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

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WisNeuro said:
How badly did they **** up to get dismissed? I've seen so many trainees get passed along that never should have, I can't imagine what it would take to get someone dismissed.
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I don't remember all of the specifics, but I believe it related to taking information for multiple patients off-site.

I'm pretty sure that back when I was still in training somewhere, I also vaguely remember hearing about an intern (before my time) being dismissed for having an inappropriate relationship with a patient.
 
AcronymAllergy said:
I don't remember all of the specifics, but I believe it related to taking information for multiple patients off-site.

I'm pretty sure that back when I was still in training somewhere, I also vaguely remember hearing about an intern (before my time) being dismissed for having an inappropriate relationship with a patient.
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Yeah, don't **** your patients, is kind of the easiest rules to follow, yet still seems to be one of the rules people forget to follow the most.
 
I really like my administrative role, but it's getting to a place where it's no longer sustainable. It's basically just another mini clinical job without any time to do the actual administrative part.
 
Shiori said:
I really like my administrative role, but it's getting to a place where it's no longer sustainable. It's basically just another mini clinical job without any time to do the actual administrative part.
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Or any actual power to enforce the policies you're supposed to be enforcing
 
Shiori said:
I thought I would struggle with very heavy or emotional cases. I can handle those just fine. I might end up retiring early if I keep getting clear MFT cases who want to fix things in individual therapy.
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Amen! These individuals who actually just need MFT take up too much of my caseload and it feels so futile. A few of the male Veterans on my caseload are convinced their significant other is having an affair and spend most of our sessions focused on their distress related to this, but refuse to pursue couples therapy. Make it make sense.
 
VintageRed said:
Amen! These individuals who actually just need MFT take up too much of my caseload and it feels so futile. A few of the male Veterans on my caseload are convinced their significant other is having an affair and spend most of our sessions focused on their distress related to this, but refuse to pursue couples therapy. Make it make sense.
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My most challenging ones are where the spouse is thoroughly and utterly over the relationship already and the Veteran is now ready to change. It's why they're in the session alone with me. The spouse was done years ago.

Editing to say this isn't for MFT. They need a divorce lawyer. I wouldn't send those cases to my poor MFT colleagues.
 
Sanman said:
Pair Of Bills Would Slash Pay For Over A Million Federal Employees | FedSmith.com
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Per the lovely architect of the bill:

Cassidy said in a statement, “Federal employees get paid extra to work in higher-cost cities. But what if they don’t show up to work? Why should they get paid? If you don’t show up for work, you don’t get paid at the same rate just for teleworking.”

Because they may still live in the same high CoL area, perchance...?

Mind you, if the subsequent numbers they show about how many employees are misclassified for their duty station are indeed accurate and commensurate with VA as a whole, there's a problem. And I have no issues with adjusting locality pay to fit where an employee lives if that area is different from their duty station and they're solely teleworking, even if lot of private industry apparently doesn't do this.

Although RE: the bolded portion, does the same apply to Congress? Can we dock their pay and retirement based on the proportion of votes, discussions, etc., to which they don't show up? I'm doubtful he'd be as supportive of that type of bill...

Also, not showing up for work is a ridiculous way of describing telework.
 
Adjusting locality pay to the locality of the teleworker rather than the VA site isn't necessarily unreasonable, but implementing that would probably cause more trouble than it is worth.


"The Federal Employee Locality Accountability in Retirement Act (S. 4833) would exclude locality pay when calculating retirement payments for federal employees enrolled in the Federal Employees Retirement System (FERS). This would have the net effect of cutting federal retirement annuities because locality pay is included in the high-3 calculation."

This is some BS though.
 
AcronymAllergy said:
Per the lovely architect of the bill:

Cassidy said in a statement, “Federal employees get paid extra to work in higher-cost cities. But what if they don’t show up to work? Why should they get paid? If you don’t show up for work, you don’t get paid at the same rate just for teleworking.”

Because they may still live in the same high CoL area, perchance...?

Mind you, if the subsequent numbers they show about how many employees are misclassified for their duty station are indeed accurate and commensurate with VA as a whole, there's a problem. And I have no issues with adjusting locality pay to fit where an employee lives if that area is different from their duty station and they're solely teleworking, even if lot of private industry apparently doesn't do this.

Although RE: the bolded portion, does the same apply to Congress? Can we dock their pay and retirement based on the proportion of votes, discussions, etc., to which they don't show up? I'm doubtful he'd be as supportive of that type of bill...

Also, not showing up for work is a ridiculous way of describing telework.
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The bill text suggests that this applies to folks teleworking even 1 day per week. If they are showing up to the office most of the time then who cares where they live? This will just increase folks showing up to work sick or using more sick leave. The only people that can currently be misclassified are fully remote employees who use their home address or people that not using proper agreements and that is on their bosses. Most of those folks are fully remote because they were hired that way or there was a need for their skills in an area of shortage. I imagine if these bill did pass, it would put a lot of government agencies at a loss for hard to fill positions.

