Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
An in-depth description is provided of the implementation of the Veterans Health Administration’s Rural Veterans Tele-Rehabilitation Initiative in supporting development and expansion of individualized community-based vocational services to rural veterans with disabling conditions. Promising practices and opportunities for OT collaborations with vocational rehabilitation specialists were identified.
Primary Author and Speaker: Consuelo Kreider
Contributing Authors: Zaccheus J. Ahonle, Jennifer L. Hale-Gallardo, Gail Castaneda, Kimberly Findley, and Sergio Romero
PURPOSE: Vocational interventions are important rehabilitation interventions for individuals with disabilities. Through the Veteran’s Health Administration (VHA), vocational rehabilitation specialists provide individualized community-based vocational services to Veterans with disabling conditions who experience challenges to obtaining competitive employment and wish to work. Geographic, technological, and cultural barriers exist to providing needed specialized tele-rehabilitation services to Veterans living in rural communities. Tele-rehabilitation is not typically used within healthcare systems in supporting patients’ individualized competitive employment needs. In 2017, the VHA’s Rural Veterans Tele-Rehabilitation Initiative (RVTRI) was leveraged to develop and extend tele-rehabilitation in the delivery of individualized community-based vocational services at two Veterans Administration Medical Centers (VAMC) serving rural Veterans. While there exists understanding of how to support Veterans’ needs, relatively little is known specific to the needs of rural Veterans. As such, this study examined the process of RVTRI program implementation in extending vocational services to rural Veterans with the aim of informing promising practices in supporting the vocational needs of rural Veterans through tele-technologies.
METHOD: A case-study approach was used to gain in-depth understanding of the multifaceted aspects of implementing the RVTRI program within real life rural contexts. Interviews were conducted in October and November 2019 as part of the RVTRI program evaluation. Interviewees were three VRS from the two VAMC, of which two VRS were also program managers at their respective site. A prepared interview guide was used to structure inquiry about the program, to include program implementation. Two qualitative researchers independently recorded interview responses and field notes while a third researcher led each interview. Thematic analysis, which included use of constant comparison, was used to identify preliminary themes. Conceptual codes within the data were independently identified by two coders, with a third researcher verifying conceptual congruence in the coding.
RESULTS: Preliminary themes arose from the interview data that include description of (1) the implementation and power of video-technologies used to extend community-based vocational services to rural Veterans; (2) barriers to tele-technology facilitated vocational services and strategies used in overcoming barriers; and (3) opportunities for expanding community-based vocational services to new populations, to include younger Veterans who were perceived to need the quiet of rurality due to hypervigilance and sensory overstimulation symptoms related to post-traumatic stress.
CONCLUSION: Findings explicate the process of implementing the VHA RVTRI program in extending individualized community-based vocational services to Veterans living in rural communities through use of tele-technologies, and shed light on needs of rural veterans and promising practices for extending vocational supports through use of tele-technologies.
IMPACT: The reported needs of younger Veterans living in rural areas suggest a potential role for occupational therapists in addressing the sensory-based needs of younger rural veterans receiving individualized community-based vocational services from VA vocational rehabilitation specialists (VRS). Such occupational therapy interventions may be a useful complement for supporting these Veteran’s employment goals.
References
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Pinto, A. D., Hassen, N., & Craig-Neil, A. (2018). Employment interventions in health settings: a systematic review and synthesis. The Annals of Family Medicine, 16(5), 447-460. https://doi.org/10.1370/afm.2286
Hale-Gallardo, J., Kreider, C. M., Castaneda, G., Freytes, M., Jia, H., Ripley, D. C., Ahonle, Z. J., Findley, K., Romero, S. (in press). Telerehabilitation for rural Veterans: A qualitative assessment of barriers and facilitators to implementation. Journal of Multidisciplinary Healthcare.
