VACO ACTIVITY

1. VACO ACTIVITY Antonette Zeiss, Ph.D. Deputy Chief Consultant Office of Mental Health Services VA Central Office

2. DEPUTY CHIEF PATIENT CARE SERVICES OFFICER FOR MENTAL HEALTH • Ira Katz, M.D. • Mark Shelhorse, M.D. remains in Acting role through May 28, when Dr. Katz formally begins

3. MY TIMELINE AS DEPUTY CHIEF CONSULTANT • Accepted position end of July, 2005 • Detailed starting August 12, 2005 • Began permanent position start of October, 2005

4. NEW ORGANIZATIONAL CHART:OFFICE OF MENTAL HEALTH SERVICES • Lead person for the office is now titled the Deputy Chief Patient Care Services Officer for Mental Health (DPCSOMH) • Important: Chief Consultant title elevated • DPCSOMH appointed to NLB • Deputy Chief Consultant for Mental Health • Directly under the DPCSOMH • Now has major supervisory responsibility within the office and for decentralized staff

5. Staff and activities organized by Sections, each with a Lead • New Section – Psychosocial Rehabilitation and Recovery Services; Bob Gresen as Lead • Mental Health Informatics Section; Katy Lysell as Lead • Domiciliary care brought into OMHS under Homeless programs

6. HURRICANE/DISASTER RESPONSE • Occurred during my detail and move to DC • Initial OMHS activities around • Care of homeless • Following the detailing of MH staff • Emergency communications • Setting up phone contact list for MH expertise needs • Developing Disaster Coordinator for MH for each VISN • Speeded timeline for completion of Psychological First Aid Manual (thanks to NCPTSD) • VISN 16 site visit now planned, ASAP

7. CENTERS OF EXCELLENCE • Congressionally mandated in Waco, Canandaigua, and San Diego • Site visits to each • Report under development, with special emphasis on clear development of Center of Excellence definitions, responsibilities, accountability, etc. to mirror MIRECCs and other Center program expectations

8. MyHealtheVet MH PORTAL • Began in Fran Murphy, MD’s office; now transferred to Office of Mental Health Services • I was Co-Chair from beginning • Ken Weingardt, Ph.D., VA Palo Alto new Co-Chair • Comprehensive content under development • Psychoeducational material by diagnoses and by functional problems • Self screening • Continuous recovery component

9. COMMUNICATION AND LIAISON ROLES FOR DEPUTY CC • Work with Media Relations and Congressional Affairs Offices • Press interviews • Congressional briefings • OMB briefings • Within VACO • Within VHA • Across to VBA • With Offices at the Secretary’s level

10. Advisory Committees • Homeless Advisory Committee • SMI Committee • PTSD Committee • Mental Health Task Force • Women’s Health • Readjustment Counseling (Vet Center) • Etc.

11. Coordination of Education Initiatives • EES • Education initiatives address recovery, suicide assessments, aging, collaborative care, MHSP implementation, etc. • OAA • Communication with OAA shared responsibility of several OMHS staff • Expansion of PSR Fellowship • Deputy specifically: Review of Psychology training positions and stipends

12. CARES PROJECTION MODEL • CACI/Milliman model updated for Mental Health • VISN MH and Domiciliary Strategic Planning guided by updated MH projections and reviewed by OMHS • Projection model still untested and known problems remain • Starting process of next iteration of model development

13. OMHS PROGRAM REVIEW • GPRA process • Design of program evaluation began about 5 years ago • Was ready to go, with SMI focus • PCS raised question re. need for a new look, given MHSP • Redefinition process completed • New evaluation plan in contract negotiations

14. EFFORTS REGARDING C&P CLINICAL EVALUATIONS FOR PTSD • “Secret Philadelphia meeting” – Dec., 2005 • Not secret at all • Multiple Psychologists present, including key presentation by Terry Keane, Ph.D. • Key stakeholders represented • Ongoing efforts, led by Gerald Cross, M.D., Deputy Chief Patient Care Services Officer

15. Goals • Define best practices for ensuring consistency of clinical evaluations • For diagnosis and for functional status • Build on and evaluate the “gold standard” process developed by NCPTSD • Define best psychometrically evaluated measures for evaluating functional status • GAF required by legislation • World Health Organization Disability Assessment Survey (WHODAS) looks promising; will be evaluated • Further define criteria for performing C&P exams • Only Psychology and Psychiatry can do initial evals • Other professionals can do re-evaluations re. disability level, if diagnosis previously established • Consideration of training and certification process

