Expand Mental Health Care for Veterans Says CNAS Scholar in New Report
Source: Center for a New American Security
Although the VA will spend nearly $7 billion this year on mental health care for veterans, CNAS Senior Fellow Phillip Carter argues in Expanding the Net: Building Mental Health Care Capacity for Veterans, this is not likely to be enough. The report urges the VA to rely more on the private sector and work more closely with local community and private philanthropic organizations.
Among his specific recommendations, Mr. Carter proposes that the VA develop and share mental health care data, pursue a portfolio approach that invests in the most promising care models, develop a wraparound information environment that integrates with the private and philanthropic sectors, build a human capital pipeline of mental health care personnel, and invest in emerging technologies, such as telemedicine. The additional investment is essential, says Mr. Carter, as “those receiving treatment do better in managing their post-traumatic stress or traumatic brain injury and are less likely to commit suicide.”
VA OIG — Healthcare Inspection: Alleged Improper Opioid Prescription Renewal Practices, San Francisco VA Medical Center
Healthcare Inspection: Alleged Improper Opioid Prescription Renewal Practices, San Francisco VA Medical Center
Source: U.S. Department of Veterans Affairs, Office of Inspector General
The VA Office of Inspector General Office of Healthcare Inspections conducted an inspection in response to complaints concerning improper opioid prescription renewal practices in the Medical Practice Clinic at the San Francisco VA Medical Center (facility), San Francisco, CA. We reviewed the following allegations: (1) attendings on-duty are tasked with evaluating numerous opioid renewal requests for patients with whom they are unfamiliar, (2) providers do not routinely document patients’ opioid prescription renewal problems in the electronic health record, and (3) there have been patient hospitalizations and deaths related to opioid misuse.
We substantiated that attendings on-duty are tasked with evaluating numerous opioid renewal requests for patients with whom they are unfamiliar; however, Veterans Health Administration regulations and local policy do not prohibit such practice.
We partially substantiated that providers do not routinely document patients’ opioid prescription renewal problems in the electronic health record. The providers did not consistently document an assessment for adherence with appropriate use of opioids and monitor patients for misuse, abuse, or addiction. The primary care providers did not consistently complete the templated Narcotic Instructions Note for patients with opioid prescription renewal problems.
We partially substantiated that there have been hospitalizations and deaths of patients related to opioid misuse. Seven patients were hospitalized for opioid overdose; however, the primary care provider, Psychiatry Service, and/or the facility’s Substance Abuse Program assessed and appropriately monitored the patients for misuse. There were no deaths related to opioid overdose.
We recommended that the Facility Director (1) ensure that providers comply with all elements of the management of opioid therapy for chronic pain, as required by Veterans Health Administration and the VA/DoD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, and (2) ensure that the Narcotic Instructions Note is reevaluated for appropriate use in the Medical Practice Clinic and that providers comply with established protocol.
The Veterans Integrated Service Network and Facility Directors concurred with our recommendations and provided an acceptable action plan. (See Appendixes A and B, pages 6–9 for the Director’s comments.) We will follow up on the planned actions until they are completed.
New GAO Reports
Source: Government Accountability Office
1. National Mediation Board: Strengthening Planning and Controls Could Better Facilitate Rail and Air Labor Relations. GAO-14-5, December 3.
Highlights - http://www.gao.gov/assets/660/659361.pdf
2. VA Health Care: Improvements Needed in Processes Used to Address Providers’ Actions That Contribute to Adverse Events. GAO-14-55, December 3.
Highlights - http://www.gao.gov/assets/660/659379.pdf
HUD Reports Continued Decline in U.S. Homelessness Since 2010
Source: U.S. Department of Housing and Urban Development
The U.S. Department of Housing and Urban Development (HUD) today released its latest national estimate of homelessness in the U.S., noting reductions in every major category or subpopulation since 2010, the year the federal government established “Opening Doors,” a strategic plan to end homelessness. HUD’s 2013 Annual Homeless Assessment Report to Congress finds significant and measureable progress to reduce the scale of long-term or ‘chronic’ homelessness as well as homelessness experienced by Veterans and families.
HUD’s annual ‘point-in-time’ estimates measure the scope of homelessness on a single night in January of each year. Based on data reported by more than 3,000 cities and counties, last January’s one-night estimate reveals a 24 percent drop in homelessness among Veterans and a 16 percent reduction among individuals experiencing long-term or chronic homelessness since 2010. HUD’s estimate also found the largest decline in the number of persons in families experiencing homelessness since the Department began measuring homelessness in a standard manner in 2005.
VA OIG — Healthcare Inspection – Gastroenterology Consult Delays, William Jennings Bryan Dorn VA Medical Center, Columbia, South Carolina
Healthcare Inspection – Gastroenterology Consult Delays, William Jennings Bryan Dorn VA Medical Center, Columbia, South Carolina
Source: U.S. Department of Veterans Affairs, Office of Inspector General
The OIG conducted a review at the William Jennings Bryan Dorn VAMC (facility) in Columbia, SC to determine whether deficient practices contributed to or caused delays in care, and whether facility leaders appropriately addressed clinical managers’ concerns. OIG substantiated the allegations and found additional factors that contributed to the events. In July 2011 VISN and facility leaders became aware of the GI consult backlog involving 2,500 delayed consults, 700 “critical”. The VISN awarded the facility $1.02M for fee colonoscopies in September 2011. Because facility leaders did not assure a structure for tracking and accountability by December 2011, the backlog stood at 3,800. The facility developed an action plan in January 2012 but had difficulty making progress in reducing the backlog. An adverse event in May 2012 prompted facility, VISN, and VHA leaders to re-evaluate the GI situation and essentially eliminated the backlog by late October 2012. During the review “look-back”, 280 patients were diagnosed with GI malignancies, 52 were associated with a delay in diagnosis and treatment. Several factors contributed to the GI backlog and hampered efforts to improve the condition. Specifically, the facility’s Planning Council did not have a supportive structure; Nursing Service did not include GI nurses on their priority hiring list; Fee Basis care had been reduced; low-risk patients were being referred for screening colonoscopies, thus increasing demand; staff members did not consistently and correctly use the consult management reporting and tracking systems; critical VISN and facility leadership positions were filled by a series of managers who often had collateral duties and differing priorities; and Quality Management was not included in discussions about the GI backlogs.
Rural Veterans at a Glance
Source: USDA Economic Research Service
Nearly 4 million veterans reside in rural (nonmetropolitan) America. They are a rapidly aging and increasingly diverse group of men and women who still comprise over 10 percent of rural adults despite consistently declining numbers.
New GAO Reports and Testimonies
Source: Government Accountability Office
1. Small Business Administration: Review of 7(a) Guaranteed Loans to Select Franchisees. GAO-13-759, September 10.
Highlights - http://www.gao.gov/assets/660/657724.pdf
2. Defense Logistics: Army Should Track Financial Benefits Realized from its Logistics Modernization Program. GAO-14-51, November 13.
Highlights - http://www.gao.gov/assets/660/658970.pdf
3. Aviation Security: TSA Should Limit Future Funding for Behavior Detection Activities. GAO-14-159, November 8.
Highlights - http://www.gao.gov/assets/660/658924.pdf
1. Information Technology: Leveraging Best Practices to Help Ensure Successful Major Acquisitions, by David A. Powner, director, information technology management issues, before the House Committee on Oversight and Government Reform. GAO-14-183T, November 13.
Highlights - http://www.gao.gov/assets/660/658959.pdf
2. VA Vocational Rehabilitation and Employment Program: Independent Living Services and Supports Require Stronger Oversight, by Daniel Bertoni, director, education, workforce, and income security, before the Subcommittee on Economic Opportunity, House Committee on Veterans’ Affairs. GAO-14-149T, November 13.
