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

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psy.d. 2021 said:
They can lay psychologists off but that would be a political nightmare.
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Nah. Besides, it won't happen all at once. Push for community care as much as possible and shrink the budgets. The hiring freezes continue and attrition follows as folks get tired of the headaches. Maybe eliminate the MSAs and other non-clinical folks. Put those responsibilities on us. Slowly, there are more folks going into the community than using us for treatment. Then you get rid of specialty medical care, replace hospitals with CBOCs, reduce inpatient care and wrap around services. The older veterans who know what services and benefits they are receiving will slowly pass away. As they cut service connections and allow for fewer things, our services will get smaller and smaller. That is until we are just seen as an impediment to going straight into community care. This stuff takes time, like boiling a frog in water.

Political nightmare? You mean the way folks would get mad that this administration will try to eliminate good government jobs? It is union busting 101.
 
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No one will care about the plight of VA psychologists. They will care about veterans dying by suicide because accessing care will be even more difficult. They very well may go down that road but they won't like the fallout as veterans are a solid voting group for them (on the whole)
 
psy.d. 2021 said:
No one will care about the plight of VA psychologists. They will care about veterans dying by suicide because accessing care will be even more difficult. They very well may go down that road but they won't like the fallout as veterans are a solid voting group for them (on the whole)
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If you squeeze budgets to the point where inpatient and step down care is eliminated, increases in suicides will just be spun as the VA being incompetent and private providers being the better alternative. If we have to ship them out to hospitalize and are out of the loop with regard to care, veterans will agree. Again, I don't think this will be tomorrow. But in 20 years? They'll tell stories of us like we do about former VA psychologists taking two hour lunches and playing golf.
 
Sanman said:
Again, I don't think this will be tomorrow. But in 20 years? They'll tell stories of us like we do about former VA psychologists taking two hour lunches and playing golf.
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Agreed. We'll have jobs until we voluntarily leave them.

But things will likely continue to get more unpleasant as resources dwindle and natural staff attrition continues to occur (which is an underlying goal of all of this federal govt reorganizing).
 
Shiori said:
In definitely related news, I think I'm ready to start my private practice side hustle. I have been really interested in family estrangement as a niche. This might be my era.
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Very interesting and expanding area. From my POV, seems to be a wide mix of people appropriately setting boundaries for fairly toxic family members, and people who just have very poor conflict resolution skills, even with common interpersonal issues.
 
Sanman said:
I really never get tired of consults where the veteran is the least interested party about getting care. Dude, we are setting up an appt. Why do I need to call back later?
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Somewhat similarly - I love when I call a Veteran for a scheduled phone appointment and I ask if now is still a good time for the appointment and they say, "Sure, if it's quick." As if they are doing me a favor. What do these people think they signed up for?
 
VintageRed said:
Somewhat similarly - I love when I call a Veteran for a scheduled phone appointment and I ask if now is still a good time for the appointment and they say, "Sure, if it's quick." As if they are doing me a favor. What do these people think they signed up for?
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Free lifetime benefits. Sometimes I think the better question is what is that we think we have signed up for?
 
VintageRed said:
Somewhat similarly - I love when I call a Veteran for a scheduled phone appointment and I ask if now is still a good time for the appointment and they say, "Sure, if it's quick." As if they are doing me a favor. What do these people think they signed up for?
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Or they're out, like, grocery shopping or something. I've even had people answer on speakerphone when they're hanging out with friends.
 
Sanman said:
Now that you mention it, I actually think he looks like Beavis with brown hair.
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Bring It Reaction GIF
 
psy.d. 2021 said:
What is BHIP 2.0.exactly? I asked a PM for information and they ignored me
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Perhaps someone else on the board can provide a more comprehensive answer than I can given my propensity to quickly lose interest in departmental staff meetings. The gist of it seems to be a new initiative invented by someone to free up BHIP capacity. All I picked up on is that there is now a new plan to discharge folks back to Pact providers/PCPs when treatment is complete ( with a handy dandy new note template) and MHTC are going to be phased out in lieu of case managers. I am not directly impacted by and, thus, stopped paying attention.
 
I've heard of it too, so I'm pretty sure it's coming in the future
 
GOD this Sychronous VVC TMS training is annoying. It's 8 modules to teach me something that I already have been doing for years now (okay to be fair I failed the opt out test, but the questions were phrased oddly)
 
cara susanna said:
GOD this Sychronous VVC TMS training is annoying. It's 8 modules to teach me something that I already have been doing for years now (okay to be fair I failed the opt out test, but the questions were phrased oddly)
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I don't think anyone could have even purposefully designed the day-to-day requirements of working as a VA outpatient psychotherapist to be any more inefficient, irritating, and frustrating than they have evolved to be over time.

On the BHIP 'FLOW' initiative, just wait until the 'Psychotherapy Orientation Note' template/requirement for 60 min "intakes" (NOT an intake) comes to your site.

