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

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summerbabe said:
I think you're getting the run around because nobody really knows what we can do/can't do and who needs to sign off on these types of moves.

Our VISN has issued guidance to freeze all org charts until further RIF details are confirmed, which I would assume would cover conversion of an NTE into an FTE. And the VISN network director is apparently personally signing off on any hires that are moving forward.

Hopefully there is more clarity and guidance for you shortly.
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Thanks. I have been told the network director has signed it, and then I have been told they are waiting for him to sign it a week later. I am not going to loose sleep over it anymore. I enjoy working for my veterans. If the administration doesn't want us to help them directly as an employee, I will go into private practice and still work with them.
 
SunshinePsych said:
Thanks. I have been told the network director has signed it, and then I have been told they are waiting for him to sign it a week later. I am not going to loose sleep over it anymore. I enjoy working for my veterans. If the administration doesn't want us to help them directly as an employee, I will go into private practice and still work with them.
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For hire, I could go into private practice and diagnose PTSD/ADHD and 'service dog + cannabis deficit disorder' until the cows come home and make bank.

If the Jedi fire me, the Sith are hiring (and they pay better).
 
What’s the latest folks are hearing about RTO for psychologists? Our most recent info was RTO on 4/14. But now I’m hearing from colleagues at other sites RTO is “on hold” while waiting to hear back about a possible exemption.
 
ac23 said:
What’s the latest folks are hearing about RTO for psychologists? Our most recent info was RTO on 4/14. But now I’m hearing from colleagues at other sites RTO is “on hold” while waiting to hear back about a possible exemption.
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I just got my telework termination agreement to sign a few minutes ago for 4/13.
 
ac23 said:
What’s the latest folks are hearing about RTO for psychologists? Our most recent info was RTO on 4/14. But now I’m hearing from colleagues at other sites RTO is “on hold” while waiting to hear back about a possible exemption.
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4/14 is my new RTO date, too. I’ve read that exemptions are being considered for fully telemental health clinics (and not for hybrid telework psychologists, for example). Have you heard differently?
 
Psychologist1234 said:
4/14 is my new RTO date, too. I’ve read that exemptions are being considered for fully telemental health clinics (and not for hybrid telework psychologists, for example). Have you heard differently?
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I’m not sure about the specifics of the exemption application. But I have heard over the last couple days from both fully remote and hybrid psychologists that RTO is “on hold.”
 
Psychologist1234 said:
4/14 is my new RTO date, too. I’ve read that exemptions are being considered for fully telemental health clinics (and not for hybrid telework psychologists, for example). Have you heard differently?
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I believe 4/14 is the national date for non-remote employees within 50 miles of your assigned facility.
 
ac23 said:
I’m not sure about the specifics of the exemption application. But I have heard over the last couple days from both fully remote and hybrid psychologists that RTO is “on hold.”
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That’s encouraging news. Maybe there’s some hope for the rest of us.
 
I get that PCPs are busy but if you're gonna place a consult on behalf of a RFS, can you at least wait until the RFS and associated note have been scanned into the chart?
 
cara susanna said:
Irrationally angry about this, but they changed our local testing consult titles to "Neuropsychol Testing." First off, not all testing is neuropsych. Second, we don't DO neuropsych testing.
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I love that all the results from the symptom self-report instruments that MHA spits out to CPRS in the form of a chart note is entitled, "MENTAL HEALTH DIAGNOSTIC STUDY NOTE."

LOL.

A phq-9, gad-7, or pcl-5 is a 'diagnostic study.' The note itself even includes automatic text saying the pcl shouldn't be ised in isolation for purposes of diagnosing PTSD.

Edit: apparently the 'cool kids' are referring to sx self-report questionnaires as 'PROMs' these days. Patient Reported Outcome Measures. I guess the phrase, "EBP protocol cheerleaders waving their PROM-PROMs around" has a nice ring to it.
 
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R. Matey said:
I'm fairly certain that most, if not all, policy decisions in the Trump Administration are made via a jump to conclusions mat.
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Unfortunately, I think it's much more insidious than that. The useful idiots in media facing roles, like the Hegseths, are pretty much there to just be their *****ic selves and distract from the people behind the scenes enacting what they want without much attention.
 
Fan_of_Meehl said:
Why did I just have a flashback to the (excellent) movie Office Space?
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frustrated office space GIF
 
psy.d. 2021 said:
God forbid you send a phq9 to a veteran with a history of SI for years. All hell breaks loose
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"I have FIVE different bosses, Bob...FIVE!!! And those five bosses have...FIVE BOSSES! If I have one veteran click a '1' on PHQ-9 Item #9...I have to answer for it 25 times that shift...and let me tell you a little something about clinical reminders..."
 
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I need some quick feedback/opinions on something that I've run into in my VA clinic. So, I do not generally phone veterans (who present to mental health contexts for assessment/treatment) at their work numbers when we have their cell numbers. I was trained to be careful in that regard due to patient privilege/confidentiality with respect to mental health treatment.

