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Home / Which Va Center Is Responsible for Initial Screening

Which Va Center Is Responsible for Initial Screening

The Veterans Health Administration (VHA), which manages the integrated health care system of the Department of Veterans Affairs (VA), provides eligible veterans, including U.S. veterans of the Iraq and Afghanistan wars, with a comprehensive assortment of mental health care services in outpatient, inpatient, and residential settings. After enrolling to receive VHA health intendance, eligible veterans can access these services in several ways. They may walk into a VHA facility and request mental health services. If they are already being seen in principal care, they may receive their mental health services within the main intendance setting, if needed, or exist referred to specialty intendance. Vet Centers provide a tertiary pathway into mental wellness care. Veterans can walk into a Vet Center on their own with or without a referral. Once more, should more specialized or acute services be required, Vet Centers can make the appropriate referral to mental health specialty care or primary care. Finally, veterans may enter the VHA health care arrangement via emergency service departments, either at VHA facilities or at civilian hospitals; those seen in civilian emergency service departments may exist subsequently referred to VHA health care.

Figure three-1 depicts an algorithm by which veterans are triaged within the mental health system. For illustrative purposes, the figure reflects a i-way procedure for the initial placement of a veteran. Notwithstanding, once veterans are receiving mental wellness care, they move within and between service levels in whatsoever direction as need dictates.

FIGURE 3-1. Algorithm to determine appropriate placement of veterans within the system of mental health care at the Department of Veterans Affairs.

Effigy three-1

Algorithm to determine advisable placement of veterans within the system of mental health intendance at the Department of Veterans Affairs. Meet the side by side section of this chapter for a description of the programs and services depicted in this figure. Notation: (more...)

Although Figure 3-one illustrates how veterans are moved through VHA mental health care, it does not reflect the way mental health intendance services are integrated with the rest of the VHA wellness care arrangement. Veterans have complete access to medical specialty services as needed. Similarly, veterans receiving medical care can exist referred at whatsoever fourth dimension to mental wellness intendance if the need arises. To support this fully integrated system of care, the VHA has an integrated electronic medical record documenting all care that is provided, with all providers within the system given complete admission to all records, including mental health care records. Given that a large percent of veterans treated by the VHA have comorbid medical and mental health diagnoses, it would announced to make skillful sense to provide veterans with a fully integrated medical and mental wellness system of intendance.

In addition to the mental health intendance services depicted in Figure iii-1, the following teams, specialists, and programs are bachelor to back up all inpatient, outpatient, and residential programs:

  • Posttraumatic stress disorder (PTSD) clinical teams and PTSD specialists,

  • Substance utilize and PTSD dual diagnosis teams,

  • Women'south stress disorder treatment teams,

  • Services for returning veterans—mental health teams,

  • Health Care for Re-Entry Veterans, and

  • Vocational rehabilitation programs.

Also, several programs take been created that specifically target the homeless veteran population: Department of Housing and Urban Development—VA Supportive Housing (HUD-VASH), Health Treat Homeless Veterans, Grant and Per Diem program, and Homeless Veterans Supported Employment Program.

This chapter is intended to be solely descriptive and to illustrate the breadth of programs and services offered past the VA. Evaluating all of the individual programs and services described below is beyond the scope of piece of work. The side by side department of this chapter defines VHA mental health programs and services without making any statements regarding quality and service gaps; those topics volition be addressed in later chapters. That section is followed by another department covering major VA mental health evaluation, inquiry, and back up centers that serve to monitor as well as inform clinical practice.

MENTAL Health–RELATED PROGRAMS AND SERVICES

The VHA offers an array of recovery-oriented mental health programs and services for eligible veterans beyond the country, including programs for substance apply disorders (SUDs). VHA mental health programs and services have been developed to create a comprehensive array of care from astute, intensive inpatient intendance to residential rehabilitation and a variety of outpatient services. Because a substantial percentage of veterans treated in any given program have comorbid mental wellness conditions, almost all programs have either in-house services or services available by referral to address the circuitous combinations of bug presented by the veteran population. This section summarizes the cardinal mental health programs and clinical services offered at VHA health care facilities.

Chief Care-Mental Health Integration

Chief care–mental health integration (PC-MHI) is based on the Institute of Medicine's definition of chief care: Primary care is the provision of continuous, comprehensive, and coordinated intendance to populations undifferentiated by gender, disease, or organ system. It provides attainable, integrated, biopsychosocial health care services past clinicians who are answerable for addressing a big majority of personal wellness care needs, developing a sustained partnership with patients, and practicing in the context of family and community (IOM, 1996).

