While similar rates of traumatic experiences exist in both rural and urban settings, mental health resources available to those living in rural areas are often scarce. Limited resources pose a problem for children and families living in rural areas, and several barriers to service access and utilization exist including reduced anonymity, few “after-hours” services, decreased availability of evidence-based treatments, few specialty clinics, and expenses associated with travel, taking time off work, and provision of childcare. As a solution, the authors discuss the utility, use, and set-up of a telemental health program through an existing community outreach program. Suggestions for establishing a telemental health clinic are presented along guidelines for the delivery of trauma-focused, cognitive-behavioral therapy (TF-CBT) via telemental health videoconferencing technology. Specific guidelines discussed include (1) establishing and utilizing community partnerships, (2) Memoranda of Understanding (MOU), (3) equipment setup and technological resources, (4) videoconferencing software, (5) physical setup, (6) clinic administration, (7) service reimbursement and start-up costs, (8) therapy delivery modifications, and (9) delivering culturally competent services to rural and remote areas.

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Treatment initiation and engagement of clients with posttraumatic stress disorder (PTSD) can be challenging due to early treatment dropout when a client with PTSD is unwilling to confront feared trauma-related stimuli and experience anxious arousal during exposure. Increased attention to these engagement issues is especially warranted with traditionally underserved populations (i.e., ethnic minorities, low socioeconomic status, rural residence). This case study describes Victor, a 34-year-old Latino man victimized during a robbery in the rural Southeastern United States, and explains the successful cultural modifications made to Victor's 10 sessions of prolonged exposure (PE) therapy. Telemedicine, or conducting therapy sessions over a secure Internet connection, was used to overcome barriers associated with rural clients with limited access to specialized and bilingual services. Victor showed marked reductions in PTSD symptoms after completion of PE via telemedicine. This article explains the client's presenting complaints, history, assessment, barriers to care, cultural modifications, and treatment implications.