For example, if I reach out to a patient via cell phone and get their voicemail I will leave a 'HIPAA-compliant' voicemail, e.g., 'This is Dr. X calling you from the VA regarding an appointment, please give us a call back at YYY-YYY-YYYY when you are able.'
Obviously, if it is a situation involving imminent risk of physical harm to self/others (under HIPAA), I would consider calling all numbers I have on record for the veteran (including home/work/emergency contact, etc.). But for ROUTINE (non-emergency) reach out attempts to schedule/reschedule MH appointments, my default is to call the cell number and leave a 'HIPAA-compliant' voicemail message.

Unfortunately, we have activist MSA/clerk staff members who have their own opinions on such matters and are making things complicated/messy. Say, hypothetically, we have an MSA staff member (veteran who also happens to work at the very VA hospital where I work) present to the MH clinic as a walk-in requesting (non-emergent, non-suicidal/homicidal) access to mental health services). We are alerted that they need to be seen as a walk-in. Maybe it takes 5-10 mins to coordinate who is going to see them. Then, they simply walk off and go back to their workstation (at the same VA hospital) because they're tired of waiting around for 5-10 minutes before being seen.

A clinician (who volunteered to see them as a walk-in) then calls their cell phone, gets voicemail, and leaves a message to call the clinic back. The ball is in their court at that point.

However, what if you have MSA's texting you 'This is Mr. X's work extension.' Implying that you're supposed to call them at their work extension (where they work as an MSA next to other MSA's (each with a phone/computer setup) in a public area. I'm concerned about reaching out directly to them in such a public area and initiating a conversation about sensitive mental health issues (presenting as a walk-in to the hospital's mental health clinic) and entering into such a discussion in a relatively 'public' area/setting. I mean, if that veteran worked at a local private (non-VA) hospital, I wouldn't be calling them at work trying to have such a discussion (or if they worked in a random office setting). I cannot even view the 'Employee Health' notes in CPRS on patients who I am currently treating for MH issues. If the organization takes patient/veteran confidentiality that seriously, then I have concerns about randomly phoning up veteran staff at their work station regarding mental health issues.

Just wondering if others had run into this and what their thoughts were on it at VA.
 
Fan_of_Meehl said:
I need some quick feedback/opinions on something that I've run into in my VA clinic. So, I do not generally phone veterans (who present to mental health contexts for assessment/treatment) at their work numbers when we have their cell numbers. I was trained to be careful in that regard due to patient privilege/confidentiality with respect to mental health treatment.

For example, if I reach out to a patient via cell phone and get their voicemail I will leave a 'HIPAA-compliant' voicemail, e.g., 'This is Dr. X calling you from the VA regarding an appointment, please give us a call back at YYY-YYY-YYYY when you are able.'
Obviously, if it is a situation involving imminent risk of physical harm to self/others (under HIPAA), I would consider calling all numbers I have on record for the veteran (including home/work/emergency contact, etc.). But for ROUTINE (non-emergency) reach out attempts to schedule/reschedule MH appointments, my default is to call the cell number and leave a 'HIPAA-compliant' voicemail message.

Unfortunately, we have activist MSA/clerk staff members who have their own opinions on such matters and are making things complicated/messy. Say, hypothetically, we have an MSA staff member (veteran who also happens to work at the very VA hospital where I work) present to the MH clinic as a walk-in requesting (non-emergent, non-suicidal/homicidal) access to mental health services). We are alerted that they need to be seen as a walk-in. Maybe it takes 5-10 mins to coordinate who is going to see them. Then, they simply walk off and go back to their workstation (at the same VA hospital) because they're tired of waiting around for 5-10 minutes before being seen.

A clinician (who volunteered to see them as a walk-in) then calls their cell phone, gets voicemail, and leaves a message to call the clinic back. The ball is in their court at that point.

However, what if you have MSA's texting you 'This is Mr. X's work extension.' Implying that you're supposed to call them at their work extension (where they work as an MSA next to other MSA's (each with a phone/computer setup) in a public area. I'm concerned about reaching out directly to them in such a public area and initiating a conversation about sensitive mental health issues (presenting as a walk-in to the hospital's mental health clinic) and entering into such a discussion in a relatively 'public' area/setting. I mean, if that veteran worked at a local private (non-VA) hospital, I wouldn't be calling them at work trying to have such a discussion (or if they worked in a random office setting). I cannot even view the 'Employee Health' notes in CPRS on patients who I am currently treating for MH issues. If the organization takes patient/veteran confidentiality that seriously, then I have concerns about randomly phoning up veteran staff at their work station regarding mental health issues.

Just wondering if others had run into this and what their thoughts were on it at VA.
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I have not run into it, but I concur. A call to their cell is enough.
 
psy.d. 2021 said:
Yeah I do not ever call numbers listed under "work" in CPRS. I stick with cell/home. If this veteran in this scenario got upset I didn't call their work number I would explain my concerns about privacy and the way I generally operate so they can look for cell calls in the future.
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Thank you both psy.d. 2021 and Sanman. This is why I find this group (anonymous VA clinicians) indispensable. I reached out to local 'leadership/supervisory' personnel and got a response that I 'could call them back at their workstation number.' I replied with my HIPAA/confidentiality-related concerns. Their reply was that I could do 'what I was comfortable with.' My reply was, 'thank you.'
 
