VA Neuropsychologists Coordinate Bilingual Virtual Care – VA News

VA providers are working together to provide culturally sensitive care to veterans of all backgrounds. Recently, two VA neuropsychologists teamed up to conduct a neuropsychological evaluation of a bilingual veteran through telemedicine. This successful meeting reflects VA’s national goals to improve VA health care services with telehealth.

It seemed like the veteran was really happy to talk to someone who could understand him, Dr. Ana Messler said. And there didn’t have to be that third party, an interpreter, stepping in in case things got lost in translation. It was really cool to see that happen.

A successful bilingual assessment using VA telehealth

Messler, a neuropsychologist at the VISN 20 Clinical Resource Hub, received a request for services for a veteran in a rural area. The referral provider was concerned about the safety of the veterans and whether they were developing dementia. The veteran required a neuropsychological evaluation.

Neuropsychological evaluations include a diagnostic interview and observations, as well as standardized cognitive tests to identify the cause of any cognitive, emotional, and behavioral changes. The neuropsychologist then recommends treatments. Tests vary based on the symptoms experienced by each veteran. They measure skills such as memory, attention, thinking speed, and problem solving. They can also predict veterans’ ability to manage independent living. Test performance can be easily influenced by language and culture.

The evaluation takes several hours. And it can be conducted in-person or via telehealth when the veteran can’t enter a facility. The assessment begins with a diagnostic interview followed by cognitive tests and discussion of the results with the Veteran.

During their first meeting, Messler discovered that the veteran spoke Spanish very well. He therefore decided that a culturally responsive assessment should be conducted in his preferred language. The veteran and his family welcomed him. Messler then contacted Dr. Yesenia Serrano to consult on the case. Serrano is a bilingual neuropsychologist at VISN 4’s Clinical Resource Hub and frequently works with Spanish-speaking veterans.

Traveling to a Spanish-speaking provider in another state was not an option for the veteran. Messler and Serrano then agreed to work together on telehealth assessment, collaborating on case planning. During the assessment, Serrano acted as an interpreter and administered tests involving language. Messler conducted the nonverbal portions of the tests.

Working with a Spanish-speaking provider made the assessment culturally relevant. It was more comfortable for the veteran. It allowed him to be more open with his responses everywhere. This has resulted in greater diagnostic clarity and more appropriate recommendations for treatment. Her caregiver also appreciated the culturally relevant recommendations provided by a provider with a similar cultural background. The veteran and his family were so grateful for the attention given during the evaluation process that, during the feedback session, the veteran exclaimed: Te amo !, in Spanish I love you!

The Power of Telemedicine VA

I think that’s just the power of being able to provide culturally appropriate assessments and having VA providers who have a variety of cultural backgrounds to help our veterans feel comfortable, Messler said. Because he was able to disclose this way, we were able to get the information we needed to help him.

The COVID-19 pandemic has provided opportunities to increase the availability and access of TeleNeuropsychology. VA neuropsychologists are empowered to better serve veterans across the country, regardless of distance from a VA facility. These adaptations allowed Messler and Serrano to help the veteran quickly and without traveling to a VA facility with a Spanish-speaking provider.

Telehealth removes the barriers we once had to reaching all veterans and especially veterans in rural areas, Messler said. And we can often connect with family members back home who may simply accompany them to visit or not attend. Thanks to this collaboration, the veteran was not only able to obtain language-compatible services, but also to be rapidly evaluated by qualified operators and provided with very important therapeutic options that truly represented a turning point in his care. We were able to offer the family ways they could support him.

I think telehealth has helped ensure equity and inclusion in terms of service quality and access to services, Serrano said. And it provides opportunities for VA facilities to work together.

Resources for VA neuropsychologists

Because of cases like this, Serrano and Dr. Julija Stelmokas, a neuropsychologist at the New York Harbor VA, Brooklyn Campus, have been working with other neuropsychologists to facilitate education and improve culturally sensitive neuropsychological care for veterans of all backgrounds.

Veterans should receive assistance in their preferred language, especially when it comes to mental health and neuropsychology, Serrano said.

Messler’s experience with the case sparked his interest in ensuring that veterans of all backgrounds can receive the care that is best suited to their needs. She recently published a literature review, co-authored by two other neuropsychologists, including Serrano, to show the benefits of using TeleNeuropsychology services for culturally and linguistically diverse populations in the United States and its territories.

I got really interested in learning more about TeleNeuropsychology with racially and ethnically diverse veterans groups. Messler said. I think a lot of times people have these questions, they have these cases and they don’t know where to go. We’re trying to encourage people to really want to know more, to develop this area of ​​expertise and to address it.

Serrano said he wants to motivate other VA providers to be culturally curious and to think outside the box to help veterans of all backgrounds.

I want suppliers from all over the world to not walk away from these kinds of cases, to approach and ask others to help and to keep in mind how much impact a little effort can have. It was a great effort on our part. But the result was a positive outcome for the Veteran and the creation of something greater.