Shirley M Glynn*, VA Greater Los Angeles Healthcare System at West Los Angeles and Semel Institue, UCLA, Los Angees, United States Barbara Dausch, VA Eastern Colorado Healthcare System, Denver, United States Track: Practice Presentation Topic: Consumer empowerment, patient-physician relationship, and sociotechnical issues Presentation Type: Oral presentation Submission Type: Single Presentation Building: Mermaid Room: Room 4 - Queenshithe Date: 2013-09-24 10:00 AM – 11:00 AM Last modified: 2013-09-04

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Family involvement in mental health services is associated with greater treatment retention and increased consumer satisfaction while participation in family interventions that are evidence-based practices (EBPs) also result in significantly better consumer outcomes). Increasing evidence confirms that individuals with serious mental illness want their family involved in their care. In fact, family involvement in care to support recovery from serious mental illness is a core principle in the US President’s New Freedom Commission on Mental Health, which states that “services and treatments must be consumer and family centered.” The UK National Institute for Health and Clinical Excellence recommend a course of family intervention for persons with schizophrenia or bipolar disorder. The US Department of Veterans Affairs (VA) 2011-2015 “Strategic Plan Refresh” includes families as key constituents of VA services throughout the report, and Public Law 110-387 mandates that the VA provide for or arrange for Veteran access to marital and family counseling. Clearly there is a groundswell of support geared toward family involvement in mental health care.

VA Mental Health Services (MHS), Office of Patient Care Services, has devoted an intensive multimodal effort over the past 6 years to involving families in the care of Veterans receiving mental health services, consistent with the guidance above. Unfortunately, uptake of family services has been slow, in part because of the many logistical impediments potential consumer participants encounter in attending sessions at (often distant) VA medical centers for care. In response, the national VA Marital and Family Counselling Training team has undertaken a major project to disseminate clinical video telemental (CVT) health approaches to the delivery of evidence-based family services throughout the VA. While videoconferencing has been used for clinical assessment and individual or group interventions, the use of the modality for evidence-based family therapy is innovative. The VA effort includes, for example, providing treatment such as integrative behavioral couples therapy through the use of regular videoconferencing between the therapist in the clinic and the Veteran consumer participants and their partners, who may be in a distant clinic or at home.

This presentation will detail the development and initial implementation efforts of national family telemental health in VA. Topics to be covered include 1) building an initial technical infrastructure to support the work in over 150 medical centers; 2) strategies utilized to motivate initially reluctant VA clinicians to use telemental health interventions for family work; 3) policies to address general clinical issues in telemental heatlh (e.g suicide and crisis management protocols) as well as adaptations required for couples/family work (e.g. identifying and intervening with domestic violence from a distance); 4) assuring manual adherence to an evidence based intervention from a distance; and 5) training methods to enhance the technical skills of “typical” VA mental health clinicians so they can conduct telemental health sessions effectively. The presentation will conclude with a review of lessons learned in the national VA family telemental health initiative which may be useful for other large systems considering such work.