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

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Is ISS replacing VSE? It has been nice being able to see if someone is checked in.
 
Shiori said:
Is ISS replacing VSE? It has been nice being able to see if someone is checked in.
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My understanding was that ISS is replacing GUI...I hope not VSE. Any idea how to see a full week of a provider's schedule (multiple clinics)?
 
coffee&CBT said:
My understanding was that ISS is replacing GUI...I hope not VSE. Any idea how to see a full week of a provider's schedule (multiple clinics)?
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Nope. Apparently, allowing a provider to simply view a straightforward "heads up display"/ GUI of his/her appointments has never been a priority for VA, despite the technology for doing so having been around (and mainstream) since at least Windows 3.11.

Making things easy/efficient for front-line providers isn't exactly a VA organizational strength.
 
psy.d. 2021 said:
thewarhorse.org

‘We Need to Terminate Treatment’: VA Mental Health Providers Say They Are Under Pressure to Limit Care

Veterans Affairs mental health providers say they are being pressured to curtail therapy sessions for veterans. VA says they following evidence-based best practices.
thewarhorse.org thewarhorse.org
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And...here we go again...

'Leadership' says therapy must be evidence-based, time-limited, protocol treatments. Beats all providers on top of their heads for seeing veterans 'long-term.'

Providers enforce leadership directives in this regard. Whether they agree or not. I mean, hey, they're 'Leadership,' they get their way. They have the 'authority,' right?

Veterans raise Holy Hell.

'Leadership' backs off.

Rinse.

Repeat.

Behold. 'Leadership.'
 
I agree that VA has, for years, had a problem with indefinite-duration "therapy" (e.g., patients coming in for years on end for what amounts to one hour a week/month of scheduled social interaction). One of the more common complaints from VA colleagues was always that they de facto weren't allowed to discharge patients. Efforts to limit that make sense. But blanket mandates (that VA then says aren't really mandates), seemingly without any actual input from frontline clinicians, aren't the way to do it.
 
AcronymAllergy said:
I agree that VA has, for years, had a problem with indefinite-duration "therapy" (e.g., patients coming in for years on end for what amounts to one hour a week/month of scheduled social interaction). One of the more common complaints from VA colleagues was always that they de facto weren't allowed to discharge patients. Efforts to limit that make sense. But blanket mandates (that VA then says aren't really mandates), seemingly without any actual input from frontline clinicians, aren't the way to do it.
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I can only speak to my VA but I have not seen anything like what the current or former staff *in the article* have discussed. However, I have seen certain colleges describe it that way because they were used to doing ineffective, never-ending care.

I haven’t had a problem explaining episodes of care and terminating with folks. By and large most folks are thankful to finally have therapy that has a structure and goal behind it. The smaller % of vets who refuse to get on board can go to PRRC for as long as they want (because they never seem to want to say they’re actually getting better…)

Edit to specify referring to the article
 
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AcronymAllergy said:
I agree that VA has, for years, had a problem with indefinite-duration "therapy" (e.g., patients coming in for years on end for what amounts to one hour a week/month of scheduled social interaction). One of the more common complaints from VA colleagues was always that they de facto weren't allowed to discharge patients. Efforts to limit that make sense. But blanket mandates (that VA then says aren't really mandates), seemingly without any actual input from frontline clinicians, aren't the way to do it.
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You want to know what's really interesting. There's absolutely zero reason to need to 'limit care' in the VA when it comes to actual, weekly, active cognitive-behavioral psychotherapy (as, for example, described in Judith Beck's book Cognitive Therapy: Basics and Beyond). It has been my experience that somewhere between 80-90% of veterans who are 'seeking therapy' in this population will (of their own accord) passively drop out (via no-shows and cancellations) if the therapist simply holds to the following basic principles:
(a) refuse to just 'rubber stamp' PTSD self-diagnoses-- for questionable cases, simply insist that veterans begin with a course of weekly therapy that requires cognitive-behavioral self-monitoring (tracking events, thoughts, emotions, behaviors) and go from there
(b) insist on pre-planned and pre-scheduled weekly sessions comprising an actual course of psychotherapy (anywhere between 8 and 20 weekly sessions)
(c) have at least semi-structured sessions (not necessarily manualized protocol treatment sessions) including agenda-setting, staying on focus, between-session assignments (homework), holding veterans accountable, identifying and addressing any lack of engagement or therapy-interfering behaviors
(d) measuring symptoms via checklists and addressing any lack of improvement

