Military Behavioral Health Staff Perspectives on Telehealth Following the Onset of the COVID-19 Pandemic

by Kimberly A. Hepner, Jessica L. Sousa, Justin Hummer, Harold Alan Pincus, Ryan Andrew Brown

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Research Questions

  1. What were the experiences of military behavioral health staff with telehealth as a method of care delivery after the onset of the pandemic?
  2. How do military behavioral health staff view audio-only and video telehealth, and do their perspectives change depending on the conditions being treated or patients' circumstances?
  3. What are the barriers to further integrating telehealth into behavioral health care provision in the MHS, and what changes are needed to enable its adoption at an enterprise scale?

The COVID-19 pandemic prompted sweeping changes to behavioral health care delivery in the Military Health System (MHS), which turned to telehealth to minimize disruptions and ensure continuity of care for service members. Four to seven months into the pandemic, MHS behavioral health staff at ten military treatment facilities shared their experiences using telehealth and their perspectives on its utility, barriers to its wider integration in the MHS, and concerns about its use in the post-pandemic future.

Telehealth use was previously low across the MHS, but it increased dramatically with the onset of the pandemic. At the time they were interviewed, nearly all providers who treated service members with posttraumatic stress disorder, depression, or substance use disorders were using audio-only telehealth in some capacity. Although most were not using video telehealth, three-quarters expressed an openness to using it in the future. However, the widespread integration of telehealth in the MHS will need to include efforts to overcome technical and administrative barriers and to address provider concerns about telehealth modalities for behavioral health care delivery—for example, the need for clinical guidance on using telehealth with specific types of patients, and provider and patient orientation on using telehealth technology.

Key Findings

The COVID-19 pandemic prompted greater use of telehealth in the MHS, and most behavioral health providers were open to using video telehealth in the future

  • Interviewees almost universally noted a dramatic shift from in-person care to audio-only or video telehealth or to a combination of in-person and telehealth modalities at military treatment facilities early in the pandemic.
  • Most providers were not using video telehealth, but more than three-quarters expressed an interest in using it in the future.
  • Nearly all providers were using audio-only telehealth, but only about one-quarter indicated that they were open to continuing to use it.
  • More than half of interviewees said they thought patients liked telehealth, citing the greater convenience over in-person visits.

MHS behavioral health staff cited a variety of concerns and barriers to using telehealth

  • Most concerns and barriers cited were related to technology and included insufficient internet bandwidth and equipment, difficulty accessing telehealth platforms while teleworking, a lack of technical support, concerns about reliability and data security, and provider and patient learning curves.
  • About half of interviewees expressed concerns about using telehealth—particularly audio-only telehealth—to treat high-risk patients or patients with high symptom severity, citing difficulty assessing symptoms and patient risks.
  • Administrative barriers were another commonly cited barrier to expanded telehealth use, including unclear guidance and policies and a perceived lack of high-level support.

Recommendations

  • Develop policy guidance on the use of telehealth for patients with specific behavioral health conditions. Policy guidance should address the technology requirements for successful telehealth delivery and expectations for high-quality treatment.
  • Develop and implement a strategic plan to ensure that providers have adequate technology to support video telehealth. The MHS could adopt a user-friendly, reliable, and secure telehealth platform that is compatible with multiple types of devices and adaptable to both individual and group treatment.
  • Provide clinical and technical training and support for telehealth. Training that targets providers' specific concerns and competency levels would increase comfort, knowledge, and skills and potentially improve attitudes toward telehealth. It might be worthwhile to identify existing IT support staff and to conduct an initial assessment of the potential scalability of their capabilities to provide telehealth technical support at a given MTF.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methods

  • Chapter Three

    Use of Telehealth Following the Onset of the COVID-19 Pandemic

  • Chapter Four

    Organizational Factors Associated with the Use of Telehealth

  • Chapter Five

    Clinical Factors Affecting the Use of Telehealth

  • Chapter Six

    Staff Reflections on Patient Satisfaction and the Importance of Provider and Patient Orientation to Telehealth

  • Chapter Seven

    Telehealth with Service Members Located Remotely from MTF Care

  • Chapter Eight

    Summary and Recommendations

  • Appendix

    Interview Guide

This research was sponsored by the Defense Health Agency and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division (NSRD).

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