Outcomes for implementation of virtual mental health care for rural native veterans.

Native Veterans experience disproportionately high rates of PTSD and suicide compared to other Veteran populations and face significant barriers to accessing mental healthcare, particularly in rural areas where many reside. This study aimed to support the delivery of Personalized Implementation of Video Telehealth for Rural Native Veterans (PIVOT-RNV) and examine the longitudinal impact on mental health engagement. PIVOT-RNV involves Implementation Facilitation strategies at the partnering VAMCs focused on technology adoption, cultural considerations, and outreach strategies for RNV communities. For this project, we engaged eight partner VAMCs in fiscal years 2023-2024. Using VA health records data, we conducted linear growth curve models to examine the effects of PIVOT-RNV on overall mental health care encounters and telemental health care specifically and whether this changed over time. Across all sites, telemental health encounters for rural Native Veterans significantly increased over time. Importantly, PIVOT-RNV sites experienced a significantly greater increase in telemental health encounters for RNVs over time compared to control sites. Sites with PIVOT-RNV also demonstrated a marginally significant greater increase in overall mental health encounters over time. These findings indicate PIVOT-RNV shows promise for improving RNV's access to VA healthcare by increasing both access to and engagement in video-based mental health. There is a need to further test and implement PIVOT-RNV across other health systems and to examine additional clinical and access outcomes.