title: A pilot project to improve access to telepsychotherapy at rural clinics.
abstract: BACKGROUND
  The U.S. Department of Veterans Affairs (VA) has pioneered telemental health (TMH) with over 500,000 TMH encounters over the past decade. VA community-based outpatient clinics were established to improve accessibility of mental healthcare for rural Veterans. Despite these clinics clinics and increased availability of TMH, many rural Veterans have difficulty receiving mental healthcare, particularly psychotherapy.
  
  
  METHODS
  Twelve therapists participated in a pilot project using TMH technologies to improve mental healthcare service delivery to rural Veterans treated at six community clinics. Therapists completed online training, and study staff communicated with them monthly and clinical leaders every other month. Therapists completed two questionnaires: before training and 10 months later. This article describes barriers and facilitators to the implementation of the project, as well as therapists' knowledge, confidence, and motivation regarding TMH.
  
  
  RESULTS
  Two clinicians were offering telepsychotherapy after 10 months. At all six sites, unanticipated organizational constraints and administrative barriers delayed implementation; establishing organizational practices and therapists' motivation helped facilitate the process. Adopters of the project reported more positive views of the modality and did not worry about staffing, a concern of nonadopters.
  
  
  CONCLUSIONS
  Despite barriers to implementation, lessons learned from this pilot project have led to improvements and changes in TMH processes. Results from the pilot showed that therapists providing telepsychotherapy had increased confidence, knowledge, and motivation. As TMH continues to expand, formalized decision-making with clinical leaders regarding project goals, better matching of therapists with this modality, and assessment of medical center and clinic readiness are recommended.
authors.affiliation: 1 Veterans Affairs South Central Mental Illness Research , Education, and Clinical Center, Houston, Texas.
authors.forename: Geri
authors.initials: G
authors.lastname: Adler
authors.forename: Lonique R
authors.initials: LR
authors.lastname: Pritchett
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kauth
authors.forename: Danielle
authors.initials: D
authors.lastname: Nadorff
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007318:Inservice Training; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D010865:Pilot Projects; D019035:Rural Health Services / Q000458:organization & administration*; D017216:Telemedicine / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans