Transcript Mental Health Strategic Plan

VACO ACTIVITY
Antonette Zeiss, Ph.D.
Deputy Chief Consultant
Office of Mental Health Services
VA Central Office
DEPUTY CHIEF PATIENT CARE
SERVICES OFFICER FOR
MENTAL HEALTH
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Ira Katz, M.D.
Mark Shelhorse, M.D. remains in Acting role
through May 28, when Dr. Katz formally
begins
MY TIMELINE AS DEPUTY
CHIEF CONSULTANT
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Accepted position end of July, 2005
Detailed starting August 12, 2005
Began permanent position start of October,
2005
NEW ORGANIZATIONAL CHART:
OFFICE OF MENTAL HEALTH SERVICES
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Lead person for the office is now titled the
Deputy Chief Patient Care Services Officer for
Mental Health (DPCSOMH)
 Important: Chief Consultant title elevated
 DPCSOMH appointed to NLB
Deputy Chief Consultant for Mental Health
Directly under the DPCSOMH
 Now has major supervisory responsibility within
the office and for decentralized staff
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Staff and activities organized by Sections,
each with a Lead
New Section – Psychosocial Rehabilitation
and Recovery Services; Bob Gresen as Lead
Mental Health Informatics Section; Katy
Lysell as Lead
Domiciliary care brought into OMHS under
Homeless programs
HURRICANE/
DISASTER RESPONSE
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Occurred during my detail and move to DC
Initial OMHS activities around
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Care of homeless
Following the detailing of MH staff
Emergency communications
Setting up phone contact list for MH expertise needs
Developing Disaster Coordinator for MH for each VISN
Speeded timeline for completion of Psychological
First Aid Manual (thanks to NCPTSD)
VISN 16 site visit now planned, ASAP
CENTERS OF EXCELLENCE
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Congressionally mandated in Waco,
Canandaigua, and San Diego
Site visits to each
Report under development, with special
emphasis on clear development of Center of
Excellence definitions, responsibilities,
accountability, etc. to mirror MIRECCs and
other Center program expectations
MyHealtheVet MH PORTAL
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Began in Fran Murphy, MD’s office; now
transferred to Office of Mental Health Services
I was Co-Chair from beginning
Ken Weingardt, Ph.D., VA Palo Alto new Co-Chair
Comprehensive content under development
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Psychoeducational material by diagnoses and by
functional problems
Self screening
Continuous recovery component
COMMUNICATION AND
LIAISON ROLES FOR DEPUTY CC
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Work with Media Relations and
Congressional Affairs Offices
Press interviews
 Congressional briefings
 OMB briefings
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Within VACO
Within VHA
 Across to VBA
 With Offices at the Secretary’s level
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Advisory Committees
Homeless Advisory Committee
 SMI Committee
 PTSD Committee
 Mental Health Task Force
 Women’s Health
 Readjustment Counseling (Vet Center)
 Etc.
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Coordination of Education Initiatives
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EES
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Education initiatives address recovery, suicide
assessments, aging, collaborative care, MHSP
implementation, etc.
OAA
Communication with OAA shared responsibility of
several OMHS staff
 Expansion of PSR Fellowship
 Deputy specifically: Review of Psychology training
positions and stipends
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CARES PROJECTION MODEL
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CACI/Milliman model updated for Mental Health
VISN MH and Domiciliary Strategic Planning
guided by updated MH projections and reviewed
by OMHS
Projection model still untested and known
problems remain
Starting process of next iteration of model
development
OMHS PROGRAM REVIEW
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GPRA process
Design of program evaluation began about 5
years ago
Was ready to go, with SMI focus
PCS raised question re. need for a new look,
given MHSP
Redefinition process completed
New evaluation plan in contract
negotiations
EFFORTS REGARDING
C&P CLINICAL EVALUATIONS
FOR PTSD
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“Secret Philadelphia meeting” – Dec., 2005
Not secret at all
 Multiple Psychologists present, including key
presentation by Terry Keane, Ph.D.