PC-MHI was widely implemented throughout the VHA wellness care organisation get-go in 2007 (Johnson-Lawrence et al., 2012) and must be available at all VA medical centers (VAMCs) and at all large and very large customs-based outpatient clinics (VA, 2015c). Primary intendance providers identify and address mental health conditions at the "sub-clinical, minor, or moderate levels earlier they escalate to full diagnostic-level problems" (Dundon et al., 2011, p. 10). PC-MHI providers are members of patient-aligned care teams (PACTs); interact with other team members to assess, support, or provide handling; and conduct follow-up care (VA, 2012a). The VHA began implementing PACTs in its main intendance clinics in 2010 (Rosland et al., 2013). PACTs are based on the patient-centered medical home model of health intendance. Each team consists of a main care provider, a registered nurse care manager, a clinical associate (a licensed practical nurse or medical assistant), an administrative clerk, the veteran, and the veteran's family and caregivers (VA, 2016k). Other personnel, such as social workers, dietitians, pharmacists, mental wellness practitioners, physical therapists, and specialists, tin be added to the team equally needed. Each squad provides care for virtually one,200 patients (Rosland et al., 2013). Mild to moderate mental health conditions are managed within the PACTs (Kearney et al., 2014). In general, only patients who have severe mental health conditions are referred to specialty mental wellness services. The goals of the PACTs are to improve patient admission to care through more efficient scheduling of appointments (including same-day appointments), to conduct more appointments by phone and by shared medical appointments, to increase patient access to personal health information and providers via the Internet, to improve coordination of care through the use of case managers and regular team "huddles," and to meliorate communication betwixt the care teams and their patients by preparation staff in patient-centered advice (Rosland et al., 2013). Affiliate 12 presents more data virtually PACTs and other evidence-based care delivery approaches that systematically coordinate care given by VHA primary intendance, mental wellness, and substance-use handling providers to effectively care for patients with mental health conditions.

General Outpatient Mental Health Services

Full general mental health clinics at VAMCs provide outpatient mental health services to veterans who do non require more than specialized programs. Veterans should receive an appointment within 30 days. They volition be seen by psychiatrists, psychologists, or other behavioral wellness providers who conduct a comprehensive evaluation and provide treatment (for instance, psychotherapy, medications, and social support services) (VA, 2014e).

The VHA has recently introduced the Behavioral Health Interdisciplinary Program (BHIP) inside its full general mental health clinics (VA, 2014e). This model of intendance assigns patients to interdisciplinary teams of providers and clerical staff who coordinate and deliver the patients' general mental health intendance. The goals of using the BHIP teams include better integration of outpatient mental health care, improved admission for patients, and improved coordination and continuity of care. Chapter 12 presents more than data most BHIP and other evidence-based intendance commitment approaches that systematically coordinate intendance given past VHA primary care, mental health, and substance-use treatment providers to effectively treat patients with mental health atmospheric condition.

Mental Health and Domiciliary Residential Rehabilitation and Handling Programs

Mental Health Residential Rehabilitation and Treatment Programs (MH RRTPs) and Domiciliary Residential Rehabilitation and Handling Programs (DRRTPs) provide services for a variety of illnesses, problems, and needs relating to the mental health of veterans in a residential setting. Care tin exist provided in general programs or, when appropriate and available, specialized programs as described below. MH RRTPs/DRRTPs provide a level of bed care that is distinct from high-intensity inpatient psychiatric care in that the patients do not require bedside nursing intendance and are generally capable of self-care (VA, 2010a). Candidates for admission have astringent and frequently multiple conditions simply do not need astute inpatient psychiatric or medical intendance and are not at significant risk to themselves or to others (VA, 2010a). To be eligible, veterans must lack stable living arrangements which are necessary for their recovery. Brief overviews of the dissimilar programs are detailed below, but the clinical policies and practices are identical for all programs, as determined past the Department of Veterans Affairs Central Office (VACO) (VA, 2013).

Some programs may provide the care inside the departments themselves (referred to as the all-inclusive residential model), or they may have veterans receive services through outpatient programs such as psychosocial rehabilitation and recovery center while keeping residence in the MH RRTPs/DRRTPs (the supportive residential model) (VA, 2010a). In either case, the purpose of the residential component is to provide a structured environment to integrate rehabilitative gains from treatment into a lifestyle of self-care and personal accountability.

