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

[cara susanna]

Oh, I call at 5 min in for VVC.

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[Fan_of_Meehl]

I mean, self-report is always going to have limitations, especially where suicide is concerned.

And, yeah, don't get me started on reminders, especially things like screening for depression and PTSD when the patient is already established and often being treated for those issues! VA national is actually is working on reducing them because poor Primary Care is swamped. Even the MST reminder, which I believe is VERY important, there is this obsession with numbers and metrics often to the detriment of common sense (sorry, I'm not gonna tell a provider to screen an 80-year-old patient with Alzheimers who's in a nursing facility). And the duty falls to the lower level staff to enforce it and improve these metrics when we can't really do much other than keep bugging providers, which has its limitations.

Not sure if you've run across this article yet but it always gives me a chuckle (and the author makes some excellent points)...

Screening for a remote history of mild traumatic brain injury: when a good idea is bad​

Screening for a remote history of mild traumatic brain injury: when a good idea is bad - PubMed

On the basis of generally accepted medical screening principles and assumptions, population screening for mild TBI is unnecessary at best and potentially harmful at worst. Because nonspecific, postconcussion-like symptoms can be effectively treated in a symptom-specific manner, tying them to...

pubmed.ncbi.nlm.nih.gov

 

[texanpsychdoc]

I mean......mTBI (most cases) tend to remit/improve within 6 months, so I am curious about this screening being necessary.

 

[Sanman]

I mean......mTBI (most cases) tend to remit/improve within 6 months, so I am curious about this screening being necessary.

It's important we give every veteran the chance to file a disability claim and make a few dollars.

 

[texanpsychdoc]

It's important we give every veteran the chance to file a disability claim and make a few dollars.

 

[cara susanna]

Really getting sick of intakes getting put on a pedestal. If a provider cancels, the provider who was out has to squeeze that person into another, non-intake slot. It feels like punishment, especially like my case where I now have an intake in a therapy appt slot right before my, you guessed it, intake slot (so literally I'll have 2 intakes in a row).

We don't put on this pressure to r/s therapy patients who are cancelled due to provider SL so quickly, why are intakes so special?

 

[AcronymAllergy]

Really getting sick of intakes getting put on a pedestal. If a provider cancels, the provider who was out has to squeeze that person into another, non-intake slot. It feels like punishment, especially like my case where I now have an intake in a therapy appt slot right before my, you guessed it, intake slot (so literally I'll have 2 intakes in a row).

We don't put on this pressure to r/s therapy patients who are cancelled due to provider SL so quickly, why are intakes so special?

My guess? Likely has something to do with numbers (e.g., time to receiving care/initial appointment).

 

[summerbabe]

My guess? Likely has something to do with numbers (e.g., time to receiving care/initial appointment).

Yup, this is 100% related to some type of 'when the consult was placed to when it is completed' type of metric that your facility is prioritizing, whereas continuity of care metrics have much broader timelines for 'success' (something random like 6 appointments with a depression focused diagnosis over the course of 1 year counts as providing psychotherapy effectively for depression according to SAIL).

 

[Fan_of_Meehl]

Really getting sick of intakes getting put on a pedestal. If a provider cancels, the provider who was out has to squeeze that person into another, non-intake slot. It feels like punishment, especially like my case where I now have an intake in a therapy appt slot right before my, you guessed it, intake slot (so literally I'll have 2 intakes in a row).

We don't put on this pressure to r/s therapy patients who are cancelled due to provider SL so quickly, why are intakes so special?

At our clinic, if all a provider's intake slots for a week are full and there are additional consults that need to be seen MSAs are encouraged to schedule the intake into any 90min space where they fit in a provider's schedule.

 

[texanpsychdoc]

At our clinic, if all a provider's intake slots for a week are full and there are additional consults that need to be seen MSAs are encouraged to schedule the intake into any 90min space where they fit in a provider's schedule.

 

[AbnormalPsych]

At our clinic, if all a provider's intake slots for a week are full and there are additional consults that need to be seen MSAs are encouraged to schedule the intake into any 90min space where they fit in a provider's schedule.

You guys are getting 90 minutes for an intake!?

 

[texanpsychdoc]

Our new (old/previous) program manager asked me to share with them my intake template which has been the talk of the clinic (because it's nicely formatted and hits all the requirements). They managed to take a perfectly good product and took a massive **** on it and made it an 11 page check box intake that takes 2.5 hours to complete.

