We delineate the TVR program model alongside supporting data. We reviewed TVR training materials and program evaluations to identify components of the program essential for increasing access to VA services and benefits. We then report a quantitative assessment of benefits attained in one tribal community. The TVR model is characterized by the exchange of two sets of knowledge and resources-'institutional' and 'community'-during a co-sponsored educational program aiming to train community liaisons about the institution. The institution leads the program's content; the community's traditions inform its process. Following the program, liaisons use support networks comprising trainers, trainees and local organizations to teach other community members to access health care and benefits. In the evaluation community, one liaison has facilitated access for hundreds of Veterans, with financial compensation exceeding $400,000 annually. The TVR program has begun to demonstrate its utility for other rural populations, though further formal evaluation is recommended. Compared with similar models to increase rural populations' access to health care and benefits, the long-term support networks from the TVR model may be most useful when the institution must build trust and engage with the target population.
PubMed ID
31227961 View in PubMed
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Rural American Indian and Alaska Native veterans' telemental health: A model of culturally centered care.

https://arctichealth.org/en/permalink/ahliterature291579
Source
Psychol Serv. 2017 Aug; 14(3):270-278
Publication Type
Journal Article
Date
Aug-2017
Author
Cynthia W Goss
W J Buck Richardson
Nancy Dailey
Byron Bair
Herbert Nagamoto
Spero M Manson
Jay H Shore
Author Affiliation
Veterans Rural Health Resource Center.
Source
Psychol Serv. 2017 Aug; 14(3):270-278
Date
Aug-2017
Language
English
Publication Type
Journal Article
Keywords
Alaska Natives
Culturally Competent Care
Health Services Accessibility
Health services needs and demand
Humans
Indians, North American
Mental health services
Models, Theoretical
Rural Population
Stress Disorders, Post-Traumatic - psychology - therapy
Telemedicine
United States
United States Department of Veterans Affairs
Veterans - psychology
Veterans Health
Abstract
American Indian and Alaska Native (AI/AN) veterans living in rural areas have unique health care needs and face numerous barriers to accessing health care services. Among these needs is a disproportionate prevalence of posttraumatic stress disorder and other mental illnesses. Since 2001, 14 rural communities have partnered with the U.S. Department of Veterans Affairs and the Centers for American Indian and Alaska Native Health at the University of Colorado Anschutz Medical Campus to extend telemental health clinics to American Indian veterans. Administrative and, to some extent, clinical considerations of these clinics have been reviewed previously. This paper describes a model of care, evolved over a 14-year period, that weaves together evidence-based Western treatment, traditional Native healing, and rural Native communities into 4 main components: mental health care, technology, care coordination, and cultural facilitation. We delineate improvements to care made by addressing barriers such as system transference, provider-patient trust, and videoconferencing. Similarly, the discussion notes ways that the care model leverages strengths within Native communities, such as social cohesion and spirituality. Future steps include selection of appropriate performance indicators for systematic evaluation. The identification of key constructs of this care model will facilitate comparisons with other models of care in underserved populations with chronic and complex health conditions, and eventually advance the state of care for our warriors. (PsycINFO Database Record
PubMed ID
28805411 View in PubMed
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Rural American Indian and Alaska Native veterans' telemental health: A model of culturally centered care.

https://arctichealth.org/en/permalink/ahliterature285035
Source
Psychol Serv. 2017 Aug;14(3):270-278
Publication Type
Article
Date
Aug-2017
Author
Cynthia W Goss
W J Buck Richardson
Nancy Dailey
Byron Bair
Herbert Nagamoto
Spero M Manson
Jay H Shore
Source
Psychol Serv. 2017 Aug;14(3):270-278
Date
Aug-2017
Language
English
Publication Type
Article
Abstract
American Indian and Alaska Native (AI/AN) veterans living in rural areas have unique health care needs and face numerous barriers to accessing health care services. Among these needs is a disproportionate prevalence of posttraumatic stress disorder and other mental illnesses. Since 2001, 14 rural communities have partnered with the U.S. Department of Veterans Affairs and the Centers for American Indian and Alaska Native Health at the University of Colorado Anschutz Medical Campus to extend telemental health clinics to American Indian veterans. Administrative and, to some extent, clinical considerations of these clinics have been reviewed previously. This paper describes a model of care, evolved over a 14-year period, that weaves together evidence-based Western treatment, traditional Native healing, and rural Native communities into 4 main components: mental health care, technology, care coordination, and cultural facilitation. We delineate improvements to care made by addressing barriers such as system transference, provider-patient trust, and videoconferencing. Similarly, the discussion notes ways that the care model leverages strengths within Native communities, such as social cohesion and spirituality. Future steps include selection of appropriate performance indicators for systematic evaluation. The identification of key constructs of this care model will facilitate comparisons with other models of care in underserved populations with chronic and complex health conditions, and eventually advance the state of care for our warriors. (PsycINFO Database Record
PubMed ID
28805411 View in PubMed
Less detail