John Kehoe, LISW Health Care for Re-Entry Veterans Specialist Veterans Health Administration, VISN 18

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VISN 16

– South Central Health Care Network

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East Texas (Houston, Beaumont, Lufkin) VISN 17 Heart of Texas Health Care Network

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North Texas HCS (Dallas & Ft. Worth)

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Central Texas HCS (Waco/Temple/Austin)

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Valley/Costal Bend HCS (Harlingen, Laredo, & CC) VISN 18 – Southwest Health Care Network

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South Texas HCS (San Antonio & Kerrville) West Texas (Amarillo, El Paso, Big Spring, Abilene)

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Health Care for Re-Entry Veterans Program

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State/Private/Federal Prisons

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Educate and Enroll Eligible Veterans

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Resource Referrals

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Appointments for Care After Release

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Case Management until connected with VA

Veterans Justice Outreach Program

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County/Local Jails Re-Entry Outreach

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Liaison with local Courts

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Educate local Law Enforcement

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Must have Honorable or General Discharge

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OTH discharges OEF/OIF/OND have full eligibility for 5 years Service-Connected Condition(SC) Co-Pays at Higher Incomes Unless SC Eligibility Restrictions for VHA Care while incarcerated

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Outreach (HCRV/VJO)

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VBA benefits reduced/stopped

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Outpatient Mental Health Clinics Acute Inpatient MH Services Residential Rehabilitation Treatment Programs

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Homeless Domiciliary, PTSD, Substance Use, MST Community-based MH Specialty Care

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PTSD & Military Sexual Trauma

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MH Intensive Case Management

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Homeless Programs

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Vocational Programs

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Tele-health & Home Health Care

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Building Motivation/Education in PCC & MHCs Outpatient SUD Program Intensive Outpatient Care (9hrs/wk) Residential Treatment Programs (30-90days) Medication/Opioid Treatment Programs Inpatient/Outpatient Detox Talk therapies: MET, CBT, Yalom interpersonal group therapy Work Therapies

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Voc. Rehab Benefits (SC at least 20%) Incentive Work Therapy (IWT) Compensated Work Therapy (CWT) Supported Community Employment Job Search Assistance Assistance with VBA/SSDI Claims (VSOs) Peer Support

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Mental Health Uniform Services Plan Mental Health in Primary Care Psychosocial Recovery & Rehabilitation Tele-Mental Health Services Evidence-Based MH Therapies Services for Women Veterans Suicide Prevention Ending Homelessness Electronic Medical Record Performance Measures to Improve Quality

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Based on President’s MH Commission Supports Recovery Model Emphasis on MH/PCC and Suicide Prevention Mandates Core MH Services at Each Site Standardized MH Care Throughout USA Significantly Enhanced MH Staff/Capacity Mandates Evidence-Based MH Services Tracks MH Outcomes and Staffing

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Co-located Mental Health Services in Primary Care Clinics

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Reduces Stigma for Seeking MH Care

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Rapid Access for MH Screening/Services

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Treatment for Mild MH issues

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Adjustment Issues/Life Stress

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Uncomplicated Depression & Anxiety

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Harm Reduction for Substance Use Issues

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Referral to MHC/Specialized Treatment Programs

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Up to 80% of Cases Managed in PCC Healthy Behaviors/Disease Management

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Routine Outpatient MH Care Primary Mental Health Provider Holistic Coordinated Care Psychotropic Medications Gender & Cultural Sensitive Care Evidence-based Psychotherapies

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Depression, Mild PTSD, Anxiety Disorders, Psychosis and/or Marital/Couples/Family Counseling

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Recovery is possible for everyone It is the Veteran’s Recovery Plan

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Uses Understandable Language

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Based on Veteran’s Strengths & Personal Goals

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Peers as Role Models Include Family Support in MH Planning Meaningful Work is the Best Therapy Building Support Systems in the Community Educating to Reduce Stigma/Facility Recovery Coordinators

