Online Telehealth Delivery of Group Mental Health Treatment Is Safe, Feasible, and Increases Enrollment and Attendance in Post-9/11 U.S. Veterans

Fortier, Catherine B.; Currao, Alyssa; Kenna, Alexandra; Kim, Sahra; Beck, BJ; Katz, Dylan; Hursh, Colleen; Fonda, Jennifer R.

doi:10.1016/j.beth.2021.11.004

Cited by 15 publications

(11 citation statements)

References 24 publications

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“…The online treatment delivery allowed veterans to remain engaged with DBT-J even while navigating difficult life circumstances, such as homelessness and admission to residential treatment programs. Consistent with previous research suggesting telehealth-based interventions may increase veteran attendance and engagement in mental health services (Fortier et al, 2021), observed attendance and retention rates in this initial DBT-J trial exceeded those often observed in veteran mental health treatment settings (e.g., Edwards-Stewart et al, 2021; Harpaz-Rotem & Rosenheck, 2011). Our team therefore plans to maintain this telehealth-based approach for DBT-J moving forward, even after the COVID-19 pandemic ends.…”

Section: Discussionsupporting

confidence: 88%

Dialectical behavior therapy for justice-involved veterans (DBT-J): Feasibility and acceptability.

Edwards¹,

Dichiara²,

Epshteyn³

et al. 2023

Psychological Services

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Justice-involved veterans are a high-risk, high-need subgroup serviced by behavioral health services within the Veterans Health Administration (VHA) system. Justice-involved veterans often have complex mental health and substance use difficulties, a myriad of case management needs, and a range of criminogenic needs that are difficult to treat with traditional outpatient VHA services. The present study represents an initial evaluation of dialectical behavior therapy for justice-involved veterans (DBT-J), a novel psychotherapy program providing 16 weeks of skills-based group therapy and individualized case management services to veterans with current or recent involvement with the criminal justice system. A total of 13 veterans were successfully enrolled into this initial acceptability and feasibility trial. Results broadly suggested DBT-J to be characterized by high ease of implementation, successful recruitment efforts, strong participant attendance and retention, high treatment fidelity, and high acceptability by veteran participants, DBT-J providers, and adjunctive care providers alike. Although continued research using comparison conditions is necessary, veterans who completed participation in DBT-J tended to show reductions in criminogenic risk across the course of treatment. Cumulatively, these findings suggest DBT-J holds potential as a VHA-based intervention to address the various needs of justice-involved veterans. Impact StatementJustice-involved veterans are a high-risk, high-need subgroup serviced by behavioral health services within the Veterans Health Administration (VHA) system. Dialectical behavior therapy for justiceinvolved veterans was developed as a novel psychotherapy program providing 16 weeks of skills-based group therapy and individualized case management services to justice-involved veterans. Results suggest DBT-J to be acceptable and feasible for use in a VHA outpatient setting.

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Section: Discussionsupporting

confidence: 88%

Dialectical behavior therapy for justice-involved veterans (DBT-J): Feasibility and acceptability.

Edwards¹,

Dichiara²,

Epshteyn³

et al. 2023

Psychological Services

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“…For instance, the acceptability constructs of ‘burden’ and ‘opportunity costs’ featured in interviews; participants cited session timing and a range of travel difficulties as reasons for non-attendance at initial and subsequent sessions. This is supported by studies investigating bariatric patients’ attendance at routine follow up [ 51 , 52 ], which has also been found to be low, with ‘geographic distance’ cited as a reason, along with family, professional and health problems. This suggests that future trials should make use of telehealth care tools to decrease the costs and burden of attendance.…”

Section: Discussionmentioning

confidence: 77%

Addressing a critical need: A randomised controlled feasibility trial of acceptance and commitment therapy for bariatric surgery patients at 15–18 months post-surgery