The VHA acknowledges that access to these programs can be difficult for the veterans who need them. The handbook outlining the MH RRTPs/DRRTPs policies cites veteran poverty, homelessness, disabilities, and psychological atmospheric condition as barriers to admission to MH RRTPs/DRRTPs. The handbook too cites transportation to screening appointments as another barrier to the programs. In response to these barriers, the VA requires that screening for admission occur during one single contact (VA, 2010a). Besides, the MH RRTP/DRRTP programme manager or the domiciliary chief is responsible for facilitating improved access to screening appointments by providing transportation assistance to veterans who may accept difficulty getting to appointments.

Psychosocial Residential Rehabilitative Treatment Plan and Full general Domiciliary

A Psychosocial Residential Rehabilitative Treatment Program (PRRTP) and a General Domiciliary (Gen Dom) provides a residential level of care to veterans who do not crave a more than specialized program. PRRTPs are typically more structured, "all inclusive" units serving veterans with serious mental illnesses, while Gen Dom beds within MH RRTPs/DRRTPs are by and large less structured and serve veterans with less astringent weather condition (VA, 2010a). Veterans who need specialty intendance for a specific status should not be admitted to the PRRTP or Gen Dom, merely rather to a program that addresses the needed specialty care (VA, 2010a).

Health Maintenance Domiciliary

Health maintenance domiciliaries are MH RRTPs/DRRTPs that focus on symptom reduction and stabilization as function of the treatment approach to recovery and customs reintegration (VA, 2010a). These programs target veterans with more complex medical problems comorbid with their psychiatric conditions than are typically found in other residential programs.

Posttraumatic Stress Disorder–Residential Rehabilitative Treatment Programs or Domiciliary Posttraumatic Stress Disorder

Posttraumatic stress disorder–residential rehabilitative treatment programs (PTSD-RRTPs) and domiciliary posttraumatic stress disorder programs (Dom-PTSDs) provide intendance to veterans who have PTSD, including those who have suffered military sexual trauma (MST). PTSD-RRTPs and Dom-PTSDs provide PTSD treatment, SUD treatment, and psychosocial rehabilitation (employment, community supports, and housing) (VA, 2010a).

Substance Abuse Residential Rehabilitative Treatment Program and Domiciliary Substance Abuse

Substance abuse residential rehabilitative treatment programs (SARRTPs) and domiciliary substance abuse (Dom SA) programs provide a residential level of care to a veteran population with diagnosed SUD. The programs provide a stable substance-free supervised recovery environment for veterans with SUDs who require a structured setting while they are treated and working toward recovery. Addiction severity, comorbidities, and a higher gamble of relapse in a less structured environs are all reasons why a SARRTP may be more appropriate than treatment in an ambulatory setting (VA, 2010a). To exist admitted to a SARRTP, veterans must either require no monitoring or be at risk for no more than balmy withdrawal according to a standardized clinician-administered cess (Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised) (VA, 2010a).

Women Trauma Recovery Program

The Women Trauma Recovery Program offers continuing PTSD treatment, sobriety maintenance, and employment and housing back up (VA, 2010c). Each Veterans Integrated Service Network (VISN) must have a residential program that meets the needs of the women veterans it serves. If the number of women veterans inside the VISN does non meet the threshold for that VISN to provide a specific program, the VISN is required to use national or regional resource to run into the clinical needs of women veterans who seek services.

Compensated Piece of work Therapy–Transitional Residence Program

The goal of compensated work therapy–transitional residences (CWT-TRs) is to effectively reintegrate veterans into their dwelling house communities by fostering greater independence, improving social status, reducing hospitalization, and enabling community work based on the veterans' capabilities and desires (VA Office of Inspector Full general, 2011). CWT-TRs target a broad diversity of veterans, including veterans with severe SUDs who frequently rely on institutional care, homeless veterans with mental disorders who under-use VA services, veterans with PTSD, and veterans with serious psychiatric disorders and concomitant vocational deficits (VA, 2010a).

