Neuropsychological evaluations include a diagnostic interview and observations as well as standardized cognitive testing to identify the cause of any cognitive, emotional and behavioral changes. The neuropsychologist then recommends treatments. The tests vary based on the symptoms each Veteran is experiencing. They measure abilities such as memory, attention, speed of thinking and problem solving. They can also predict the Veteran\u2019s ability to manage independent living. Test performance can easily be affected by language and culture.<\/p>\n
The evaluation takes several hours. And it can be conducted in person or through telehealth when the Veteran cannot come into a facility. The evaluation starts with a diagnostic interview followed by cognitive testing and a discussion of the results with the Veteran.<\/p>\n
During their first meeting, Messler discovered the Veteran was most proficient in Spanish. She then decided that a culturally responsive evaluation would need to be conducted in his preferred language. The Veteran and his family welcomed this. Messler then reached out to Dr. Yesenia Serrano to consult about the case. Serrano is a bilingual neuropsychologist in VISN 4\u2019s Clinical Resource Hub and often works with Spanish-speaking Veterans.<\/p>\n
Traveling to a Spanish-speaking provider in another state wasn\u2019t an option for the Veteran. Messler and Serrano then decided to work together on the evaluation using telehealth, collaborating on planning for the case. During the evaluation, Serrano was an interpreter and administered tests that involved language. Messler conducted the nonverbal portions of testing.<\/p>\n
Working with a Spanish-speaking provider made the evaluation culturally relevant. It was more comfortable for the Veteran. It enabled him to be more open with his responses throughout. This resulted in stronger diagnostic clarity and more appropriate recommendations for treatment. His caregiver also appreciated the culturally relevant recommendations given by a provider of a similar cultural background. The Veteran and his family were so grateful for the care taken throughout the evaluation process that, during the feedback session, the Veteran exclaimed, \u201cTe amo!\u201d, Spanish for \u201cI love you!\u201d<\/p>\n
The power of VA telehealth<\/h2>\n
\u201cI think that\u2019s just the power of being able to provide culturally appropriate evaluations and to have VA providers who have a variety of cultural backgrounds to help our Veterans feel comfortable,\u201d Messler said. \u201cBecause he was able to disclose like that, we were able to get the information that we needed to help him.\u201d<\/p>\n
The COVID-19 pandemic brought opportunities to increase availability of and access to TeleNeuropsychology. VA neuropsychologists gained the tools to better serve Veterans all over the country, regardless of how far they are from a VA facility. These adaptations enabled Messler and Serrano to help the Veteran quickly and without traveling to a VA facility with a Spanish-speaking provider.<\/p>\n
\u201cTelehealth removes the barriers that we once had in reaching all Veterans and especially Veterans in rural areas,\u201d said Messler. \u201cAnd often, we can connect with family members in the home who might either just drop them off at the visit or not participate. Because of this collaboration, the Veteran was not only able to get language-compatible services but also to be rapidly evaluated by qualified providers and provided with very important treatment options that were really a turning point in his care. We were able to give the family ways that they could support him.\u201d<\/p>\n
\u201cI think telehealth has helped provide equity and inclusion in terms of quality of services, access to services,\u201d said Serrano. \u201cAnd it provides opportunities for VA facilities to work together.\u201d<\/p>\n
Resources for VA neuropsychologists<\/h2>\n
Because of cases like this, Serrano and Dr. Julija Stelmokas, a neuropsychologist at New York Harbor VA<\/a>, Brooklyn Campus, have worked with other neuropsychologists to facilitate education and enhance culturally sensitive neuropsychologic care for Veterans of all backgrounds.<\/p>\n
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