System-wide implementation of telehealth to support military Veterans and their families in response to COVID-19: A paradigm shift
Abstract: The need for the expansion of telehealth services in behavioural health care existed long before the COVID-19 pandemic. Yet, for a variety of reasons – including technological costs, reluctance of behavioural care providers to adapt telehealth to their practices, privacy concerns, and client aversion to receiving care remotely, among many others– telehealth has not been widely implemented. However, the COVID-19 crisis, and the accompanying social isolation that ensued, necessitated either a swift transition to telehealth delivery of behavioural health care, the termination of behavioural health care, or the clinician continuing to meet face-to-face with clients, placing both the clinician and the client at increased risk of infection. Shifting behavioural health care to a telehealth platform seemed the most sensible and, quite candidly, the only option, although many clinics still operate employing the face-to-face modality. In this article, we describe how an emerging national behavioural health care network, Cohen Veterans Network (CVN) in the United States, rapidly and relatively seamlessly transitioned to a full-service, virtual network of outpatient behavioural health clinics when faced with a national crisis.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.