I give up. I certainly won't be using the intake template, I will use mine. But go figure, they brought back the same manager they removed from our department 3 years ago because they caused a mass exodus of 95% of the staff in our clinic, then they were like "hey, we never did fill that open program manager spot, let's bring them back and hope things will be different." (definition of insanity).

 

[summerbabe]

But go figure, they brought back the same manager they removed from our department 3 years ago because they caused a mass exodus of 95% of the staff in our clinic, then they were like "hey, we never did fill that open program manager spot, let's bring them back and hope things will be different." (definition of insanity).

Ahhh, the VA - where the people you actually need to get rid of, you can only move around, and sometimes temporarily.

And the people you need to keep, many will eventually accumulate enough reasons to leave.

 

[WisNeuro]

Ahhh, the VA - where the people you actually need to get rid of, you can only move around, and sometimes temporarily.

And the people you need to keep, many will eventually accumulate enough reasons to leave.

The VA is the perfect setting for people to fail upwards.

 

[Fan_of_Meehl]

The VA is the perfect setting for people to fail upwards.

I've always referred to it as an 'inverse meritocracy'

 

[cara susanna]

Our new (old/previous) program manager asked me to share with them my intake template which has been the talk of the clinic (because it's nicely formatted and hits all the requirements). They managed to take a perfectly good product and took a massive **** on it and made it an 11 page check box intake that takes 2.5 hours to complete.

I give up. I certainly won't be using the intake template, I will use mine. But go figure, they brought back the same manager they removed from our department 3 years ago because they caused a mass exodus of 95% of the staff in our clinic, then they were like "hey, we never did fill that open program manager spot, let's bring them back and hope things will be different." (definition of insanity).

Yeah, my VA also LOVES using dialogue boxes for notes and I can't stand them. I've just started making my own version of the text (so populating the note from the dialogue box, then saving that in Notepad). Then when I need to write a note, I click out of the dialogue box and copy and paste my version.

 

[Fan_of_Meehl]

Yeah, my VA also LOVES using dialogue boxes for notes and I can't stand them. I've just started making my own version of the text (so populating the note from the dialogue box, then saving that in Notepad). Then when I need to write a note, I click out of the dialogue box and copy and paste my version.

I have many such plaintext 'blurbs' saved in Notepad covering things like the (actual APA) definition of evidence-based psychotherapy, legal/ethical analyses/disclaimers explaining, for example, why I am NOT sending the police to the place of a client to "check up" on them after a routine no-show, or explaining (in the context of a REACH VET prompt asking if we are doing 'everything possible' to treat a non-engaged veteran that the standards of care/practice in the field is not an 'are we doing everything humanly possible OMFG-pantsonfire-hyperventilation response', etc. I don't know what 'enhanced' treatment means in this context Mr/Mrs 'REACH VET Coordinator expertologist/excellentologist person, but, as a doctoral level psychologist I'm pretty damned sure that medication and weekly psychotherapy is the appropriate care for most MH conditions...including this one. For this REACH VET patient we have offered state of the art pharmacotherapy and multiple forms of weekly psychotherapy by a doctoral-level provider but...you got me...I'm sure that we're not actually doing literally 'everything humanly possible' here. Checklists/forms are good for what they are (rarely) but, most often, they are soul-sucking empty formalities at this place or they actually detract from the best care and are more akin to 'swatting away flies' with my mouse pointer during my shift rather than being invaluable tools facilitating competent clinical practice.

 

[texanpsychdoc]

I have many such plaintext 'blurbs' saved in Notepad covering things like the (actual APA) definition of evidence-based psychotherapy, legal/ethical analyses/disclaimers explaining, for example, why I am NOT sending the police to the place of a client to "check up" on them after a routine no-show, or explaining (in the context of a REACH VET prompt asking if we are doing 'everything possible' to treat a non-engaged veteran that the standards of care/practice in the field is not an 'are we doing everything humanly possible OMFG-pantsonfire-hyperventilation response', etc. I don't know what 'enhanced' treatment means in this context Mr/Mrs 'REACH VET Coordinator expertologist/excellentologist person, but, as a doctoral level psychologist I'm pretty damned sure that medication and weekly psychotherapy is the appropriate care for most MH conditions...including this one. For this REACH VET patient we have offered state of the art pharmacotherapy and multiple forms of weekly psychotherapy by a doctoral-level provider but...you got me...I'm sure that we're not actually doing literally 'everything humanly possible' here. Checklists/forms are good for what they are (rarely) but, most often, they are soul-sucking empty formalities at this place or they actually detract from the best care and are more akin to 'swatting away flies' with my mouse pointer during my shift rather than being invaluable tools facilitating competent clinical practice.

