Competent Cultural Telebehavioral Healthcare to Rural Diverse Populations: Administration, Evaluation, and Financing
Medical healthcare settings have begun to use telepsychiatry and telebehavioral health to improve access to evidence-based care for culturally diverse patients. This paper is a companion paper to another, which focused on components of culturally competent clinical care, fundamental approaches, and linkage of outcomes to competencies. An administrative foundation is needed to address workforce, program evaluation, and short- and long-term financing and reimbursement issues. This paper focuses on three questions, particularly related to medical settings: (1) What administrative approaches facilitate culturally competent care via telebehavioral health? (2) What outcomes should be prioritized for program evaluation? (3) What financing and reimbursement approaches help to overcome/prevent obstacles/barriers and promote sustainability? Administrators need an approach to evaluation, interprofessional/disciplinary teams, stepped/comparable models of care, and telebehavioral health to leverage expertise. Clinicians and team members need integrated cultural and telebehavioral health skills and all members of a clinic/system need to support diversity by reducing stigmatization, facilitating language access and flexibly adapting practices. On one hand, telehealth and culturally competent care are just part of regular services, but on the other hand, few accommodations are made for these in short- and long-term financing and reimbursement streams. Building a viable system and sustaining requires prevention/management of many barriers/obstacles. Populations need culturally competent care and telebehavioral access. More quantitative/qualitative research/evaluation is suggested to improve the approach and outcomes.
KeywordsTelepsychiatry Culture Behavioral health Academic health center Finance Administration
The authors would like to thank the Coalition for Technology in Behavioral Science (CTIBS), Telebehavioral Behavioral Health Institute (TBHI), University of California, Davis School of Medicine and Department of Psychiatry & Behavioral Sciences, VA Northern California Health Care System, and University of Cincinnati Lindner College of Business.
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