 Key stakeholders represented
 Ongoing efforts, led by Gerald Cross, M.D.,
Deputy Chief Patient Care Services Officer
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Goals
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Build on and evaluate the “gold standard” process
developed by NCPTSD
Define best psychometrically evaluated measures for
evaluating functional status
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Define best practices for ensuring consistency of clinical
evaluations
For diagnosis and for functional status
GAF required by legislation
World Health Organization Disability Assessment Survey
(WHODAS) looks promising; will be evaluated
Further define criteria for performing C&P exams
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Only Psychology and Psychiatry can do initial evals
Other professionals can do re-evaluations re. disability
level, if diagnosis previously established
Consideration of training and certification process
VHA/DOD INTERACTIONS
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Joint VHA/DoD Mental Health committee
established
Liaison with and through Seamless
Transition Office
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E.g., Postdeployment Health Re-Assessment
process
Joint presentations to HEC and JEC
New DoD MH Committee forming; will
have VA representation
MHSP IMPLEMENTATION
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Primary responsibility
Tasks include
Guidance of previously planned funding efforts for
FY06
 Development of new funding efforts (e.g., PSR;
upcoming guidelines for Integration of MH and
Primary Care)
 Ensuring recurring funds
 Monitoring use of allotted funds, FY05 and FY06
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Coordination with other Strategic Planning
efforts
Patient Care Services SP
 Dr. Perlin’s 8 for Excellence SP
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Work with Fiscal and Operations (10N) on
implementation
Usual activities, e.g., 10N actually sends the
memos that we generate re. funding awards
 Unusual activity, e.g., this year’s complex
problems re. IT budgets
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Initial weekly meetings with Dr. Kussman’s
office to report on progress
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Now every other week; soon to reduce further
GAO review of MHSP implementation
currently ongoing
Document requests
 Interviews at VACO
 Planned VISN/Facility visits
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ROLE AS NATIONAL
LEAD PSYCHOLOGIST
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Difficult to devote enough time to this role
Approval to hire new position, for OMHS
staff person as my Assistant for Psychology
related responsibilities
Working to make that a reality
PSYCHOLOGY ISSUES
AND ACTIVITIES
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Hybrid Title 38 conversion
Refocus on approval for Psychology
Directive (requirement for lead Psychologist
in every facility)
Monitoring of MH Leadership Position
Directive (requirement that MH lead
positions be advertised for all relevant MH
professions)
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Psychology Advisory Committee
 Combined
group of former PAC and
Psychology Training Advisory groups
 Long
history, with important contributions to
Deputy specifically and Psychology generally
 Efforts to redefine and revitalize needed – fine
tuning
 Concerns
 Mission
needs to be revisited
 Membership fairly static
 Explicit expectations regarding responsibilities,
actions, products, etc. of PAC members
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Process to date
Monthly calls (approximately)
 Current heritage members provided history from
their perspective, their interests, their ideas about
future directions:
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Jeff Burk
Pat Dubbert
Bob Gresen
Mary Jansen
Dan Kivlahan
Christine LaGana
Ed Nightingale
Judy Patterson
One new replacement member added: Steve
McCutcheon
 Turning now to new issues
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Proposed new organization
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Membership will be rotating with 3 year terms
Renewal of appointment possible
 All current members will remain, but with term assignments
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PAC members will take responsibility for specific
actions/issues, e.g.,
Newsletter Chair
 Scribe/Historian
 Psychology evidence-base and dissemination
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Some members will be defined by roles that should be
represented on the PAC, e.g.,
Chair of Psychology National Professional Standards Board
 Chair of VA Section, Division 18
 Chair of Council of VA Training Directors
 OMHS representative (in addition to Deputy)
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Small number of “At the Deputy’s pleasure” members
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Membership will be as representative as
possible; including:
Diversity – racial/ethnic/cultural; geographical;
gender; professional focus; disability; etc.
 Predominantly senior psychologists, but with some
more junior membership
 At least one Psychologist in VISN of facility
leadership positions (e.g., ACOS for Behavioral
Health)
 Research, practice, and administration
 “Heritage” and new membership
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Questions remaining
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Representation for AVAPL and Division 18?
What do these groups want?
 How to determine rep, given one year Presidential
terms vs. 3 year membership on PAC
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Ultimate ideal size of PAC
 Should there be a limit on number of terms?
 Process of identifying replacements (except for
reps defined by role)
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Council of VA Training Directors of Psychology
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Original motivations
Political issues – e.g., increasing likelihood of COA
permanent seat for VA
 Community of training issues – helpful resource for
TDs, being seen within broader training communities,
etc.
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Actions to date
Jeff Burk has been spearheading, with particular
involvement of Steve McCutcheon, Christine LaGana,
and Bob Gresen
 PAC has started to review this issue
 Moral support from OAA, especially Linda Johnson
 Moral and potential financial support from APA
Education Directorate, e.g., to fund a conference for
final development and launching of Council
 Supportive discussion at Council of Chairs of Training
Councils – Jeff Burk our rep at that group
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Two models originally considered
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Free standing (a la AVAPL) vs.
Placement under Deputy in OMHS
Jeff Burk developed document laying out pros and cons
of each; reviewed by PAC
Current thinking is to develop a hybrid model
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Placement under Deputy in OMHS
But with elected Chair and Board
And with Bylaws
Needs to be reviewed with General Counsel
Goal = define soon, work toward Fall conference
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Questions for input
Ensuring financial stability, e.g., in lean VA
budget years
 Ensuring broadest possible participation – how
can we make this most attractive to current and
future TDs?
 Development of a political strategy
simultaneously with finalizing plans; i.e., how
best to keep focus on COA seat?
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