Key Army Medical Department (AMEDD) Telebehavioral Health goals were developed to address the question of how telehealth technology can improve behavioral heath access. The first and foremost goal is to conserve fighting strength. Telebehavioral Health allows the Army the ability to shift providers across the enterprise to meet unforeseen service requirements or surge demands by allowing Telebehavioral Health providers the ability to see Service Members remotely. This has been evident in the last few years with increases in demands for IDES/Psych Narrative Summary (NARSUM), a component of the medical evaluation board process, as well as backlogs in the Reverse Soldier Readiness Processing (RSRP) of different Regional Medical Commands (RMCs).
RSRP is part of the Army Force Generation Cycle (ARFORGEN) that processes soldiers at different touch points to maintain readiness and ensure fitness, including the identification and treatment of behavioral health issues. Telebehavioral Health allows the AMEDD to have access to behavioral health assets from different regions so that the existing behavioral health infrastructure does not become adversely affected, thus maintaining access to care standards. With the increase of access, providers, service members and commanders have fondly coined the term "Doc in a Box" when referencing Telebehavioral Health services across the AMEDD.
Second, Telebehavioral Health reduces stigma associated with behavioral health.For example, soldiers in Alaska do not have to worry about seeing their Telebehavioral Health providers who treat them for posttraumatic stress disorder at the local PX or commissary.This increases the willingness of a soldier to seek needed behavioral health care in order to remain fit for duty. A 2009 study across several RMCs identified that Telehealth delivery of care was at least as good in terms of patient satisfaction when compared to face-to-face. In fact, in some areas, namely “items I find difficult to discuss” Telebehavioral Health was identified as more preferred to openly discuss these “difficult” items. Qualitative discussions suggest a comfortable distance between soldier and provider that the technology provides resulting in an openness to discuss these difficult items. In addition, the level of comfort suggests the natural and intuitive use of technology by today’s soldiers further supports this finding (Folen, Jones, Stetz, Edmonds, & Carlson, 2010 ). These findings continue to be confirmed and replicated in Process Improvement surveys across the AMEDD Telebehavioral Health cells.
Third, Telebehavioral Health offers the AMEDD a cost-effective, comprehensive, efficacious and timely way to offer access to quality outpatient behavioral health care regardless of the location.This is critical in remote areas or where the demands for behavioral health care outweighs the available assets. One example is that service members are able to have conjoint therapy with their spouses. Also, Telebehavioral Health provides service members with opportunities to participate in psychoeducation groups. Furthermore, members of the National Guard and Reserves have access to the services of Telebehavioral Health while they are on active orders or when the reserve unit needs to identify if a condition is a Line of Duty item, thus a Line of Duty evaluation is referred and conducted through Telebehavioral Health because often, these units are not near the local military treatment facilities .
These examples demonstrate how Telebehavioral Health allows for the delivery of standard of care across the Army enterprise by making readily available, well-trained behavioral health providers, who are informed of the current Department of Defense-Army regulations around behavioral health and the nuances of Army Medicine/behavioral health, such as Army Force Generation Cycles (ARFORGEN), available to the soldier. Additionally, it makes these providers available for consultation and able to further inform a soldier’s command regarding the soldier’s fitness and readiness. This understanding of military, and specifically Army culture, would not necessarily be readily available in the referral network.
Overall, Telebehavioral Health adds a technological dimension to the AMEDD’s portfolio of behavioral health supports that along with the existing behavioral infrastructure at military treatment facilities and the robust networks, can better address the soldier’s unique needs.
Folen, R.A., Jones, S.L, Stetz, M.B., Edmonds, B., &Carlson, J. (2010). The Role of Telehealth in Treating Military Personnel, The Register Report. Retrieved June 15, 2012, from http://www.nationalregister.org/trr_fall10_folen.html