title: VA community mental health service providers' utilization of and attitudes toward telemental health care: the gatekeeper's perspective.
abstract: BACKGROUND
  Mental health (MH) providers in community-based outpatient clinics (CBOCs) are important stakeholders in the development of the Veterans Health Administration (VA) telemental health (TMH) system, but their perceptions of these technologies have not been systematically examined.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the attitudes of CBOC providers about TMH services, current utilization of these technologies in their clinics, and sources of knowledge regarding TMH.
  
  
  METHODS
  The study employed a mixed-methods design to examine aspects of TMH in CBOCs located in a VA network in the south-central United States. Semistructured, on-site group interviews conducted with 86 CBOC MH providers were followed by in-depth phone surveys with an MH provider identified as a key informant at each of 36 CBOCs in the VA network.
  
  
  RESULTS
  The utilization of TMH services varied widely between CBOCs, and the scope of services provided typically focused on delivery of medication management, with little provision of psychological services. Further, several important barriers to expanded use of TMH were identified, including limited education and training and shortage of dedicated space for TMH encounters.
  
  
  CONCLUSIONS
  General attitudes toward TMH were positive, and most CBOC providers indicated that they would like to expand use of TMH in their clinics.
authors.affiliation: Houston Center for Quality of Care & Utilization Studies, Houston, Texas, USA. jamesonjp@appstate.edu
authors.forename: John Paul
authors.initials: JP
authors.lastname: Jameson
authors.forename: Mary Sue
authors.initials: MS
authors.lastname: Farmer
authors.forename: Katharine J
authors.initials: KJ
authors.lastname: Head
authors.forename: John
authors.initials: J
authors.lastname: Fortney
authors.forename: Cayla R
authors.initials: CR
authors.lastname: Teal
mesh_terms: D001291:Attitude of Health Personnel; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003625:Data Collection; D020793:Gatekeeping; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D001523:Mental Disorders / Q000628:therapy; D008603:Mental Health; D012424:Rural Population; D017216:Telemedicine / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology