Clinical Needs of Rural Veterans:

1
Clinical Needs of Rural Veterans

• Providing Mental Health Care
• in CBOCs

Kathy L. Henderson, MD April 18, 2008
2
Mental Health Services in CBOCs

• VHA Directive 2001-060
• Establish minimum standards for CBOCs, including
  mental health services
• Provide ability to screen for mental disorders
  and establish mental health diagnosis
• Provide pharmacotherapy and psychotherapy
  services
• Referral for inpatient/residential care
• Access to specialty consultation (PTSD)
• VHA Handbook 1006.1 (May 2004)
• Extended above to include SUD and MST services

3
Map of Mental Health in CBOCs
( 9/01)
4
Mental Health in CBOC Plan

• Initiated by MHPL in FY02
• Conducted VISN-wide population-based analysis
• Established 3 priority levels of CBOCs
• Services phased in over 2 years
• Facilities determined staff and mechanism to
  provide service
• Disciplines requested
• VA-staffed, contract, thru telemedicine
• Space needs
• Plan submitted to network for approval

5
Mental Health in CBOC Plan

• BY FY04
• 22.4 new FTE in CBOCs
• 20 telemedicine units for 15 CBOCs
• Almost 25,000 veterans provided mental health
  services in CBOCs (60 since FY02)
• Over 2.2 million supported by network
• MHPL overseeing implementation and workload
  (network performance measure)

6
National Mental Health in CBOC Performance Measure

• Established in FY05 FY07
• CBOCs serving gt 1500 unique patients will
  provide specialty mental health services in at
  least 10 of visits
• Targets - 85/95 for all clinics
• Resources needed by most networks to accomplish

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Mental Health in CBOC Initiative Funding
Total MH CBOC Staffing FY07 169.5 FTEE
8
Telemental Health Initiative Funding
9
Mental Health in CBOCWorkload (Uniques)
80 ? in uniques FY03-FY07
117 ? in encounters FY03-FY07
10
Telemental Health Workload
304 ? in uniques FY03-FY07 1032 ? in encounters
FY03-FY07
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Map of VISN 16 CBOCs
12
CBOCs by Parent Facility
To be activated in FY08
13
FY08 CBOC Activation

• Branson, MO September
• Eglin AFB, FL April-May
• Stillwater, OK - September

14
Pending CBOC Activations

• FY09
• Searcy, AR
• Fort Polk, LA
• Lake Charles, LA
• Altus, OK
• Enid, OK
• Vinita, OK
• Katy, TX
• Tomball, TX
• FY10
• Conway, AR
• Jay, OK
• Richmond, TX

• FY11
• Russellville, AR
• McComb, MS
• Natchitoches, LA
• Lake Jackson, TX
• FY12
• Ozark, AR
• Bogalusa, LA
• Franklin, LA

15
Accomplishments from FY02 FY07

• Expanded general mental health services from 8
  CBOCs to 38 CBOCs
• Increased staffing by almost 70 FTEE
• Developed and greatly enhanced telemental health
  program
• Implemented specialty mental health in larger
  CBOCs (MHICM, PTSD, SUD)
• Achieved 100 on mental health in CBOC
  performance measure

16
Uniform Services Package for Mental Health

• Draft released January 2008
• Further roll-out of MH Strategic Plan
• Minimum requirements that must be provided at VA
  Facility/VISN/CBOC
• Guidance for filling gaps between veteran needs
  and services provided
• Develop metrics for outcomes

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Uniform Services Package for Mental Health
(CBOCs)

• Facility MH leadership must have oversight of
  CBOC MH services
• Provide options for MH services for veterans
  living gt 90 minutes from facility/CBOC
• CBOCs serving 5,000 or gt veterans will provide
  general and specialty MH services
• CBOCs serving 1,500 5,000 veterans will
  provide general MH services (can use telemental
  health)

18
Uniform Services Package for Mental Health
(CBOCs)

• Smaller CBOCs will provide access to
  general/specialty MH services through on-site
  telemental health, referral or contract
• CBOCs serving gt 10,000 veterans must have
  full-time on-site integrated PC/MH services
• CBOCs serving 5,000 10,000 veterans must have
  on-site integrated PC/MH services depending on
  clinical need