Again, if you have 100 veterans 'needing help' and 'begging for therapy' lined up, at the end of 3-6 months, you will be left with only 10-20 veterans still engaged in 'therapy.' If the provider sticks to the above principles, most simply self-select out of therapy because they were not actually there for therapy (self-evaluation and self-change) in the first place. Most are there to document symptoms ('My PTSD has gotten worse') or create 'evidence' of worsening condition for service-connection related claims (either initial s/c, 'upgrade' to PTSD, and/or increase in percentage to 100%, permanent and total, TDIU, caregiver support/ aid and attendance). They are there with a motive that has nothing to do with participating in an active process of taking responsibility for their patterns of thoughts/emotions/behaviors or learning more effective coping skills. However, they are never going to come clean about their true motives. The only way to address it is to just assume that they're there for actual therapy and provide that service (and do not give in to the temptation to just 'give them what they want' to make them go away). The upside is that--regardless if they are truly there for therapy or not--the problem works itself out in time because you are offering everyone active, evidence-based, potentially-effective courses of psychotherapy. The ones that are really there for therapy stay, engage, and improve. The ones who are there for some other reason dropout on their own (passively). Problem solved. But it does take work on the part of the therapist up front and it takes the courage to stop avoiding the 'elephants' in the room.

This is a problem with a very straightforward solution. That has been my experience. The problem is that everyone is stuck in a maladaptive cycle of avoidance, most therapists included.

That and the fact that 'leadership' isn't really leadership. Spitting out mandates (one-size-fits-all) isn't 'leadership.' Leading by example and then teaching others how to properly engage patients in therapy would be true leadership.

There are 'unwritten rules' that are intermittently (but sometimes brutally) enforced in the VA. One of those appears to be 'you never say no to a veteran...especially where PTSD is involved.' This rule has tremendous negative consequences (one of which is the 'access' issue). But nobody will ever admit that it is an actual rule. It isn't written down anywhere (it doesn't have to be), it is simply enacted. People know that if you are the type of provider who tells the truth, refuses to lie, and hold boundaries with veterans you will elicit many complaints and grievances against you. People know that is career (advancement) ending in the VA system. You will get painted as 'not an advocate' for your veterans. True leadership would be making it clear that appropriate professional behavior and boundary setting and holding will be rewarded (not punished) in the system. But that will never happen because politics runs everything (even 'healthcare') at VA.
 
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Fan_of_Meehl said:
You want to know what's really interesting. There's absolutely zero reason to need to 'limit care' in the VA when it comes to actual, weekly, active cognitive-behavioral psychotherapy (as, for example, described in Judith Beck's book Cognitive Therapy: Basics and Beyond). It has been my experience that somewhere between 80-90% of veterans who are 'seeking therapy' in this population will (of their own accord) passively drop out (via no-shows and cancellations) if the therapist simply holds to the following basic principles:
(a) refuse to just 'rubber stamp' PTSD self-diagnoses-- for questionable cases, simply insist that veterans begin with a course of weekly therapy that requires cognitive-behavioral self-monitoring (tracking events, thoughts, emotions, behaviors) and go from there
(b) insist on pre-planned and pre-scheduled weekly sessions comprising an actual course of psychotherapy (anywhere between 8 and 20 weekly sessions)
(c) have at least semi-structured sessions (not necessarily manualized protocol treatment sessions) including agenda-setting, staying on focus, between-session assignments (homework), holding veterans accountable, identifying and addressing any lack of engagement or therapy-interfering behaviors
(d) measuring symptoms via checklists and addressing any lack of improvement