Domiciliary Care for Homeless Veterans

Domiciliary care for homeless veterans (DCHV) provides time-limited residential treatment to homeless veterans with significant health and social–vocational deficits. The program provides access to medical, psychiatric, and SUD treatment also every bit access to social and vocational programs (VA, 2010a). The goals of the program are to accost weather and barriers that contribute to homelessness, health status, and employment operation. DCHV also aims to reduce the overall reliance of homeless veterans on VHA inpatient services and to prepare veterans for and place them in a safety community environment. The program admits veterans who are homeless or at run a risk of becoming homeless and gives priority to veterans who have recently been discharged from the military machine (VA, 2010a).

Acute Inpatient Mental Wellness Services

Veterans in demand of intensive crisis-oriented assessment and intervention for their mental affliction or SUDs are admitted to inpatient mental health programs. The inpatient program may be located within a VAMC, which is most common, or a non-VHA customs facility that has an understanding with the VHA (VA, 2015c). Veterans who accept urgent and severe mental health conditions must exist admitted to an inpatient unit without delay. Inpatient SUD-specific units are far less numerous than in years past as these services are now generally provided past SUD-experienced staff in inpatient general psychiatry, medical, and surgical units (VA, 2012b). Inpatient stays are typically short term, with veterans moving to other levels of intendance when clinically appropriate and safe to do so. All VHA emergency departments are required to accept mental health providers on site or on telephone call (VA, 2015c). VAMCs with emergency departments have to be equipped to provide observations or evaluations for up to 23 hours when necessary, either in the emergency department or on inpatient units.

Select Population Programs

Housing and Urban Development-Veterans Affairs Supportive Housing

The HUD-VASH program was established to provide housing and clinical help to the neediest veterans and their immediate families. In partnership with the Department of Housing and Urban Development (HUD), the VA provides instance management and clinical services, while HUD provides permanent housing subsidies through its Housing Choice program. Working with an assigned instance manager, veterans in the HUD-VASH program develop a house stabilization plan that includes both housing and treatment needs and recovery goals. To be eligible for the programme, veterans must be eligible for VHA health care services and either lack a regular nighttime residence or accept a primary residence that is a shelter, temporary housing facility, or a place not normally used every bit a regular sleeping accommodation (National Center on Homelessness Among Veterans, 2012). In improver to housing, the veteran will be offered needed master intendance, mental health, and SUD services also equally employment and financial direction assistance and preparation. Case management services proceed as long as the veteran needs them; however, the subsidized housing tin can extend indefinitely afterward case management support has ended (National Center on Homelessness Among Veterans, 2012).

Health Care for Homeless Veterans

The Health Intendance for Homeless Veterans (HCHV) program serves as a gateway to VA services for eligible veterans who are homeless and in need of intendance. Services and functions of the HCHV include outreach to veterans, treatment, rehabilitative services, instance management, and transitional housing assistance. Through the use of contracted residential services in different communities, the plan engages otherwise difficult-to-accomplish homeless veterans and connects them with needed mental health, primary care, and SUD services (VA, 2014f).

Grant Programs

The Grant and Per Diem (GPD) program is designed to fund new projects in the public or non-profit sector that will provide services for homeless veterans. Competitively awarded grants may exist used to fund upward to 65 percent of the acquisition, renovation, or construction costs for a building that will be used to supply supportive housing or support services for homeless veterans. Grant awardees may also asking per diem funding to assistance outset the operational costs of the associated projects (VA, 2014a). All VAMCs with at least 100 homeless veterans in their principal service area must have a GPD or alternative residential care setting (VA, 2015c).

The Supportive Services for Veterans Families plan gives grants to individual non-profit organizations and customs cooperatives to provide a variety of supportive services (for case, case management; assist in obtaining VA and other public benefits; and providing temporary financial aid for rent, utilities, and other expenses) for depression-income veteran families (VA, 2017a). The goal of this program is to promote housing stability to homeless and at-risk veterans and their families.

Healthcare for Re-Entry Veterans

The Healthcare for Re-Entry Veterans (HCRV) plan is intended to connect veterans recently released from federal or land prison to needed primary care, mental health, or SUD services. The programme besides provides outreach through a police force training coordinator and justice outreach coordinator to local law enforcement and criminal justice systems to educate and advocate for mental wellness treatment as an culling to incarceration when veterans with mental illness commit non-vehement offenses (VA, 2015c). Each VISN must engage a full-fourth dimension HCRV specialist to lead the attempt (VA, 2015c). VACO policy encourages the assignment of one specialist per country (VA, 2015c).

