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. Ira Katz, M.D. Mark Shelhorse, M.D. remains in Acting role through May 28, when Dr. Katz formally begins 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 Accepted position end of July, 2005 Detailed starting August 12, 2005 Detailed starting August 12, 2005 Began permanent position start of October, 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) Lead person for the office is now titled the Deputy Chief Patient Care Services Officer for Mental Health (DPCSOMH) Important: Chief Consultant title elevated Important: Chief Consultant title elevated DPCSOMH appointed to NLB DPCSOMH appointed to NLB Deputy Chief Consultant for Mental Health Deputy Chief Consultant for Mental Health Directly under the DPCSOMH Directly under the DPCSOMH Now has major supervisory responsibility within the office and for decentralized staff Now has major supervisory responsibility within the office and for decentralized staff

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

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

CENTERS OF EXCELLENCE Congressionally mandated in Waco, Canandaigua, and San Diego Congressionally mandated in Waco, Canandaigua, and San Diego Site visits to each 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 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 Began in Fran Murphy, MD’s office; now transferred to Office of Mental Health Services I was Co-Chair from beginning I was Co-Chair from beginning Ken Weingardt, Ph.D., VA Palo Alto new Co-Chair Ken Weingardt, Ph.D., VA Palo Alto new Co-Chair Comprehensive content under development Comprehensive content under development Psychoeducational material by diagnoses and by functional problems Psychoeducational material by diagnoses and by functional problems Self screening Self screening Continuous recovery component Continuous recovery component

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Process to date Process to date Monthly calls (approximately) Monthly calls (approximately) Current heritage members provided history from their perspective, their interests, their ideas about future directions: Current heritage members provided history from their perspective, their interests, their ideas about future directions: Jeff BurkDan Kivlahan Pat DubbertChristine LaGana Bob GresenEd Nightingale Mary JansenJudy Patterson One new replacement member added: Steve McCutcheon One new replacement member added: Steve McCutcheon Turning now to new issues Turning now to new issues

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

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

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

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

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

Questions for input Questions for input Ensuring financial stability, e.g., in lean VA budget years 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? 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? Development of a political strategy simultaneously with finalizing plans; i.e., how best to keep focus on COA seat?