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Leveraging telebehavioral health services for rural veterans

Kathy Cook, ASPIN CEO/president and Indiana Veterans Behavioral Network program director

6 questions with the Indiana Veterans Behavioral Health Network

Through a public-private partnership between the Veterans Health Administration and Affiliated Service Providers of Indiana (ASPIN), the Indiana Veterans Behavioral Health Network provides telebehavioral health and other services to veterans in rural Indiana. This innovative program has been successful in improving access and quality of care for veterans and their families. As a Rural Health Network Development Program grantee, this project was funded by a grant and administered by the Federal Office of Rural Health Policy.

Kathy Cook, CEO/president of ASPIN and program director of Indiana Veterans Behavioral Health Network, answers questions about ASPIN and its community impact, as well as the potential for implementing similar programs serving rural veterans in other states.

Q: What is ASPIN?

A: ASPIN is a 501(c)(3) not-for-profit behavioral health network that serves rural areas in Indiana. ASPIN’s mission is to provide innovative educational programs, resource management, program development, and network management in collaboration with all health care entities to address health disparities and whole health management.

ASPIN administration operates as a third-party contractor to centralize contracts for state and federal funding for its network members. The organization’s budget is $9 to $13 million per year, with most of the money coming from the Indiana Division of Mental Health and Addiction (DMHA) for clinical services and $2 to $3 million in grant funding for special projects.

ASPIN became the first clinical provider network for the Indiana DMHA in 1995. We were the first to have a private telehealth network with the VA and the first to have a statewide health navigator network. We’ve also been an education network for more than 20 years.

Q: What services does ASPIN provide to veterans in Indiana?

A: We provide mental health and addiction services to veterans, assisting them in health insurance enrollment and connecting them to the VA through telehealth for appointments with their VA therapist or medication prescriber. In the ASPIN network:

  • We treat about 2,000 veterans annually for mental health or addiction diagnoses who may not have sought care because of various barriers.
  • We increased our services for military families from 416 individuals in 2014 to 4,756 individuals in 2017.
  • We have served over 2,156 rural veterans who are on VA benefits through our telehealth network, allowing them to receive services locally in rural areas without having to travel to Indianapolis.

Q: What has helped your program achieve success in providing mental health and addiction services to veterans?

A: Identifying veterans and their families is a critical first step that can easily be overlooked in the intake process. In 2010, we started asking consumers if they were veterans. In 2014, we changed the intake question to “Have you ever served in the military?” We also started asking, “Has anyone in your family served in the military?” The number of veteran families served has steadily increased since we started tracking the data, serving 4,756 military families in 2017.

Our focus on military culture is another factor that has been integral to the program’s success. We trained more than 500 clinical behavioral health providers in military culture so they understand words to use and ways to support effective communication. We also try to hire veterans so they can assist with a peer-to-peer approach. This helps establish trust so veterans are more comfortable and confident when they come to our network for services.

Q: How does your program help uninsured veterans enroll in coverage?

A: Many people assume that serving in the military automatically qualifies a person for VA coverage — but that is not always the case. About a third of our veterans did not have health insurance in 2010 when they visited our mental health and addiction centers.

With a core group of federal and state certified health insurance navigators, we conducted outreach to this population, and we were successful in assisting them get covered. We learned that in some cases, veterans had coverage but their family members did not. We’ve been connecting with the American Legion and reaching out to veteran families to help them find health insurance. Looking at the network data, we are seeing an increase in veterans utilizing our providers and a decrease in the number of uninsured veterans and families, from 35 percent uninsured in 2013 to 13 percent uninsured in 2017.

Q: How does telebehavioral health help rural veterans access care?

A: ASPIN has a contract with VA to operate an eight-site telehealth network throughout Indiana. This program started as a 2012 Health Resources and Services Administration (HRSA) planning grant in partnership with the Richard L. Roudebush VA Medical Center and was then funded for three years as an HRSA Rural Health Network Development Grant.

The VA leases space for approximately four hours a week at each site. VA therapists or medication prescribers can schedule an appointment with a veteran they are treating by setting an appointment on a private and encrypted website. ASPIN then notifies the telehealth site of the appointment, and the veteran goes to the local office and connects through the telehealth unit to the VA. ASPIN then invoices the VA for facility fees utilized and then passes the fees to the individual providers.

Providing telebehavioral health services to veterans improves their access to specialty care and reduces travel burden and expenditures, such as gas and lodging for veterans and their families. Through telebehavioral health services, ASPIN has served more than 700 patients per year, saved over 35,000 miles driven to outlying facilities and increased veteran health care enrollment and other services.

Q: How does ASPIN benefit your community?

A: We take pride in helping veterans and their families with accessing health care and mental health services. We are very thankful for the sacrifices they make on a daily basis, and this is our way of giving back to them to make their lives better at home. They have earned this privilege, and we are proud to assist them.

“Through telebehavioral health services, ASPIN has served more than 700 patients per year and increased veteran health care enrollment and other services.” – Kathy Cook, ASPIN CEO/president and Indiana Veterans Behavioral Network program director

Making a difference for veterans and families

A veteran sent the following message after his family received help enrolling in health insurance with an ASPIN navigator:

Things are a whole lot better around here since we can work on getting healthier instead of being completely stressed out about how we are going to pay for our groceries and utilities. God bless you for all your help.

This project was funded under grant # D06RH21664 by the U.S. Department of Health and Human Services, Health Resources and Services Administration.

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