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2023 HSR&D/QUERI National Conference Abstract

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4002 — Promoting Equitable Access to Mental Healthcare for Rural Veterans with SCI: Stakeholder Engagement and Lessons Learned

Lead/Presenter: Hilary Touchett,  COIN - Houston
All Authors: Touchett HT (Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC, Houston, Texas), Lindsay, J (Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC, Houston, Texas) Helmer, D (Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC, Houston, Texas) Skelton, F (Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC, Houston, Texas)

Among Veterans with a mobility impairment, having a diagnosis a mental health disorder is significantly associated with less functional days and lower satisfaction with life. In rural areas, VA Video Connect (VVC) is used to ameliorate staffing challenges and travel burden, but Veterans with Spinal Cord Injury and Disorders (SCI/D), often require additional support when using VVC for the first time. To address these issues, our team collaborated with stakeholders to develop, disseminate, and refine resources designed to support rural mental health clinicians in initiating virtual care services with Veterans who have mobility impairments. In this presentation, we discuss our process for iterative stakeholder engagement and lessons learned.

Our stakeholders included Veterans with SCI/D, Clinicians from mental health and SCI/D service lines, as well as Office of Rural Health and SCI/D Telehealth program offices. We conducted semi-structured interviews with 21 Veterans diagnosed with spinal cord injury to understand their needs when seeking mental healthcare services. To gain insights from mental health clinicians, we analyzed chat responses from an interactive educational seminar about ethical considerations when using virtual care for disabled veterans which included approximately 400 rural mental health clinicians. We then gathered feedback regarding best practices, by interviewing SCI/D clinicians and presenting at departmental and leadership meetings to develop resources designed to support rural clinicians when conducting virtual care with Veterans who have mobility impairments. We then shared our findings on national calls with SCI leadership and the office of mental health and suicide prevention to iteratively refine our resources.

Veterans reported liking the convenience of virtual care, wanted providers to have more knowledge about available resources, and desired disability competent care from their providers. Mental Health providers reported that perceived tech savviness of the patient/caregiver, and access to necessary technology and adaptive equipment influenced recommendations for virtual care, while expressing limited experience with disability as a barrier to initiating services. SCI/D providers shared that avoiding assumptions, planning ahead (test calls or referrals to OT), flexibility, and patience were essential to promoting positive experiences.

During this project the ongoing pandemic, pressure to rapid virtualize care, and increasing burnout and turnover among clinical staff presented several challenges to engaging these groups. However, using a flexible approach, we were able to engage groups creatively by using existing trainings, meetings, and communities of practice. During this process potential ‘unintended consequences’ were discovered related to the VA Digital Divide Consult that may overlook special issues, problems with VA tablet loss prevention software blocking accessibility features, and the burden of requiring long log in information for Veterans with limited hand dexterity.

Using a flexible and iterative approach to assessing needs surrounding the use of telehealth for mental health for veterans with SCI allowed our team to gather data, present findings, and gather feedback in real time to develop supportive resources, while fostering relationships with key partners. This process allowed us to reach a wide range of audiences, aggregate experiences, and disseminate these issues to relevant leadership groups quickly.