Highlights - http://www.gao.gov/assets/660/658949.pdf
3. Personnel Security Clearances: Opportunities Exist to Improve Quality Throughout the Process, by Brenda S. Farrell, director, defense capabilities and management, before the Subcommittee on Counterterrorism and Intelligence, House Committee on Homeland Security. GAO-14-186T, November 13.
Highlights - http://www.gao.gov/assets/660/658961.pdf
Profile of Veteran Business Owners: More Young Veterans Appear To Be Starting Businesses (PDF)
Source: U.S. Small Business Administration
What Share of Business Owners Are Veterans?
Veterans made up 9.1 percent of all business owners in 2012.
How Old Are Veteran Business Owners?
In 2012, 7.1 percent of veteran business owners were under age 35, an increase from 4.6 percent in 2008.
What is Their Gender Distribution?
Most veteran business owners are male. The share of business ownership by female veterans is lower than in the overall population, but it is growing. In 2012, 4.4 percent of veteran business owners were women, up from 2.5 percent in 2008. In the overall population, 35.9 percent of business owners were women.
How Well Are Minorities Represented?
The rate of minority business ownership by veterans was lower than non-veterans. However, Hispanic veteran business ownership appears to have increased: from 3.2 percent in 2008 to 6 percent in 2012.
What Industry Sectors Do They Operate In?
Veteran business owners are more likely to be in the goods producing sector than their non-veteran counterparts.
How Many Businesses Do They Own?
Veteran business owners were more likely than their non-veteran counterparts to own two or more businesses. In 2012, 10.3 percent of veteran business owners had two or more firms, compared to only 7.4 percent of non-veteran owners.
The Perfect Storm: Veterans, culture and the criminal justice system (PDF)
Source: Justice Policy Journal
In 2008 an article was published that suggested an Emerging Storm, relative to veteran entanglement in criminal justice, was approaching (Brown, 2008). Well, that storm appears to have hit land. The actual/ potential damage is likely to depend upon the responses of the legal system and the American public at large. There are many veterans who appear to return to the civilian culture and manage to hold their own without significant problems. Other veterans experience socio-cultural problems, along with psychological issues, but are able to camouflage those problems and issues. Some veterans are less fortunate and they find themselves confronting criminal charges. Some end up behind bars for extended periods of time. This article addresses the complexities associated with understanding why some veterans appear normal while other veterans become entangled in our criminal justice system. Specifically, we will be addressing issues related to socio-cultural differences and irregularities between civilian and military cultures, cultural competency in relation to psychology and the court system.
FTC Poses Eight Questions to Ask When Choosing a College After Military Service
Source: Federal Trade Commission
The Federal Trade Commission is advising servicemembers, veterans, and their families that some for-profit schools may be more interested in gaining access to their post 9/11 GI Bill benefits than helping them fulfill their education goals. To help servicemembers identify a school that will meet their needs as they transition to student status, the FTC released a new tip sheet.
The guidance, 8 Questions to Ask When Choosing a College, encourages servicemembers, veterans and their families to carefully assess the schools they’re interested in attending, whether working toward a certificate or a higher degree. Using words such as “veteran” or “military-approved” may not necessarily equate to better education and support.
Battle for Benefits: VA Discrimination Against Survivors of Military Sexual Trauma
Source: American Civil Liberties Union, Service Women’s Action Network, Yale Law School
Sexual assault and harassment are serious problems in the United States armed forces. Thousands of service members each year are estimated to have experienced some form of military sexual trauma (MST), including rape, sexual assault, and sexual harassment.
Less well known is the second battle that many veterans who survive sexual violence must fight with the U.S. Department of Veterans Affairs (VA) when they return to civilian life.
“Battle for Benefits: VA Discrimination Against Survivors of Military Sexual Trauma,” a report released by Service Women’s Action Network (SWAN), the American Civil Liberties Union Women’s Rights Project (ACLU), and the American Civil Liberties Union of Connecticut (ACLU-CT), with assistance by the Yale Law School Veterans Legal Services Clinic, reveals that the process of obtaining VA disability benefits for the enduring mental health effects of military sexual trauma (MST) is an unfair fight in which veterans are often unsuccessful. Veterans who survive in-service sexual trauma face discrimination in seeking compensation.
