Implementation of Video Telehealth to Improve Access to Evidence-Based Psychotherapy for Posttraumatic Stress Disorder
Open accessAbstract
BACKGROUND: Increasing access to psychotherapy for posttraumatic stress disorder (PTSD) is a primary focus of the Department of Veterans Affairs (VA) healthcare system. Delivery of treatment via video telehealth can expand availability of treatment and be equally effective as in-person treatment. Despite VA efforts, barriers to establishing telehealth services remain, including both provider acceptance and organizational obstacles. Thus, development of specific strategies is needed to implement video telehealth services in complex healthcare systems, like the VA. MATERIALS AND METHODS: This project was guided by the Promoting Action on Research Implementation in Health Services framework and used external facilitation to increase access to psychotherapy via video telehealth. The project was conducted at five VA Medical Centers and their associated community clinics across six states in the South Central United States. RESULTS: Over a 21-month period, 27 video telehealth clinics were established to provide greater access to evidence-based psychotherapies for PTSD. Examination of change scores showed that participating sites averaged a 3.2-fold increase in unique patients and a 6.5-fold increase in psychotherapy sessions via video telehealth for PTSD. Differences between participating and nonparticipating sites in both unique patients and encounters were significant (p=0.041 and p=0.009, respectively). Two groups emerged, separated by degree of engagement in the facilitation intervention. Facilitation was perceived as useful by providers. CONCLUSIONS: To our knowledge, this is the first prospective study of external facilitation as an implementation strategy for telehealth. Our findings suggest that external facilitation is an effective and acceptable strategy to support providers as they establish clinics and make complex practice changes, such as implementing video telehealth to deliver psychotherapy.
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Widespread implementation requires patients to have access to appropriate infrastructure (computer, webcam, data allowance) to participate in a video consultation.
“Additionally, widespread implementation requires patients to have access to the appropriate “infrastructure” to participate in a video consultation (computer, webcam, data allowance) [40].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [40]
Authors reported that support and high-quality training were necessary to achieve widespread growth.
“Authors reported that support and high-quality training were necessary to achieve widespread growth [2,32-43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [40]
Sites with existing video consulting programs and pre-existing routines may be hesitant or slower to implement new technologies and redesign workflows around a new technology.
“Other challenges included how sites with existing video consulting programs and pre-existing routines may be hesitant or slower to implement new technologies and redesign workflows around a new technology [40]”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [40]
Complexity in the organizational domain was managed more effectively when telehealth champions were available, as reported in 11 reviewed articles.
“Complexity in the organizational domain was managed more effectively when telehealth champions were available, as reported in 11 of the reviewed articles [2,33-37,39-43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [40]
At least one challenge or opportunity related to political, regulatory, cultural, contextual, or financial factors was reported in all 13 reviewed studies.
“At least one challenge or opportunity related to political, regulatory, cultural, contextual, or financial factors was reported in all studies (n=13) [2,32-43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [40]
Other telehealth champion roles included health care coordinators or IT staff.
“Other roles included health care coordinators or IT staff [33,35,40,43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [40]
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Jaske, E. L., Wheat, C. L., Rubenstein, L. V., Leung, L. B., Curtis, I., Wahlberg, L., & Felker, B. L. (2024) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2023.0573 · Cited by 6 · see citing works
Strategies for implementation of virtual home visitation in the United States
Traube, D. E., Taylor, A., Cederbaum, J. A., Naish, L., & Rau, A. (2021) · Health & Social Care in the Community · doi:10.1111/hsc.13650 · Cited by 6 · see citing works
Clemmons, N. G., Coates, E. E., & McLeod, A. B. (2023) · Children s Health Care · doi:10.1080/02739615.2023.2179489 · Cited by 6 · see citing works
“…with the prior literature in which telemedicine continued to provide good quality care, while also resulting in beneficial outcomes such as increased participation and improved quality of life (Burgoyne & Cohn, 2020; Demiris, Oliver, Wittenberg-Lyles, & Washington, 2011; Lindsay et al., 2015).”
BackgroundMethodCucciare, M. A., Marchant‐Miros, K., Lindsay, J. A., Craske, M. G., Ecker, A. H., Day, S. C., Hogan, J., Henn, J., LeBeau, R. T., Rabalais, A., et al. (2019) · The Journal of Rural Health · doi:10.1111/jrh.12398 · Cited by 5 · see citing works
Self-citationCarpenter, J. G., Hanson, L. C., Demiris, G., Hodgson, N. A., & Ersek, M. T. (2025) · BMC Geriatrics · doi:10.1186/s12877-025-05820-0 · Cited by 4 · see citing works
Pescatello, M. S., Pedersen, T. R., & Baldwin, S. A. (2020) · Psychotherapy Research · doi:10.1080/10503307.2020.1822559 · Cited by 4 · see citing works
“Available technologies for providing services include websites, video conferencing, computeradministered psychotherapy, and texting apps in addition to face-to-face therapy (Backhaus et al., 2012; Bauer & Moessner, 2013; Khatri et al., 2013; Lindsay et al., 2015; Richards et al., 2016).”
BackgroundHamlett, G. E., Tyler, J., Bredemeier, K., Ballentine, E., & Brown, L. A. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.115044 · Cited by 3 · see citing works
Feasibility of Group-Based Implementation Facilitation for Video Telemental Health
Ecker, A. H., Day, G., Amspoker, A. B., Bryan, J. L., Day, S. C., Wassef, M., Weaver, K. R., & Lindsay, J. A. (2023) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-022-00295-x · Cited by 3 · see citing works
“Although this one-on-one method enabled strong partnerships and personalized facilitation (Lindsay et al., 2015, 2019), it had several limitations.”
