Best Practices
Using Life Stories to Connect Veterans and Providers
The My Life, My Story patient-centered program uses veterans’ personal narratives by veterans to create a strong connection between patients and...
In both cases, the driver for success was the VJO specialist. The New Jersey specialist, Mr. Correale (June 10, 2015) suggested, “It’s helpful to find out what works locally and try to adapt the telehealth model that’s already working.” It is also important for the VJO specialist to get to know local and VISN telehealth staff, as they potentially could provide access to a variety of resources, including assistance with the TSA, locating appropriate equipment, etc. In both pilots, the specialists were very flexible in amending their protocols, documentation, and/or clinic times.
Related: Funding for Innovative Federal Employees
Although there is no national mandate to establish TJPs, there is support from VJO leadership for specialists to investigate the need in their local communities. Information contained in this article and supporting documentation and resources available on the Tele-Justice SharePoint site can provide an adequate starting point for any VJO specialist to initiate their own pilot. Communication through the various VJO listservs is also another mode of acquiring information for those interested in pursuing similar telejustice services.
Compensation and Pension (C&P) examinations for mental health provide a rich opportunity for further exploration. Much of the same operational guidance in this article may be applied to a C&P for mental health clinics. The only significant difference would be the referral source and how the encounter is charted.
Program Launch
A successful telehealth program launch is achieved through distinct development, planning, and implementation stages. Embedded throughout the process are building good relationships, consistent and transparent communication, and coordination. Clinical services drive the need for telehealth; telehealth should not drive the need for clinical services.
A descriptive analysis was approved as a quality improvement project by the institutional review board of the VA Portland HCS. Using information from the 2 pilot projects, the intent is to furnish practical guidance for those developing a TJP. If there is anything the reader should take away from the following guide, it is that implementing a VA TJP is very possible.
Development
Identify the need. With every telehealth program comes a fundamental question: Is there a need to deliver clinical services from a distance? The need can be viewed in many ways, but at the core is access. Identifying a need can be any of the following: travel burden, a judge interested in addressing the increasing number of veterans on their docket, limited resources at the jail/prison for transporting veterans to court hearings, inability to identify a C&P examiner willing to see a veteran in a correctional facility, or a need for the VJP to increase the number of veterans served. In the New Jersey pilot, the local VJO specialist spent time with the New Jersey County Jail Wardens Association to describe how screening justice-involved veterans via telehealth may create more opportunities for veterans and positively impact recidivism.
Evaluate feasibility. Is there buy-in from local leadership and local telehealth personnel? Does the distant site (non-VA) administration agree to a telehealth program? Does the technology at the distant site permit a videoconferencing connection? Are there individuals at the court/jail/prison who can serve as points of contact to assist with a variety of tasks?
Planning
Coordinate with the local facility telehealth coordinator (FTC). All VAMCs have an FTC whose primary role is to implement telehealth programs at the facility. As with any relatively new initiative, the FTC may be unfamiliar with the feasibility of a TJP. It is important to work closely with the FTC to ensure all necessary steps are taken, consistent with national policy regarding telehealth in non-VA settings. For most, the national CVT-IH platform will be the logical approach to establishing a TJP. In some instances, involvement with either the VISN telehealth program manager and/or the VISN behavioral health director may be recommended in addition to the VJP specialist’s supervisor.
In general, the FTC will assist with all required documentation, establishment of a clinic, and ongoing technical support. The FTC may also provide needed guidance with logistics around technical specifications at the distant site.
Conduct a site visit. Meeting with administrative and technology decision makers at the site is an important part of the process and is an opportunity to alleviate any apprehension. They may want to hear more about how telehealth is used at the VA, telehealth research in general, and/or other active TJPs.
Identify a suitable space. There will be a variety of appointments that may be considered for the TJP. If the appointment is an encounter between the provider and veteran, it is recommended to find a space at the detention facility that is as private as possible. The law library, which has windows and a cage, was the designated space for the Portland pilot. The desktop computer and webcam were situated on the outside of the cage. The veteran entered the cage with the correctional officer, who established the Internet connection (Figure).
