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

[aim-agm]

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And they'll still have to wait several weeks to actually begin therapy

Only weeks?

 

[cara susanna]

Only weeks?

We have new patient slots that have better access than f/u slots, so when I say begin, I am being very specific. Lol

 

[Shiori]

I got a comment on my consult with an established patient to "add CBT-CP to our treatment plan." They spoke to the patient about adding it and the veteran thought it was a good idea.

 

[futureapppsy2]

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.

You can also just diagnose yourself if you’ve ever had anything remotely unpleasant happen to you. /s

 

[butteredtoast27]

My intake this afternoon cancelled and they managed to fill the open timeslot in less than 24 hrs. Whyyyy

I hate the guidance about "missed opportunities." Like we need to hunt these people down and drag them in for therapy, whether they really want it or not.

 

[R. Matey]

I hate the guidance about "missed opportunities." Like we need to hunt these people down and drag them in for therapy, whether they really want it or not.

If they can make it to the marijuana store, they can make it to your session.

 

[cara susanna]

I hate the guidance about "missed opportunities." Like we need to hunt these people down and drag them in for therapy, whether they really want it or not.

Yeah, same here.

 

[cara susanna]

I'm noticing this trend where a lot of my patients don't have "comfort movies" or "comfort TV shows." I wonder if that's an indication of coping skills in general. Kind of want to do a study on this, lol.

 

[psycho1391]

"add CBT-CP to our treatment plan.

UM, who is they? And doing two ebps at the same time is rough. There is a combined CPT/CBT-CP protocol.

 

[psycho1391]

I hate the guidance about "missed opportunities." Like we need to hunt these people down and drag them in for therapy, whether they really want it or not.

And its always in my VVC clinics. My in-person missed opss are so low, but VVC is OUTRAGEOUS

 

[summerbabe]

I'm noticing this trend where a lot of my patients don't have "comfort movies" or "comfort TV shows." I wonder if that's an indication of coping skills in general. Kind of want to do a study on this, lol.

What does it say about me if Children of Men is my favorite the movie and the one that I’ve watched the most times in my life?

 

[Shiori]

UM, who is they? And doing two ebps at the same time is rough. There is a combined CPT/CBT-CP protocol.

A nurse practitioner.

 

[psycho1391]

A nurse practitioner.

Yeah, no. We don't take recs for a TYPE of EBP. Wth?

 

[cara susanna]

That's like when non-psychologist providers ask you to give someone an MMPI or something

 

[WisNeuro]

That's like when non-psychologist providers ask you to give someone an MMPI or something

We had psychiatrists who would commonly ask for CPT/TOVA and MMPI in the VA.

 

[R. Matey]

We had psychiatrists who would commonly ask for CPT/TOVA and MMPI in the VA.

I think you're referring to the magical malingering tests that tells them if they should or should not prescribe stimulants.

 

[Shiori]

I try to defend the neuropsychologist from unreasonable requests like "evaluate if the Veteran has ADHD, BPD, or ASD." I get weird stuff, but they get wild consults.

I don't think anyone knows what we all do across psychology.

 

[AcronymAllergy]

I try to defend the neuropsychologist from unreasonable requests like "evaluate if the Veteran has ADHD, BPD, or ASD." I get weird stuff, but they get wild consults.

I don't think anyone knows what we all do across psychology.

Yeah, those were fun to receive, although I honestly didn't mind them as much; at least they were asking about something that it seemed like a formal assessment could help with.

The ones I really enjoyed were, "evaluate for malingering." Medical necessity? Sure!

 

[cara susanna]

We keep getting testing consults for psychosis and personality disorders. People really can't tell this stuff on their own?

 

[WisNeuro]

We keep getting testing consults for psychosis and personality disorders. People really can't tell this stuff on their own?

Come now, you can't expect psychiatry to spend more then 10 minutes with a patient here.

 

[summerbabe]

We keep getting testing consults for psychosis and personality disorders. People really can't tell this stuff on their own?

Could be code for ‘I want the psychologist to break this news to them.”

 

[aim-agm]

We keep getting testing consults for psychosis and personality disorders. People really can't tell this stuff on their own?

In reality, testing for reality testing should not be sent to you. But that practice is our special reality, testing of your patience as it may be.

Are these requests coming from psychiatrists?

 

[cara susanna]

In reality, testing for reality testing should not be sent to you. But that practice is our special reality, testing of your patience as it may be.

Are these requests coming from psychiatrists?

Personality, yes. Psychosis, no.

 

[Shiori]

The hardest phone calls are to minimally engaged patients in the last slot of the day.

 

[Fan_of_Meehl]

The hardest phone calls are to minimally engaged patients in the last slot of the day.

{crosses fingers and closes eyes shut tight} "Pleasedon'tpickupPleasedon'tpickupPleasedon'---"

Damn.

 

[Shiori]

{crosses fingers and closes eyes shut tight} "Pleasedon'tpickupPleasedon'tpickupPleasedon'---"

Damn.

They always pick up.

 

[cara susanna]

This is why I love the new rule that we don't have to make n/s calls or r/s attempts if they've no showed or cancelled 2x consecutively or 3x within an episode of care.

 

[psycho1391]

This is why I love the new rule that we don't have to make n/s calls or r/s attempts if they've no showed or cancelled 2x consecutively or 3x within an episode of care.

Yeah. That SOP is my favorite.

 

[Shiori]

This is why I love the new rule that we don't have to make n/s calls or r/s attempts if they've no showed or cancelled 2x consecutively or 3x within an episode of care.

