Rural American Indian and Alaska Native veterans’ telemental health: A model of culturally centered care

Abstract: American Indian and Alaska Native (AI/AN) veterans living in rural areas have unique healthcare needs and face numerous barriers to accessing healthcare services. Among these needs is a disproportionate prevalence of post-traumatic stress disorder and other mental illnesses. Since 2001, fourteen rural communities have partnered with the U.S. Department of Veterans Affairs and the Centers for American Indian and Alaska Native Health at the University of Colorado Anschutz Medical Campus to extend telemental health clinics to American Indian veterans. Administrative and, to some extent, clinical considerations of these clinics have been reviewed previously. This paper describes a model of care, evolved over a 14-year period, that weaves together evidence-based Western treatment, traditional Native healing, and rural Native communities into four main components: mental health care, technology, care coordination, and cultural facilitation. We delineate improvements to care made by addressing barriers such as system transference, provider-patient trust, and videoconferencing. Similarly, the discussion notes ways that the care model leverages strengths within Native communities, such as social cohesion and spirituality. Future steps include selection of appropriate performance indicators for systematic evaluation. The identification of key constructs of this care model will facilitate comparisons to other models of care in underserved populations with chronic and complex health conditions, and eventually advance the state of care for our warriors.