Home-Based Clinical Video-Teleconferencing Technology for PTSD: A Patient Centered

Model

Leslie Morland, PsyD,

Steven Thorpe, PhD.,

Ron Acierno, PhD.

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What is Clinical VideoTeleconferencing?

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VISN

Rural

Highly Rural Counties

Census Urban Area

Highly Rural, Rural and Census Defined Urban Areas

Map generated by VHA Planning Systems Support Group, field unit for the VHA Office of Assistant Deputy Under

Secretary for Health for Policy & Planning, April 6, 2007

Why Use CVT?

VHA CVT Services FY 2003-2011

What Do We Know? Evidence Base for CVT

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Non-inferiority Trials Underway

• Group Cognitive Processing Therapy (CPT) with male PTSD combat veterans

• Individual Cognitive Processing Therapy (CPT) with female PTSD combat veterans

• Individual Prolonged Exposure with male PTSD combat veterans

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Primary Research Goal• Evaluate the efficacy of using Video Teleconferencing

(VTC) modality as compared to the traditional face-to-face in-person (NP) modality for providing an evidence-based cognitive-behavioral group anger

management intervention to veterans with PTSD.

• Hypotheses: EBP over CVT modality will be as effective as in-person service delivery for providing CPT, PE, AMT...• 1: Clinical outcomes • 2: Process outcome• 3: Cost Outcomes

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Clinical Implications:• Data supports that using a video teleconferencing modality for

providing an evidence-based anger group therapy treatment is as good as providing this treatment in a traditional face-to-face modality. Clinical efficacy for this modality was established.

• Preliminary data support feasibility and effectiveness of using video teleconferencing for a CPT group intervention and PE and CPT individual intervention to treat PTSD directly.

• Veterans reported an acceptance and willingness to use these services in the future & reported satisfaction & comfort this modality.

Limitations of Traditional Model

• Long Term Sustainment

• Hi degree of Coordination

• Personnel Cost

• Facility Resources

• Patient Burden

• Staff Burden

Home-based CVT

• Provide Care in the home through MOVI or Jabber technology

• Less need for coordination, space, travel reimbursements

• Pilots under way through Portland and Charleston have demonstrated feasibility

• Providers reach remote Veterans via secure and encrypted software with two-way facing cameras

• Providers from multiple disciplines can access their VA network and patients

• Less need for coordination, • space, travel reimbursements

Home Based CVT

PCL Scores across Time (N=33)

PCL Scores across Time (N=33)

Recently or Pending Funding

• Comparison of Prolonged Exposure for PTSD in OIF-OEF Veterans Delivered In-Office vs. Home-Based Telemedicine vs. Home-Based In Person ModalitiesPIs: Thorp and Morland; Funding Approved FY12 (FY12-FY16)

•Home-Based Cognitive-Behavioral Conjoint Therapy for PTSD via Video teleconference” In response to NIMH RFA titled Harnessing Advanced Health Technologies to Drive Mental Health Improvement“ PI: Morland

Future Research Directions• Continue to evaluate when, how, & with

whom technologies can be used to impact care with difficult to reach military populations.

• Examine integration of different technology platforms to overcome barriers across the access to continuum of care.