It was another instance of my being a big ol' softy.

 

[summerbabe]

It was another instance of my being a big ol' softy.

Is there an opposite of RO-DBT treatment that you can participate in? Jk

 

[Shiori]

Is there an opposite of RO-DBT treatment that you can participate in? Jk

Haha, I have joined a book club for therapists which has been slowly helping me relax. They're mostly private practice and much better at healthy boundary setting. It's good modeling.

 

[psycho1391]

Can we please talk about this new leaf request nonsense for AL?

 

[Shiori]

Can we please talk about this new leaf request nonsense for AL?

The 45 days part or is there some new horror coming?

 

[Sanman]

Can we please talk about this new leaf request nonsense for AL?

See and I thought it was just my VA. Extra fun for you as a clinician.

 

[Sanman]

The 45 days part or is there some new horror coming?

Not sure if it is the the same for @psycho1391, but I know that leaf requests now need to be entered to block grid clinics.

 

[Shiori]

Not sure if it is the the same for @psycho1391, but I know that leaf requests now need to be entered to block grid clinics.

Oh, I've been doing that since I started as staff.

 

[Sanman]

Oh, I've been doing that since I started as staff.

There have been some arguments here about whether admin staff or clinicians need to enter leaf requests. I imagine this will be falling on clinicians in more places as the 'not a hiring freeze' continues...

We just had some clinicians in non-clinical/admin roles pulled back to clinical work as well.

 

[AcronymAllergy]

There have been some arguments here about whether admin staff or clinicians need to enter leaf requests. I imagine this will be falling on clinicians in more places as the 'not a hiring freeze' continues...

We just had some clinicians in non-clinical/admin roles pulled back to clinical work as well.

I left VA a few years back and, like Shiori, had been doing LEAF requests for a year or two before that. It was annoying but generally tolerable. The 45-day rule is what always irked me.

 

[Sanman]

I left VA a few years back and, like Shiori, had been doing LEAF requests for a year or two before that. It was annoying but generally tolerable. The 45-day rule is what always irked me.

I imagine it depends on how much admin support your facility happens to have. Not having actual grid clinics, I never really paid much attention to that stuff. I always sit in dept meetings glassy eyed while they talk about stuff that does not apply to the specialty clinics (and if it does, I need to ask my chief for clarification anyway because it is always a different process).

 

[psycho1391]

Not sure if it is the the same for @psycho1391, but I know that leaf requests now need to be entered to block grid clinics.

Yep. And it looks like they are making it harder for last minute AL <45 days.

 

[psycho1391]

There have been some arguments here about whether admin staff or clinicians need to enter leaf requests. I imagine this will be falling on clinicians in more places as the 'not a hiring freeze' continues...

At our VA, its the ADPAC that enters the leaf requests.

 

[AcronymAllergy]

I imagine it depends on how much admin support your facility happens to have. Not having actual grid clinics, I never really paid much attention to that stuff. I always sit in dept meetings glassy eyed while they talk about stuff that does not apply to the specialty clinics (and if it does, I need to ask my chief for clarification anyway because it is always a different process).

Likely so, although they made it sound like it was VA-wide, same as the 45-day rule. Seems like that was...less than accurate. We actually had pretty decent admin support, surprisingly, but MSA leadership was very antagonistic to giving them any duties beyond what they already had. .

 

[psycho1391]

The 45-day rule is what always irked me.

Right. I understand not wanting to have a ton of patients rescheduled, but at the same time, reducing burnout is important.

 

[AcronymAllergy]

Right. I understand not wanting to have a ton of patients rescheduled, but at the same time, reducing burnout is important.

Yep. And so is treating your doctors like, you know, semi-responsible adults.

 

[summerbabe]

Can we please talk about this new leaf request nonsense for AL?

Yup, we have a renewed emphasis on LEAF and accurate grids here as well.

Supposedly, it's to tighten up actual availability/RVU tracking since clinic blocking will then adjust your clinic and performance expectations accordingly.

And it's also a very useful way to decline AL requests & unofficial things/ways that people have been doing.

 

[Sanman]

Yep. And it looks like they are making it harder for last minute AL <45 days.

Which just means more people using sick days. It's not like there aren't an abundance of those.

 

[Shiori]

Yeah, we generally do the LEAFs ourselves here. If I call out sick or there is a big, mandatory event, admin does the LEAFs. That's it though. Because I've only known it this way, it has felt pretty balanced. They do all of my harassing phone calls to re-engage no-showing clients, which I deeply appreciate. One of the admin staff also tracks the LEAFs for us to make sure they are entered properly. That was the biggest LEAF headache for me.

 

[cara susanna]

Yeah, we enter LEAF requests ourselves here. The 45 day rule can be circumvented if you can get your pt r/s in a reasonable timeframe (and offer earlier or same day) - at least, here it can.

 

[psycho1391]

And it's also a very useful way to decline AL requests & unofficial things/ways that people have been doing.

I love how this comes out after they spent so much time on this ReBoot initiative. Like "we want to reduce burn out", but also "hey all, lets put an emphasis on grid utilization and bookability"

 

[AcronymAllergy]

Yeah, we enter LEAF requests ourselves here. The 45 day rule can be circumvented if you can get your pt r/s in a reasonable timeframe (and offer earlier or same day) - at least, here it can.

This was usually the case for us as well, and my direct supervisor was great, but we still had to wait for approval of the request by service line leadership. And based on how long it took them to reply to the requests, it was not uncommon for the AL date to pass without the request even being reviewed.