Random question, but do you live in a state that has master's level psychological associates or "limited licensed psychologists?"

 

[Fan_of_Meehl]

Random question, but do you live in a state that has master's level psychological associates or "limited licensed psychologists?"

We have master's level psychologists who must be supervised by a doctoral-level psychologist (they are 'assistants' to the psychologist). There are, of course, social workers and licensed professional counselors ('LPCs') however.

 

[texanpsychdoc]

We have master's level psychologists who must be supervised by a doctoral-level psychologist (they are 'assistants' to the psychologist). There are, of course, social workers and licensed professional counselors ('LPCs') however.

It sounds like they are not psychologists (i.e., Licensed Psychologists/LP) but rather, associates. To my knowledge, the only folks who can refer to themselves as psychologists are those who are independently licensed (LP), otherwise they would need to indicate they are "limited licensed psychologists" etc. I always try to get the point across to folks, that, despite having master's level folks, they are not psychologists, not in the definition as it relates to the LP license.

 

[Fan_of_Meehl]

It sounds like they are not psychologists (i.e., Licensed Psychologists/LP) but rather, associates. To my knowledge, the only folks who can refer to themselves as psychologists are those who are independently licensed (LP), otherwise they would need to indicate they are "limited licensed psychologists" etc. I always try to get the point across to folks, that, despite having master's level folks, they are not psychologists, not in the definition as it relates to the LP license.

Right. They are 'associates to a psychologist' and cannot practice independently. They have masters degrees in psychology and can practice under the supervision of a licensed psychologist.

One of the interesting things is that it is actually against the law (by state statute) to 'practice psychology without a license.' However, that doesn't keep all sorts of folks who are not psychologists--including people with LCSW's, bachelors degrees in whatever (including religious studies)--who hold 'administrative' or 'oversight' positions in mental health in certain organizations (Veterans Affairs, state hospitals) to practice what I would consider to be (inappropriate) oversight (supervision?) over the clinical work of licensed psychologists via implementation of 'quality control' audits enforcing 'policies and procedures' on the books of the organization (e.g., three phone calls and a letter required after a MH no-show; the most recent one (are other VA sites doing this one?) involves a requirement that if a clinician checks off any boxes on the comprehensive suicide risk evaluation (CSRE) template, e.g., 'instilled hope,' associated with a clinical encounter, then there are 'auditors' going around enforcing a 'rule' that, in the progress note associated with that encounter there must be explicit written statements indicating exactly how hope was instilled during the session. LOL. It's a ridiculous level of de facto clinical oversight/supervision nitpicking that actually I believe amounts to practicing psychology without a license but nobody gives a damn about it because healthcare has become all about ticking off boxes and doing 'audits' and not about standards of care and clinical reasoning and informed judgment.

 

[AcronymAllergy]

Right. They are 'associates to a psychologist' and cannot practice independently. They have masters degrees in psychology and can practice under the supervision of a licensed psychologist.

One of the interesting things is that it is actually against the law (by state statute) to 'practice psychology without a license.' However, that doesn't keep all sorts of folks who are not psychologists--including people with LCSW's, bachelors degrees in whatever (including religious studies)--who hold 'administrative' or 'oversight' positions in mental health in certain organizations (Veterans Affairs, state hospitals) to practice what I would consider to be (inappropriate) oversight (supervision?) over the clinical work of licensed psychologists via implementation of 'quality control' audits enforcing 'policies and procedures' on the books of the organization (e.g., three phone calls and a letter required after a MH no-show; the most recent one (are other VA sites doing this one?) involves a requirement that if a clinician checks off any boxes on the comprehensive suicide risk evaluation (CSRE) template, e.g., 'instilled hope,' associated with a clinical encounter, then there are 'auditors' going around enforcing a 'rule' that, in the progress note associated with that encounter there must be explicit written statements indicating exactly how hope was instilled during the session. LOL. It's a ridiculous level of de facto clinical oversight/supervision nitpicking that actually I believe amounts to practicing psychology without a license but nobody gives a damn about it because healthcare has become all about ticking off boxes and doing 'audits' and not about standards of care and clinical reasoning and informed judgment.

