{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:33:03Z","timestamp":1747182783444,"version":"3.40.5"},"reference-count":33,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T00:00:00Z","timestamp":1677628800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Following rapid uptake of telehealth during the COVID\u201019 pandemic, we examined barriers and facilitators for sustainability and spread of telemental health video (TMH\u2010V) as policies regarding precautions from the pandemic waned.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a qualitative study using semistructured interviews and observations guided by RE\u2010AIM. We asked four groups, local clinicians, facility leadership, Veterans, and external partners, about barriers and facilitators impacting patient willingness to engage in TMH\u2010V (reach), quality of care (effectiveness), barriers and facilitators impacting provider uptake (adoption), possible adaptations to TMH\u2010V (implementation), and possibilities for long\u2010term use of TMH\u2010V (maintenance). Interviews were recorded, transcribed, and analyzed using framework analysis. We also observed TMH\u2010V encounters in one emergency department (ED) and one urgent care (UC) to understand how clinicians and Veterans engaged with the technology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We conducted 35 interviews with ED\/UC clinicians and staff (<jats:italic>n<\/jats:italic>\u00a0=\u200910), clinical and facility leadership (<jats:italic>n<\/jats:italic>\u00a0=\u20097), Veterans (<jats:italic>n<\/jats:italic>\u00a0=\u20095), and external partners (<jats:italic>n<\/jats:italic>\u00a0=\u200913), January\u2013May 2022. We completed 10 observations. All interviewees were satisfied with the TMH\u2010V program, and interviewees highlighted increased comfort discussing difficult topics for Veterans (reach). Clinicians identified that TMH\u2010V allowed for cross\u2010coverage across sites as well as increased safety and flexibility for clinicians (adoption). Opportunities for improvement include alleviating technological burdens for on\u2010site staff, electronic health record (EHR) modifications to accurately capture workload and modality (telehealth vs. in\u2010person), and standardizing protocols to streamline communication between on\u2010site and remote clinical staff (implementation). Finally, interviewees encouraged its spread (maintenance) and thought there was great potential for service expansion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Interviewees expressed support for continuing TMH\u2010V locally and spread to other sites. Ensuring adequate infrastructure (e.g., EHR integration and technology support) and workforce capacity are key for successful spread. Given the shortage of mental health (MH) clinicians in rural settings, TMH\u2010V represents a promising intervention to increase the access to high\u2010quality emergency MH care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14682","type":"journal-article","created":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T14:06:05Z","timestamp":1676383565000},"page":"368-378","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Telemental health in emergency care settings: A qualitative analysis of considerations for sustainability and spread"],"prefix":"10.1111","volume":"30","author":[{"given":"McKenzie K.","family":"Roddy","sequence":"first","affiliation":[{"name":"Geriatric Research, Education, and Clinical Center (GRECC) Veterans Affairs Tennessee Valley Healthcare System  Nashville Tennessee USA"},{"name":"Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Chen","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alvin D.","family":"Jeffery","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education, and Clinical Center (GRECC) Veterans Affairs Tennessee Valley Healthcare System  Nashville Tennessee USA"},{"name":"School of Nursing Vanderbilt University  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeydith","family":"Gutierrez","sequence":"additional","affiliation":[{"name":"Iowa City Veterans Affairs Health Care System  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Rubenstein","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Vanderbilt University Medical Center  Nashville Tennessee 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