Update from the Office of Mental Health and Suicide Prevention

David Carroll, PhDExecutive Director

Wendy Tenhula, PhDDirector, Innovation & Collaboration

May 30, 2018

Psychology Leadership Conference

• VA/VHA Priorities

• Office of Mental Health and Suicide Prevention updates

• Legislative and White House initiatives

• MH Access initiative – 2018 update

• Psychology Staffing & Hiring

• Leadership & Mentoring

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AGENDA

NO MORE IMPORTANT TIME, NO GREATER OPPORTUNITY

• We have a critically important mission and a long-term, meaningful purpose about which there is no question. We should remain confident in our sustained commitment regardless of the daily cross-fire or transitions in team members which have always been part of our journey.

• There are health care and mental health services and research that VHA does that simply cannot be replicated in the private sector. There is tremendous agreement that VHA is improving and has many successes to be proud of. We must emphasize our essential services for Veterans and stories of improvement to continue restoring trust in VA.

• VHA has always used community care to supplement our great work. VHA staff provide the vast majority of care within VA’s high performing network and community care represents about 20% of our budget.

• Commitment to creating an amazing health care system so that Veterans choose VA is the primary driver for what we do every day.

• VHA Operational Plan lays the pathway for our future.

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EXECUTIVE ORDER: JOINT ACTION PLAN

Executive Order 13822: “Supporting Our Veterans During Their Transition From Uniformed Service to Civilian Life”

• Instructs VA, DoD, and DHS to work together to ensure newly separated Veterans receive one year of mental health care from VA after discharge.

• The goal is to support new Veterans in making a successful transition to a fulfilling civilian life and to have access to any mental health care needed during the critical first year period following separation from active duty.

Joint Action Plan Goals:1. Ensure ALL transitioning Service members are aware of and have access to

mental health services.

2. Ensure the needs of at-risk Veterans are identified and met.

3. Improve mental health and suicide prevention services for individuals that have been identified (indicated populations) in need of care.

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CRITICAL COMPONENT - VSOs

• Veteran Service Organizations (VSOs) are our shareholders - versus stakeholders - and our greatest advocates. They make it a priority to know our business and we must make a stronger effort to understand their business – so that we can work even more collaboratively.

• VSOs can reach most Veterans through social media. For example, the Vietnam Veterans of America can reach 10 million followers and the Wounded Warrior Project can reach 3 million instantly. VHA can both leverage and learn from VSOs to reach more Veterans through social media.

• VSOs are committed to helping us magnify our good works and positive stories, as well as provide support when those stories are not positive. They will stand with us when we own our mistakes and help us in fixing them. VA must be transparent and willing to tell the story first.

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Executive Director

Special Programs

Executive Assistant

Veterans Crisis Line

Suicide Prevention

Continuum of Care, General Mental Health

Field Support and Analytics

Innovation and Collaboration

OFFICE OF MENTAL HEALTH AND SUICIDE PREVENTION

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1. Expand into a public health approach to suicide prevention • Suicide Prevention team

2. Support Transitioning Service member mental health• SP team leading but will draw upon all teams in the office

3. Expand open access to care and Foundational Services work• Continuum of Care team

4. Spread measurement-based care across all mental health • Continuum of Care team and Field Support & Analytics team

5. Increase consistency in service delivery & use of data• Field Support & Analytics team plus Special Programs team

6. Maintain and advance VCL services including outreach• VCL team

7. Advance innovations and application of technology• Innovations & Collaboration team plus Special Programs Team

10NC5 GOALS AND DRIVERS OF CHANGE (1.0)

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LEGISLATIVE CHANGES AFFECTING MH CARE

MENTAL HEALTH SERVICES FOR OTHER THAN HONORABLE DISCHARGE (OTH)

During a March 7, 2017 House Veterans Affairs Committee hearing Secretary Shulkin announced his intention to expand provisions for urgent mental health care needs to former Service members with Other Than Honorable (OTH) administrative discharges

• Since implementation:• 5,160 Service members with OTH discharge have requested VA

healthcare services• Between April 1, 2017 and March 30, 2018 –

• 940 OTH Service members received VHA MH care• Average age = 44.2 years• 270 received care in ED• 20 received Residential care• 93 inpatient stays• Overall, 4,445 MH Encounters

