Utilizing Telehealth to Meet the Needs of Rural Veterans: Introduction the VA's Clinical Resource Hubs Geriatric Mental Health Programs

Abstract

The Department of Veterans Affairs Clinical Resource Hubs (CRHs) offer a variety of telehealth initiatives designed to expand access to care. Each VA Integrated Service Network (VISN) or region has its own CRH to provide telehealth services to veterans residing in that region. Many older veterans receiving services through the telemental health programs reside in rural areas, with limited access to specialty care. Several CRHs offer geriatric mental health consults to expand older veterans’ access to specialty mental health treatment. By utilizing telehealth consultations, older veterans are able to receive high quality mental health care in their homes or at small local clinics.At this time, the CRHs serving VISN 9 (Tennessee and Kentucky), VISN 23 (North Dakota, South Dakota, Nebraska, Iowa, and Minnesota), VISN 1 (New England), VISN 20 (Washington, Oregon, Idaho and Alaska), and VISN 4 (Pennsylvania) offer specialized geriatric mental health services. All of these CRHs offer consultative care with exception of VISN 20, which offers fully virtual continuity clinics to highly underserviced areas within that region. VISN 23 was the first region to offer such a program and has been in operation through the CRH since 2018 (although its geriatric psychiatrist was providing consultative telehealth services prior to that). VISN 9, VISN 20, and VISN 1 began program development and services in 2021. The programs receive additional support from the VA Office of Rural Health, which has also funded a program evaluation team.Each region's geriatric mental health program has a geriatric psychiatrist as well as additional team members with geriatric specialty experience in various fields such as psychology, pharmacy, neuropsychology, internal medicine, and nursing. Care is provided through a range of modalities, including electronic consultations (e-consults), direct to home video visits, video visits at local clinics and inpatient/residential settings, and telephone evaluations. A range of diagnosis and concerns are addressed including, but not limited to, dementia diagnosis and management, caregiver support, treatment of complex psychiatric conditions in late life, and capacity. Veterans residing in outpatient, inpatient, and VHA residential/long term care settings are all eligible for care through CRH programs. Although these programs share a common goal to expand access to geriatric mental health treatment, each program operates uniquely, with different models of care based on the needs of their region's specific population. Our session will start by highlighting the care offered by CRHs and the VA Office of Rural Health's program evaluation research. The geriatric psychiatrist from VISN 9, VISN 23, and VISN 1 will present the specifics of their program, focusing on program development, types of care provided, and population served.