Services for Returning Veterans-Mental Health

Services for Returning Veterans-Mental Wellness (SeRV-MH) teams were first used in 2005 to identify and reach out to veterans returning from deployment in Iraq and Transitional islamic state of afghanistan, to provide them with data about stress-related disorders and coping mechanisms, and to assess their mental wellness needs. The goal of the program is to engage veterans for early detection and correction of problems relating to mental wellness (VA, 2010c). Near SeRV-MHs are associated with facility PTSD programs. There are no requirements for facilities to implement SeRV-MH; the only requirement is that they are able to appraise and treat the mental health needs specific to OEF and OIF veterans (VA, 2010c).

Occupational Programs

Compensated work therapy (CWT) programs provide vocational preparation and employment opportunities to veterans with the ultimate goal of successfully reintegrating the veteran into their home communities. CWTs are required in every VAMC and must be made available to any veterans who have trouble obtaining or maintaining employment because of occupational challenges relating to their mental illness or physical affliction co-occurring with their mental illness (VA, 2015c). A variety of specialized programs operate under the CWT umbrella. These include the Incentive Therapy program, the Sheltered Workshop programme, the Transitional Work program, the Supported Employment programme, and the Transitional Residence program (described in the Mental Health Residential Handling Program section in a higher place).

Vet Centers

The Vet Eye program offers services that specifically accost the psychological and social sequelae of combat-related problems in old active-duty, National Guard, and Reserve service members (VA, 2010b). In addition to providing readjustment counseling, Vet Centers offer community education, outreach to special populations, brokering of services with community agencies, and the referral of veterans to other VA services (VA, 2010b).

Every Vet Middle has a multidisciplinary staff with at least one licensed mental health professional. The program is designed to provide like shooting fish in a barrel admission to services, separate from the bureaucratic obstacles veterans frequently face navigating the VA organization (VA, 2010d). Services are provided confidentially and do not announced on the veterans' VHA health record (although Vet Centers do maintain their own patient-record organization). There are about 300 Vet Centers in the The states and its territories and near 70 mobile Vet Centers which are used for outreach and to reach veterans who live in rural areas (VA, 2016l).

Services offered by Vet Centers include individual and group counseling for veterans and their families; family counseling for armed services-related issues; bereavement counseling for families who experience an active-duty death; counseling and referral for MST-related atmospheric condition; SUD assessment and referral; employment assessment and referral; Veterans Benefit Administration referral for benefit help; and medical and mental health screening and referral (VA, 2010d).

Chaplaincy

The VHA employs hospital chaplains and considers them to be a part of patient intendance teams (VA, 2015b). The chaplains' role is to provide spiritual and pastoral care to veterans receiving treatment in all settings and levels of care, if desired by the veteran. Chaplain-provided intendance for veterans and service members who have mental health needs is a component of the VA/Department of Defense'due south (DoD's) Integrated Mental Health Strategy (DoD and VA, 2011). The VHA has a national Mental Health and Chaplaincy initiative that fosters the evolution of a more integrated system of health care (VA, 2016h). The reasons that veterans may seek mental health care from chaplains rather than mental health professionals include "reduced stigma, greater confidentiality, more than flexible availability, and comfort with clergy as natural supports inside a community" (Nieuwsma et al., 2013, p. 11).

Department of Veterans Affairs Crisis Line

The Veterans Crisis Line, which the VA administers jointly with the Department of Defence, was established in 2007 (originally called the National Veterans Suicide Prevention Hotline). The service, which can be accessed via a toll-free hotline, online conversation (added in 2009), and text messaging (added in 2011), provides veterans and service members in crisis and their families and friends with immediate support and connects them with VHA mental health services. The responders are trained to accost the mental wellness concerns of service members and veterans, and some responders are veterans themselves. Since 2007 virtually 2.9 million calls, 350,000 chats, and 73,000 texts have been received by the Crisis Line. ane Boosted data on the Veterans Crisis Line can exist found in Chapters 4 and nine.

PROGRAMS AND CENTERS SUPPORTING QUALITY OF MENTAL HEALTH SERVICES

This section summarizes the key VA centers and initiatives that support the VHA's mental health clinical services. It does not describe the interaction of these entities with each other and with the clinical intendance systems, nonetheless, every bit that goes well across the scope of the nowadays written report. Nor does this section provide an exhaustive list of back up centers; there are additional VA centers that include mental wellness as function of their portfolios.