Again, if you have 100 veterans 'needing help' and 'begging for therapy' lined up, at the end of 3-6 months, you will be left with only 10-20 veterans still engaged in 'therapy.' If the provider sticks to the above principles, most simply self-select out of therapy because they were not actually there for therapy (self-evaluation and self-change) in the first place. Most are there to document symptoms ('My PTSD has gotten worse') or create 'evidence' of worsening condition for service-connection related claims (either initial s/c, 'upgrade' to PTSD, and/or increase in percentage to 100%, permanent and total, TDIU, caregiver support/ aid and attendance). They are there with a motive that has nothing to do with participating in an active process of taking responsibility for their patterns of thoughts/emotions/behaviors or learning more effective coping skills. However, they are never going to come clean about their true motives. The only way to address it is to just assume that they're there for actual therapy and provide that service (and do not give in to the temptation to just 'give them what they want' to make them go away). The upside is that--regardless if they are truly there for therapy or not--the problem works itself out in time because you are offering everyone active, evidence-based, potentially-effective courses of psychotherapy. The ones that are really there for therapy stay, engage, and improve. The ones who are there for some other reason dropout on their own (passively). Problem solved. But it does take work on the part of the therapist up front and it takes the courage to stop avoiding the 'elephants' in the room.

This is a problem with a very straightforward solution. That has been my experience. The problem is that everyone is stuck in a maladaptive cycle of avoidance, most therapists included.

That and the fact that 'leadership' isn't really leadership. Spitting out mandates (one-size-fits-all) isn't 'leadership.' Leading by example and then teaching others how to properly engage patients in therapy would be true leadership.

There are 'unwritten rules' that are intermittently (but sometimes brutally) enforced in the VA. One of those appears to be 'you never say no to a veteran...especially where PTSD is involved.' This rule has tremendous negative consequences (one of which is the 'access' issue). But nobody will ever admit that it is an actual rule. It isn't written down anywhere (it doesn't have to be), it is simply enacted. People know that if you are the type of provider who tells the truth, refuses to lie, and hold boundaries with veterans you will elicit many complaints and grievances against you. People know that is career (advancement) ending in the VA system. You will get painted as 'not an advocate' for your veterans. True leadership would be making it clear that appropriate professional behavior and boundary setting and holding will be rewarded (not punished) in the system. But that will never happen because politics runs everything (even 'healthcare') at VA.
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The other half of this is that it is not "veterans" but a self-selecting group of veterans. The way priority groups work at the VA means that those not after a service connection that are functioning in some way and holding down a job are often never seen at rhe VA in the first place.
 
I'm sorry, but if someone is in therapy for ten years it is past time to revisit the treatment plan and determine if 1) therapy is still needed and 2) if it is, what might be a more appropriate and effective option?

I don't get why unlimited therapy is viewed as an entitlement. It's a healthcare service. Do you expect to do physical therapy for ten years? And the active episodes of care model postulates that you can reengage whenever you need to for a new episode of care. What is the difference between having a prescheduled appt every 2-3 months or calling your therapist to schedule an appt when you need one? Especially when most, if not all VAs, offer same day mental health access. In the private sector, you don't get unlimited therapy either.

It's mathematically impossible to expect us to keep taking on new patients and not ever discharge anyone or place any boundaries around care.

(That being said, this needs to be a clinical decision and not some predetermined metric coming from administration)
 
Sanman said:
The other half of this is that it is not "veterans" but a self-selecting group of veterans. The way priority groups work at the VA means that those not after a service connection that are functioning in some way and holding down a job are often never seen at rhe VA in the first place.
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Very true and very good point.
 
cara susanna said:
I'm sorry, but if someone is in therapy for ten years it is past time to revisit the treatment plan and determine if 1) therapy is still needed and 2) if it is, what might be a more appropriate and effective option?

I don't get why unlimited therapy is viewed as an entitlement. It's a healthcare service. Do you expect to do physical therapy for ten years? And the active episodes of care model postulates that you can reengage whenever you need to for a new episode of care. What is the difference between having a prescheduled appt every 2-3 months or calling your therapist to schedule an appt when you need one? Especially when most, if not all VAs, offer same day mental health access. In the private sector, you don't get unlimited therapy either.

It's mathematically impossible to expect us to keep taking on new patients and not ever discharge anyone or place any boundaries around care.

