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. However, rural communities seeking to expand telehealth services to tribes should
consider possible barriers to implementation, such as resistance to new technology.
One systematic review of
telehealth programs serving tribal populations found that acceptance of telehealth technologies was 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
Store-and-Forward Telehealth in Alaska: A Seven Year Retrospective
Describes the outcomes of a store-and-forward telehealth program in Alaska. Describes the program
utilization, benefits, potential areas for fraud and abuse, and barriers.
Author(s): Ferguson, A.S., Kokesh, J., Patricoski, C., Hofstetter, P., & Hogge, N.
Organization(s): Alaska Native Tribal Health Consortium
Guide for Setting Up Telebehavioral Health Services
Serves a comprehensive step-by-step guide to set up telebehavioral services at a program site.
Highlights the importance of health information technology staff and a telebehavioral health
coordinator to the success of a program.
Organization(s): Indian Health Service: Telebehavioral Health Center of Excellence
The Success of Telehealth Care in the Indian Health
Describes three successful telehealth initiatives in Indian Country. Highlights barriers and
opportunities to better reach 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