Northeast Program Evaluation Heart

The Northeast Program Evaluation Middle, located in Due west Oasis, Connecticut, is responsible for overseeing and evaluating the VHA'south mental wellness services' programs, and information technology produces several products. Information technology periodically releases "report cards" on the National Mental Health Program Performance Monitoring System, which are evaluation reports of the VHA's mental health programs. Similarly, information technology produces the Long Journey Home reports, which study on the status of the VHA's specialized treatment programs for PTSD, the VHA'southward PTSD specialists, and the SeRV-MH plan (VA, 2010c, 2014b). The heart produces toolkits for sites to use in creating reports for accreditation purposes and likewise produces PTSD fact sheets. Information technology supports ad hoc data requests from the Office of Mental Health and Suicide Prevention and provides back up to the PTSD Mentoring Program and other National Middle for PTSD initiatives (Hoff, 2014).

Mental Affliction Research, Education and Clinical Centers

Congress established the Mental Illness Research, Education and Clinical Centers (MIRECCs) program in 1996 to explore the causes of and treatments for mental wellness disorders. The centers are charged with disseminating new findings into clinical practice and are located in 10 VISNs (VA, 2016f). Each MIRECC has a different focus. For a complete listing of MIRECCs and their focus, meet Tabular array 3-1.

TABLE 3-1. MIRECCs in the VHA.

In improver to conducting research on mental health conditions, the MIRECCs also piece of work to implement the new findings in gild to improve clinical practice in the VHA. For example, efforts to implement supported employment, an evidence-based treatment for schizophrenia, in four VISNs resulted in 2.3 times more veterans receiving this type of treatment (VA, 2015a). These centers also are funded to provide postdoctoral training in mental health for physicians in psychiatry, neurology, radiology, internal medicine, or other areas of medicine and for allied health professionals from clinical psychology, counseling psychology, social work, nursing, and pharmacy (VA, 2016g).

Centers of Excellence

Centers of excellence are designed to exist incubators for new methods of treatment and service delivery (VA, 2011). Each center has a different focus. See Tabular array 3-two for a list of the centers, their locations, and their focuses.

TABLE 3-2. VA Centers of Excellence.

Quality Enhancement Research Initiative and Heart for Mental Health and Outcomes Inquiry

The Quality Enhancement Research Initiative (QUERI) and the Center for Mental Wellness and Outcomes Enquiry operate under the Wellness Services Research and Development Service within the VHA (VA, 2014c). QUERI's mission is to enhance the quality and outcomes of VHA wellness care by systematically implementing clinical research findings and evidence-based recommendations into routine clinical practice (VA, 2014c). QUERI evaluates quality of care across iii domains—structure, process, and outcomes—and is committed to using research results to drive improved interventions within the VHA wellness organisation. The QUERI program, commencement established in the 1990s, has recently evolved from 10 centers, each with a focus on a specific disease or condition, such as the Substance Apply Disorder QUERI and the Mental Health QUERI, to a drove of 15 interdisciplinary programs with cantankerous-cut partnerships aimed at achieving VHA national priority goals and specific implementation strategies. For example, in the area of mental health, the QUERI for Team-Based Behavioral Health (in Piddling Rock, Arkansas) focuses on how squad-based behavioral wellness care tin can be improved through the use of implementation facilitation strategies, with the ultimate goal of improving veteran outcomes. The Care Coordination QUERI (in Los Angeles, California) aims to learn how to improve coordination between the veteran, his or her master intendance team, and any specialty care, emergency section, hospital, and home community resources the veteran may need (VA, 2017b). And the mission of the Center for Mental Health and Outcomes Inquiry (located in North Fiddling Rock, Arkansas) is "to optimize outcomes for veterans by conducting innovative research to improve access to and engagement in testify-based mental health and substance use care" (VA, 2017c). In particular, its focus is to conduct inquiry to meliorate mental health care for rural veterans.

Serious Mental Disease Inquiry and Evaluation Center

The Serious Mental Affliction Research and Evaluation Heart (SMITREC) is a national center for data collection and management and focuses on veterans with serious mental affliction. The center runs the National Psychosis Registry and the National Registry for Depression, which collect and maintain information from all VHA patients with these diagnoses (VA, 2014d). Offices within VACO also as at the VISN and facility level can access these data in order to evaluate clinical practices and inform policy. SMITREC is located within the Ann Arbor VA Center for Clinical Direction Research.

