A Pilot Project to Improve Access to Telepsychotherapy at Rural Clinics
Open accessAbstract
Background: The U.S. Department of Veterans Affairs (VA) has pioneered telemental health (TMH) with over 500,000 TMH encounters over the past decade. VA community-based outpatient clinics were established to improve accessibility of mental healthcare for rural Veterans. Despite these clinics clinics and increased availability of TMH, many rural Veterans have difficulty receiving mental healthcare, particularly psychotherapy. Materials and Methods: Twelve therapists participated in a pilot project using TMH technologies to improve mental healthcare service delivery to rural Veterans treated at six community clinics. Therapists completed online training, and study staff communicated with them monthly and clinical leaders every other month. Therapists completed two questionnaires: before training and 10 months later. This article describes barriers and facilitators to the implementation of the project, as well as therapists' knowledge, confidence, and motivation regarding TMH. Results: Two clinicians were offering telepsychotherapy after 10 months. At all six sites, unanticipated organizational constraints and administrative barriers delayed implementation; establishing organizational practices and therapists' motivation helped facilitate the process. Adopters of the project reported more positive views of the modality and did not worry about staffing, a concern of nonadopters. Conclusions: Despite barriers to implementation, lessons learned from this pilot project have led to improvements and changes in TMH processes. Results from the pilot showed that therapists providing telepsychotherapy had increased confidence, knowledge, and motivation. As TMH continues to expand, formalized decision-making with clinical leaders regarding project goals, better matching of therapists with this modality, and assessment of medical center and clinic readiness are recommended.
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In addition, 11 studies did not specify the analysis method used to analyze the data.
“In addition, 11 studies did not specify the analysis method used to analyze the data [33,41-50].”
From Barriers to and facilitators of user engagement with digital mental health interventions: Systematic review (2021) · cites this paper as [42]
Other implementation factors were administrative barriers and barriers related to the organization in which the intervention was or would be implemented.
“Other implementation factors were administrative barriers [42,118,129,211] and barriers related to the organization in which the intervention was or would be implemented [118,122,135].”
From Barriers to and facilitators of user engagement with digital mental health interventions: Systematic review (2021) · cites this paper as [42]
Cites
Fostering empowerment in online support groups
Barak, A., Boniel-Nissim, M., & Suler, J. (2008) · Computers in Human Behavior · doi:10.1016/j.chb.2008.02.004 · Cited by 778 · see citing works
Gagnon, M.-P., Desmartis, M., Labrecque, M., Car, J., Pagliari, C., Pluye, P., Frémont, P., Gagnon, J., Tremblay, N., & Légaré, F. (2012) · Journal of Medical Systems · doi:10.1007/s10916-010-9473-4 · Cited by 637 · see citing works
Videoconferencing psychotherapy: a systematic review
Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Ross, B., Zuest, D., Rice-Thorp, N. M., Lohr, J., & Thorp, S. R. (2012) · Psychological Services · doi:10.1037/a0027924 · Cited by 586 · see citing works
Tuerk, P. W., Yoder, M. S., Ruggiero, K. J., Grös, D. F., & Acierno, R. E. (2010) · Journal of Traumatic Stress · doi:10.1002/jts.20494 · Cited by 209 · see citing works
Psychotherapy mediated by remote communication technologies: a meta-analytic review
Bee, P. E., Bower, P., Lovell, K., Gilbody, S., Richards, D., Gask, L., & Roach, P. (2008) · BMC Psychiatry · doi:10.1186/1471-244x-8-60 · Cited by 189 · see citing works
Godleski, L., Darkins, A. W., & Peters, J. (2012) · Psychiatric Services · doi:10.1176/appi.ps.201100206 · Cited by 153 · see citing works
Deen, T. L., Godleski, L., & Fortney, J. C. (2012) · Psychiatric Services · doi:10.1176/appi.ps.201100458 · Cited by 52 · see citing works
Morland, L. A., Greene, C. J., Rosen, C., Mauldin, P. D., & Frueh, B. C. (2009) · Contemporary Clinical Trials · doi:10.1016/j.cct.2009.06.006 · Cited by 47 · see citing works
A team approach to quality improvement.
