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VACO ACTIVITY. Antonette Zeiss, Ph.D. Deputy Chief Consultant Office of Mental Health Services VA Central Office. 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.
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VACO ACTIVITY Antonette Zeiss, Ph.D. Deputy Chief Consultant Office of Mental Health Services VA Central Office
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
MY TIMELINE AS DEPUTY CHIEF CONSULTANT • Accepted position end of July, 2005 • Detailed starting August 12, 2005 • Began permanent position start of October, 2005
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
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
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
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
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
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
Advisory Committees • Homeless Advisory Committee • SMI Committee • PTSD Committee • Mental Health Task Force • Women’s Health • Readjustment Counseling (Vet Center) • Etc.
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
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
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
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
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
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
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
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
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
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
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)
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
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
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
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
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)
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
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
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?