SMITREC's mission is to comport critical evaluation that will (1) raise the mental and physical health care of veterans with serious mental illnesses by providing clinicians with state-of-the-art information on the effectiveness of treatment options; (ii) inform the VA on issues of access to care, customer and clinician satisfaction, efficiency, and the delivery of quality health care; and (iii) provide VA policy makers with relevant and timely guidance on key issues important to optimizing the system-wide delivery of health intendance to veterans with serious mental illness (VA, 2014d).

Program Evaluation and Resource Center

The VA's Program Evaluation and Resource Centre (PERC) provides program evaluation and technical assistance for mental health quality comeback efforts across the VHA (Trafton, 2014). Specific activities conducted by PERC include monitoring the organization and delivery of mental wellness and substance-use treatment services in primary and specialty intendance programs; improving the accessibility, processes, and outcomes of interventions for patients with mental health and SUDs; providing data, analyses, and technical assistance to facilitate the implementation of policies on mental health and substance use handling; and conducting programme evaluations, as requested. An example of an ongoing evaluation conducted past PERC is its quarterly review of more than 200 quality measures used to assess implementation of the Uniform Mental Health Services Handbook, admission to care, utilise of evidence-based practices, and veterans' health status. The heart likewise conducts annual VHA provider and veteran satisfaction surveys, an annual assessment of wellness care diagnosis and treatment trends for VHA patients with SUDs, and monthly assessments of VHA mental wellness staffing levels, among other evaluations.

National Center for Posttraumatic Stress Disorder

The National Center for Posttraumatic Stress Disorder (NCPTSD), which was created in 1984, consists of seven divisions located at bookish centers beyond the United States (Schnurr, 2014). Each division has a specific focus area (run into Table 3-three).

TABLE 3-3. National Center for Posttraumatic Stress Disorder Focus Areas by Division.

TABLE iii-three

National Heart for Posttraumatic Stress Disorder Focus Areas past Division.

The mission of the NCPTSD is to "advance the clinical care and social welfare of America's veterans and others who take experienced trauma, or who suffer from PTSD, through research, pedagogy, and preparation in the science, diagnosis, and treatment of PTSD and stress-related disorders" (VA, 2016j). The center's accomplishments include development of the Clinician-Administered PTSD Scale, which is considered the gold standard for assessing PTSD; conducting the first VHA multisite study on PTSD; and creating a comprehensive website on trauma and PTSD (world wide web.ptsd.va.gov). The NCPTSD has conducted several research projects on PTSD in veterans of OEF/OIF/OND. Examples include studies of neuropsychological and mental health outcomes post-obit deployment (Vasterling et al., 2006), research on the effectiveness of specific treatments for PTSD (Brief et al., 2013; Lang et al., 2012), and work on predicting postdeployment mental health needs (Vogt et al., 2011).

National Telemental Wellness Middle

The VHA National Telemental Health Center, based in the VHA Connecticut Healthcare System, was created to unify the apply of tele-mental health within the VHA. The centre works to ensure that telemental health is bachelor nationwide, and it strives to increment access to specialty care via telehealth. Furthermore, it convenes panels of experts to assistance advance the field and acts as a resources bank for best practices (Godleski, 2014). For PTSD handling, the National Telemental Health Center is promoting the delivery of prolonged exposure therapy and cerebral processing therapy via tele-mental health, peculiarly to veterans in rural areas where these therapies may not be otherwise available (IOM, 2014).

National Center on Homelessness Among Veterans

The VA's National Eye on Homelessness amongst Veterans was established in 2009 and collaborates with the Office of Mental Health and Suicide Prevention to address homelessness among veterans. The heart'due south goal is "to promote recovery-oriented care for veterans who are homeless or at-risk for homelessness by developing and disseminating show-based policies, programs, and best practices" (VA, 2016a). Between 2010 and 2015, efforts by the VA and its partners reduced the estimated number of homeless veterans past 36 percent. According to estimates based on data nerveless during the almanac point-in-time count, conducted on a unmarried night in January 2015, there were fewer than 48,000 homeless veterans in the United States, a pass up of more than 26,360 veterans since 2010. ii

The center conducts population-based and program-specific research on homelessness and also develops cess tools. One particular expanse of this population-based enquiry is mental illness, SUDs, and comorbid conditions (VA, 2016d). For instance, VA researchers have studied housing disparities and instability among veterans who have mental illnesses, substance employ and housing programs for homeless veterans, and unemployment among homeless veterans (Bossarte et al., 2013; Montgomery et al., 2015; O'Connor et al., 2013; Schinka et al., 2011). A study specific to the OEF/OIF/OND veterans is identifying adventure factors for homelessness in this cohort (Metraux et al., 2013). Program-specific enquiry is focusing on patterns of resource use and access to and provision of services as well as on identifying the factors that touch the outcomes of individual plan initiatives on homelessness (VA, 2016e). Finally, tools are being developed so that the VA's homelessness programs tin be evaluated and the individual needs of veterans can be finer assessed (VA, 2016b).

