VA Mental Health Provider Venting / Problem-solving / Peer Support Thread

[Fan_of_Meehl]

I've heard refreshers being essentially about 5 minutes' worth of performing compressions on an autonomous training dummy. I'd probably rather do that than have to complete yet another TMS course.

I have no idea what our facility has implemented, though. But I did appreciate the move of essentially all the classroom learning to TMS as opposed to having to sit through a 4-hour class. Much easier to work around clinic schedules.

Interestingly enough, I confirmed at the clinic staff meeting this morning that everyone's understanding is that the new BLS/CPRS requirements (at our facility) will involve in-person recertification every 90 days. Unfortunately, the BLS training staff (who was to discuss the new requirements with our clinic staff 'no-showed' this morning so we couldn't get confirmation).

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[Pragma]

5 minutes of performing compressions every 3 months. Evidence for increased survival rates when using this protocol. I really don't see what the problem people have with this is. At my VA you can do it with BLS staff there or you can just go to a cart and login with your PIV and do it yourself once you know the drill. They also keep your BLS perpetually renewed. I really do not see what the big deal is.

 

[WisNeuro]

5 minutes of performing compressions every 3 months. Evidence for increased survival rates when using this protocol. I really don't see what the problem people have with this is. At my VA you can do it with BLS staff there or you can just go to a cart and login with your PIV and do it yourself once you know the drill. They also keep your BLS perpetually renewed. I really do not see what the big deal is.

Yeah, I mean in the realm of the VA where you waste your time on dozens of things with zero bearing on clinical care or health, I'd imagine being marginally competent in CPR would be one of the better things I can think of to spend my time on periodically.

 

[Pragma]

Yeah, I mean in the realm of the VA where you waste your time on dozens of things with zero bearing on clinical care or health, I'd imagine being marginally competent in CPR would be one of the better things I can think of to spend my time on periodically.

Honestly, the simulation in TMS is way harder. A lot of people complain about that...

 

[Fan_of_Meehl]

5 minutes of performing compressions every 3 months. Evidence for increased survival rates when using this protocol. I really don't see what the problem people have with this is. At my VA you can do it with BLS staff there or you can just go to a cart and login with your PIV and do it yourself once you know the drill. They also keep your BLS perpetually renewed. I really do not see what the big deal is.

If it ends up being (in practice) a mere 5 mins of your time chosen at your convenience then sure, no problem. However, the last time I had to get my BLS renewed it required me to effectively place the BLS coordinator nurse (who could never be tracked down via phone/email/Skype) under physical 'siege/stalking' in order to coordinate the training (and, yes, I even involved my supervisors (who can do nothing)). I stopped just shy of hiring a private investigator to track her down. If the numbers of training/recerts at my facility per provider are going to increase from ONE to EIGHT training occasions every two years then there's no way that it isn't going to end up being a royal clusterboink for all providers involved. But, we'll see, LOL. Parenthetically, focusing so intently on CPR competency for psychotherapists while there are plenty of therapists in our system without training on EBT protocols just seems odd.

 

[Fan_of_Meehl]

Honestly, the simulation in TMS is way harder. A lot of people complain about that...

Yes...I remember that godawful thing. Really needed a human factors psychologist and test subjects to work out some glitches in the awkward interface (e.g., "Am I supposed to start now or do I wait for some sort of prompt?")

Hell...come to think of it, nearly every computerized process at VA could benefit from assessment/revision by a human factors psychologist and test subjects. Oh well, time to go participate in 'whole health' drum circles for burnout

 

[cara susanna]

5 minutes of performing compressions every 3 months. Evidence for increased survival rates when using this protocol. I really don't see what the problem people have with this is. At my VA you can do it with BLS staff there or you can just go to a cart and login with your PIV and do it yourself once you know the drill. They also keep your BLS perpetually renewed. I really do not see what the big deal is.

It can just be hard to access the dummy if you're at a CBOC. Ours is in another physical building, and we don't have a lot of time to run over there for as long as it takes.

 

[Sanman]

It can just be hard to access the dummy if you're at a CBOC. Ours is in another physical building, and we don't have a lot of time to run over there for as long as it takes.

The problem is that in practice, for me, it goes like this:

Step 1: Cancel patients and other tasks for the day to travel to main medical center where I have no work space.

Step 2: Cross fingers and hope that the dummy is working and there is not a long line given that I cleared a day to do this.

Step 3: Spend way more than 5 min fighting with dummies that never seem to like my compressions or rebound.

Step 4: Ignore all of this info as I work with community HBPC patients that are largely DNR. I won't know their status as it is not clearly marked in the home, so likely I will call 911 who will be there by the time I sort out their DNR status.

 

[Pragma]

It can just be hard to access the dummy if you're at a CBOC. Ours is in another physical building, and we don't have a lot of time to run over there for as long as it takes.

The problem is that in practice, for me, it goes like this:

Step 1: Cancel patients and other tasks for the day to travel to main medical center where I have no work space.

Step 2: Cross fingers and hope that the dummy is working and there is not a long line given that I cleared a day to do this.

Step 3: Spend way more than 5 min fighting with dummies that never seem to like my compressions or rebound.

Step 4: Ignore all of this info as I work with community HBPC patients that are largely DNR. I won't know their status as it is not clearly marked in the home, so likely I will call 911 who will be there by the time I sort out their DNR status.

Sure, it would be a pain if it involved those kinds of logistical challenges. If your VA were like the one I am talking about, you literally have 6 different options that always seem available within the building.

Having done it for quite awhile now, I definitely have felt more carryover. Maybe psychologists are unlikely to be in a situation where they need to use CPR, but for me I always felt pretty good after a 2 year refresher for a brief amount of time, followed by a sense of dread should anything come up where I had to do anything until I had a refresher again nearly 2 years later.

 

[Sanman]

Sure, it would be a pain if it involved those kinds of logistical challenges. If your VA were like the one I am talking about, you literally have 6 different options that always seem available within the building.

Having done it for quite awhile now, I definitely have felt more carryover. Maybe psychologists are unlikely to be in a situation where they need to use CPR, but for me I always felt pretty good after a 2 year refresher for a brief amount of time, followed by a sense of dread should anything come up where I had to do anything until I had a refresher again nearly 2 years later.

If I recall the research on this, chest compressions are much more important than breathes. If all else fails, find the correct place on the sternum and administer chest compressions until help arrives.

 

[psychRA]

5 minutes of performing compressions every 3 months. Evidence for increased survival rates when using this protocol. I really don't see what the problem people have with this is. At my VA you can do it with BLS staff there or you can just go to a cart and login with your PIV and do it yourself once you know the drill. They also keep your BLS perpetually renewed. I really do not see what the big deal is.

Practicing compressions for 5 minutes every few months is no problem. Having to go across campus to find one of the dummies, hoping that the dummy is available AND that the computer it's connected to is still connecting to the network, waiting forever to logon, fighting with the computer program, dealing with the face mask that's slowly leaking air because the entire hospital has been using it...that's the annoyance. It took me close to an hour last time.

And since none of our regular responsibilities are reduced to make room for each new training requirement, I'm having to do all of that on my own time, after hours or on a weekend.

 

[Fan_of_Meehl]

Unfortunately, VA 'leadership' appears to think that issues related to access, quality, and provider burnout (to say nothing about recruitment/retention) are somehow going to be ameliorated if they can add JUST ONE MORE (x 1,000,000,000) thing to the provider's to do list. Reminds me of all the positive feedback loops that perpetuate most psychopathological processes (all of the 'doubling down' on obviously ineffective strategies).

 

[cara susanna]

Yeah, I'm pretty great at chest compression but I am TERRIBLE at giving air (making the mask seal is just really hard for me). So that's good to know!

Seriously, it'd be nice if they let us take some time out of our schedules to do this. When I worked in PCMHI it was a lot easier but now I'm in OPMH full time and it's really difficult to squeeze things in, especially since I have to go to another building.

