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Development of a Virtual Reality Assessment of Everyday Living Skills

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Published on: April 23, 2014

A Roadmap for Implementing Virtual Geriatric Mental Health Services for Rural Veterans: Qualitative Longitudinal

Christine E Gould^1,2,3, Marika Blair Humber^1,2, Chalise Carlson^1,2

¹Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA, 94304, United States, 1 650-4935000.

|June 16, 2026

Summary

This study outlines a roadmap for implementing and sustaining telehealth geriatric mental health (GMH) services for rural veterans. Key phases include pre-implementation, scale-up, and sustainment, with tailored strategies improving access to care.

Keywords:

CFIR older adults rural health telehealth virtual care

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Area of Science:

Geriatric Mental Health
Telehealth Services
Rural Health Access

Background:

Geriatric mental health (GMH) care access is limited in rural areas.
The Veterans Health Administration uses regional telehealth hubs for specialty tele-GMH care for aging rural veterans.

Purpose of the Study:

To create a roadmap for implementing and sustaining tele-GMH services.
To identify key phases and determinants of success for tele-GMH service delivery.

Main Methods:

Qualitative longitudinal evaluation of tele-GMH teams.
Semistructured interviews with clinicians (n=25) across 8 teams over 3 years.
Templated rapid qualitative approach guided by CFIR 2.0, followed by thematic analysis.

Main Results:

Identified three cyclical phases: pre-implementation, implementation scale-up/expansion, and sustainment.
Barriers included unfamiliarity with local resources; facilitators included tailored strategies and clinician engagement.
Key activities involved leader engagement, funding, service definition, advertising, feedback, and refinement.

Conclusions:

A unified roadmap for tele-GMH service development and sustainment was created.
The roadmap can guide the creation of tele-GMH services in new regions.
Enhancing access to specialty care for aging rural veterans is the ultimate goal.