16. VHA/DOD INTERACTIONS • Joint VHA/DoD Mental Health committee established • Liaison with and through Seamless Transition Office • E.g., Postdeployment Health Re-Assessment process • Joint presentations to HEC and JEC • New DoD MH Committee forming; will have VA representation

17. MHSP IMPLEMENTATION • Primary responsibility • Tasks include • Guidance of previously planned funding efforts for FY06 • Development of new funding efforts (e.g., PSR; upcoming guidelines for Integration of MH and Primary Care) • Ensuring recurring funds • Monitoring use of allotted funds, FY05 and FY06

18. Coordination with other Strategic Planning efforts • Patient Care Services SP • Dr. Perlin’s 8 for Excellence SP • Work with Fiscal and Operations (10N) on implementation • Usual activities, e.g., 10N actually sends the memos that we generate re. funding awards • Unusual activity, e.g., this year’s complex problems re. IT budgets

19. Initial weekly meetings with Dr. Kussman’s office to report on progress • Now every other week; soon to reduce further • GAO review of MHSP implementation currently ongoing • Document requests • Interviews at VACO • Planned VISN/Facility visits

20. ROLE AS NATIONAL LEAD PSYCHOLOGIST • Difficult to devote enough time to this role • Approval to hire new position, for OMHS staff person as my Assistant for Psychology related responsibilities • Working to make that a reality

21. PSYCHOLOGY ISSUES AND ACTIVITIES • Hybrid Title 38 conversion • Refocus on approval for Psychology Directive (requirement for lead Psychologist in every facility) • Monitoring of MH Leadership Position Directive (requirement that MH lead positions be advertised for all relevant MH professions)

22. Psychology Advisory Committee • Combined group of former PAC and Psychology Training Advisory groups • Long history, with important contributions to Deputy specifically and Psychology generally • Efforts to redefine and revitalize needed – fine tuning • Concerns • Mission needs to be revisited • Membership fairly static • Explicit expectations regarding responsibilities, actions, products, etc. of PAC members

23. Process to date • Monthly calls (approximately) • Current heritage members provided history from their perspective, their interests, their ideas about future directions: Jeff Burk Dan Kivlahan Pat Dubbert Christine LaGana Bob Gresen Ed Nightingale Mary Jansen Judy Patterson • One new replacement member added: Steve McCutcheon • Turning now to new issues

24. Proposed new organization • Membership will be rotating with 3 year terms • Renewal of appointment possible • All current members will remain, but with term assignments • PAC members will take responsibility for specific actions/issues, e.g., • Newsletter Chair • Scribe/Historian • Psychology evidence-base and dissemination • Some members will be defined by roles that should be represented on the PAC, e.g., • Chair of Psychology National Professional Standards Board • Chair of VA Section, Division 18 • Chair of Council of VA Training Directors • OMHS representative (in addition to Deputy) • Small number of “At the Deputy’s pleasure” members

25. Membership will be as representative as possible; including: • Diversity – racial/ethnic/cultural; geographical; gender; professional focus; disability; etc. • Predominantly senior psychologists, but with some more junior membership • At least one Psychologist in VISN of facility leadership positions (e.g., ACOS for Behavioral Health) • Research, practice, and administration • “Heritage” and new membership

26. Questions remaining • Representation for AVAPL and Division 18? • What do these groups want? • How to determine rep, given one year Presidential terms vs. 3 year membership on PAC • Ultimate ideal size of PAC • Should there be a limit on number of terms? • Process of identifying replacements (except for reps defined by role)

27. Council of VA Training Directors of Psychology • Original motivations • Political issues – e.g., increasing likelihood of COA permanent seat for VA • Community of training issues – helpful resource for TDs, being seen within broader training communities, etc. • Actions to date • Jeff Burk has been spearheading, with particular involvement of Steve McCutcheon, Christine LaGana, and Bob Gresen • PAC has started to review this issue • Moral support from OAA, especially Linda Johnson • Moral and potential financial support from APA Education Directorate, e.g., to fund a conference for final development and launching of Council • Supportive discussion at Council of Chairs of Training Councils – Jeff Burk our rep at that group

28. Two models originally considered • Free standing (a la AVAPL) vs. • Placement under Deputy in OMHS • Jeff Burk developed document laying out pros and cons of each; reviewed by PAC • Current thinking is to develop a hybrid model • Placement under Deputy in OMHS • But with elected Chair and Board • And with Bylaws • Needs to be reviewed with General Counsel • Goal = define soon, work toward Fall conference

29. Questions for input • Ensuring financial stability, e.g., in lean VA budget years • Ensuring broadest possible participation – how can we make this most attractive to current and future TDs? • Development of a political strategy simultaneously with finalizing plans; i.e., how best to keep focus on COA seat?