As for the FERS locality adjustment, that is just reneging on an agreement already in place in order to gut the pension even more. It may not go anywhere, but it is always a good look when the federal government breaks an agreement with its own citizens. Certainly, does not encourage a selfish mentality.
 
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Oh man, it's so funny when specialty clinic people recommend just sending a patient who isn't engaging in treatment back to OPMH, but then you *are* OPMH
 
Sanman said:
The bill text suggests that this applies to folks teleworking even 1 day per week. If they are showing up to the office most of the time then who cares where they live? This will just increase folks showing up to work sick or using more sick leave. The only people that can currently be misclassified are fully remote employees who use their home address or people that not using proper agreements and that is on their bosses. Most of those folks are fully remote because they were hired that way or there was a need for their skills in an area of shortage. I imagine if these bill did pass, it would put a lot of government agencies at a loss for hard to fill positions.

As for the FERS locality adjustment, that is just reneging on an agreement already in place in order to gut the pension even more. It may not go anywhere, but it is always a good look when the federal government breaks an agreement with its own citizens. Certainly, does not encourage a selfish mentality.
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I agree, which is why I was careful to say that I'd support the change if the person is solely telework. If they're hybrid, they should stay at their regular locality adjustment.

And yeah, politicians always seem to love coming after federal worker pensions. I could realistically only see it happening with new employees (i.e., same as when they significantly increased the employee contribution rate ~10 years ago-ish). But who knows.
 
AcronymAllergy said:
I agree, which is why I was careful to say that I'd support the change if the person is solely telework. If they're hybrid, they should stay at their regular locality adjustment.
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This is already the case for full time remote workers as their home is their duty station.

AcronymAllergy said:
And yeah, politicians always seem to love coming after federal worker pensions. I could realistically only see it happening with new employees (i.e., same as when they significantly increased the employee contribution rate ~10 years ago-ish). But who knows.
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I imagine making it retroactive would end in one large class action lawsuit.
 
Shiori said:
I think I'm going to sign up for the "Working With Politically Charged Veterans in Mental Health Practice" TMS training. It's been rough keeping things contained.
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Be forewarned that it's just exposure to Fox News for 12 hours a day over the course of a week.
 
Shiori said:
I think I'm going to sign up for the "Working With Politically Charged Veterans in Mental Health Practice" TMS training. It's been rough keeping things contained.
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I need this! My tolerance is waning.
 
Research question—it’s been a couple of years since I’ve been out of research and something occurred recently that didn’t sit well, but I wasn’t sure if it was a big deal. I decided to volunteer for a research study and was contacted by a grad student to schedule an appointment. However, the grad student sent the email to about 100 people who had expressed interest in the study. Not bcc, I can see everyone’s emails. Even though we’re not officially participants, this is… not good, right? I don’t know if it qualifies as a breach of confidentiality or anything but it bothered me. I debated whether I should give feedback or just ignore and don’t sign up for the study. Thoughts?
 
ccpsych16 said:
Research question—it’s been a couple of years since I’ve been out of research and something occurred recently that didn’t sit well, but I wasn’t sure if it was a big deal. I decided to volunteer for a research study and was contacted by a grad student to schedule an appointment. However, the grad student sent the email to about 100 people who had expressed interest in the study. Not bcc, I can see everyone’s emails. Even though we’re not officially participants, this is… not good, right? I don’t know if it qualifies as a breach of confidentiality or anything but it bothered me. I debated whether I should give feedback or just ignore and don’t sign up for the study. Thoughts?
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Reply all: Hey new friends. So just confirming, we are all going to answer C for all multiple choices questions. And oh ya, do that other weird thing during the study, right?

I mostly want to see how that would be responded to.
 
AbnormalPsych said:
Reply all: Hey new friends. So just confirming, we are all going to answer C for all multiple choices questions. And oh ya, do that other weird thing during the study, right?

I mostly want to see how that would be responded to.
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Everyone needs to cluck like a chicken whenever the experimenters say the word "study"
 
Oh, cool, they just announced another thing we have to implement because Congress decided we have to, even though it has no clinical utility and might even be detrimental (don't worry, this will only affect people in a certain administrative role)
 
Shiori said:
They always sound so convincing when they're in crisis though.
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I'll give you the same advice that a supervisor once gave me regarding suicidal ideation and patient suicide... if their friends, family, and loved ones have all failed them to the point that they are turning to you as a last resort; what is it that you think you are going to say that will make a difference?

It's our job to give them the tools to build their supports, not be the support that keeps them together.
 