 

[cara susanna]

Random vent: This whole idea of "I have to be engaged with mental health in order to keep my service connection" thing is just so much BS. Same with "I have to be evaluated by mental health in order to get SC."

 

[Sanman]

Random vent: This whole idea of "I have to be engaged with mental health in order to keep my service connection" thing is just so much BS. Same with "I have to be evaluated by mental health in order to get SC."

BS? Perhaps. However, in this case it is BS that I am for as it justifies the existence of more psychologist jobs.

 

[WisNeuro]

BS? Perhaps. However, in this case it is BS that I am for as it justifies the existence of more psychologist jobs.

SC and the VA welfare system is probably responsible for at least 20-40% of psychology jobs in the VA in a conservative estimate. Definitely fluctuates depending on specialty. But, if you took all of the malingering evals out of neuropsych, you easily cut the referral load by that 40%, more in some clinics.

 

[Fan_of_Meehl]

SC and the VA welfare system is probably responsible for at least 20-40% of psychology jobs in the VA in a conservative estimate. Definitely fluctuates depending on specialty. But, if you took all of the malingering evals out of neuropsych, you easily cut the referral load by that 40%, more in some clinics.

Hard truth.

 

[clausewitz2]

If I recall the research on this, chest compressions are much more important than breathes. If all else fails, find the correct place on the sternum and administer chest compressions until help arrives.

Having been involved in multiple codes in my day I can reassure you that compressions are the thing and that in ACLS training nowadays for adults there is essentially no rescue breathing being done if you don't feel a pulse. Training y'all on where to find the AED and getting you comfortable busting it out quickly would be much more useful than trying to get you competent with a bag mask (which is not super easy to use really well).

If you go over onto the medical forums you can find stories of medicine residents almost done with their overnight shifts being stat-paged to patient rooms at various VAs at 8 AM to code a training dummy. So at least that's not happening to you.

This 90 day re-certification thing for therapists makes no sense to me, my ACLS certification is good for years at a time. That said, you guys are more likely to be in situations where CPR/BLS will actually have a good outcome (as opposed to very medically ill people already hospitalized, where it is often rather more futile).

 

[OneNeuroDoctor]

At a conference I attended recently there was a VA employment booth with notifications of openings and that the VA is actively recruiting. They showed me a paper as of two weeks ago the VA no longer requires completion of APA accredited programs for VA Psychologist openings. Apparently this has not hit the USAJOBS website yet due to being a new event or change. They were very interested in me and took my name and number. Rarely do I remember the VA ever recruiting at conferences. The Federal Prisons normally always has a booth, but not this year and they have an age requirement but do not require APA program. Indian Health Center does not require APA program or have an age requirement.

It seems that many of the VA psychologist trainees are not staying with the VA as they had in the pasts, so with retirements and VA expansion there is now a shortage of psychologist in the VA is my understanding. They have a new loan forgiveness program that sounded similar to Physicians loan forgiveness with a higher rate than the NHSC loan forgiveness. They indicated they would hire part-time psychologist or contractors that work one to two days a week.

 

[AcronymAllergy]

VA still requires completion of an APA- or CPA-accredited internship for employment positions. Exceptions include: 1) the non-accredited internship is a VA site in good standing with OAA (typically meaning it's within its first 3 years of existence); 2) the internship was completed before 1979; 3) the provider is specialty ABPP-certified in an area related to the position for which they're applying. I've not heard any word that this is changing.

VA Handbook 5005 (appendix G18) details psychologist qualification standards.

I don't know how the MISSION Act might impact hiring, now and in the future.

Some VAs do have trouble filling some positions. These typically seem to be in less geographically-popular areas. VAs in bigger cities don't appear to have any problems, at least based on my experience (caveat emptor).

 

[WisNeuro]

But I mean, someone showed him a piece of paper. What are you going to trust, the VA Handbook, or random piece of paper?

As for VAs in mid sized and larger cities, can confirm. Good friends at the local VA here, they get swamped with apps whenever they post a job. If anything, some departments expanded too quickly and they plan on not backfilling some positions once someone leaves due to this. As a frame of reference, their neuropsych waiting list is about 2 weeks out.