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Tele-Mental Health Services

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Hospitals to Remote Clinics

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Cross coverage for Smaller Clinics

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“Health Buddies” to Monitor SMI at Home

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Home-based Videophones for Highly Rural

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Reduces Barriers of Distance & Stigma Future Directions

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Anonymous Chat Rooms (Suicide Hot Line)

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Peer Support Networks

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Secure Email with MH Providers

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Several VA Utilized Evidence-Based Treatments

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Prolonged Exposure ( PE ) and Cognitive Process Therapy ( CPT )- PTSD

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Acceptance and Commitment Therapy ( Management ACT )-PTSD, Depression, Anxiety, Substance Use, Chronic Pain, Smoking Cessation, Diabetes

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Yalom-based Interpersonal Group Therapy – PTSD, Substance Use

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Cognitive Behavioral Therapy ( CBT )- Depression, Anxiety, Substance Use, PTSD

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Motivational Enhancement Therapy ( MET )- Substance Use

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Medications

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Couples/Marital Therapy

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National Training Program in Evidence-Based Treatment

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One-week intensive workshop (national experts)

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6-12 Months of weekly case supervision

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Train the Trainer Model for future staff

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National Suicide Hotline 1-800-273-TALK (8255)

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Staffed by Trained MH Providers 24/7

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Live Hand Off to Local VA Facilities Facility Suicide Prevention Coordinators

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Arrange for Immediate Help Maintain List of High Risk Patients/Chart Flags

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Develop/Implement Suicide Safety Plans

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Investigate Suicide Attempts/Completed Suicides

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Educates Staff and Community Around-the-Clock MH Services

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VA Secretary’s 5-Year Plan From 160K to ZERO Homeless Veterans!

Enhancing Existing Homeless Services

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New HUD-VASH Vouchers

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VA SUD and MH Capacity

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Residential & Contract Beds

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Court/Jail/Prison Outreach New Initiatives/Services

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Homeless Hot Line

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Emergency Funding to Prevent Homelessness

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Health Care for Homeless Veterans Contract Emergency Shelters Homeless Domiciliaries Grant and Per Diem Transitional Housing HUD/VASH Emergency Cash Assistance to prevent Homelessness

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Follows Veterans Across Sites/Locations of Care Digital X-Rays, Consults, Medications, Labs, etc.

Flags High-Risk Conditions Clinical Reminders for Better Care

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Smoking Cessation

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Obesity

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Diabetes

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Hypertension Tracks Quality of Care (Performance Measures) Integration of Department of Defense Medical Records

The VA uses the data gathered in its computers to pinpoint problem areas, such as medication errors. The network also allows it to track how closely the medical staff is following evidence-based treatment and monitor deficiencies. Such tracking pays off. When Rand did an extensive study comparing quality of care at the VA with private-sector hospitals, it found that performance measurement played an important role in helping the VA score higher in every category except acute care, where it came in about even.

Business Week, 2006

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www.texvet.com

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Supports Texas Military, Veterans & Family

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Health & Wellness, Employment, Education, Crisis, Legal, Claim Support Services, etc.

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Statewide Peer-to-Peer Counseling 211 Texas

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Just Dial 211

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Services for Veterans/Active Duty Vet Centers

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24/7 Information Line Storefront locations, walk-in service

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Veteran and Family Counseling

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Moving from Hospitals to the Community CPRS & Performance Measures

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Improved Access to Care

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Improved Quality of Care & Outcomes

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Improved Cost Effectiveness

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Improved Patient Satisfaction Holding VA Staff Accountable

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Managers’ Performance Plans

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Providers Performance Plans/Incentive Pay

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Contact your VISN MH Lead

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VISN 16 : [email protected]

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VISN 17 : [email protected]

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VISN 18 : [email protected]

Meet your local VJO and Re-Entry Specialists Work to Establish Veteran Dockets & Courts Ask your clients if they ever served in the US Military and give VA a chance to help