Fan_of_Meehl said:
Thank you both psy.d. 2021 and Sanman. This is why I find this group (anonymous VA clinicians) indispensable. I reached out to local 'leadership/supervisory' personnel and got a response that I 'could call them back at their workstation number.' I replied with my HIPAA/confidentiality-related concerns. Their reply was that I could do 'what I was comfortable with.' My reply was, 'thank you.'
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You can also split the difference and ask the MSA to call to let the vet know they can come back to be seen

I feel like it is more important to not call VA employees at their work numbers than it is for other vets because it helps to maintain boundaries and a more normal therapeutic relationship in much the same way one doesn't permit messaging over teams (stick to MHV)
 
I have heard from several remote psychology colleagues from a range of visns and programs that they were informed by their supervisors that they were "exempt" from RTO currently. No one seemed to know if that was forever or just a delay. My facility has not given any feedback though.
 
Sydney Huffman said:
I have heard from several remote psychology colleagues from a range of visns and programs that they were informed by their supervisors that they were "exempt" from RTO currently. No one seemed to know if that was forever or just a delay. My facility has not given any feedback though.
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From my understanding the RTO is being phased in many places. 4/14 for us is the date for anyone on Telework and I believe there was a VACO memo somewhere that had that deadline.

From what I have read, remote within 50 miles has a deadline of 5/4. Remote outside of 50 miles, 7/28. Also from VACO.
 
Sanman said:
From my understanding the RTO is being phased in many places. 4/14 for us is the date for anyone on Telework and I believe there was a VACO memo somewhere that had that deadline.

From what I have read, remote within 50 miles has a deadline of 5/4. Remote outside of 50 miles, 7/28. Also from VACO.
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Right but these folks are saying that they have been given guidance that they will not be required to RTO at all. Again, not clear if it is permanent or an extension. But the feedback was pretty clear that those dates do not apply. E.g. they work remotely for a site over 50 miles away, live within 50 miles of another vamc, and were told they are exempt.

The other rumor is that there is a list of exempted positions from RTO. Maybe these supes jumped the gun.
 
Sydney Huffman said:
Right but these folks are saying that they have been given guidance that they will not be required to RTO at all. Again, not clear if it is permanent or an extension. But the feedback was pretty clear that those dates do not apply. E.g. they work remotely for a site over 50 miles away, live within 50 miles of another vamc, and were told they are exempt.

The other rumor is that there is a list of exempted positions from RTO. Maybe these supes jumped the gun.
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Well, that is surprising.
 
Sydney Huffman said:
I have heard from several remote psychology colleagues from a range of visns and programs that they were informed by their supervisors that they were "exempt" from RTO currently. No one seemed to know if that was forever or just a delay. My facility has not given any feedback though.
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I've heard things like this as well, and what the criteria is for those who are exempt seems to vary based on VISN, from what I've heard from colleagues at different VAs. AND it's possible (probable even) this will keep changing, so it's probably not worth getting excited about yet.
 
Apparently this neuropsychol(ogy) consult title is for all psych assessment and there's nothing we can do about it, since it's nationally mandated for standardization... so I guess I'm a neuropsychologist now!

Again, my anger about this is probably not fitting the facts in terms of intensity but ARGH people already think all psych testing is neuropsych and this is NOT gonna help matters.
 
Sanman said:
From my understanding the RTO is being phased in many places. 4/14 for us is the date for anyone on Telework and I believe there was a VACO memo somewhere that had that deadline.

From what I have read, remote within 50 miles has a deadline of 5/4. Remote outside of 50 miles, 7/28. Also from VACO.
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Yea, mine was phased early and got moved up a few weeks ugh
 
cara susanna said:
Apparently this neuropsychol(ogy) consult title is for all psych assessment and there's nothing we can do about it, since it's nationally mandated for standardization... so I guess I'm a neuropsychologist now!

Again, my anger about this is probably not fitting the facts in terms of intensity but ARGH people already think all psych testing is neuropsych and this is NOT gonna help matters.
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Just when I thought the organization couldn't get any stupider...lol

Since I've been at VA, my clinic names have been changed about 67 times and you know how many times they asked for my input (as the provider). You guessed it...0.

The most egregious example is how I found out that my VVC clinic had been renamed to something else. I'm looking at future appointments for one of my patients and I see a clinic name I don't recognize (but close to already existing ones)...I reach out for clarification and they pull me in and say...'oh yeah...about that...about a month ago we had to rename your VVC clinic to X for Y reasons.'

Anyone ever think to inform ME that my clinic had changed names??? Nah. Not at the VA where providers come last.

The program manager knew. The clerks knew. Hell, even the janitor who never enters my office probably knew.

But nobody thought to tell me.
 
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