MethodSelf-citationSciarrino, N. A., & Myers, U. S. (2023) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2023.87.1.46 · Cited by 3 · see citing works
Implementation strategies for telemental health: a systematic reviewPreprint
Appleton, R., Barnett, P., Juan, N. V. S., Tuudah, E., Lyons, N., Parker, J., Roxburgh, E., Spyridonidis, S., Tamworth, M., Worden, M., et al. (2022) · medRxiv · doi:10.1101/2022.04.29.22274367 · Cited by 3 · see citing works
The American Telemedicine Association ATA 2017 Telehealth 2.0 Conference Abstracts
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Frameworks for Developing Digital Mental Health Interventions
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Haderlein, T. P., Lov, D., Bonilla, A., Lee, M. L., & Leung, L. B. (2025) · Journal of General Internal Medicine · doi:10.1007/s11606-025-09816-9 · Cited by 1 · see citing works
(2019) · The Journal of Psychology · doi:10.1080/00223980.2019.1578154 · Cited by 1 · see citing works
Videoconferencing for Improved Access to Care
Hernandez, A. L. (2015) · USF Scholarship Repository (University of San Francisco)
Future Directions in Clinical Care, Research, and Nosology
Stoddard, F. J., Benedek, D. M., Milad, M. R., & Ursano, R. J. (2018) · doi:10.1093/med/9780190457136.003.0030
Virtual Behavioral Health for Army Soldiers: Soldier Perspectives and Patterns of Treatment
Hepner, K. A., Breslau, J. A., Sousa, J., Roth, C. P., Ruder, T., González, I. E., Montemayor, C., & Griffin, B. A. (2023) · Rand health quarterly · doi:10.7249/rhq-11-01-05
Ponzini, G. T., Hundt, N. E., Christie, I. C., Chen, P. V., Ecker, A. H., Lindsay, J. A., Teng, E. J., Storch, E. A., Myers, U. S., Roussev, M. S., et al. (2024) · Contemporary Clinical Trials · doi:10.1016/j.cct.2024.107445
Self-citationWildfire mental health support programs
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“Video telehealth, for example, can improve access to and continuity of mental health services [35, 36].”
Afeadie, R. K. (2025) · International Journal for Equity in Health · doi:10.1186/s12939-025-02616-x
Muir, S. D., de Boer, K., Nedeljkovic, M., & Meyer, D. (2020) · Figshare · doi:10.6084/m9.figshare.13175560
Muir, S. D., de Boer, K., Nedeljkovic, M., & Meyer, D. (2020) · Figshare · doi:10.6084/m9.figshare.13175563
Additional file 3 of Implementation strategies for telemental health: a systematic review
Appleton, R., Barnett, P., Juan, N. V. S., Tuudah, E., Lyons, N., Parker, J., Roxburgh, E., Spyridonidis, S., Tamworth, M., Worden, M., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22607993
Additional file 2 of Implementation strategies for telemental health: a systematic review
Appleton, R., Barnett, P., Juan, N. V. S., Tuudah, E., Lyons, N., Parker, J., Roxburgh, E., Spyridonidis, S., Tamworth, M., Worden, M., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22607990
Additional file 1 of Implementation strategies for telemental health: a systematic review
Appleton, R., Barnett, P., Juan, N. V. S., Tuudah, E., Lyons, N., Parker, J., Roxburgh, E., Spyridonidis, S., Tamworth, M., Worden, M., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22607987
Kroupina, M., Parker-McGowan, Q., Kotz, M., & Somani, A. (2026) · Frontiers in Oncology · doi:10.3389/fonc.2026.1627533
“Given the extremely sensitive period of development and the added complexity that hospitalization can bring to pediatric cancer patients requiring PICU admission, the approach to assessment and intervention must be systematic and evidence-based in order to ensure optimal neurodevelopmental and…”
Chen, P. V., Smith, A. H., Touchett, H. N., Day, S. C., Caloudas, A. B., Day, G., & Lindsay, J. A. (2026) · Telemedicine Journal and e-Health · doi:10.1177/15305627261498499
Self-citation
- Authors
- Lindsay, J. A., Kauth, M. R., Hudson, S., Martin, L. A., Ramsey, D. J., Daily, L., & Rader, J.
- Affiliations
- Michael E. DeBakey VA Medical Center (US)
- Baylor College of Medicine (US)
- Central Arkansas Veterans Healthcare System (US)
- Corresponding author
- Lindsay, Jan A.
- Venue
- Telemedicine and e-Health
- Publisher
- SAGE Publications
- Published
- 2015-06
- Volume
- 21
- Issue
- 6
- Pages
- 467-472
- ISSN
- 1530-5627 (ISSN-L)
- 1556-3669
- PMC
- PMC4458738
- OpenAlex
- W2326654011
- Cited by
- 66
- References
- 35
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 3 · 2023: 9 · 2022: 4 · 2021: 9 · 2020: 11 · 2019: 6 · 2018: 7 · 2017: 6 · 2016: 1 · 2015: 3
- FWCI
- 6.06
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Telemedicine Journal and e-Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Health Services Research and Development (CIN 13‐413)
- Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413)
- 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
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Keywords
- video telehealth, post-traumatic stress disorder, evidence-based psychotherapy, access to mental health care, external facilitation, implementation strategies, Department of Veterans Affairs, veterans, provider engagement
- MeSH terms
- Health Services Accessibility, Humans, Prospective Studies, Psychotherapy, Stress Disorders, Post-Traumatic, United States, Veterans, Telemedicine, Evidence-Based Medicine
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