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

Background: Access to geriatric mental health (GMH) care is limited in rural areas. To meet this need, the Veterans Health Administration provides specialty tele-GMH care for aging rural veterans via regional telehealth hubs. Objective: This study aims to create a roadmap describing key phases and determinants underlying the implementation and sustainment of tele-GMH services as part of a qualitative longitudinal evaluation of tele-GMH teams. Methods: Semistructured interviews were conducted with clinicians from all 8 tele-GMH teams (n=25) at 3 time points across a 3-year period (October 2021-September 2024). Interview (n=46) data were summarized into key domains using a templated rapid qualitative approach, guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Further thematic analysis and team discussion elucidated the findings. Results: We identified key activities and determinants of success in three phases: (1) preimplementation (engaging leaders, securing funding/hiring, and defining services); (2) implementation scale-up and expansion (advertising, addressing challenges, seeking feedback, refining, and growth); and (3) sustainment (maintenance). Activities within each phase were cyclical and iterative (ie, nonlinear). Barriers to implementation included unfamiliarity with local aging resources; facilitators included tailoring strategies and engaging referring clinicians. Conclusions: Similar processes emerged across regions in the development and sustainment of tele-GMH services, allowing for the creation of a unified roadmap. Limitations including sampling bias are discussed. Further work could apply and evaluate the utility of the roadmap to guide creation of tele-GMH services in new regions to enhance access to specialty care for aging rural veterans.