 

[psychRA]

At a conference I attended recently there was a VA employment booth with notifications of openings and that the VA is actively recruiting. They showed me a paper as of two weeks ago the VA no longer requires completion of APA accredited programs for VA Psychologist openings. Apparently this has not hit the USAJOBS website yet due to being a new event or change.

Do you have an official source for this?

My VA has had a few positions open up this year, and from the standpoint of the hiring/search committee side of things I haven't heard of any changes.

 

[OneNeuroDoctor]

I was asked if I was interested in applying for a Psychologist position with the VA, but I informed them that my program was a non-APA accredited program. They indicated as of two-weeks ago this was changed and they showed me a document stating employment requirements with the VA where an APA accredited program is not required as of two-weeks ago. You still must be licensed as a Psychologist in one of the States, but no longer is it required that you have completed an APA accredited program. I questioned this change as some of my supervisors during internship had worked at the VA back in the 80's prior to having the requirement of being from an APA accredited program. They left the VA and worked at a University Health Setting and later. they reapplied to go back to the VA, but were not approved due to not meeting the APA accredited program requirement that was implemented while they were working at the University Health Setting.

At the Conference they had indicated that the APA accredited program completion is no longer a requirement per recent changes happening several weeks ago. They did not mention about internship being an APA accredited internship. I completed an APA accredited internship, but I believe all internships must be APA accredited via APPIC now and I guess there is a surplus of predoctoral internships currently.

This may have been changes happening at the Federal Government level and has not reached all of the state or local VA systems yet.

 

[psychRA]

I was asked if I was interested in applying for a Psychologist position with the VA, but I informed them that my program was a non-APA accredited program. They indicated as of two-weeks ago this was changed and they showed me a document stating employment requirements with the VA where an APA accredited program is not required as of two-weeks ago. You still must be licensed as a Psychologist in one of the States, but no longer is it required that you have completed an APA accredited program.

I understand that you were told that. I'm wondering if you (or anyone else) have anything official to support it.

 

[OneNeuroDoctor]

VA had a Recruitment Booth at the Oklahoma Psychological Association Conference in Oklahoma City and there were two-three VA representatives at the Booth, a younger and older man recruiting for VA in Oklahoma. I was shocked or surprised as I had recently accepted a new position and did not consider applying for a VA position. I told them I was not currently looking for a job, but they indicated to let others know about the changes and the openings nationwide for Psychologist in the VA.

 

[AcronymAllergy]

If VA has made a policy change regarding hiring qualifications that was enacted, it would be enacted nationally (i.e., they would not be able to only enact it gradually or at specific sites). All VA facilities are bound by the same national hiring qualifications for psychologists. I've not heard of any changes to this regarding accreditation at the graduate school level, and handbook 5005 wouldn't indicate that any have occurred, although I don't pretend to be the most well-connected individual.

I don't doubt that's what was said. I do doubt the accuracy of that information.

Out of curiosity, I just looked at a posting for a VA psychologist in OK put up today. It still lists the same qualification requirements.

 

[futureapppsy2]

I was asked if I was interested in applying for a Psychologist position with the VA, but I informed them that my program was a non-APA accredited program. They indicated as of two-weeks ago this was changed and they showed me a document stating employment requirements with the VA where an APA accredited program is not required as of two-weeks ago. You still must be licensed as a Psychologist in one of the States, but no longer is it required that you have completed an APA accredited program. I questioned this change as some of my supervisors during internship had worked at the VA back in the 80's prior to having the requirement of being from an APA accredited program. They left the VA and worked at a University Health Setting and later. they reapplied to go back to the VA, but were not approved due to not meeting the APA accredited program requirement that was implemented while they were working at the University Health Setting.

At the Conference they had indicated that the APA accredited program completion is no longer a requirement per recent changes happening several weeks ago. They did not mention about internship being an APA accredited internship. I completed an APA accredited internship, but I believe all internships must be APA accredited via APPIC now and I guess there is a surplus of predoctoral internships currently.

