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and measure the level of a panel of hormones in
an attempt to identify hormone levels or patterns
of hormone levels that differ from those of indi-
viduals not afflicted with TBI.
reintegrate themselves into, communities where
access to provider experts is not readily available.
This research examines the effectiveness of
such telehealth service delivery models for veter-
ans and active duty soldiers who have sustained a
mild to moderate TBI. We plan to use a three-arm
randomized control trial to test the hypothesis that
evidenced-based CBT for TBI patients, delivered
via videoconferencing technology (“Telehealth”)
will be at least as effective as traditional (“In-
Person”) CBT delivery for improving psycho-
logical functioning, and that both CBT service
delivery modes will be superior to “Usual Medical
Rehabilitation Care.” Consented participants are
assigned randomly to one of the three treatment
arms (consented means those subjects who have
freely given their consent to participate). Our
methods allow the direct comparison of each
service delivery mode's effectiveness in terms
of two categories of outcome variables: (1) clini-
cal outcomes, including symptom severity and
overall psychological functioning as represented
by symptoms of depression and anxiety, sleep
disturbance, and pain; and (2) process outcomes,
such as treatment adherence, session attendance,
attrition, patient perception of treatment, and
patient acceptance of technology facilitated treat-
ment delivery.
Demonstrated efficacy of telehealth-delivered
CBT for patients with mild to moderate TBI will
allow for the development of remote service de-
livery and chronic support programs that do not
require patients to travel repeatedly or to travel
to distant hospitals for outpatient treatment. Our
ultimate goal is telehealth-delivered CBT in
the home in order to provide long-term access
to high quality treatment by, and support from,
trained mental health providers when and where
that treatment and support is needed, to reduce
stigma associated with mental health treatment by
military personnel, and to promote both optimal
recovery and successful community reintegration.
Project B: “Telehealth Psychological
Service Delivery to Patients with TBI”
Collaborating Agencies:
•
Center for Telehealth, Medical College of
Georgia
•
Charlie Norwood VA Medical Center
A growing literature suggests several prom-
ising directions for both the assessment of, and
treatment for, individuals with mild to moderate
TBI during acute and post-acute rehabilitation.
For example, cognitive behavioral therapy (CBT)
has been shown to be effective for treating the
psychological and behavioral consequences of
TBI, including depression, anxiety, sleep distur-
bance, and pain (e.g., Ouellet & Morin, 2004).
As the longer-term implications for adjustment
to injury and quality of life post-TBI are just now
beginning to be realized, it is clear that efficacious,
cost-effective, non-stigmatizing and even novel
post-acute interventions are needed. It is essential
that these new approaches must take into account
access to mental health care because definitive
treatment is seldom completed in hospital and ac-
tive duty soldiers and veterans are often discharged
to their homes or to other care facilities that have
limited access to the healthcare systems most able
to provide the required effective interventions.
In the past decade, telehealth technologies
have emerged as efficient and effective service
delivery tools to bridge geographical barriers.
Telehealth service delivery models, especially
those incorporating web-based telehealth tech-
nologies available in the home, provide a solution
to the problem of access by allowing health care
professionals to provide mental and behavioral
health care to patients living in, and attempting to
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