Yeah, this is pretty common across healthcare as a whole, and certainly isn't limited to psychologists or mental health.

During my time at VA, there were some things I let pass and/or accepted, and others I pushed back on. The latter situations were almost universally related to when I felt someone was attempting to tell me how to practice (or was asking me to do evals that I didn't feel were appropriate).

 

[texanpsychdoc]

Yeah, this is pretty common across healthcare as a whole, and certainly isn't limited to psychologists or mental health.

During my time at VA, there were some things I let pass and/or accepted, and others I pushed back on. The latter situations were almost universally related to when I felt someone was attempting to tell me how to practice (or was asking me to do evals that I didn't feel were appropriate).

I shut that stuff down real fast. I have had that happen a couple of times in the past couple of months. My personality style has its pros and cons...I am an "acquired taste" for some, but I will say one benefit is that I really don't take BS, I am very transparent and vocal for things that matter to me and I will convey that in a manner befitting of the situation (some could call it being an a**)

 

[Shiori]

It's so awkward doing therapy with a person who has made it obvious they're jumping through S/C hoops.

 

[Fan_of_Meehl]

It's so awkward doing therapy with a person who has made it obvious they're jumping through S/C hoops.

Actually--and I am not even being funny or flippant--I would consider it to be a core competency of any VA mental health provider.

I mean, fundamentally, the goals of psychotherapy and the goals of increasing S/C %ages are DIAMETRICALLY OPPOSED goals. This can, with appropriate tact, be made repeatedly and carefully clear to the veteran as many times as is necessary to get the point across...you can even draw the arrows pointing in opposite directions on a whiteboard or blank sheet of paper.

Just as it is the case that you can't travel both east and west at the same time...

We cannot pursue the opposite goals of increased disability from a MH condition and decreased disability from a MH condition simultaneously.

If the veteran accepts that our goal is to reduce symptom severity/impairment by actively engaging in psychotherapy, then we cannot have a goal of increasing their disability and do, in fact, have the goal of DECREASING IT.

And if their goal ISN'T decreasing the degree of impairment that they experience as a result of their condition then I don't care how you code the encounter, they ARE NOT IN PSYCHOTHERAPY and there is no point pretending otherwise.

Of course they may claim that their rating is inaccurate, but that's a whole nother issue. You could share the actual criteria for 100% SC for MH with them, or you could just reinforce the separation of clinical vs forensic roles.

 

[cara susanna]

Yup, and pointing out that you don't need to do treatment to get SC.

 

[Fan_of_Meehl]

Yup, and pointing out that you don't need to do treatment to get SC.

Correct. This is a myth/rumor that won't die and causes so much waste in the system and burnout.

 

[Fan_of_Meehl]

It's so awkward doing therapy with a person who has made it obvious they're jumping through S/C hoops.

The most important thing is not to accept their 'frame' or presupposition that 'service connection deficit disorder' is the condition that they have and that you are obligated to 'help' them with.

 

[Shiori]

Most of my clients are receptive to the S/C conversation. I have a handful of cases where they're wanting something very specific in their chart because they've been told by "an insider" it needs to be in there. I haven't been asked to do anything inaccurate or exaggerated. They just want me to be really thorough about documenting things. They bug me about the content of the note and the kinds of things they want to do in therapy to check some sort of box. I provide education, but they think I'm trying to keep them from their S/C increase. I wonder if there is some article or video floating around that has people thinking my little therapy note is the gateway to an increase.

 

[Fan_of_Meehl]

I totally hear ya and feel your frustration, I know what you're talking about there.

Hope I didn't come off as preachy, there's just no small amount of frustration on this issue coming from the therapist's side.

To be fair, I have encountered cases of apparent 'lowballing,' i.e., veterans only having 30% but seeming more like 70% and we really do (and really should) want to help the veterans we work with but, I mean, they fill out their own PCL's and they attend their own C & P appointments and can share the relevant info with those examiners. I don't see it as my role to 'gussy up' or otherwise alter my progress notes in order to increase S/C. To me, it is a conflation of clinical (treatment) vs forensic roles but well-informed and well-intentioned clinicians do disagree (sometimes passionately) on this issue.

I guess that the moral imperative I always fall back on is...