This may have been changes happening at the Federal Government level and has not reached all of the state or local VA systems yet.

I highly doubt this is true at all.

 

[OneNeuroDoctor]

Hmm.... Seems odd as other psychologist at the conference who were from non APA accredited programs had indicated applying for contractor or part-time work with the VA. Could it be they don't require APA program completion for contractors and part-time psychologists?

 

[AcronymAllergy]

For contractors, I don't know; might have some wiggle room. I believe the same qualifications apply for all VA employees, whether they are part-time or full-time.

 

[cara susanna]

I'm willing to bet money that if such a change had been made, VA psychologists would have heard about it. Our chief of psychology keeps us pretty well informed on this sort of thing.

Also, I work at a CBOC in a smaller town and we generally don't even have trouble filling positions.

 

[iliketohelppeople]

Another anecdotal experience. Did internship at a more rural VA, and they had plenty of applications per slot. Varied widely in terms of quality from rubbish to pretty good. At my current VA (much bigger), I cannot imagine how many applicants they get for each spot. VA jobs here for psychologists are quite competitive. I don't see them changing this anytime soon.

 

[AcronymAllergy]

At least in my experience, the bigger hurdle is getting the firm offer out, and then getting the person onboarded (i.e., HR). Finding people to hire isn't an issue.

 

[erg923]

At least in my experience, the bigger hurdle is getting the firm offer out, and then getting the person onboarded (i.e., HR). Finding people to hire isn't an issue.

This leads to another grip of mine about the VA: stupid language

On-boarding? I'm not getting on a ship.

Tour of duty: shift. Why make one word into 3?

Leave: Again, I'm not a sailor

 

[Fan_of_Meehl]

This leads to another grip of mine about the VA: stupid language

On-boarding? I'm not getting on a ship.

Tour of duty: shift. Why make one word into 3?

Leave: Again, I'm not a sailor

They like to LARP as if they're the military or something. All the barking without any of the discipline or effectiveness.

 

[Sanman]

Hmm.... Seems odd as other psychologist at the conference who were from non APA accredited programs had indicated applying for contractor or part-time work with the VA. Could it be they don't require APA program completion for contractors and part-time psychologists?

It is possible that the rule is being changed for individuals sub-contracted to do work at DOD or VA sites via a private company contract. That said, I'm not sure I would want to work with military or veterans without the benefits of an actual federal position. All stick no carrot.

I haven't heard of any such changes for full-time VA employees and I am on the hiring committee at my facility.

 

[WisNeuro]

It is possible that the rule is being changed for individuals sub-contracted to do work at DOD or VA sites via a private company contract. That said, I'm not sure I would want to work with military or veterans without the benefits of an actual federal position. All stick no carrot.

I haven't heard of any such changes for full-time VA employees and I am on the hiring committee at my facility.

Only VA contractor positions in this area are to do C&P evals. But the pay is terrible, so I can see why they may need to relax hiring requirements for that type of contractor position.

 

[cara susanna]

This leads to another grip of mine about the VA: stupid language

On-boarding? I'm not getting on a ship.

Tour of duty: shift. Why make one word into 3?

Leave: Again, I'm not a sailor

Haha, I completely agree with this. The "AWOL" thing especially kills me.

On the plus side, I've become excellent at military time.

 

[cara susanna]

I just read the minutes from the latest psychology meeting call (from late Oct) and they directly mentioned the APA accreditation hiring requirement without saying anything about changes to the requirement. Sooo I don't think that's a thing because I assume it would have been brought up when the requirement was mentioned.

 

[erg923]

Haha, I completely agree with this. The "AWOL" thing especially kills me.

On the plus side, I've become excellent at military time.

One word: "Access"...MFer

It always made me think of veterans have problems getting to a bathroom at the VA, or something.

 

[futureapppsy2]

This leads to another grip of mine about the VA: stupid language

On-boarding? I'm not getting on a ship.

Tour of duty: shift. Why make one word into 3?