(That being said, this needs to be a clinical decision and not some predetermined metric coming from administration)
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Yes, some of them do. If they experience pain, they expect they should have physical therapy. When they get turned away, they usually get another consult for a chiropractor.

I think the BHIP model has a recommendation to re-evaluate a veteran seen 20 sessions or more. I know some therapists bristle at the additional oversight, but I think it would be nice to have a team of people on the same page that a veteran has probably received maximum benefit from therapy. I will "discharge" a patient I have taught all the appropriate skills to, but psychiatry or the PCP will send them back because they're still unhappy with parts of their life or stressed out. I would never leave therapy either if the baseline expectation is they're chronically happy. I'm a doctor, not a magician.
 
cara susanna said:
I'm sorry, but if someone is in therapy for ten years it is past time to revisit the treatment plan and determine if 1) therapy is still needed and 2) if it is, what might be a more appropriate and effective option?

I don't get why unlimited therapy is viewed as an entitlement. It's a healthcare service. Do you expect to do physical therapy for ten years? And the active episodes of care model postulates that you can reengage whenever you need to for a new episode of care. What is the difference between having a prescheduled appt every 2-3 months or calling your therapist to schedule an appt when you need one? Especially when most, if not all VAs, offer same day mental health access. In the private sector, you don't get unlimited therapy either.

It's mathematically impossible to expect us to keep taking on new patients and not ever discharge anyone or place any boundaries around care.

(That being said, this needs to be a clinical decision and not some predetermined metric coming from administration)
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This is what I was going to say in a Devil's advocate sort of way. If a person is stable, then do they need to be seeing a psychologist indefinitely on a once-monthly basis when a different level/type of care may be more appropriate, thereby allowing the psychologist to possibly see other (higher acuity?) patients? Maybe they do, but it seems like a fair question.
 
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cara susanna said:
I'm sorry, but if someone is in therapy for ten years it is past time to revisit the treatment plan and determine if 1) therapy is still needed and 2) if it is, what might be a more appropriate and effective option?

I don't get why unlimited therapy is viewed as an entitlement. It's a healthcare service. Do you expect to do physical therapy for ten years? And the active episodes of care model postulates that you can reengage whenever you need to for a new episode of care. What is the difference between having a prescheduled appt every 2-3 months or calling your therapist to schedule an appt when you need one? Especially when most, if not all VAs, offer same day mental health access. In the private sector, you don't get unlimited therapy either.

It's mathematically impossible to expect us to keep taking on new patients and not ever discharge anyone or place any boundaries around care.

(That being said, this needs to be a clinical decision and not some predetermined metric coming from administration)
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Agree 100%. With the caveat (that I believe you would agree with, as well) that this should be up to the (responsible) clinician and that there may be some valid courses of therapy beyond, say 12-16 weeks (comorbid disorders, personality disorders). As long as we have (1) weekly sessions, (2) an active treatment approach based on empirical literature and case formulation, (3) specific goals/ skills building/ homework, and (4) accountability by objectively documenting progress, or lack thereof in the record, then therapy can continue.
 
Shiori said:
Yes, some of them do. If they experience pain, they expect they should have physical therapy. When they get turned away, they usually get another consult for a chiropractor.

I think the BHIP model has a recommendation to re-evaluate a veteran seen 20 sessions or more. I know some therapists bristle at the additional oversight, but I think it would be nice to have a team of people on the same page that a veteran has probably received maximum benefit from therapy. I will "discharge" a patient I have taught all the appropriate skills to, but psychiatry or the PCP will send them back because they're still unhappy with parts of their life or stressed out. I would never leave therapy either if the baseline expectation is they're chronically happy. I'm a doctor, not a magician.
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Ten consecutive years, though?

In our clinic we discuss episode of care length with the pt at their first appt, and then reevaluate at that point. It doesn't mean therapy can't continue, it just means that we check in and see how things are going.

Don't get me wrong, the VA is understaffed and that's a major issue that needs fixing, but that's a separate issue from the active episodes of care model.
 