I do not lie TO my patients and I do not lie FOR my patients and

Any life built on a lie is bound to fail to be psychologically healthy

'Lie' may be a bit harsh (though pithy) but deception (including self-deception) is a continuum with a very slippery slope.

 

[Shiori]

You didn't sound preachy at all! The only reason I'm as comfortable with it as I am is due to great supervision in a PCT clinic. I got pretty quick at dispelling myths and redirecting folks to where they needed to be. I usually ask whether someone is pursuing S/C early on, so they don't waste their time. I have just run into a few recently who have been quite focused on what I write in the note and check in during the session about what will be in the note. They're also looking at information as a consumer and not a provider. I keep having to explain that their condition is well-documented and present throughout their chart. I had someone question me on how I captured behavioral observations. Fortunately, I usually only have 1 or 2 of those kinds of clients a quarter.

 

[Fan_of_Meehl]

You didn't sound preachy at all! The only reason I'm as comfortable with it as I am is due to great supervision in a PCT clinic. I got pretty quick at dispelling myths and redirecting folks to where they needed to be. I usually ask whether someone is pursuing S/C early on, so they don't waste their time. I have just run into a few recently who have been quite focused on what I write in the note and check in during the session about what will be in the note. They're also looking at information as a consumer and not a provider. I keep having to explain that their condition is well-documented and present throughout their chart. I had someone question me on how I captured behavioral observations. Fortunately, I usually only have 1 or 2 of those kinds of clients a quarter.

Yeah, I mean I guess I would want be flexible on how I handled this on a client--by-client basis and I guess it would depend on several factors. If the person was truly participating in active psychotherapy but just wanted to make sure that reality was captured in the notes, I may have no problem obliging (to an extent) and be careful not to leave important areas out of the note...but it's a potentially slippery slope. I would start to get uncomfortable if a dynamic were to form around the client trying to control what I put in the note or how I wrote my notes. It's a tricky area.

 

[AcronymAllergy]

Yeah, I mean I guess I would want be flexible on how I handled this on a client--by-client basis and I guess it would depend on several factors. If the person was truly participating in active psychotherapy but just wanted to make sure that reality was captured in the notes, I may have no problem obliging (to an extent) and be careful not to leave important areas out of the note...but it's a potentially slippery slope. I would start to get uncomfortable if a dynamic were to form around the client trying to control what I put in the note or how I wrote my notes. It's a tricky area.

Agreed. If a patient finds information in a note that they say is inaccurate, I'm fine with an addendum or possibly even seeking retraction to enter a new note. But I'd be careful of letting patients attempt to dictate what's in a note. Like you've said, the dynamic that forms probably wouldn't be a great one. At the same time, I can see from a patient's perspective their role in advocating for their own healthcare (e.g., wanting something well-documented in a note so that future providers actually know they discussed it with you and/or so that it's not brushed aside). But doing so for the purposes of service-connection/compensation goes beyond the role of the clinician.

I remember one provider at my last VA who would refer mTBI patients to neuropsych specifically for the purposes of seeking/increasing service-connection. Sometimes said provider would even include that in their notes. I'd often start the appointment with those folks delineating what I do and what the purposes of my evaluation are, and what they are not. That's about the best we can do in a less-than-ideal situation.

 

[Fan_of_Meehl]

Agreed. If a patient finds information in a note that they say is inaccurate, I'm fine with an addendum or possibly even seeking retraction to enter a new note. But I'd be careful of letting patients attempt to dictate what's in a note. Like you've said, the dynamic that forms probably wouldn't be a great one. At the same time, I can see from a patient's perspective their role in advocating for their own healthcare (e.g., wanting something well-documented in a note so that future providers actually know they discussed it with you and/or so that it's not brushed aside). But doing so for the purposes of service-connection/compensation goes beyond the role of the clinician.

I remember one provider at my last VA who would refer mTBI patients to neuropsych specifically for the purposes of seeking/increasing service-connection. Sometimes said provider would even include that in their notes. I'd often start the appointment with those folks delineating what I do and what the purposes of my evaluation are, and what they are not. That's about the best we can do in a less-than-ideal situation.

To me it boils down to the question...what are we doing here are we:

(a) trying to ensure that reality is accurately captured in the documentation or...
(b) are we trying to 'manipulate' the picture that is being painted in the notes in any way that is not fully and accurately portraying reality.

If it's (a), then I'm all for it...if it's (b) then...no.

