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Research findings and dissemination are making healthcare more effective. Electronic health records systems and advanced tools are making care delivery more efficient. Legislative reforms are striving to make care more affordable. Efforts still need to be focused on making healthcare more accessible. Clinical Videoconferencing in Telehealth takes a comprehensive and vital step forward in providing mental health and primary care services for those who cannot make traditional office visits, live in remote areas, have transportation or mobility issues or have competing demands. Practical, evidence-based information is presented in a step by step format at two levels: for administrators, including information regarding selecting the right videoconferencing technology, navigating regulatory issues, policy temples, boilerplate language for entering into care agreements with other entities and practical solutions to multisite programming; and for clinicians, including protocols for safe, therapeutically sound practice, informed consent and tips for overcoming common technical barriers to communication in clinical videoconferencing contexts. Checklists, tables, templates, links, vignettes and other tools help to equip professional readers for providing safe services that are streamlined and relevant while avoiding guesswork, false starts and waste. The book takes a friendly-mentor approach to communication in areas such as: Logistics for administrators: Clinical videoconferencing infrastructures and technologies Policy development, procedures and tools for responsible and compliant programming Navigating issues related to providing services in multiple locations Protocols for clinicians: The informed consent process in clinical videoconferencing Clinical assessment and safety planning for remote services Minimizing communication disruption and

Research findings and dissemination are making healthcare more effective. Electronic health records systems and advanced tools are making care delivery more efficient. Legislative reforms are striving to make care more affordable. Efforts still need to be focused on making healthcare more accessible. Clinical Videoconferencing in Telehealth takes a comprehensive and vital step forward in providing mental health and primary care services for those who cannot make traditional office visits, live in remote areas, have transportation or mobility issues or have competing demands. Practical, evidence-based information is presented in a step by step format at two levels: for administrators, including information regarding selecting the right videoconferencing technology, navigating regulatory issues, policy temples, boilerplate language for entering into care agreements with other entities and practical solutions to multisite programming; and for clinicians, including protocols for safe, therapeutically sound practice, informed consent and tips for overcoming common technical barriers to communication in clinical videoconferencing contexts. Checklists, tables, templates, links, vignettes and other tools help to equip professional readers for providing safe services that are streamlined and relevant while avoiding guesswork, false starts and waste. The book takes a friendly-mentor approach to communication in areas such as: Logistics for administrators: Clinical videoconferencing infrastructures and technologies Policy development, procedures and tools for responsible and compliant programming Navigating issues related to providing services in multiple locations Protocols for clinicians: The informed consent process in clinical videoconferencing Clinical assessment and safety planning for remote services Minimizing communication disruption and

The Veteran's Health Administration (VHA) has launched a large-scale initiative to promote prolonged exposure (PE) therapy, an evidence-based treatment for PTSD. While existing randomized controlled trials (RCTs) unambiguously support the efficacy of PE in civilian and some military populations, there is a need to better understand the course of treatment for combat Veterans of the current wars receiving PE in normative mental healthcare settings. The current study investigates 65 Veterans receiving care at an urban VA medical center. All Veterans were diagnosed with PTSD via a structured interview and treated with PE. Measures of PTSD and depression were collected pre- and post-treatment and every two sessions during treatment. Dependent means t-tests were used to estimate pre- and post-treatment d-type effect sizes. Additionally, hierarchical linear models (HLM) were used to investigate treatment effects over time, relationships between patient characteristics and outcomes, and to provide estimates of R2-type effect sizes. Results indicate that PE in regular VA mental healthcare contexts can be as effective as when implemented in carefully conducted RCTs.

Structured diagnostic interviews are widely considered to be the optimal method of assessing symptoms of posttraumatic stress; however, few clinicians report using structured assessments to guide clinical practice. One commonly cited impediment to these assessment approaches is the amount of time required for test administration and interpretation. Empirically keyed methods to reduce the administration time of structured assessments may be a viable solution to increase the use of standardized and reliable diagnostic tools. Thus, the present research conducted an initial feasibility study using a sample of treatment-seeking military veterans (N = 1,517) to develop a truncated assessment protocol based on the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale (CAPS). Decision-tree analysis was utilized to identify a subset of predictor variables among the CAPS items that were most predictive of a diagnosis of PTSD. The algorithm-driven, atheoretical sequence of questions reduced the number of items administered by more than 75% and classified the validation sample at 92% accuracy. These results demonstrated the feasibility of developing a protocol to assess PTSD in a way that imposes little assessment burden while still providing a reliable categorization.

Among both civilian and veteran populations, substance use disorders (SUDs) and anxiety disorders frequently co-occur. One of the most common comorbid anxiety disorder is posttraumatic stress disorder (PTSD), a condition which may develop after exposure to traumatic events, such as military combat. In comparison with the general population, rates of both SUDs and PTSD are elevated among veterans. Recent data show that soldiers returning from Iraq and Afghanistan demonstrate high rates of co-occurring SUDs, PTSD, and traumatic brain injury. Careful assessment of these conditions is critical and may be complicated by symptom overlap. More research targeting integrated interventions for these conditions is needed to establish optimal treatments.

OBJECTIVE: People with posttraumatic stress disorder (PTSD) commonly report difficulties with sexual desire and other aspects of sexual functioning, but it is currently unknown if people who respond to psychotherapy for PTSD also report improvements in sexual desire. METHOD: One hundred and eighty-seven veterans with PTSD received prolonged exposure (PE) therapy at two outpatient PTSD specialty clinics and completed measures of PTSD symptoms (the PTSD Checklist – Military Version) and sexual desire (item 21 of the Beck Depression Inventory – Second Edition) repeatedly throughout the course of treatment. RESULTS: The results of a conditional generalized mixed ordinal regression model showed a significant interaction between weeks in treatment and PTSD treatment response in predicting change in sexual desire across the course of treatment. Specifically, PTSD treatment responders reported improvement in sexual desire over the course of treatment, whereas nonresponders did not show changes in sexual desire over time. However, the effect of PTSD treatment response was no longer significant when accounting for severity of depression at the start of treatment. Participants reporting more severe depression at the start of treatment reported less improvement in sexual desire, regardless of PTSD symptom response. CONCLUSIONS: People with PTSD who respond to PE also report improvements in sexual desire over time, indicating that response to PE is associated with improved sexual desire, but the effect is complicated by the presence of co-occurring depression symptomatology.

Home-based telemedicine (HBT) is a validated method of evidence-based treatment delivery for posttraumatic stress disorder (PTSD), and justification for its use has centered on closing gaps related to provider availability and distance to treatment centers. However, another potential use of HBT may be to overcome barriers to care that are inherent to the treatment environment, such as with female veterans who have experienced military sexual trauma (MST) and who must present to VA Medical Centers where the majority of patients share features with perpetrator (e.g. gender, clothing) and may function as reminders of the trauma. Delivering evidence-based therapies to female veterans with MST-related PTSD via HBT can provide needed treatment to this population. This manuscript describes an ongoing federally funded randomized controlled trial comparing Prolonged Exposure (PE) delivered in-person to PE delivered via HBT. Outcomes include session attendance, satisfaction with services, and clinical and quality of life indices. It is hypothesized that based on intent-to-treat analyses, HBT delivery of PE will be more effective than SD at improving both clinical and quality of life outcomes at post, 3-, and 6-month follow-up. This is because 'dose received', that is fewer sessions missed, and lower attrition, will be observed in the HBT group. Although the current manuscript focuses on female veterans with MST-related PTSD, implications for other populations facing systemic barriers are discussed.