National Mental Health Providers Survey: Baseline Results

Dr. Kendra WeaverSenior Consultant, MH Clinical Operations, Office of Mental Health Operations

VETERANS HEALTH ADMINISTRATION

• To ensure excellent access to mental health care for Veterans, VHA instituted an annual survey of outpatient mental health providers that assesses barriers to care.

• VA developed the national mental health provider survey to assess providers’ perceptions of mental health care.

• Survey plan was included in the Mental Health Action Plan submitted to the Senate Veterans Affairs’ Committee in November 2011.

• Survey was developed with input from the Director of Survey Development, mental health field staff, and MH leadership over the spring and summer of 2012. It was reviewed by Union partners and approved through the National Center for Organizational Development (NCOD) survey clearance process.

• Survey was administered on NCOD website.

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Background

VETERANS HEALTH ADMINISTRATION

• Initial administration of the web-based survey occurred from September 6 to September 21, 2012. All licensed independent outpatient MH providers were asked to participate.

• Survey was reopened for select facilities from January 16 to February 4, 2013, to ensure all facilities had responses.

• In total, over 4200 survey respondents completed the survey representing approximately 55% of outpatient MH LIPs.

• Survey is a baseline measure prior to majority of new staff being brought on board.

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Implementation

VETERANS HEALTH ADMINISTRATION

• National report– Shows the demographics of survey responders and item-by-item responses– For each survey item, the average (i.e., mean) response for VHA and each VISN

is displayed. • Facility-specific reports

– Quantitative report• Showing percentage of VHA, VISN, and facility respondents who answered

each item in a certain way• Showing standard deviation bars for the average of all VHA facilities and

average of all VISN facilities bars for each response choice. – List of verbatim comments generated from the open-ended survey items that

asked about providers’ “concerns” or “compliments” about mental health services at their facility.

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Survey Reports

VETERANS HEALTH ADMINISTRATION

• MH programs and providers offer best practices and are Veteran-centric, recovery-oriented, and effective in helping Veterans.

• MH providers support care coordination, as well as treatment.• MH providers are working at the top of their license.• MH providers are involved in planning improvements regarding access to care,

performance metrics, and to meet Uniform Mental Health Services Handbook requirements.

• Telemental health improves access at Community-Based Outpatient Clinics (CBOCs).

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Identified Strengths in the Provider Survey

VETERANS HEALTH ADMINISTRATION

• Mental health continues to have difficulties filling vacancies. • Access to evidence-based psychotherapies is not always available in individual

clinics and in CBOCs.• Collateral duties reduce available time for patient care. More clerical support is

needed.• Availability of extended hours is limited due to various barriers, including clerical

support and security.• Transportation and parking improvements are needed for Veterans seeking care.• Space limitations in some cases need to be addressed.• Telemental health equipment shortages or technical performance issues limit the

availability of these services.

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Areas for Improvement Identified in the Survey

VETERANS HEALTH ADMINISTRATION

Consistent with quantitative results• Extent that services at the facility are perceived as Veteran-centric or recovery-oriented. • Problems associated with communication or care coordination between programs or services• The use of (or failure to use) mental health staff capabilities• Use of mental health staff time, including a lack of staff, to accomplish necessary work• Scheduling of mental health services• Staffing issues associated with human resources or facility factors• Relationship between mental health staff and mental health or facility leadership• A gap in specific services or services for a specific population• Telemental health • After hours services• Physical accessibility of services to Veterans• Space• Morale or burnout level of staff• Focus on mandates and performance measures over local needs

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Themes from the Verbatim Comments

VETERANS HEALTH ADMINISTRATION

Comparison to OMHO Site Visit Findings

• FY12 site visit findings below identified many of the same areas needing improvement including Staffing, Access, CBOCs, and Scheduling.

• Provider Survey identified a high rate of staff involvement in quality improvement and pride in quality of mental health services delivered.

Providing adequate staffing

MH access

Scheduling MH services

MH services at CBOCS

Suicide prevention

Community partnerships

PC-MHI

Care transitions

Evidence-based treatments

Recovery-oriented care

OPPORTUNITIES FOR IMPROVEMENT

STRENGTHS

VETERANS HEALTH ADMINISTRATION

• VA is executing President Obama’s Executive Order to improve MH access.• VA provides ongoing monitoring of mental health staffing levels.• VA monitors access times and is working with facilities to improve

accessibility of evidence-based psychotherapies (EBP).• VA is monitoring the hiring of clerical support staff to assist the field in

decreasing clerical time of clinical providers.• VA has required facilities to expand hours for mental health services within

the new Extended Hours Directive.• VA continues to make provision of space for mental health a priority in the

Strategic Capital Investment Portfolio (SCIP) planning process.• VA is expanding telehealth services to outlying CBOCs to improve access to

care for rural Veterans.

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VHA’s Next Steps and Actions to Address Areas of Improvement   

VETERANS HEALTH ADMINISTRATION

• OMHO has reviewed results with VHA senior leadership. • OMHO has disseminated survey reports to facilities/Veterans Integrated

Service Networks(VISN ) to develop local action plans. – Facilities can use this data to develop and implement strategies to

better serve Veterans’ mental health needs. – Facility action plans will be submitted as part of the quarterly updates

on each facility’s mental health strategic action plan submitted to OMHO.

– OMHO is available for technical assistance/consultation.• OMHO will conduct the second administration of this survey in fall 2013 to

assess the impact of the new hires on mental health practice. • Annual surveys will be conducted in future years.

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VHA’s Use of Survey Results to Guide Future Actions

VETERANS HEALTH ADMINISTRATION

• Review national quantitative report and themes• Review facility quantitative report

– Identify facility-level strengths – Identify facility-level areas for improvement

• Review verbatim comments with key leadership• Initiate direct and candid discussions about these results with staff• Review OMHO site visit report findings and other external/internal data• Create themes based on assimilation of survey report data• Add action items to existing facility strategic action plan to be submitted

to OMHO• Create an ongoing forum(s) for communication/feedback from ALL staff

(providers and clerical staff).

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How to Use Reports to Guide Facility Action Planning

VETERANS HEALTH ADMINISTRATION

What else do you need from us to help you with the survey report action planning?

What changes or suggestions might you have for the survey or survey process?

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Questions/Feedback?