Facts for Features — Veterans Day 2013: Nov. 11
Source: U.S. Census Bureau
Veterans Day originated as “Armistice Day” on Nov. 11, 1919, the first anniversary of the end of World War I. Congress passed a resolution in 1926 for an annual observance, and Nov. 11 became a national holiday beginning in 1938. President Dwight D. Eisenhower signed legislation in 1954 to change the name to Veterans Day as a way to honor those who served in all American wars. The day honors military veterans with parades and speeches across the nation. A national ceremony takes place at the Tomb of the Unknowns at Arlington National Cemetery in Virginia.
Health Care Provider Awareness of the Military Status of Patients: Asking the Question (PDF)
Source: American Association of Medical Colleges
This Analysis in Brief (AIB) examines whether U.S. health care providers ask about their patients’ military service and presents data on health care access for the nation’s military personnel and veterans. Information about the prevalence of the “unasked question” may encourage medical educators in U.S. medical schools and teaching hospitals, where many current and former military service personnel receive their care, to introduce curricular or clinical experiences in medical training that address this important issue.
New GAO Reports
Source: Government Accountability Office
1. Native American Veterans: DOL Needs a Clear Plan to Improve Employment and Training Services on Tribal Lands. GAO-13-664, September 26.
Highlights - http://www.gao.gov/assets/660/658213.pdf
2. Department of Homeland Security: Opportunities Exist to Enhance Visibility over Collaborative Field Mechanisms. GAO-13-734, September 27.
Highlights - http://www.gao.gov/assets/660/658305.pdf
3. Small Business Innovation Research: Data Rights Protections. GAO-14-116R, November 4.
New GAO Reports and Testimony
Source: Government Accountability Office
1. Security Clearances: Additional Mechanisms May Aid Federal Tax-Debt Detection. GAO-13-733, September 10.
Highlights - http://www.gao.gov/assets/660/657701.pdf
2. Biomedical Research: NIH Should Assess the Impact of Growth in Indirect Costs on Its Mission. GAO-13-760,September 24.
Highlights - http://www.gao.gov/assets/660/658088.pdf
3. VA Health Care: Additional Guidance, Training, and Oversight Needed to Improve Clinical Contract Monitoring. GAO-14-54, October 31.
Highlights - http://www.gao.gov/assets/660/658686.pdf
1. Personnel Security Clearances: Full Development and Implementation of Metrics Needed to Measure Quality of Process, by Brenda S. Farrell, director, defense capabilities and management, before the Senate Committee on Homeland Security and Governmental Affairs. GAO-14-157T, October 31.
Highlights - http://www.gao.gov/assets/660/658670.pdf
Posttraumatic Stress Disorder and Cardiometabolic Disease
The need for addressing posttraumatic stress disorder (PTSD) among combat veterans returning from Afghanistan and Iraq is a growing public health concern. Current PTSD management addresses psychiatric parameters of this condition. However, PTSD is not simply a psychiatric disorder. Traumatic stress increases the risk for inflammation-related somatic diseases and early mortality. The metabolic syndrome reflects the increased health risk associated with combat stress and PTSD. Obesity, dyslipidemia, hypertension, diabetes mellitus, and cardiovascular disease are prevalent among PTSD patients. However, there has been little appreciation for the need to address these somatic PTSD comorbidities. Medical professionals treating this vulnerable population should screen patients for cardiometabolic risk factors and avail themselves of existing preventive diet, exercise, and pharmacologic modalities that will reduce such risk factors and improve overall long-term health outcomes and quality of life. There is the promise that cardiometabolic preventive therapy complementing psychiatric intervention may, in turn, help improve the posttraumatic stress system dysregulation and favorably impact psychiatric and neurologic function. © 2013 S. Karger AG, Basel
Veterans Field Guide to Government Shutdown (PDF)
Source: U.S. Department of Veterans Affairs
The President, the Secretary of Veterans Affairs and the administration strongly believe that a lapse in appropriations should not have occurred on October 1, 2013, and Congress should act to fund critical Government operations. During the government shutdown, VA medical centers, clinics and other health services have advance appropriations for 2014 and will remain open. VA has funds available to ensure claims processing and payments in the compensation, pension, education, and vocational rehabilitation programs will continue through late October. However, in the event of a prolonged shutdown, claims processing and payments in these programs will be suspended when funds are exhausted.