Schwarz, M., Landis, S. E., & Rowe, J. E. (1999) · PubMed · Cited by 17 · see citing works
TELEMENTAL HEALTH: Delivering Mental Health Care at a Distance
Smith, H. A., & Allison, R. A. (1998) · Cited by 15 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Evaluating barriers to adopting telemedicine worldwide: A systematic review
Scott Kruse, C., Karem, P., Shifflett, K., Vegi, L., Ravi, K., & Brooks, M. (2018) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x16674087 · Cited by 1,735 · see citing works
Borghouts, J., Eikey, E., Mark, G., De Leon, C., Schueller, S. M., Schneider, M., Stadnick, N., Zheng, K., Mukamel, D., & Sorkin, D. H. (2021) · Journal of Medical Internet Research · doi:10.2196/24387 · Cited by 1,069 · see citing works
“As seen in Multimedia Appendix 2, the 208 articles included in this review [27-237] reported on 2 types of user studies: (1) 69 studies were needs assessments that aimed to understand user needs and attitudes toward DMHIs without or before engaging with a specific intervention as part of a study and (2) 135 studies we…”
BackgroundA systematic review of providers’ attitudes toward telemental health via videoconferencing.
Connolly, S. L., Miller, C. J., Lindsay, J. A., & Bauer, M. S. (2020) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12311 · Cited by 389 · see citing works
Pierce, B. S., Perrin, P. B., Tyler, C. M., McKee, G. B., & Watson, J. D. (2021) · American Psychologist · doi:10.1037/amp0000722 · Cited by 374 · see citing works
Vis, C., Mol, M., Kleiboer, A., Bührmann, L., Finch, T., Smit, J., & Riper, H. (2018) · JMIR Mental Health · doi:10.2196/mental.9769 · Cited by 183 · see citing works
Perry, K., Gold, S., & Shearer, E. M. (2020) · Journal of Clinical Psychology · doi:10.1002/jclp.22770 · Cited by 111 · see citing works
Lindsay, J. A., Kauth, M. R., Hudson, S., Martin, L. A., Ramsey, D. J., Daily, L., & Rader, J. (2015) · Telemedicine and e-Health · doi:10.1089/tmj.2014.0114 · Cited by 66 · see citing works
Self-citationBringing chronic-pain care to rural veterans: A telehealth pilot program description.
Glynn, L. H., Chen, J. A., Dawson, T. C., Gelman, H., & Zeliadt, S. B. (2021) · Psychological Services · doi:10.1037/ser0000408 · Cited by 40 · see citing works
- Authors
- Adler, G., Pritchett, L. R., Kauth, M. R., & Nadorff, D.
- Affiliations
- Baylor College of Medicine (US)
- Corresponding author
- Adler, Geri
- Venue
- Telemedicine and e-Health
- Publisher
- SAGE Publications
- Published
- 2014-01
- Volume
- 20
- Issue
- 1
- Pages
- 83-85
- ISSN
- 1530-5627 (ISSN-L)
- 1556-3669
- PMC
- PMC3880058
- OpenAlex
- W1427892224
- Cited by
- 48
- References
- 10
- Citations by year
- 2026: 4 · 2025: 1 · 2023: 8 · 2022: 6 · 2021: 8 · 2020: 11 · 2019: 2 · 2018: 3 · 2016: 2 · 2015: 3
- FWCI
- 1.70
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Telemedicine Journal and e-Health (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs (CIN13-413)
- Office of Research and Development (CIN 13-413)
- NIH Clinical Center
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- telepsychotherapy, telemental health, rural veterans, veterans' mental health services, community-based outpatient clinics, implementation barriers and facilitators, therapist training, organizational constraints, clinical leadership, telehealth adoption
- MeSH terms
- Adult, Attitude of Health Personnel, Female, Health Services Accessibility, Humans, Inservice Training, Male, Mental Health Services, Middle Aged, Pilot Projects, United States, United States Department of Veterans Affairs, Veterans, Telemedicine, Rural Health Services
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