Although differentiating between a veteran's motives for (a) vs (b) can be tricky, it usually reveals itself with time.

For instance, if a veteran is concerned that I'm not paying enough attention to his 'nightmares' and their impact on his functioning then that can prompt me to do a more thorough assessment of his nighttime sleep habits, insomnia, things that disturb his sleep, his 'nightmares' and their impact on his functioning and I'm more than happy to do that investigation and to document it in considerable detail. But if what I uncover is that the veteran doesn't actually report remembering any 'nightmare' content (which means it is not technically a 'nightmare'), has many risk factors for obstructive sleep apnea, or otherwise is suffering from what sounds like a parasomnia (e.g., REM Sleep Behavior Disorder) and all of that is documented in my notes...if that upsets the veteran because the results aren't what they wanted to hear then I tend to think we're dealing with situation (b).

 

[Psychologist1234]

You didn't sound preachy at all! The only reason I'm as comfortable with it as I am is due to great supervision in a PCT clinic. I got pretty quick at dispelling myths and redirecting folks to where they needed to be. I usually ask whether someone is pursuing S/C early on, so they don't waste their time. I have just run into a few recently who have been quite focused on what I write in the note and check in during the session about what will be in the note. They're also looking at information as a consumer and not a provider. I keep having to explain that their condition is well-documented and present throughout their chart. I had someone question me on how I captured behavioral observations. Fortunately, I usually only have 1 or 2 of those kinds of clients a quarter.

Do you mind sharing how you word the conversation around "redirecting folks to where they needed to be" and about "not "wasting their time?"

 

[cara susanna]

You didn't sound preachy at all! The only reason I'm as comfortable with it as I am is due to great supervision in a PCT clinic. I got pretty quick at dispelling myths and redirecting folks to where they needed to be. I usually ask whether someone is pursuing S/C early on, so they don't waste their time. I have just run into a few recently who have been quite focused on what I write in the note and check in during the session about what will be in the note. They're also looking at information as a consumer and not a provider. I keep having to explain that their condition is well-documented and present throughout their chart. I had someone question me on how I captured behavioral observations. Fortunately, I usually only have 1 or 2 of those kinds of clients a quarter.

I actually know VA therapists who will document in the chart that the Veteran asked them to write certain things for purposes of obtaining SC.

 

[Shiori]

Do you mind sharing how you word the conversation around "redirecting folks to where they needed to be" and about "not "wasting their time?"

When they came into the PCT clinic, I would ask about their interest in service connection pretty early in the "how can I help you?" questions. I'd say something like "so, with you wanting to work on service connection, I just want to make it clear that therapy is not something that is required for that. During the review process, they'll be looking at all of your records, many of them prior to you even leaving the service. I am happy to begin therapy with you, but doing therapy while seeking service connection at the same time can be challenging." I get a sense of their reaction here. If their primary goal was S/C, the conversation would shift to the VSO and a print out of the FAQs for filing a disability claim. The first part of the FAQs talked about how the evidence is gathered across a variety of sources, which was reassuring that things didn't have to come from me.

If they were still interested, I would do one more round of the "are you sure?" discussion. If they're unfamiliar with the exposure component of PTSD therapy, I would say something like "so, I alluded to doing your application and therapy at the same time. Let's talk a little about why. When we do PTSD work, we spend a lot of time discussing things you've been avoiding. *insert explanation of PE and CPT* During the application process, you might be asked to give many details about what has happened as well. That can be a lot. Hearing that, would you like to set up an appointment to start psychotherapy or wait? We'll still be here after the process is over..., etc." I also like having the conversation because it let them know that I'm not the gatekeeper. My role is just to help improve their symptoms. Some people still chose to do it at the same time, but I feel like they were better prepared to do the work.

Many would drop off after the intake for unknown reasons. All I can do is my job. I just try to be transparent about my role, do my assessments to the best of my ability, and let benefits sort it out.

 

[cara susanna]

Yeah, my last PCT at the clinic orientation we would have a spiel about SC and making sure people knew the distinction between the VBA and the VHA.