So, folks are getting a consult for outpatient MH psychotherapy sent to BHIP/General MH and--instead of actually doing a psych eval, diff dx, or actual intake--they are copying/pasting an invariant (in structure and content) "Psychotherapy Orientation Note" wall of text to document the 'intake' (which is NOT an intake/eval) and then promptly entering a consult to the PTSD specialty clinic where we have to do the entire general MH intake/eval plus, of course, the whole PTSD intake diff dx, etc.

What will be interesting/hilaruous is when I start sending cases (for whom I've ruled out PTSD) BACK to BHIP/GMH, will they answer that (now) SECOND CONSULT IN A ROW to BHIP/GMH with yet another meaningless empty ('Psychotherapy Orientation Note') or will they actually do an actual psychological intake/evaluatuon and maybe offer treatment? Time will tell. They may try to "FLOW" them back to primary care, lol.
 
WisNeuro said:
I can't see the fake/trolling DOGE group liking spending more on this boondoggle.
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Don't worry, they are busy gutting NASA. Though I hear that they want to design a computerized tax filing program to make that easier. Happy to hear that, though apparently H&R block and Intuit stocks are not doing well.
 
Sanman said:
Don't worry, they are busy gutting NASA. Though I hear that they want to design a computerized tax filing program to make that easier. Happy to hear that, though apparently H&R block and Intuit stocks are not doing well.
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Holy 'conflict of interest' for the head of SpaceX
 
The political TikTok videos have been top tier. I'm enjoying everything before it gets banned.
 
Sanman said:
It's not a conflict of interest when the Republicans do it. In unrelated news, Matt Gaetz recused himself for AG. Let's see what happens with Doug Collins.
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Or Hegseth. The rape allegations are...pretty bad.
 
cara susanna said:
Or Hegseth. The rape allegations are...pretty bad.
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New thing thing is apparently MacMahon covered up a child sex abuse scandal for a WWE employee going back to the 1980s. I am sensing a trend here...
 
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Sanman said:
New thing thing is apparently MacMahon covered a child sex abuse scandal for a WWE employee going back to the 1980s. I am sensing a trend here...
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Yeah, his picks have been ghoulish.
 
Shiori said:
Yeah, his picks have been ghoulish.
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Is anyone else's VA site that is using MH Suite all of a sudden pushing the insanity that we're going to start being required to break down every damned separate component of a manualized protocol (like CPT) into that stupid Problem, Goal, Objective, Intervention (PGOI) format?

A fellow staff member emailed us for input regarding how to do that today (for CPT) and I finally realized exactly why I'm so frustrated by this nonsense. It was cathartic to write out. Shorter and Longer versions below:

Shorter version:

Is writing out specific low-level elements and agenda items of a 12-session CPT protocol into the PGOI format in MH Suite going to alter (in any way) how we IMPLEMENT the protocol or EVALUATE PROGRESS within that protocol?

If the answer is 'yes,' then doesn't that mean that we're experimenting with a novel, untested variant of the CPT protocol and, therefore, aren't doing 'evidence-based therapy' anymore?

If the answer is 'no,' then what could POSSIBLY be the point of the exercise?

Longer version:

Are we really talking about INDIVIDUALIZING/CUSTOMIZING the implementation of the CPT protocol based on breaking down and separately conceptualizing/implementing/monitoring its component parts using a PGOI format (e.g., a new variant of CPT we could call...I dunno... "CPT-PGOI")?

If so, then:

a) where can I find the treatment manual/instructions for doing so? Is there any training available on this? Any book chapters or articles whatsoever to serve as a guide? Maybe even a rationale for doing so? Is this discussed or addressed *anywhere* in the professional literature?

b) what is the nature of the empirical evidence bearing on the efficacy of this CPT-PGOI variant vs. (plain ole) CPT? What does the literature (in general) or the VA/DoD Clinical Practice Guidelines for Management of PTSD have to say about this?

The point I'm trying to make is that...well...the ENTIRE POINT of implementing a manualized protocol is that you implement the manualized protocol rather than breaking it down into its component parts and 'customizing' the implementation of those separate components separately (each of them broken down into a separate objective according to the 'PGOI' nested format). What I have found online (generally, Youtube videos and cutely formatted Powerpoints/.pdf presentations [rather than anything from the professional published literature]) seems to emphasize the PGOI approach as maximizing INDIVIDUALIZATION and CUSTOMIZATION of implementation of specific components of a treatment plan to 'fit' the individual. So, again, is this what we're talking about doing to the CPT protocol as a modification to our standard approach of implementing CPT per the manual? Are we doing CPT-PGOI or just plain ole CPT?

How is 'CPT for PTSD' not a sufficient 'treatment plan?' I mean, 'sertraline for PTSD' is a sufficient 'treatment plan,' right? Or is the medication provider supposed to break down the treatment plan by subcomponents addressing, I dunno, specific pathways in the central nervous system or various neurotransmitter systems, etc.? Why the double-standard here in terms of required level of specificity of a 'mental health treatment plan?'

