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Veteran and Provider Perspectives on Telehealth for Vocational Rehabilitation Services

Federal Practitioner. 2021 May;38(5)a:e32 | 10.12788/fp.0120
May 12, 2021|Federal Practitioner
Lisa Ottomanelli, PhD;Bridget A. Cotner, PhD;Eni Njoh, MPH;Danielle R. O’Connor, MA, MPH;Victor A. Jones, MS;Bridget M. Smith, PhD;Jaclyn Fishalow, PsyD;Charles E. Levy, MD
Author and Disclosure Information

Lisa Ottomanelli is a Clinical Psychologist; Bridget Cotner is a Health Science Specialist; Eni Njoh was a Data Manager; Danielle O’Connor is a Qualitative Data Manager; Victor Jones was a Supported Employment Telerehabilitation Coordinator; and Jaclyn Fishalow was a Rehabilitation Psychology Resident; all at the James A. Haley Veterans’ Hospital & Clinics in Tampa, Florida. Bridget Smith is a Health Research Scientist at the Center of Innovation for Complex Chronic Healthcare, US Department of Veterans Affairs, Chicago, Illinois, and a faculty member at the Feinberg School of Medicine, Northwestern University, Chicago,Illinois. Charles Levy was Chief, Physical Medicine and Rehabilitation Service, at the North Florida/South Georgia Veterans Health System, Gainesville, Florida. Lisa Ottomanelli is an Associate Professor, Department of Child and Family Studies, College of Behavioral and Community Sciences, and Bridget Cotner is a Courtesy Faculty member at the Department of Anthropology; both at the University of South Florida in Tampa. Eni Njoh is now a private contractor. Jaclyn Fishalow is now a Clinical Psychologist at Tampa General Hospital in Florida Victor Jones is currently affiliated with the 6th Air Mobility Wing, MacDill Air Force Base in Tampa. Charles Levy was a Professor of Occupational Therapy in the College of Public Health and Health Professions and in the Center for Arts in Medicine, College of the Arts, University of Florida, Gainesville.
Correspondence: Lisa Ottomanelli (lisa.ottomanelli@va.gov)

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.

Background: Establishing employment for veterans with disabilities is a common goal for rehabilitation, but there are barriers to accessing vocational services. Telehealth has been developed to increase access, especially for rural veterans with disabilities. Providing access and training in the use of videoconferencing for vocational rehabilitation (VR) for both staff and their clients may improve access and timeliness of vocational services while reducing travel costs and barriers.

Methods: This program evaluation of a field-initiated clinical demonstration project was conducted at 2 Veterans Affairs medical centers in the Southeast United States. Data were collected during the first year of a teleconference-provided vocational program (VRtele). Data on demographics, primary diagnosis, and VR usage were collected from patient records. Veterans completed satisfaction surveys, and qualitative interviews were obtained from VR staff and their patients.

Results: A total of 22 veterans participated in the first year of the program. On average, 63 miles of travel were saved per visit. Survey data indicated high levels of satisfaction with VRtele. Interviews indicated that flexibility, time saved, and increased interactions were strengths of VRtele. Challenges identified by staff included patients’ lack of familiarity with technology and change in quality of interaction. Veterans also reported a learning curve due to technology concerns.

Conclusions: Both VR providers and their patients recognized the benefit of VRtele. Factors that affect success include technology troubleshooting and supportive leadership to facilitate implementation. As this program evaluation was limited by sample size and lack of a comparison group or outcome data, further research on the acceptability and effectiveness of VRtele is needed.

Discussion

This first report on the perspective of providers and veterans using VRtele suggests that it is a viable option for service delivery and that is highly satisfactory for serving veterans with disabilities, many of whom live in rural areas or have travel barriers. These findings are consistent with data on telerehabilitation for veterans with cognitive, physical, and mental disabilities.13-22 Further, the data support the notion of using VRtele to facilitate long-term VR follow-up for persons with disabilities, as illustrated by successful continuation of vocational services after a veteran moved out of state.23

Similar to other reports, our experience highlighted 2 factors that affect successful VRtele: (1) Troubleshooting technology barriers for both VR providers and clients; and (2) supportive leadership to facilitate implementation.24-26These areas have been improved with recent telehealth VHA initiatives and upgrades. After the conclusion of this project evaluation, the program was expanded, and local facilities may now receive mentored support to implement similar programs.27 This ongoing telerehabilitation program uses the recently upgraded VHA telehealth platform that enables encrypted sessions to be provided to any mobile or online device, and veterans simply click on a link to connect rather than waiting for a session-specific password.28 By using virtual medical rooms accessed by cameras on tablets, smartphones, or computers, veterans and VR providers now have an easier time scheduling and attending online appointments.29 Improved access to VRtele is important as VHA began providing the majority of appointments via video telemedicine in Spring of 2020 due to the COVID-19 pandemic. The accelerated use of telehealth due to the COVID crisis makes these findings highly relevant to the current practice environment.

Changes to technology and increased usage of VA Video Connect may indicate that the barriers identified from the earlier process described here have been diminished or eliminated. More evaluation is needed to assess whether system upgrades have increased ease of use and access for veterans with disabilities.

Conclusions

Encouragingly, this clinical demonstration project showed that both providers and clients recognize the benefits of VRtele. Patient satisfaction and decreased travel costs were clear advantages to using VRtele for this small group of veterans who had barriers to care due to travel or disability barriers. As this program evaluation was limited by a small sample, absence of a comparison group, and lack of outcome data (eg, employment rates, hours, wages, retention), future research is needed on implementation and outcomes of VRtele.

Acknowledgments
The authors thank Lynn Dirk, MAMC, for substantial editorial assistance. This material was based on work supported by Rural Veterans Supported Employment TeleRehabilitation Initiative (RVSETI), funded by the VA Office of Rural Health (Project # N08-FY14Q3-S2-P01222) and by support of the VA Health Services Research and Development Service. This work was presented in part at the 114th Annual Meeting of the American Anthropological Association at Denver, Colorado, November 21, 2015; a field-based Health Services Research and Development Service meeting, US Department of Veterans Affairs at Washington, DC, September 12, 2016; and the 2016 Annual Conference of the American Congress for Rehabilitation Medicine at Chicago, Illinois, October-November 2016.

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