兰德-Improving-Access-to-Behavioral-Health-Care-for-Remote-Service-Members-and-Their-Families_13页_571kb

Summary: Improving Access to Behavioral Health Care for Remote Service Members and Their Families

Core Content

This document outlines the challenges faced by remote service members and their families in accessing behavioral health care, and presents recommendations to improve this access. It emphasizes the need for better data infrastructure and the implementation of innovative care models such as collaborative care and telemental health (TMH).

Key Findings

• Population Affected: Approximately 1.3 million individuals, including 300,000 service members and 1 million dependents, live 30 minutes or more from behavioral health care services.
• Impact of Remoteness: Longer drive times significantly reduce the frequency of behavioral health care use. Remote service members and dependents make 20% fewer visits to behavioral health providers.
• Geographic Challenges:
  • Fewer care providers in rural areas.
  • Long travel times and limited transportation options.
  • Cultural stigma associated with mental health.
• Data Gaps: There is no systematic way to monitor policy outcomes related to behavioral health care access for remote populations.
• Promising Practices:
  • Collaborative Care: Integrating behavioral health into primary care can improve access and outcomes, especially in rural areas.
  • Telemental Health (TMH): Offers potential for increased access and reduced stigma, though faces technical and regulatory barriers.

Main Recommendations

1. Establish Clear Policies:

   • Set an official standard of a maximum 30-minute drive to behavioral health specialty care.
   • Work on closing the gap for active component service members to achieve near 100% access.
   • Set goals for improving access for National Guard and Reserve service members and their dependents.

2. Monitor Implementation:

   • Develop a computing infrastructure and interactive data portal to track access and quality of care.
   • Integrate monitoring with efforts to test and assess alternative care delivery methods.
   • Require regional managed care contractors to share and update provider databases with the DoD.

3. Improve Remote Behavioral Health Care:

   • Remove outdated technical and regulatory barriers to TMH and collaborative care.
   • Continue to innovate and collect systemwide evidence on the effectiveness of TMH and collaborative care.
   • Use collected evidence to improve monitoring systems and ensure better access and quality of care.

Key Information

• National Guard and Reserve: Most remote service members (260,000 out of 300,000) are from these groups, due to their part-time nature and employment outside the military.
• Coast Guard: Has the highest number of full-time active component service members living far from care facilities.
• Dependents: Spouses and children of remote service members are also affected, experiencing emotional and psychological challenges due to deployment cycles.
• Telemental Health: While promising, it faces barriers such as limited broadband access and reimbursement policies.
• Collaborative Care: Has shown effectiveness in civilian populations, especially for depression and anxiety, but more research is needed in military settings.

Challenges to Access

• Provider Shortage: 80% of U.S. rural areas are medically underserved, with many overlapping with Health Professional Shortage Areas (HPSAs).
• Transportation Limitations: Rural areas lack public transportation, making it difficult for those with disabilities or in one-car households to access care.
• Stigma: Cultural stigma associated with mental health challenges can deter individuals from seeking care.
• Insurance and Reimbursement: TRICARE policy mandates specific standards for reimbursement of telehealth services, such as the use of video technology equipment.

Data Infrastructure

• Need for Monitoring: A formal monitoring system is essential to assess the effectiveness of current policies and guide future reforms.
• Data Portal: An interactive data portal should include information on provider types, training, availability of evidence-based procedures, and client needs.

Conclusion

Improving access to behavioral health care for remote service members and their families requires a multifaceted approach, including policy reform, data monitoring, and the adoption of innovative care delivery models. These efforts must be supported by sustained action within the DoD and collaboration with the VA and other stakeholders.