Telejustice: Reaching Incarcerated Veterans via Telehealth

The Portland VJO specialist saw the first veteran on November 27, 2012. Through May 28, 2015, she has conducted 28 assessments with incarcerated veterans via CVT. Among the 28 individuals were 15 army, 11 navy, and 2 marine
veterans aged 24 to 70 years (mean 49.6 y). All 28 veterans were identified as male and white (non-Hispanic). Fifty percent of the veterans seen had at least 1 service-connected disability, and all 28 veterans had at least 1 recorded mental health diagnosis (Tables 2 and 3) (Belinda Maddy, LCSW, written communication, June 9, 2015).

Many of the veterans enrolled in the Portland pilot were able to successfully access services at the VA for substance abuse treatment, PTSD treatment, other mental health services, and/or medical services (Belinda Maddy, LCSW, written communication, June 9, 2015). Like the HBTMH pilot, the Portland VJO pilot has also yielded numerous unexpected patient outcomes, including access to services otherwise not available, access to community resources, enrollment in VA services, and an increase in social connectedness.

“This saved my life,” said one veteran in a testimonial. “Now I have a chance to get treatment instead of prison.” Another veteran noted, “I need to not live in this area to be able to learn how to be sober. Going to a long-term treatment program will help me learn how to live sober so I can stay out of trouble.”

New Jersey Pilot

Similar to the Portland pilot, the VA New Jersey HCS VJP specialist spearheaded the pilot and in June 2013 visited with the warden at the Mercer County Correction Center. In November 2014, a year and a half later and with numerous steps in between, a memorandum of understanding (MOU) and telehealth service agreement (TSA) were signed (Mark Correale, LICSW, written communication, June 10, 2015).

For documentation, the New Jersey specialist established a VA MOU and a TSA; whereas the Portland pilot used documentation specific to the Innovation 669 program (http://vaww.visn20.portal.va.gov/sites/clinical/TH/TeleJustice/SitePages/Home.aspx). From the outset, the specialist explored the CVT-IH model of using an Internet connection, Jabber software, and webcam. According to Mr. Correale (June 10, 2015), VA telehealth-issued webcams and Jabber video used on a VA campus did not work. In testing, it failed to provide synced video and audio but was successful after switching to the Cisco EX90 (San Jose, CA).

Mr. Correale was able to get access to desktop technology in the jail, where a stand-alone monitor was connected to a network inside the facility. As of June 2015, the New Jersey pilot has successfully made 9 videoconferencing connections in Monmouth County and has an additional signed MOU for Hudson County.

Related: Using Life Stories to Connect Veterans and Providers

Mr. Correale (June 10, 2015) indicated, “Dialing into a web-based system from the VA would have been outside the traditional VA telehealth arrangement and was therefore not pursued further.” This indicated that the web-based system used by the Portland VJO specialist may not be accepted at all VA facilities.

In the New Jersey pilot, a video-telephone booth was used, which had an EX90 desktop monitor and connection to the jail’s network. The VA information technology (IT) personnel obtained contact numbers for videoconferencing locations within the New Jersey justice system through an arrangement with the New Jersey State Parole Board. The specialist coordinated with the correctional officers (COs) responsible for escorting veterans to the chosen locations regarding privacy and visit scheduling. The CO would escort the veteran to the video-telephone booth in the jail. For scheduling and completing the encounter, the specialist scheduled the appointment time in VISTA, as did the specialist in Portland.

Discussion

A key element of the Portland pilot was autonomy. The pilot was implemented in the context of a VHA Innovation grant, which reduced a number of required approvals. Utilizing a web-based solution also eliminated significant technical obstacles. A peer technical consultant was on-call during each scheduled appointment and provided all technical support. The peer technical consultant, who had logged 2,500 hours of volunteer services in the HBTMH pilot and who worked full-time as a contractor in the Innovation 669 program, was a critical component to the success of the Portland pilot. The Portland pilot demonstrated an effective, simple, and cost-responsible clinical pathway to connect VA providers with incarcerated veterans through telehealth technologies.

The New Jersey pilot also demonstrated a feasible pathway to connect with incarcerated veterans, achieved through a different approach. The New Jersey pilot accessed incarcerated veterans through the correction center’s internal videoconferencing system, whereas the Portland pilot used VA-approved software over the Internet.