VA has produced a 2-page information sheet, the Veterans Field Guide to Government Shutdown, which summarizes all of the services that will be available and those that will be impacted by potential lapse in appropriations. This file will be updated as needed. The department’s detailed contingency plan is also available below.
See also: Appropriations Lapse Contingency Plan (PDF)
DOE OIG — Review of Allegations Regarding Prohibited Personnel Practices at the Bonneville Power Administration
Review of Allegations Regarding Prohibited Personnel Practices at the Bonneville Power Administration
Source: U.S. Department of Energy, Office of Inspector General
The Office of Inspector General received a complaint alleging prohibited personnel practices at Bonneville. The allegations included violations of OPM regulations and the inappropriate dismissal of veterans during their probationary period. The complaint also alleged violations of Department policies regarding the application of veterans’ preference and the use of the category rating process in the exercise of Bonneville’s delegated examining authority for competitive hiring.
We found that Bonneville’s hiring practices disadvantaged veterans and other applicants. Bonneville consistently manipulated the applicant rating process, and did not fully disclose to the Department that the inappropriate personnel practices had occurred or the adverse impact on veterans and other applicants despite specific requirements to do so. Further, Bonneville neither notified the affected applicants nor did it initiate corrective actions required to remedy the inappropriate practices.
The management culture at Bonneville contributed to an environment that enabled the prohibited practices to occur. Notably, we observed that Bonneville officials spent considerable effort trying to distance the organization from Departmental procedures, processes and oversight. Compounding problems associated with the general environment and culture, our inquiry revealed that Bonneville exercised inadequate oversight and accountability of its own personnel recruitment functions. In short, there was a massive breakdown in procedures, processes and management attentiveness at several levels of Bonneville’s operation.
The impact of Bonneville’s improper hiring practices is widespread, has subjected affected individuals to economic consequences, has disrupted Department and Bonneville operations, and has exposed the Department to a variety of legal challenges. Most importantly, adversely impacted veterans have not received promised benefits. The Department expressed concurrence with our report, and its corrective actions, taken and planned, were fully responsive to our findings and recommendations.
Legion releases women veterans health-care report
Source: American Legion
The American Legion has issued its report on the quality of health care for women veterans at 15 Department of Veterans Affairs (VA) medical centers across the country,
Key findings of The American Legion’s report include the fact that many former women servicemembers do not identify themselves as veterans, many VA medical centers lack long-term health-care plans for women veterans, and VA facilities often have no inpatient or residential mental health programs for women veterans.
The “2013 Task Force Report on Women Veterans Health Care,” released to the public on Sept. 17, is based on site visits by the Legion’s System Worth Saving (SWS) Task Force to VA facilities in Buffalo, N.Y.; Augusta, Maine; Fargo, N.D.; Chicago; Tampa, Fla., Erie and Coatesville, Pa.; Dublin, Ga.; Salem, Va.; Las Vegas; Tuscaloosa, Ala.; San Antonio; Texas; Madison, Wis.; Spokane, Wash.; and St. Cloud, Minn. During these visits, SWS task force members and American Legion field service representatives interviewed each facility’s leadership and staff on the delivery of health care for women veterans.
The report’s objectives were to understand what perceptions and barriers prevent women veterans from enrolling in VA health care, determine what challenges women veterans face with their health care, and provide recommendations that VA can take to improve access to health care for women veterans.