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• $10M in new funding for furthering Clay Hunt Act’s development of community peer support network pilot programs at existing sites and to create more in highly rural areas • OMHSP has identified 5 additional networks where there are high

numbers of active duty transitioning military members including the Guard and Reserve components• VISNs 9, 15, 19, 20, 23 submitted proposals for participation in

the remaining months of the current pilots• The original VISNs (6, 7, 16, 17, and 22) have submitted

proposals to enhance existing programs• Funding will be disbursed within the next few weeks to activate the

submitted proposals• The VISN 16 MIRECC team is modifying the current evaluation

protocols and reporting methodologies to include the new networks and enhanced provisions for the existing networks

LEGISLATIVE CHANGES AFFECTING MH CARE (cont.)ENHANCEMENTS IN SECTION 5 OF THE CLAY HUNT ACT

ACCESS INITIATIVE – 2018 UPDATE

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• Expand SUD Same Day Access • All VA Medical Centers must ensure that Same Day Services is

available at the Medical Center. Focus is on Same Day Services, which may include Same Day appointment, MAT access, prescriptions, scheduling, etc.

• Implement Open Access Model for MH

ACCESS INITIATIVE – 2018 UPDATE

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• Enhanced Access Memo • Expand on-line direct scheduling for General Mental

Health appointments• Enhance team-based, warm-hand off processes

• One Million Appointment Initiative• VETexting appointment reminders• No Show reduction

• Provider Utilization Initiative• Mental Health providers with reduced productivity based

upon their individualized target expectations, will be available to provide timely care.

PSYCHOLOGISTS ON BOARD

3165

35203734

4101

46234822

51435332

5470 5541

0

1000

2000

3000

4000

5000

6000

FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18

E

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PSYCHOLOGISTS ON-BOARD READY TO SERVE

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Onboard Employees, Non-Trainees, 0180 Psychology

Fiscal

Year 2009 2010 2011 2012 2013 2014 2015 2016 2017* 2018*

Grade GS-11 GS-11 GS-11 GS-11 GS-11 GS-11 GS-11 GS-11 GS-11 GS-11

120 118 77 107 139 97 97 91 88 83

GS-12 GS-12 GS-12 GS-12 GS-12 GS-12 GS-12 GS-12 GS-12 GS-12

272 262 231 229 281 272 334 345 315 292

GS-13 GS-13 GS-13 GS-13 GS-13 GS-13 GS-13 GS-13 GS-13 GS-13

2,529 2,872 3,129 3,436 3,810 4,011 4,235 4,402 4,478 4,526

GS-14 GS-14 GS-14 GS-14 GS-14 GS-14 GS-14 GS-14 GS-14 GS-14

180 200 218 238 288 339 370 388 480 532

GS-15 GS-15 GS-15 GS-15 GS-15 GS-15 GS-15 GS-15 GS-15 GS-15

64 68 79 91 104 103 107 106 108 107

Total 3,165 3,520 3,734 4,101 4,622 4,822 5,143 5,332 5,470 5,541

* Updated 2017 and 2018 numbers from VHA PAID data as of 3/31/2018

PSYCHOLOGISTS ON BOARD

MENTAL HEALTH HIRING INITIATIVE (MHHI) OVERVIEW

• Goal: 1,000 net mental health providers by December 31, 2018.

• Hiring Plan: In July 2017, facilities submitted plans in response to OMHSP staffing recommendations (SAIL, 7.72 ratio)

• Critical Hiring Sites: 20 Critical Site Hiring Memos issued in April 2018 based on low SAIL performance (>.8 SD below mean) and low MH staffing ratios (needing > 11 FTE to reach ratio)• Provided additional EDRP resources

and WMC hiring support

Net Gain / New Hires

(April 2018)

Occupation Vacancy

Net

Gain Hires

Psychiatrist 10.26% 63 316

Psychologist 9.83% 165 611

MFT &

LPMHC11.62% 44 73

Nurse 9.58% 20 432

Social

Workers10.09% 135 443

Peer Support 9.8% 14 54

0 100 200 300 400 500 600 700 800 900 1000

Goal 1,000

441

Currently we have only increased Suicide Prevention staffing by 47

(Goal: 300)

MHHI RECENT UPDATES

• Marketing• Conference marketing SME and Recruiter joint efforts

• Working with MH Associations (like American Psychological Association –upcoming issue in APA Monitor)

• Social media efforts by WMC

• VA Mental Health Trainee and Early Career Recruitment and Connection Event Launched• “Connect, Match, and Place” MH trainees and Early Career with VA positions

using expedited, non-competitive hiring process.

