Barriers and facilitators of videoconferencing psychotherapy implementation in veteran mental health care environments: a systematic review

Background Whilst treatment for mental health issues has traditionally been conducted in-person, advances in technology has seen a recent growth in the use of online video therapy services to help overcome access-to-care barriers faced by those living in rural locations and those unable to travel. These barriers are particularly apparent in the case of veteran populations, which is the focus of this review. Whilst the research investigating the efficacy of online video therapy to treat mental health issues among veterans is promising, widespread adoption and utilisation of this modality remains low with efforts often failing to progress past the pilot phase to implementation. This review focuses on the implementation of online video therapy in veteran mental health care settings and aims to identify the potential barriers and facilitators relevant to implementing the modality in military organisations. Methods A systematic search of three databases (PsycInfo, PubMed, and Web of Science) was conducted. To be eligible for inclusion, studies had to investigate the challenges, lessons learnt, or factors operating as barriers and/or facilitators to the implementation of online video therapy in veteran health care systems. Results The initial search revealed a total of 202 articles. This was reduced to 133 when duplicates were removed. After screening the titles and abstracts a further 70 articles were excluded leaving 63 to be retrieved for full review. A total of 10 studies were included in this review. The most commonly reported barriers were related to clinician concerns, logistical problems, and technology. Other barriers included access to resources as well as challenges posed by collaborations, policy and recruitment. Facilitators included experience using the modality and having dedicated staff responsible for promoting and managing the new service (e.g., on-site champions and telehealth technicians). Conclusions This review suggests that numerous barriers must be identified and addressed before attempting to implement an online video therapy service in veteran organisations. Further research is needed to establish best practice for implementation, particularly across geographically dispersed sites. It is hoped that the findings of this review will be used to help inform future implementation efforts and research initiatives in this space.

Enhancing the Capacity of the Australian Health Care Workforce to Support Veterans’ Mental Health: A Collaborative Interdisciplinary Approach

Introduction Military personnel and veterans can have higher rates of mental health problems than the general population, but are no more likely to receive appropriate mental health care. A lack of experience among Australia’s mental health workforce in treating veteran-specific issues has been identified, pointing to a need for strategies to strengthen the workforce capacity. To this end, the Department of Veteran’s Affairs joined with the Mental Health Professionals Network (MHPN) to produce and deliver a series of veteran-specific webinars for health professionals working with military personnel, veterans and their families. Materials and Method Five webinars were produced and delivered between August 2016 and July 2017. Each involved a panel of health professionals with content expertise and was facilitated by a nationally recognized expert in veteran mental health. Each webinar was evaluated using an online survey to address whether learning needs were achieved, likely improvements to work practice, and improvements in knowledge of and confidence in treating veteran mental health issues. Results Of the 5,127 attendees across the five webinars, registration data was collected for 4,809 (94%) and post-webinar data for 3,334 (70%) of registrants. Of these, over 90% indicated that their learning objectives were achieved, that the content was relevant to their practice, and that their work practices would be improved as a result of their participation. Further, almost three quarters reported increased knowledge and skills, and two-thirds increased confidence in treating veterans’ mental health needs. Conclusions The Veterans’ webinar series was effective in engaging a large number and a wide range of professionals working in mental health care in Australia, underscoring the strength of MHPN’s initiatives in terms of scale and reach. With its emphasis on interdisciplinary practice and collaborative care, MHPN is well-placed to continue to support Australia’s mental health workforce.