AcronymAllergy said:
This is what I was going to say in a Devil's advocate sort of way. If a person is stable, then do they need to be seeing a psychologist indefinitely on a once-monthly basis when a different level/type of care may be more appropriate, thereby allowing the psychologist to possibly see other (higher acuity?) patients?
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Right, and if they're so unstable that they need weekly therapy to stay alive, they probably need a different therapeutic intervention.
 
AcronymAllergy said:
This is what I was going to say in a Devil's advocate sort of way. If a person is stable, then do they need to be seeing a psychologist indefinitely on a once-monthly basis when a different level/type of care may be more appropriate, thereby allowing the psychologist to possibly see other (higher acuity?) patients?
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For the life of me, I don't understand why we cannot just administratively abolish the once/month therapy session practice model. There is NO school/approach to therapy that endorses this as an evidence-based manner of implementing psychotherapy. They outlaw everything else by administrative decree. This is something that SHOULD be outlawed.
 
AcronymAllergy said:
I agree that VA has, for years, had a problem with indefinite-duration "therapy" (e.g., patients coming in for years on end for what amounts to one hour a week/month of scheduled social interaction). One of the more common complaints from VA colleagues was always that they de facto weren't allowed to discharge patients. Efforts to limit that make sense. But blanket mandates (that VA then says aren't really mandates), seemingly without any actual input from frontline clinicians, aren't the way to do it.
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Right. And neither are directives that lead to clinicians getting thrown underneath a massive bus when there's any sort of Veteran pushback. Your local manager will have you believe they'll support you but it's laid out clearly here national VA will say you're a bad egg
 
Fan_of_Meehl said:
For the life of me, I don't understand why we cannot just administratively abolish the once/month therapy session practice model. There is NO school/approach to therapy that endorses this as an evidence-based manner of implementing psychotherapy. They outlaw everything else by administrative decree. This is something that SHOULD be outlawed.
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We actually have had some therapists in our clinic start saying that we don't schedule 3 month f/u appts for therapy. I've had a few patients I've gotten off my schedule that way. They weren't benefitting from therapy anymore but they kept wanting to see me. I got them to agree to just call if they need me.

A lot of patients are terrified that if therapy ends, they will get worse and be stuck on their own, so part of the process is helping them gain more confidence about trying things on their own, and also what they can do, and how they will know, when it's time to come back for care. For patients with PTSD, I also like to point out the research showing that PCL-5 scores continue to drop even after weekly EBP is completed.
 
psy.d. 2021 said:
Right. And neither are directives that lead to clinicians getting thrown underneath a massive bus when there's any sort of Veteran pushback. Your local manager will have you believe they'll support you but it's laid out clearly here national VA will say you're a bad egg
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I would say that's facility dependent. My local leadership is VERY supportive of setting boundaries around care. The caveat is that you have to offer some option, but those options don't have to include "be seen once a month in perpetuity"
 
cara susanna said:
Ten consecutive years, though?

In our clinic we discuss episode of care length with the pt at their first appt, and then reevaluate at that point. It doesn't mean therapy can't continue, it just means that we check in and see how things are going.

Don't get me wrong, the VA is understaffed and that's a major issue that needs fixing, but that's a separate issue from the active episodes of care model.
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I had a veteran complain just last week that they "keep taking away my PT." Taking it away means they're just done with an episode of care. They want PT for the duration of their pain symptoms...which will likely be forever. I thought they were going to riot when we started limiting the amount of chiropractic appointments people could have.
 
Shiori said:
I had a veteran complain just last week that they "keep taking away my PT." Taking it away means they're just done with an episode of care. They want PT for the duration of their pain symptoms...which will likely be forever. I thought they were going to riot when we started limiting the amount of chiropractic appointments people could have.
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People generally get more upset when you take away their placebos than when you take away their actual medicine.
 
Shiori said:
I had a veteran complain just last week that they "keep taking away my PT." Taking it away means they're just done with an episode of care. They want PT for the duration of their pain symptoms...which will likely be forever. I thought they were going to riot when we started limiting the amount of chiropractic appointments people could have.
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Oh wow, I haven't run into that fortunately. I wonder though what the public reaction would be if that person was featured in an article. Would it be "wow, the VA really sucks for that" or would it be "why does this person need PT for ten years?"

