Reach Outcomes
In the two years following the enhanced TMH training, 38% of the Veterans who received TMH from trained providers lived in rural areas. The overall population seen by mental health providers throughout all of VA Puget Sound during this same period was 23% rural.
Effectiveness Outcomes
The number of TMH encounters increased from 6,752 to 14,124 in the two-year period following training. The number of Veterans who received TMH similarly increased from 1,301 (5% of Veterans who received mental health) to 2,755 (10%) during the same time frame. Of the 2,755 Veterans who received TMH post-training, 449 (16%) received services from providers who participated in the training.
Adoption Outcomes
One hundred providers participated in the training (72 staff and 28 trainees who operate under licensed staff). The percentage of Mental Health Service Line providers with at least one TMH visit increased from 16% to 39%, comparing the 2-year period prior to the training to the 2 years after. The participants’ disciplines included psychology (37%), social work (22%), other/not specified (19%), psychiatry (17%), and nursing (5%). The clinics participating included outpatient mental health (49%), undisclosed (26%), outpatient addictions treatment (13%), inpatient mental health (4%), primary care mental health (4%), and other (e.g., trainee rotating through multiple clinics; 4%).
Implementation Outcomes
Satisfaction. Following the training, 95% of providers agreed (n = 42) or strongly agreed (n = 35) that they were satisfied with the training provided. Regarding provider perception of the training, 95% of providers agreed (n = 50) or strongly agreed (n = 28) that the amount of information covered in this training was sufficient to begin using TMH. After completion of the workshop, 76% of participants agreed (n = 45) or strongly agreed (n = 17) that they felt confident using TMH.
Barriers among providers with no previous experience. The most frequently endorsed barrier pre training was administrative burden (28%), followed by preference for in-person appointments (25%), not having completed the training (25%), concern about increased workload (17%), some other specified reason (7%; e.g., finding a space with technology capability, lack of facility support, lack of technological skills, technological problems), lack of supervisor support (4%), lack of patient interest (4%), and lack of provider interest (2%). Post training, the most frequently endorsed barrier was lack of patient interest (45%), followed by administrative burden (20%), preference for in-person appointments (18%), concern about increased workload (11%), not having completed the training (6%), lack of supervisor support (4%), lack of provider interest (4%), and some other reason (4%).
Barriers among providers with previous TMH experience. The most frequently endorsed barrier pre training was additional administrative burden (13%), followed by concern about increased workload (6%), preference for in-person appointments (5%), some other reason (2%), lack of supervisor support (1%), lack of patient interest (1%), and concern about TMH cases making in-person clinic grids appear underutilized (1%). The most frequently endorsed barrier post training was some other specified reason (98%; e.g., technical support, telehealth being more useful for reoccurring sessions), lack of supervisor support (8%), concern about increased workload (4%), administrative burden (4%), lack of patient interest (2%), concern about TMH cases making in-person clinic grids appear underutilized (2%), and preference for in-person appointments (1%).
Knowledge, skills, and interest. A Wilcoxon signed-rank test was used to determine significant differences in providers’ perception of knowledge, skills, and interest in using TMH from pre- to post-training. Results indicated that providers’ perceptions of knowledge (Z = -6.67, p < .001), skills (Z = -6.09, p < .001), and interest (Z = -2.54, p = .01) in using TMH each significantly increased after the training.
Maintenance Outcomes
Wilcoxon signed-rank tests were used to compare post-training responses to those on 3-, 6-, and 12-month follow-up assessments. Results showed no differences in providers’ perceived knowledge, skills, or interest over the follow up period, indicating that the gains were maintained.