 

[Fan_of_Meehl]

When they came into the PCT clinic, I would ask about their interest in service connection pretty early in the "how can I help you?" questions. I'd say something like "so, with you wanting to work on service connection, I just want to make it clear that therapy is not something that is required for that. During the review process, they'll be looking at all of your records, many of them prior to you even leaving the service. I am happy to begin therapy with you, but doing therapy while seeking service connection at the same time can be challenging." I get a sense of their reaction here. If their primary goal was S/C, the conversation would shift to the VSO and a print out of the FAQs for filing a disability claim. The first part of the FAQs talked about how the evidence is gathered across a variety of sources, which was reassuring that things didn't have to come from me.

If they were still interested, I would do one more round of the "are you sure?" discussion. If they're unfamiliar with the exposure component of PTSD therapy, I would say something like "so, I alluded to doing your application and therapy at the same time. Let's talk a little about why. When we do PTSD work, we spend a lot of time discussing things you've been avoiding. *insert explanation of PE and CPT* During the application process, you might be asked to give many details about what has happened as well. That can be a lot. Hearing that, would you like to set up an appointment to start psychotherapy or wait? We'll still be here after the process is over..., etc." I also like having the conversation because it let them know that I'm not the gatekeeper. My role is just to help improve their symptoms. Some people still chose to do it at the same time, but I feel like they were better prepared to do the work.

Many would drop off after the intake for unknown reasons. All I can do is my job. I just try to be transparent about my role, do my assessments to the best of my ability, and let benefits sort it out.

I consider all of this to be encompassed under our professional and ethical obligations to provide patients with the opportunity to give true 'informed consent' (to the actual service being offered, i.e., psychotherapy) in the context of true 'shared decisionmaking.'

 

[Harry3990]

Sorry for the off-topic question (other than this being VA-related). I was wondering if anyone knows off-hand or could point me to the current family-leave benefits for psychologists in the VA system?

 

[Harry3990]

Sorry for the off-topic question (other than this being VA-related). I was wondering if anyone knows off-hand or could point me to the current family-leave benefits for psychologists in the VA system?

That was easier to find than I thought. Apologies for the lazy question…For anyone interested: Benefits | VA Careers

 

[Fan_of_Meehl]

Sorry for the off-topic question (other than this being VA-related). I was wondering if anyone knows off-hand or could point me to the current family-leave benefits for psychologists in the VA system?

Heck, this is a general VA provider support and info sharing thread...not off topic at all!

 

[deleted1038433]

Anyone else lose SSOi access today and not remember or update their access/ verify codes so they couldn't log into the EMR?

What are folks thoughts on canceling vs. proceeding with video sessions when unable to log in and document risk?

 

[PsychPhDone]

Anyone else lose SSOi access today and not remember or update their access/ verify codes so they couldn't log into the EMR?

What are folks thoughts on canceling vs. proceeding with video sessions when unable to log in and document risk?

Personally very uncomfortable doing this. I would be ok seeing established patients with no safety risks.

 

[cara susanna]

We aren't supposed to see patients if we can't document, I don't think.

 

[texanpsychdoc]

I always tell my vets who are seeking treatment and who are SC that when they begin treatment, there is a possibility that if their records are reviewed for renewed SC benefits, that there is the possibility their SC benefits could be modified in part because of our treatment. I emphasize that the purpose of treatment is to improve quality of life and functioning, thus, if their continued SC benefits are associated with their functioning, then it is possible it can be affected.

 

[cara susanna]

I always tell my vets who are seeking treatment and who are SC that when they begin treatment, there is a possibility that if their records are reviewed for renewed SC benefits, that there is the possibility their SC benefits could be modified in part because of our treatment. I emphasize that the purpose of treatment is to improve quality of life and functioning, thus, if their continued SC benefits are associated with their functioning, then it is possible it can be affected.

Unless they're permanent and total, then they're good to go. UNLESS they apply for a new SC.

 

[texanpsychdoc]

Unless they're permanent and total, then they're good to go. UNLESS they apply for a new SC.

Yeah this is for folks not 100% P&T...that's what I tell them.

 

[cara susanna]

My f/u access is garbage, as is everyone else's, and the new patients. just. keep. coming. Or people coming back. They're offered community care but they always decline. It's really burning me out.

 

[summerbabe]

My f/u access is garbage, as is everyone else's, and the new patients. just. keep. coming. Or people coming back. They're offered community care but they always decline. It's really burning me out.

I totally feel ya. And I experience this grind the most as summer approaches and the weather gets warmer and I get lazier lol.

We should start a ‘hey maybe it’s OK to go back to not talking about our feelings?’ PSA campaign. I’ll write it up for that VA Shark Tank thing.