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. Lack of infrastructure to support telecommunications, such as lack of high-speed broadband internet service, remains a core challenge to delivering telehealth on rural tribal lands.

One systematic review of telehealth programs serving tribal populations found that acceptance of telehealth technologies was also 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

As Providers Turn to Telehealth During COVID-19, Calls Rise for More Resources in Indian Country
Document
Describes how persistent underfunding of infrastructure on tribal lands is affecting the ability to provide telehealth services to rural AI/AN populations.
Author(s): Barton, A.
Organization(s): Cronkite News Arizona PBS
Date: 8/2020

Step-by-Step Guide for Setting Up Telebehavioral Health Services
Document
A guide for setting up telebehavioral services at an Indian Health Service (IHS) program site. Covers contracting for services, identifying locations needs, setting up a provider, and pharmacy considerations. Highlights the importance of information technology (IT) staff and a telebehavioral health coordinator to the success of a program.
Organization(s): IHS Telebehavioral Health Center of Excellence (TBHCE)
Year: 2018

The Success of Telehealth Care in the Indian Health Service
Document
Describes three telehealth initiatives in Indian Country highlighting their strategies, partners, outcomes, barriers, and future opportunities to better serve 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
Date: 12/2014

Telehealth for American Indian and Alaska Native Communities
Website
Provides considerations for developing telehealth programs serving American Indian and Alaska Native (AI/AN) populations. Includes strategies for setting up a telehealth practice and a telebehavioral program. Covers billing, planning workflow, patient preparation, telebehavioral health, and managing chronic conditions.
Organization(s): Health Resources and Services Administration (HRSA)