Jones Andrea M, Shealy Kristen M, Reid-Quiñones Kathryn, Moreland Angela D, Davidson Tatiana M, López Cristina M, Barr Simone C, de Arellano Michael A
National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina.
Psychol Serv. 2014 Nov;11(4):398-409. doi: 10.1037/a0034963. Epub 2013 Dec 9.
Although similar rates of traumatic experiences exist in both rural and urban settings, mental health resources available to those living in rural areas are often scarce. Limited resources pose a problem for children and families living in rural areas, and several barriers to service access and utilization exist including reduced anonymity, few "after hours" services, decreased availability of evidence-based treatments, few specialty clinics, and expenses associated with travel, taking time off work, and provision of childcare. As a solution, the authors discuss the utility, use, and set-up of a telemental health program within an existing community outreach program. Suggestions for establishing a telemental health clinic are presented along with guidelines for the delivery of trauma-focused, cognitive-behavioral therapy (TF-CBT) via telemental health videoconferencing technology. Specific guidelines discussed include (1) establishing and using community partnerships, (2) Memoranda of Understanding (MOU), (3) equipment setup and technological resources, (4) videoconferencing software, (5) physical setup, (6) clinic administration, (7) service reimbursement and start-up costs, (8) therapy delivery modifications, and (9) delivering culturally competent services to rural and remote areas.
尽管农村和城市地区的创伤经历发生率相似，但农村地区居民可获得的心理健康资源往往稀缺。资源有限给农村地区的儿童和家庭带来了问题，在服务获取和利用方面存在一些障碍，包括匿名性降低、“非工作时间”服务少、循证治疗的可及性降低、专科诊所少，以及与交通、请假和提供儿童保育相关的费用。作为一种解决方案，作者讨论了在现有的社区外展项目中开展远程心理健康项目的效用、使用方法和设置。文中提出了建立远程心理健康诊所的建议，以及通过远程心理健康视频会议技术提供以创伤为重点的认知行为疗法（TF-CBT）的指导方针。讨论的具体指导方针包括：（1）建立和利用社区伙伴关系；（2）谅解备忘录（MOU）；（3）设备设置和技术资源；（4）视频会议软件；（5）物理设置；（6）诊所管理；（7）服务报销和启动成本；（8）治疗提供方式的调整；（9）为农村和偏远地区提供具有文化胜任力的服务。
