The Vet Center in Sioux Falls, SD. The future of the facilities is under discussion. VA photo
WASHINGTON — As VA looks at the future of its Vet Center program and whether it is meeting current demand, one of its tasks is to find the balance between keeping Vet Centers’ historic autonomy and making sure the department is providing up-to-date care, especially for veterans who are high-risk for suicide and other mental health issues.
A recent report from VA’s Office of Inspector General (OIG) found that Vet Center staff are undertrained, most notably in the areas of suicide prevention and military sexual trauma (MST). The report also found that many centers did not consistently consult with VAMCs on shared high-risk clients. On the other side of the scale are recent staffing regulations that might be preventing some long-time Vet Center counselors from providing the care they’ve been able to in the past.
“I think it’s important that we talk about finding the right balance that keeps the autonomy and more informal culture of Vet Centers intact while being systematic enough and collecting data to ensure that VA knows when and where to invest more staffing and other resources,” said Rep. Julia Brownley (D-CA.), chair of the House VA Subcommittee on Health at a hearing on the subject last month. “[At the same time] we need to be mindful not to push Vet Centers to their limits.”
The Vet Centers, which are run by VA’s Readjustment Counseling Service (RCS) were established by Congress in 1979 to help Vietnam-era veterans who were having readjustment problems. The Vet Centers were intended to be a more informal alternative to medical facilities where veterans could talk about their experiences with other veterans. In 1991, Congress opened Vet Centers to veterans who served in later conflicts. And in 1996, they opened them to veterans who served in early wars.
There are 300 Vet Centers in operation today, as well as a number of outstations and mobile Vet Centers.
“Vet Centers were designed to be located away from VA campuses and to offer confidential care to veterans who seek them out. That is a central function of Vet Centers and part of their success. Over time, that has led to a dangerous disconnect between Vet Centers and other VA medical facilities,” declared Rep. Jack Bergman (R-MI), ranking Republican on the subcommittee and a retired Marine Corps. general. “Vet Centers are a key access point for veterans contemplating suicide and for those having difficulty coping with civilian life. They should be fully integrated into the larger mental health and suicide prevention efforts the rest of the VA healthcare system is undertaking. As an equal partner. Not treated as a distant relative.”
The OIG recently began a new line of cyclical inspections examining Vet Center operations with a focus on how Vet Centers collaborate with VA medical facilities on high-risk veterans with complex conditions.
Of the 20 inspected Vet Centers mentioned in its report, the OIG found that only four had completed suicide prevention training for all clinical staff, and only 12 for all nonclinical staff. Inspectors also found that only four of the 20 had documented MST training.
They also found that few centers had standardized ways of communicating with VA medical facilities during the times when they needed to partner on a patient’s care.
“Not all Vet Centers consistently consulted or coordinated with VA medical facilities on shared high-risk clients,” explained Deputy Assistant IG Julie Kroviak, MD. “With suicide prevention being VA’s top clinical priority, Vet Centers are critical partners in reducing the risk of suicide.”Â
According to Kroviak, there remain numerous opportunities for VA leadership to become more involved in Vet Center operation.
VA is starting to take those steps, said RCS Chief Michael Fisher. That includes looking more closely at the training deficiencies noted by the OIG report.
“We’ve worked to get access at the RCS level into that [training] system, so we can make sure our staff are taking those training and we’re able to provide effective oversight,” Fisher explained.”
There was some concern among legislators about recent shifts in accreditation at Vet Centers that might be cutting off veterans from the counselors they have grown to trust and rely on.
Rep. Matt Rosendale (R-MT) read a letter from the mother of a veteran whose Vet Center counselor was no longer able to treat him due to these new accreditation requirements. The mother went on to explain how this counselor was the only person her son had talked to about his experiences.
According to Fisher these requirements represent VA getting in line with its own rules.
“We recognized that some of our Title 5 counselors were providing work that was really limited by VA policy to our social workers and psychologists,” he explained to the committee. “We made some adjustments in their job descriptions to make sure they were providing the right balance of services to make sure they were protected if there were any negative outcomes.”
Fisher said that VA is giving these Title 5 counselors the opportunity to submit paperwork to possibly be switched to a hybrid Title 38 position. The department also will provide training to help counselors pass licensing exams.
“To fix any of those situations [where a Title 5 counselor can no longer provide services they had previously] we’ve implemented a current scholarship program that VA offers where we can take our Title 5 counselors if they get accepted to a particular school and award them scholarships to get the appropriate degrees to then move into a hybrid 38 position,” Fisher said.
However, VA has only handed out seven such scholarships to date.
While Fisher said that he did not know how many counselors Vet Centers had lost due to new accreditation processes, Dr. Thomas Hall, who later testified on behalf of the Vietnam Veterans of America, said he had heard that 200 counselors had been suspended from providing the services they were previously.
“That’s the message I got in the field,” Hall said. “I was very concerned about Vet Centers being able to provide the services they’re supposed to when taking a hit on that many people.”