Telejustice: Reaching Incarcerated Veterans via Telehealth

Identify a point of contact and staff at the distant site. As feasibility is evaluated, identifying a point of contact at the distant site is vital. During the site visit, it is important to meet with the point of contact to review any ongoing logistic issues. One or more staff members should be available to escort the veteran into the space where the telehealth appointment will occur. In some cases, a correctional officer will be on standby during the appointment to address any technical issues with the VA provider and/or in case of a medical or behavioral emergency. In most if not all cases, it is important for the staff member at the distant site to have telephone contact information for the VA provider and/or their respective technical support contact person.

Evaluate technology. Does the distant site facility have Internet access for the space under consideration? If it does, it is likely the FTC will follow the protocols outlined in the CVT-IH platform. Although Jabber is currently the only nationally accepted video teleconferencing software, VISN 20 has successfully used Vidyo (Hackensack, NJ) and VSee (Sunnyvale, CA) on iPads for VISN 20 mobile telehealth programs and is in the process to deploy alternative software solutions and iPads for all VISN 20 TJPs. If the jail/prison facility is open to discussing using their own videoconferencing technologies to bridge into the VA system, these efforts should be coordinated through the FTC. In some cases, the correctional facility will request a desktop computer or laptop with Internet access. The most common issue that prevents a program from being further developed is the lack of viable technology.

VA facility preparation. After the site visit is complete, the FTC should assist with the planning process. This will include identifying a telehealth clinical technician on the VA side and development of appropriate documentation and emergency management protocols. The planning package will also include a MOU between the local VA program leadership representatives and the institution/justice entity where the veteran is being served.

Emergency management protocols must include, at a minimum, a point of contact at the distant site and a contingency point of contact. Phone numbers for each should be acquired well in advance. At the beginning of each session, the provider should have access to those names and numbers in case an emergency arises during the session. At the same time, the VA provider should communicate the emergency protocols to the veteran receiving the services. In the event of an emergency, the provider should do whatever possible to remain connected via video with the veteran and call the distant site point of contact to assist with the emergency. Importantly, participants should follow emergency protocols as outlined by the correctional facility. Readers may contact the author at
shore@ohsu.edu for a copy of the Portland pilot emergency protocol.

A telehealth clinic will need to be built to capture workload. In most cases, this will be a CVT-IH clinic at the facility. Typically, the FTC will initiate the process with the facility clinical applications coordinator to establish the appropriate clinic build. As the program begins to take shape, an operations manual or practice guidelines will need to be created and updated regularly.

Implementation

After the setup documentation has been completed and before the first appointment, the technology support person and the distant site point of contact should be contacted to confirm the appointment and assist in establishing the Internet connection. (An implementation checklist is available at http://wp.me/p6jTLD-5.)

As the TJP grows, it will be important to evaluate and test the technology, technical support, staffing, and modifications to local protocols to ensure the safety and welfare of the veteran and the provider. Also consider whether the program will collect data and if so, what type.

The Portland pilot collected a variety of data sets, including provider and veteran perspectives on their experiences with the technology. The VHA Innovation 669 program used a brief technology impact questionnaire, designed to monitor how technology has impacted quality of care.⁵ Data was collected iteratively and used in part to improve aspects of the program. This included both veteran and provider satisfaction, clinical outcomes, quality of life, and levels of occupational and social functioning.

Conclusion

Reaching incarcerated veterans sends an important message: The VA will go to great lengths to ensure that veterans have access to services to help ease the transition back into the community. Connecting with incarcerated veterans via telehealth takes the VA mission to a new level.

Given the wide array of technical solutions currently being used in correctional facilities, VA TJPs may benefit from exploring a consumer-based technology solution. However, one factor in expanding VA TJPs is that current telehealth systems rely on VA Office of Information and Technology resources that build systems within the VA network. There are privacy and security standards the VA adheres to in order to maintain a safe clinical video connection.