Delivering an Evidence-Based Mental Health Treatment to Underserved Populations Using Telemedicine: The Case of a Trauma-Affected Adolescent in a Rural Setting

https://doi.org/10.1016/j.cbpra.2014.04.007Get rights and content

Highlights

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    Telemedicine can reduce barriers for receipt of evidence-based trauma treatments.

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    Telemedicine increases access to specialized treatment for underserved populations.

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    Telemedicine reduces burden to providing outreach services in remote areas.

Abstract

Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychological treatment that can effectively ameliorate symptoms of depression and anxiety that are common responses to trauma exposure. However, access to high-quality mental health services can be problematic, especially for traditionally underserved populations such as rural/remote residents, racial/ethnic minorities, and those from low socioeconomic strata. Individuals living in remote areas encounter additional obstacles to care, including long travel distances to reach services, increased time out of work or school, lack of access to transportation, and childcare difficulties. Many rural/remote communities struggle with scarcity of resources in general, and specialized mental health resources specifically, which may inadvertently exclude patients from obtaining the most appropriate health care. Telemedicine, or the use of Internet-based video conferencing, allows a patient live and direct virtual access to specialized mental health care providers. This article examines the application of TF-CBT via telemedicine to treat trauma exposure in a teenager living in a rural setting. Though this case example originates in the rural southeastern United States, the barriers and concepts addressed are generalizable to other remote areas in the United States and worldwide. Specific attention is given to evidence-based treatments for trauma, the merits of the telemedicine modality, and confidentiality considerations when using Internet-based teleconferencing for the application of psychological services.

Section snippets

Rural Considerations

While effective treatments for trauma-exposed youth exist, more recent attention has been appropriately focused on disparities in access to mental health care and understanding causes of the significant underutilization of trauma-related (and general mental health) services among certain demographic groups. The emphasis on identifying potential barriers to treatment that individuals from underserved populations may experience includes youth and families from ethnic minority groups as well as

Client Description

“Sean” was 13 years old when he was referred for mental health assessment following a severe car accident leading to his own personal injury, but more significantly in Sean’s mind, his mother’s death. Sean, a Caucasian male, lived with his paternal grandmother and younger brother (who was not involved in the accident) and attended a public middle school in a rural town in the southeastern United States. The car accident occurred 3 months before the intake session, and involved Sean, his mother,

Discussion

The use of telemedicine was able to reduce several barriers to treatment for Sean and his family. Sean’s community did not have specialized mental health services for children, and the use of videoconferencing allowed Sean to receive TF-CBT, an evidence-based treatment for children and adolescents in a remote area in which access to mental health professionals, in general, is limited. The use of telemedicine meant that Sean’s family did not have to bear the burden of costs associated with

Conclusions

Overall, the results of this case report suggest that the use of telemedicine for trauma-related services may serve as a promising method to engage underserved populations in appropriate, specialized mental health treatment. Results from this case report indicated a significant decrease in both PTSD and depressive symptoms posttreatment, suggesting that a child does not have to meet full diagnostic criteria for a diagnosis of PTSD to benefit significantly from therapy services. However, given

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