The center as well has a programme to develop and implement models related to housing, health intendance, prevention, and supportive services for homeless veterans (VA, 2016a). This programme uses interventions developed from research studies and applies them to clinical do. It also evaluates the efficacy of the interventions through airplane pilot programs.

Finally, the eye has an instruction and dissemination programme that "provides instruction, technical assistance, and consultation to heighten and improve the delivery of services to homeless veterans by sharing evidence-based and all-time practices with VA and community partners" (VA, 2016c). This program develops treatment manuals and trainings and organizes virtual conferences and webinars to disseminate information.

Social and Community Reintegration Research

The Social and Community Reintegration Research (SoCRR) programme is working to increase the VA's capacity for conducting research on sustaining and recovering "full community involvement by veterans with psychiatric disorders" (VA, 2016i). SoCRR is funded by the VA's Rehabilitation Research and Development Service under the Enquiry Enhancement Award Program mechanism. The goal of the enquiry program is to improve the understanding of how mental health conditions affect customs interest factors such equally education, work, and family unit and social relationships. The goal is to apply the research findings to clinical practices to assist veterans with their reintegration in the community.

SUMMARY

This affiliate has provided a summary of VA programs and services related to mental health care and of major mental health evaluation, research, and support centers that serve to monitor also every bit inform clinical practice. The affiliate is intended to be solely descriptive. Select programs and services are examined in more than detail with regard to access and quality in after capacity. The salient points from this affiliate are as follows:

  • The VHA offers an array of recovery-oriented mental wellness programs for eligible veterans across the state, including programs for SUDs.

  • The VHA also provides support services not traditionally found in non-VHA mental health venues, such as services targeting homeless veterans, vocational rehabilitation, and transitional services from federal or state prison house to VHA wellness intendance.

  • Both full general and specialty mental health services are offered with a particular emphasis on areas that address the needs of the veteran population (for example, posttraumatic stress disorder and armed forces sexual trauma).

  • With few exceptions (for example, the Services for Returning Veterans–Mental Health teams), VHA mental health services take been adult to address the needs of military veterans broadly. Mental health services for the Operation Enduring Freedom, Operation Iraqi Liberty, and Operation New Dawn veterans are, for the most part, delivered within the existing mental wellness organisation described here.

  • VHA mental health services and programs accept been developed to create a comprehensive continuum of care from acute, intensive inpatient intendance to residential rehabilitation and an array of outpatient services.

  • In addition to being a direct provider of and payer for services, the VHA has a large infrastructure defended to supporting and evaluating its programs and services, to conducting research to ameliorate mental wellness care for veterans, and to training future health intendance providers (which will be discussed further in another affiliate).

  • Not all programs and services created by the VHA and described in this chapter are bachelor at all sites of VHA care.

    • The types and number of mental health services available at a particular site are determined by such factors as the number of veterans served and their needs and the size and location of the site.

    • The location of services and how those services are delivered (for example, directly care, tele-mental health, or contracts with non-VHA providers) are prescribed by written national policy.

    • In response to the diverse needs of veterans, the range of site size and locations (for example, rural versus urban), and other locally determined factors, a large number of general and specialized mental health programs have been created and are implemented in accordance with local needs.

    • As such, varying subsets of these programs may be available at a particular site.

  • Regardless of whether a mental wellness plan is described equally general or specialized, a substantial percentage of veterans treated in a given programme typically have comorbid mental health atmospheric condition. Therefore, virtually all programs have either in-firm services or services available by referral to address the circuitous collection of problems presented by the veteran population.

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one

Personal communication, VA, June xvi, 2017.

2

Personal communication, Stacy Gavin, OMHSP/VA, June ii, 2016.

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Source: https://www.ncbi.nlm.nih.gov/books/NBK499499/