I just think that mental healthcare is viewed so differently compared to non-mental healthcare. In fact, there's a document floating around in MH national that uses medical analogies to show how absurd some of the expectations people have for us are. Some examples:

–“Mr. Edwards completed chemotherapy and his cancer is in remission, but he really likes the oncology team and wants to keep seeing them. Can they keep scheduling him for visits?”
–“Ms. Jefferson has a diagnosis of lung cancer, but refused radiation and chemotherapy. She requested an oral antibiotic instead. Can you prescribe that?”
–“Mr. Washington is refusing surgery and physical therapy for his shoulder. But he has a shoulder problem, so ortho should keep seeing him even though he doesn’t want to engage in the treatment that they do.”
–“We need to increase access. If we knock it down to one dialysis session a week instead of three, we could manage triple the Veterans. Can you make that happen?”
 
cara susanna said:
Oh wow, I haven't run into that fortunately. I wonder though what the public reaction would be if that person was featured in an article. Would it be "wow, the VA really sucks for that" or would it be "why does this person need PT for ten years?"

I just think that mental healthcare is viewed so differently compared to non-mental healthcare. In fact, there's a document floating around in MH national that uses medical analogies to show how absurd some of the expectations people have for us are. Some examples:

–“Mr. Edwards completed chemotherapy and his cancer is in remission, but he really likes the oncology team and wants to keep seeing them. Can they keep scheduling him for visits?”
–“Ms. Jefferson has a diagnosis of lung cancer, but refused radiation and chemotherapy. She requested an oral antibiotic instead. Can you prescribe that?”
–“Mr. Washington is refusing surgery and physical therapy for his shoulder. But he has a shoulder problem, so ortho should keep seeing him even though he doesn’t want to engage in the treatment that they do.”
–“We need to increase access. If we knock it down to one dialysis session a week instead of three, we could manage triple the Veterans. Can you make that happen?”
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It's a wild situation. Pain is another domain where I think people get really activated by limitations. I feel like a substantial number of our codes happen due to pain management disagreements (stimulants and sleep aids follow closely behind). I would be curious how many of our congressional complaints are pain related.
 
Shiori said:
It's a wild situation. Pain is another domain where I think people get really activated by limitations. I feel like a substantial number of our codes happen due to pain management disagreements (stimulants and sleep aids follow closely behind). I would be curious how many of our congressional complaints are pain related.
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We created a big part of that situation.

"Have all the opioids you want"

"Wait, stop taking so many opioids"
 
It seems like we did the same with therapy. Forever therapy vs dose of care is upsetting in a system that rewards maladaptive behaviors.

I think the next battle should be the ancient "supportive therapy" groups where it's really just socializing, but they refuse to meet without a facilitator because it suggests they actually kind of like each other.
 
Shiori said:
It seems like we did the same with therapy. Forever therapy vs dose of care is upsetting in a system that rewards maladaptive behaviors.

I think the next battle should be the ancient "supportive therapy" groups where it's really just socializing, but they refuse to meet without a facilitator because it suggests they actually kind of like each other.
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They also don't get travel pay. That's a big issue that needs more inclusion in these types of discussions, imo
 
cara susanna said:
They also don't get travel pay. That's a big issue that needs more inclusion in these types of discussions, imo
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You mean money is a potent and universal / generalized reinforcer and behavior is a function of its consequences?

Who knew?

Certainly not people with doctoral degrees in psychology.

Could this apply to any other scenarios in VA mental health care? Would it be 'non-veteran-centric' to think so?
 
Fan_of_Meehl said:
You mean money is a potent and universal / generalized reinforcer and behavior is a function of its consequences?

Who knew?

Certainly not people with doctoral degrees in psychology.

Could this apply to any other scenarios in VA mental health care? Would it be 'non-veteran-centric' to think so?
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At the end of the day, I am not sure which is worse, the overly generous inclusion of mental health symptoms and services for veterans or the systemic minimization and lack of proper services for the general public?

