Implementation Considerations for Tribal Telehealth Programs
Many telehealth programs have focused on improving access to care for rural
tribal communities, which can face persistent barriers to care related to geographic isolation and
health workforce shortages. Lack of infrastructure to support telecommunications, such as lack of high-speed
broadband internet service, remains a core challenge to delivering telehealth on rural tribal lands.
One systematic review of
telehealth programs serving tribal populations found that acceptance of telehealth technologies was also
a key barrier to program success. To address this challenge, rural telehealth programs should consider involving
tribal leaders and patients during initial program development to ensure that the telehealth program will be
accepted by and useful to participants. For example, this review describes how one telehealth program serving
rural American Indian veterans with post-traumatic stress disorder adapted their program to feature family
involvement in order to increase the acceptability of the program. Family members attended telehealth
appointments with patients to offer support.
Another study of the diffusion of telehealth
in VA-sponsored telehealth clinics for rural American Indians emphasized the importance of hiring staff who were
aware of the cultural needs of the community. Rural communities seeking to serve tribes through telehealth
programs should consider the importance of training and hiring clinical staff who are from the local community.
In addition to clinical staff, rural communities could consider engaging community health workers to help
patients address other needs outside of the healthcare setting.
The Indian Health Service's Telebehavioral
Health Center of Excellence offers free continuing medical education credits to providers from rural and
remote sites. For example, the on-demand IHS
Essential Training on Pain and Addiction course focuses on best practices for safely prescribing opioids
and other treatment options for chronic pain.
Resources to Learn More
Turn to Telehealth During COVID-19, Calls Rise for More Resources in Indian Country
Describes how persistent underfunding of infrastructure on tribal lands is affecting the ability to provide
telehealth services to rural AI/AN populations.
Author(s): Barton, A.
Organization(s): Cronkite News Arizona PBS
Guide for Setting Up Telebehavioral Health Services
A guide for setting up telebehavioral services at an Indian Health Service (IHS) program site. Covers
contracting for services, identifying locations needs, setting up a provider, and pharmacy considerations.
Highlights the importance of information technology (IT) staff and a telebehavioral health coordinator to the
success of a program.
Organization(s): IHS Telebehavioral Health Center of Excellence (TBHCE)
Success of Telehealth Care in the Indian Health Service
Describes three telehealth initiatives in Indian Country highlighting their strategies, partners, outcomes,
barriers, and future opportunities to better serve American Indian and Alaska Native populations.
Author(s): Hays, H., Carroll, M., Ferguson, S., Fore, C., & Horton, M.
Citation: Virtual Mentor, 16(12), 986-996
for American Indian and Alaska Native Communities
Provides considerations for developing telehealth programs serving American Indian and Alaska Native (AI/AN)
populations. Includes strategies for setting up a telehealth practice and a telebehavioral program. Covers
billing, planning workflow, patient preparation, telebehavioral health, and managing chronic conditions.
Organization(s): Health Resources and Services Administration (HRSA)