Treating veterans’ mental health needs remotely
Dr. Peter Shore has always been a maverick—that guy with the idea no one thought could be done.
Even when he was applying to doctoral programs, he had an unorthodox vision for a dissertation that included creating a documentary about the history of suicidology—a dissertation he ended up completing for his Psy.D. degree at The Chicago School and a documentary that is now used around the country as a training tool for those who work with suicidal patients.
So when someone at Dr. Shore’s new job at the U.S. Department of Veteran’s Affairs (VA) in Portland told him that administering mental health services to veterans through online videoconferencing technology could not be done securely and in accordance with national HIPAA standards, his response was “let’s find a way to make it work.”
He joined the Portland VA Medical Center as a staff psychologist soon after graduating from TCSPP in 2009 and went on to help pioneer a program that did just that.
As Dr. Shore explains, many of his patients at that time were required to drive to their nearest outpatient VA center for treatment that often included receiving counseling from him not in person, but remotely on a television screen. “So we had veterans complaining that they had to drive 30 miles to see me, on TV,” explains Dr. Shore. “They were wondering why they couldn’t just do it from home.”
From that moment, Dr. Shore quickly became an instrumental player as the VA began to work on a first-of-its-kind program that allowed any returning soldier who needed help the opportunity to receive mental health treatment remotely. Using encrypted software developed according to strict guidelines and video teleconferencing (VTC) tools, a pilot program was developed in December 2009 that connected patients to clinicians in real time.
Security was critical, and the web-based equipment required a reliable connection. But they made it work, and access was quickly established to veterans, first at the Portland VA, then throughout the Northwest Health Network’s VISN-20, the largest geographical VA network covering Oregon, Alaska, Idaho, and Washington. The Portland-based pilot program was well-received by veterans and provided enough data to justify a regional expansion.
“We found in the first two years of the program, about 80 percent of those enrolled in the program would not have received mental health care if it had not been available in the home,” says Shore, who received TCSPP’s So-Cal Campus 2015 Distinguished Alumnus Award for this and other accomplishments.
As a result, Telehealth Services in the Veterans Health Administration adopted this modality in February 2013 and now offers veterans across the country in-home treatment options through the Clinical Video Teleconference (CVT) Into the Home program. Not only does the in-home treatment eliminate the barriers of travel and access to treatment, it also provides a safe, secure environment where they can feel comfortable confiding in providers.
Dr. Shore says his experience shows how beneficial telemental health can be, and encourages his colleagues and fellow TCSPP alumni to consider these new options in their practice. The results can be life-changing.
As a veteran once told him, “I’m in my own bunker, around my things, my stuff. Being in this environment allows me the comfort to speak freely.”
Some veterans may be apprehensive and self-conscious in visiting a VA medical center for care and sit in a waiting room while others around them may know what they are being treated for.
“It offers less visibility to the general population and is an effective tool in addressing the stigma,” adds Dr. Shore, who currently serves as Director of Telehealth (VISN 20, VA). Additionally some veterans become less guarded and feel solace in the distance between themselves and the therapist. “They become naturally vulnerable and let their guard down—that vulnerability is potentially a pathway for change.”
Dr. Shore, who recalls TCSPP President Dr. Nealon as one of his favorite professors, credits The Chicago School for his success in taking risks and innovating new ideas.
“One of the big selling points for me was the school’s ability to support the creative, unorthodox component of my dissertation,” he says. “No other schools I was interested in could do that.”
In addition to his 2015 award at TCSPP, Dr. Shore was the recipient of the 2013 James Beysner Early Career Award by the Association of VA Psychologist Leaders (AVAPL) and is now applying what he learned in the telemental health pilot to VA-based telejustice projects that connect incarcerated veterans with their VA social workers.
“We pride ourselves in pushing boundaries and creating access where access is limited,” adds Dr. Shore.
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