While you can't win either way, work is work. Better demand be too high than having to spend time justifying why spending the least money possible on MH care is a bad idea, like in the other thread.
 
Sanman said:
At the end of the day, I am not sure which is worse, the overly generous inclusion of mental health symptoms and services for veterans or the systemic minimization and lack of proper services for the general public?

While you can't win either way, work is work. Better demand be too high than having to spend time justifying why spending the least money possible on MH care is a bad idea, like in the other thread.
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I think it's a complex and debatable topic of whether the current mental health disability system does more good than harm (in the long term) in its present form. I think everyone wants to help veterans (or anyone) struggling with MH issues. A reasonable debate could be had regarding how to best accomplish that task of "helping" and what that means (to 'help'). I think it would also be interesting (though potentially problematic) to implement the rough equivalent of the VA disability system in society-at-large (without serious reform or improvement in the quality of the disability examination process, for example). If SSDI paid 4-5k / month for a mental health diagnosis/disability... what would be the impact on workforce participation rates? I would imagine we'd be in big trouble.
 
Can't we explore that by looking at countries that have implemented universal basic income?

I think that there's a huge difference between that and paying someone to essentially be sick. If the money isn't tied to the diagnosis, people might be more willing to try working or at least doing thing that they find meaningful.
 
cara susanna said:
Can't we explore that by looking at countries that have implemented universal basic income?

I think that there's a huge difference between that and paying someone to essentially be sick. If the money isn't tied to the diagnosis, people might be more willing to try working or at least doing thing that they find meaningful.
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No country really does UBI, best we have is limited cash transfers or regional experiments. At least as far as widespread cash transfer/income, Iran may come the closest, and last I knew, there was no effect of the cash transfers on employment rate, which went against the opponents who believed that a lot of people would drop out of the workforce. some African countries have tried limited versions, and they essentially found increased graduation rates and sharply increased rates of people opening businesses.
 
cara susanna said:
They also don't get travel pay. That's a big issue that needs more inclusion in these types of discussions, imo
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I did a year at a rural VA and the travel pay was ESSENTIAL for most of the veterans bc they got paid to “come to the city”. I covered my mentor’s group for a bit and like 70% would go out to lunch afterwards. It was a therapy group, but it basically was an excuse for them to get their travel covered for their weekly lunch meetups.
 
Therapist4Chnge said:
I did a year at a rural VA and the travel pay was ESSENTIAL for most of the veterans bc they got paid to “come to the city”. I covered my mentor’s group for a bit and like 70% would go out to lunch afterwards. It was a therapy group, but it basically was an excuse for them to get their travel covered for their weekly lunch meetups.
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Yup, I have patients who can't afford to go anywhere except on days they have VA appts and get travel pay. It's a huge barrier to setting limits to care.
 
Shiori said:
I am running on fumes, but celebrating my wins. I have gotten a stream of straight-forward EBP cases where the patients seem engaged in motivated. It's been nice.
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I'm sorry, you must be trolling. Multiple patients in the VA who are engaged, motivated and getting better? I call BS
 
Shiori said:
I am running on fumes, but celebrating my wins. I have gotten a stream of straight-forward EBP cases where the patients seem engaged and motivated. It's been nice.
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I have some wonderful ongoing EBP cases too. They really keep me going! I totally understand why research shows that more EBP usage is associated with lower burnout.
 
cara susanna said:
I have some wonderful ongoing EBP cases too. They really keep me going! I totally understand why research shows that more EBP usage is associated with lower burnout.
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In my experience, the Veterans that are good fits for and follow-through with EBPs are also lower acuity/less complex/have fewer psychosocial stressors
 
coffee&CBT said:
In my experience, the Veterans that are good fits for and follow-through with EBPs are also lower acuity/less complex/have fewer psychosocial stressors
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I actually have quite a few complex patients who've benefitted or are benefitting from EBPs
 
cara susanna said:
I actually have quite a few complex patients who've benefitted or are benefitting from EBPs
Click to expand...

Second this. I still did therapy for PTSD as a neuropsych when I was in the VA and this was my experience as well. I hate the self-serving myth that CE/CPT are only for easy cases that the snakeoil people peddle.
 
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