Sanman said:
I'll give you the same advice that a supervisor once gave me regarding suicidal ideation and patient suicide... if their friends, family, and loved ones have all failed them to the point that they are turning to you as a last resort; what is it that you think you are going to say that will make a difference?

It's our job to give them the tools to build their supports, not be the support that keeps them together.
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It's true. I will keep practicing my own humility and professional boundaries.
 
cara susanna said:
Just had two people d/c PTSD EBPs this week and a third request a provider change. Hard not to feel a little disheartened in these moments.
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Oof, those are hard days. PTSD EBPs are my hardest buy-in conversations. I have ended up modifying a few of my recent cases to just in-vivos/BA because they just couldn't tolerate therapy at the level of fidelity. Some people I literally just switch to CBT-D or ACT, because they are very minimally engaged. I also feel like folks are less engaged lately because school is starting and the weather is cooling off here.

If you're anything like you are here in your sessions, I'm sure you're doing amazing work.
 
Shiori said:
If you're anything like you are here in your sessions, I'm sure you're doing amazing work.
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@cara susanna definitely cite SND in your next self performance eval thing (unless you're like me and leave it completely blank since it doesn't seem to matter lol).

Hang in there! It's the VA EBP cycle of life. So out of these ashes, a phoenix will arise (or something like that).
 
For those of you previously/currently employed at the VA, how often do you get motivated, consistent clients that are engaged throughout the course of therapy and have meaningful symptom improvement?
 
RxPsych said:
For those of you previously/currently employed at the VA, how often do you get motivated, consistent clients that are engaged throughout the course of therapy and have meaningful symptom improvement?
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Maybe about 25% of the time. My non-VA PTSD patients were usually a good 80% of the time.
 
RxPsych said:
For those of you previously/currently employed at the VA, how often do you get motivated, consistent clients that are engaged throughout the course of therapy and have meaningful symptom improvement?
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I'm in a specialty clinic focused on doing structured EBPs & we have the option of discharging back to BHIP for poor fit with our model so I'm pretty sure I'm decently over 50%, at least for engagement.

Or people make it clear at intake that they aren't interested (or don't even show up to the intake) to self select out.
 
WisNeuro said:
Maybe about 25% of the time. My non-VA PTSD patients were usually a good 80% of the time.
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My individual pain patients are good about 75% of the time. I usually weed out the SSDI and workman's comp folks by explaining that therapy is designed for them to get better and it may harm their case. After that explanation, they usually decline.

For the pain program(10wk intensive outpatient), it's about a 50% drop out rate.
 
RxPsych said:
For those of you previously/currently employed at the VA, how often do you get motivated, consistent clients that are engaged throughout the course of therapy and have meaningful symptom improvement?
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Honestly, I would say about 50%. We have a very good clinic that emphasizes EBPs and active episodes of care, and half of my time is spent providing PTSD EBPs, which often does result in meaningful change.
 
psycho1391 said:
My individual pain patients are good about 75% of the time. I usually weed out the SSDI and workman's comp folks by explaining that therapy is designed for them to get better and it may harm their case. After that explanation, they usually decline.

For the pain program(10wk intensive outpatient), it's about a 50% drop out rate.
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I use this strategy now (and will outright refuse the case/referral) and used it before VA, but unfortunately, never found it to be especially helpful at VA. Even on the rare occasion when a person explicitly told me they were considering applying for SSDI in the future.
 
AcronymAllergy said:
I use this strategy now and used it before VA, but unfortunately, never found it to be especially helpful at VA. Even on the rare occasion when a person explicitly told me they were considering applying for SSDI in the future.
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I'll get a few referrals a year decline neuropsych testing after I explain the difference between clinical evals and IMEs in terns of discoverability in the medical record regardless or not if the eval supports their claims.
 
I do the same with PTSD claim stuff, but unfortunately the person usually is just like "oh yeah, i want treatment!" so we complete the eval, and then declines it at the end. But then I usually will just list PTSD as a rule-out because I didn't formally assess it during the intake, unless I have REALLY compelling evidence to diagnose it from the intake alone. I am very upfront with them too that I can't formally assess for PTSD during an intake. Back when I saw patients in PCMHI I never diagnosed them with PTSD from that alone, and I would tell them it wasn't possible for me to assess for PTSD in that setting.
 
cara susanna said:
I do the same with PTSD claim stuff, but unfortunately the person usually is just like "oh yeah, i want treatment!" so we complete the eval, and then declines it at the end. But then I usually will just list PTSD as a rule-out because I didn't formally assess it during the intake, unless I have REALLY compelling evidence to diagnose it from the intake alone. Back when I saw patients in PCMHI I never diagnosed them with PTSD from that alone, and I would tell them it wasn't possible for me to assess for PTSD in that setting.
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You need to work on your diagnostic skills. Out here in the real world, social workers Dx PTSD in a 35 minute intake, with no formal assessment of symptoms.
 
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