et al. 2023

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Bariatric surgery is an effective treatment for obesity. However, around one in five people experience significant weight regain. Acceptance and Commitment Therapy (ACT) teaches acceptance of and defusion from thoughts and feelings which influence behaviour, and commitment to act in line with personal values. To test the feasibility and acceptability of ACT following bariatric surgery a randomised controlled trial of 10 sessions of group ACT or Usual Care Support Group control (SGC) was delivered 15–18 months post bariatric surgery (ISRCTN registry ID: ISRCTN52074801). Participants were compared at baseline, 3, 6 and 12 months using validated questionnaires to assess weight, wellbeing, and healthcare use. A nested, semi-structured interview study was conducted to understand acceptability of the trial and group processes. 80 participants were consented and randomised. Attendance was low for both groups. Only 9 (29%) ACT participants completed > = half of the sessions, this was the case for 13 (35%) SGC participants. Forty-six (57.5%) did not attend the first session. At 12 months, outcome data were available from 19 of the 38 receiving SGC, and from 13 of the 42 receiving ACT. Full datasets were collected for those who remained in the trial. Nine participants from each arm were interviewed. The main barriers to group attendance were travel difficulties and scheduling. Poor initial attendance led to reduced motivation to return. Participants reported a motivation to help others as a reason to join the trial; lack of attendance by peers removed this opportunity and led to further drop out. Participants who attended the ACT groups reported a range of benefits including behaviour change. We conclude that the trial processes were feasible, but that the ACT intervention was not acceptable as delivered. Our data suggest changes to recruitment and intervention delivery that would address this.

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“…Besides of general advantages of telemedical treatment such as greater geographical and temporal flexibility, the reduction of age-, gender-, and ethnicity-specific treatment barriers (8) and cost effectiveness (9), telemedical interventions were an essential tool in maintaining the continuity of communitybased treatment paths for patients with severe mental health conditions like schizophrenia-spectrum disorders during the COVID-19 pandemic (10). Telemedical interventions also promoted the involvement of peers and relatives at multiple stages of diagnostic and treatment procedures (11). Despite these advantages, there are some valid concerns about possible tool-related limitations of the reliability and reproducibility of telemedical assessments and categorical diagnostics under the conditions of telemedical consultations compared to traditional face-to-face evaluations (12).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patients with affective disorders profit most from telemedical treatment: Evidence from a naturalistic patient cohort during the COVID-19 pandemic

et al. 2022

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BackgroundDuring the COVID-19 pandemic telemedicine became essential in maintaining diagnostic procedures and treatment in psychiatry. However, it is still an open question if telemedicine is a feasible treatment option for all groups of psychiatric patients alike. This prospective monocentric observational trial was conducted to assess the general applicability of telemedical treatment in a naturalistic psychiatric outpatient cohort and to identify groups of disorders and clusters of psychopathology that respond particularly well to telemedical treatment considering sociodemographic characteristics and patients' perspectives.MethodsPatients were recruited April 2020–April 2021 and asked to fill out the WHO-5 and the SCL-90R at baseline, after 4–6 and 8–12 weeks and a feedback-survey. Additionally, medical records, psychopathology, psychosocial functioning, and socio-demographic data were analyzed. Primary outcomes were well-being, psychopathology and functioning during treatment. Secondly, diagnostic groups and psychopathology linked to a superior treatment-response were determined with respect to patients' subjective experiences.ResultsOut of 1.385 patients, 254—mostly with hyperkinetic (35.3%) and depressive disorders (24.6%)—took part. Well-being and SCL-90R total scores improved substantially (both p < 0.001). CGI and GAF scores were worse in depressed subjects (both p < 0.05). Improvement was mainly seen in depressed patients; chronic disorders experienced a decline in well-being. Sociodemographic characteristics could not explain this difference. Particularly female (r = 0.413) patients found telepsychiatry equivalent to conventional treatment. The more virtual sessions participants attended the more likely they were to find telepsychiatry equal to conventional treatment (r = 0.231).ConclusionTelemedicine is an effective treatment for patients with depression under naturalistic conditions. Telemedical consultations are a simple and reliable way of monitoring symptom severity and directing treatment choices during the treatment of depressive disorders. Patients with depression benefited more from telemedical treatment compared to participants with chronic non-episodic psychiatric disorders. Future research needs to concentrate on improving telemedical treatment options suited for the latter conditions. Psychiatric telemedicine yielded overall high degrees of satisfaction among users.

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Online Telehealth Delivery of Group Mental Health Treatment Is Safe, Feasible, and Increases Enrollment and Attendance in Post-9/11 U.S. Veterans

Cited by 15 publications

References 24 publications

Dialectical behavior therapy for justice-involved veterans (DBT-J): Feasibility and acceptability.

Dialectical behavior therapy for justice-involved veterans (DBT-J): Feasibility and acceptability.

Addressing a critical need: A randomised controlled feasibility trial of acceptance and commitment therapy for bariatric surgery patients at 15–18 months post-surgery

Patients with affective disorders profit most from telemedical treatment: Evidence from a naturalistic patient cohort during the COVID-19 pandemic

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