Leave: Again, I'm not a sailor

On-boarding and leave are both common HR terms everywhere, FWIW.

 

[erg923]

On-boarding and leave are both common HR terms everywhere, FWIW.

Ok. But Its just for fun at this point, K?

I do think its funny that the VA sticks to this pseudo-military stuff/culture when one of their larger goals is to help veterans transition out of that culture and lifestyle though.

And I don't care for most HR language anyway, VA or not.

 

[cara susanna]

One word: "Access"...MFer

It always made me think of veterans have problems getting to a bathroom at the VA, or something.

As I've mentioned numerous time, I hate that word more than anything. It sends chills up my spine.

 

[futureapppsy2]

As I've mentioned numerous time, I hate that word more than anything. It sends chills up my spine.

Behaviorism wins yet again!

 

[Therapist4Chnge]

Only VA contractor positions in this area are to do C&P evals. But the pay is terrible, so I can see why they may need to relax hiring requirements for that type of contractor position.

If it's for a contractor position, that isn't the type of job we should want. Those companies run like a sweatshop for psychologists cranking out C&Ps and the company getting paid handsomely, while the psychologist makes peanuts.

 

[foreverbull]

SC and the VA welfare system is probably responsible for at least 20-40% of psychology jobs in the VA in a conservative estimate. Definitely fluctuates depending on specialty. But, if you took all of the malingering evals out of neuropsych, you easily cut the referral load by that 40%, more in some clinics.

Is there any research out there regarding malingering in comp & pen evals for service connection at VAs? I’m curious about whether there are any numbers published about this.

 

[WisNeuro]

Is there any research out there regarding malingering in comp & pen evals for service connection at VAs? I’m curious about whether there are any numbers published about this.

It's harder to do research on those as they are somewhat siloed, also, I imagine there is a political cost to doing that research as it will not be a good look for Vets. Logic would dictate that it would be sky high. I worked in a polytrauma clinic with a PVT/SVT failure rate of ~40% and a general neuropsych clinic through MHSL that ran a ~50% failure rate. We actually kept the stats, so that is not a number out of a hat. Also, those numbers are conservative estimates, as they only include those who had very clear evidence of failure and/or malingering, not counting some of the "caution" cases.

 

[DynamicDidactic]

This may have been changes happening at the Federal Government level and has not reached all of the state or local VA systems yet.

Recently, the law was changed to allow PCSAS programs to also qualify for VA positions. I wonder of the OK VA folks are a bit confused about that change.

 

[DynamicDidactic]

I have never worked (or practicum or internship) in a VA setting but this always annoyed the crap out of me:

VA Chicago health care | Veterans Affairs

Find a health facility near you at VA Chicago Healthcare System, and manage your health online. Our health care teams are deeply experienced and guided by the needs of Veterans, their families, and caregivers.

www.chicago.va.gov

In particular,

https://www.healingtouchprogram.com/content_assets/docs/current/VISN_12.pdf

 

[PsyDr]

I have never worked (or practicum or internship) in a VA setting but this always annoyed the crap out of me:

VA Chicago health care | Veterans Affairs

Find a health facility near you at VA Chicago Healthcare System, and manage your health online. Our health care teams are deeply experienced and guided by the needs of Veterans, their families, and caregivers.

www.chicago.va.gov

In particular,

https://www.healingtouchprogram.com/content_assets/docs/current/VISN_12.pdf

Eleven-Year-Old Debunks Therapeutic Touch: The Case of Emily Rosa

An "alternative" therapy is put to the test.

www.psychologytoday.com

 

[cara susanna]

I have never worked (or practicum or internship) in a VA setting but this always annoyed the crap out of me:

VA Chicago health care | Veterans Affairs

Find a health facility near you at VA Chicago Healthcare System, and manage your health online. Our health care teams are deeply experienced and guided by the needs of Veterans, their families, and caregivers.

www.chicago.va.gov

In particular,

https://www.healingtouchprogram.com/content_assets/docs/current/VISN_12.pdf

Yeah, I have a lot of issues with the Whole Health initiative.