• 1700+ trainees/early career professionals, matching with over 500 positions across VA (approx. 500 were psychologists)

5/21-5/25:

Matching

5/28-6/4:

15 minute meet and greets

6/5-6/15:

Interviews

6/16-6/30:

Job offers

Note: Additional resources available at the end of this slide deck

BEHAVIORAL HEALTH LEADERSHIP TRAINING (BHLT)

• FY17: Trained 16 psychologists

• FY18: Will train 28 psychologists

• Secured 32 additional BHLT slots for FY18 (96 total slots for all of Mental Health)

• Selected 28 Psychologists (29% of total slots, better representing psychology’s % of the mental health workforce)

• Looking at how to address ‘program manager’ training need in future

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MENTAL HEALTH LEADERSHIP MENTORING PROGRAM

• Target Audience: New MH Chiefs or New Service Chiefs

• Next Class: Recruitment begins this summer; October 1 start

• Duration: 1 year with monthly meetings (optional site visit)

• Learning Plans/Topic Areas: Learning Plans tailored and may include: 1) Strategic Planning

2) Human Resources

3) Systems Understanding

4) Administrative Operations

5) Professional and Personal Development

• Outcomes: Pilot study shoes significant improvement for all 5 areas [Kearney, L. K., Smith, C., Carroll, D., Burk, J. P., Cohen, J. L., & Henderson, K. (2018). Veterans Health Administration’s (VHA) National Mental Health Leadership Mentoring Program: A pilot evaluation. Training And Education In Professional Psychology, 12(1), doi:10.1037/tep0000164]

• Need for Mentors: Current and prior MH Chiefs and Psychology Chiefs are needed as mentors. Will you please consider helping?

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• Leadership is a choice, based upon trusted earned in our relationships

• Leaders help recreate meaning every day

• Leaders find ways to get to yes

• Leaders need to speak in specifics – focus on a few clear actions rather than a sea of shiny objects

• What are your local numbers – for access, for Veteran and staff satisfaction, for new Veterans coming into care, for former Service members with Other Than Honorable discharges, for productivity

• Know about the great things others are saying about VHA mental health care – National Academy of Medicine Report, Rebecca Price et al., …

OWN YOUR LEADERSHIP & KNOW YOUR DATA

REMEMBER THE FULL QUOTE WHICH CONTAINS OUR ORIGINAL MISSION STATEMENT:

• With malice toward none, with charity for all, with firmness in the right as God gives us to see the right, let us strive on to finish the work we are in, to bind up the nation's wounds, to care for him who shall have borne the battle and for his widow and his orphan, to do all which may achieve and cherish a just and lasting peace among ourselves and with all nations. (Abraham Lincoln, Second Inaugural Address, March 4, 1865)

• The modern statement of which: “To care for those who have borne the battle, and for their survivors and orphans.”

• And the commitment to care and look out for extends to each other and all of those on our teams with whom we share our daily work.

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MHHI Resources

Information for Applicants

• External Mental Health Hiring Initiative Site: information on jobs, connecting with recruiters, and career information for each stage of career trajectory (e.g., early, mid)

• USA Jobs: site for listing of positions and application instructions

• Job Search Guide for Trainees: provides informational guidance on the application and preparation process for obtaining a VA job

• Getting a Job in the VA: Guide for Trainees and Early Career: a PowerPoint presentation given by Human Resources (HR) and Office of Academic Affiliation (OAA)s at a prior psychology conference

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Recruitment and Hiring Strategies Information

• Education Debt Reduction Program Quick Reference

Guide: provides an overview of the program and how

to use it for hiring and retention

• Human Resources Myth Busters: addresses common

misconceptions about hiring (e.g., trainee hiring,

incentive utilization, etc.)

• FAQ on Hiring Trainees: provides answers to common

questions from the field on trainee hiring

• Hiring VA Trainees: outlines guidelines for hiring of

trainees, providing the top 10 tips from HT

• Hiring in VA: A Guide For Chiefs: a PowerPoint

presentation with tips from HR and OAA

• Telework FAQs: provides answers to common

questions on telework for employees

Resources for Briefing Others on Staffing Needs:

• White Paper on the Connection between Mental Health Staffing

and MH Performance Metrics

• PowerPoint Presentation on Staffing Levels and Relationship to

MH Performance