Edit: To let people know what kind of specificity we're talking about, the colleague who emailed us shared what they'd already written out (objective and intervention) for one of the first subcomponents of CPT ('better identifying feelings and labeling emotions') and, I guess, was asking for input on the "Problem" and "Goal" parts (of that one) and guidance on how to write up th 30+ additional CPT components in the protocol in the PGOI format? Hell, I have no idea at this point. Here's what they sent:
[Problem?] _______
[Goal?] _________

"Objective: I will learn how to better identify feelings and label them. Progress will be measured through PCL-5 and PHQ-9.

Intervention: My provider will work with me to achieve this goal and objective through CPT individual."
 
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Shiori said:
I'm curious which services the veterans would fight hardest to keep. I know they deeply connected to all of the political structures in my state and would lose their collective minds if we started removing things. We can't even get rid of our ancient PTSD groups that are basically social events. Just transitioning them to peer support specialists instead of us felt like an act of congress.

I feel like they would fight for therapy and chiropractic services. Honestly, anything related to pain management will be defended vigorously.
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In a fight between services and service connection money, I think I know the winner.
 
cara susanna said:
I have someone scheduled for intake who did a CSRE earlier this month and apparently I still have to do a CSSRS because it's an intake. How stupid is that?
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This just happened to me recently. I was then told I needed to do another CSRE since the CSSRS was positive (which, duh, because the original CSRE was in the past month). Even though there had been no SI since the initial SI that triggered the first CSRE.
 
cara susanna said:
I have someone scheduled for intake who did a CSRE earlier this month and apparently I still have to do a CSSRS because it's an intake. How stupid is that?
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Just as stupid as:

A) I've had to repeat a C-SSRS a day later one was already done (and negative) by another provider because--if I don't--I may be placed on a supervised practice plan (FPPE) if it were to be discovered that I failed to--per policy--complete a CSSRS on EVERY initial encounter with a new patient (with an exception noted below)--and, yes, I know of this actually happening to people at my facility.

B) Due to--I think-- a Joint Commission survey where they freaked out and criticized us for having a pt who received 2 separate CSSRS' on the same day (separate providers), we have been formally admonished via email, however, NOT to do a 2nd CSSRS if another provider had already done one earlier in the SAME DAY. I recently had a case (intake) this applied to and I made sure to document in the chart that I was intentionally OMITTING doing/documenting the CSSRS due to the policy forbidding us to repeat it on the same day if already done. Of course, I screened the veteran for suicide as standard practice during the intake, I just had to omit entering the CSSRS note.

Just another shining example of the 54itshow that cumulatively results from decades of no leadership.
 
Fan_of_Meehl said:
Just as stupid as:

A) I've had to repeat a C-SSRS a day later one was already done (and negative) by another provider because--if I don't--I may be placed on a supervised practice plan (FPPE) if it were to be discovered that I failed to--per policy--complete a CSSRS on EVERY initial encounter with a new patient (with an exception noted below)--and, yes, I know of this actually happening to people at my facility.

B) Due to--I think-- a Joint Commission survey where they freaked out and criticized us for having a pt who received 2 separate CSSRS' on the same day (separate providers), we have been formally admonished via email, however, NOT to do a 2nd CSSRS if another provider had already done one earlier in the SAME DAY. I recently had a case (intake) this applied to and I made sure to document in the chart that I was intentionally OMITTING doing/documenting the CSSRS due to the policy forbidding us to repeat it on the same day if already done. Of course, I screened the veteran for suicide as standard practice during the intake, I just had to omit entering the CSSRS note.

Just another shining example of the 54itshow that cumulatively results from decades of no leadership.
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Someone better tell Elon about this.
 
cara susanna said:
Or they're out, like, grocery shopping or something. I've even had people answer on speakerphone when they're hanging out with friends.
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I’ve told veterans that I can’t do telehealth with them while they are driving sooo many times!
 
Fan_of_Meehl said:
I mean...we all know about people &*^%-ing around on the clock, &*%$-ing over subordinates, and general (typically metaphorical) &^(%-ery at VA but...this takes the cake, lol:

nypost.com

Sex-crazed workers at troubled VA facility had 12-person orgy — and one official bedded 32 co-workers: bombshell probe

“The fact that the culture would even allow this to happen in the first place is absolutely wild and it all starts at the top,” a congressional aide familiar with the probe said.
nypost.com nypost.com
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I keep hearing about how federal workers are going to be on top of each other if there is a mass RTO. I guess TN got a head start.
 
Fan_of_Meehl said:
I mean...we all know about people &*^%-ing around on the clock, &*%$-ing over subordinates, and general (typically metaphorical) &^(%-ery at VA but...this takes the cake, lol:

nypost.com

Sex-crazed workers at troubled VA facility had 12-person orgy — and one official bedded 32 co-workers: bombshell probe

“The fact that the culture would even allow this to happen in the first place is absolutely wild and it all starts at the top,” a congressional aide familiar with the probe said.
nypost.com nypost.com
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I interviewed there for internship. I thought it was a little weird when the campus tour insisted on stopping by the staff sex dungeon but it makes a lot of sense now.
 
summerbabe said:
I interviewed there for internship. I thought it was a little weird when the campus tour insisted on stopping by the staff sex dungeon but it makes a lot of sense now.
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I wonder if the orgies count as "contact hours"...
 
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