Wednesday, May 31, 2017

No Veteran Help

From USA Today:
"It's been a year. Why hasn't vets' suicide hotline fixed its problems?"

More than a year after an investigation, the government agency that manages the nation's suicide-prevention hotline for veterans has not been able to put in place seven recommendations from its own inspector general designed to improve the crisis line's performance. That February 2016 report on the Veterans Health Administration substantiated allegations that "some calls routed to backup crisis centers were answered by voicemail and callers did not always receive immediate assistance from VCL (Veterans Crisis Line) and/or backup staff." The recommendations included gathering better data when callers were routed to backup centers, silent monitoring of responders and ensuring staff orientation and training goals are being met.  Veterans Affairs' officials did not answer a request for comment. An average of 20 veterans die by suicide every day, according the federal Department of Veterans Affairs' own assessment. The crisis line was established in 2007 and operates at its own site at Canandaigua Veterans Affairs Medical Center here with an additional center in Atlanta that opened in October 2016. The VA estimates that the crisis line has answered close to 2.8 million calls since it was launched and initiated emergency services more than 74,000 times. The Veterans Health Administration was scheduled to put recommendations in place for the crisis line by September and then asked for an extension to March — a deadline it also hasn't met. The report from the Veterans Affairs' Office of the Inspector General released March 20 found that the agency's "failure to implement our previous recommendations impairs the VCL's ability to increase the quality of crisis intervention services to veterans seeking help." 

Additional findings:
• The crisis line did not respond adequately to a veteran's urgent need.
• Crisis line workers continue to poorly manage incoming phone calls.
• Governance and oversight of the Veterans Crisis Line's operations also continue to be deficient.

One veteran's interaction with the crisis line and backup centers led the Office of Inspector General to identify problems with manually writing down of callers' numbers, a lack of process to review adverse outcomes, an inability to record calls and an inability to track the performance of the backup call centers that take calls when counselors in Canandaigua are busy with other veterans. And follow-up was lax, according to the most recent evaluation from the Office of Inspector general.  "VCL leaders did not collect data regarding attempted or completed suicides following a veteran's contact with the VCL," the report indicated. Nor did crisis line leadership review or debrief staff if veterans who had been in contact attempted or committed suicide. VA Inspector General Michael Missal acknowledged staff members' dedication but said in a statement accompanying the release of the report: "It is imperative that VA take further steps to increase effectiveness of VCL operations." The crisis center has had no permanent leadership since June when the director appointed after a shakeup following the February 2016 report resigned four months later, said the most recent report and further information from the Military Times in June. 

The March 20 report makes an additional 16 recommendations intended to address the ongoing deficiencies including these:
• Hold backup call centers to the same standards as the Veterans Crisis Line in New York.
• Develop more robust reporting of the clinical outcomes.
• Use an automated transcription function for callers' phone numbers.
• Review data on outcomes.

The problems continued in part because of the October launch of the additional call center in Atlanta that redeployed Canandaigua staff to provide training. The VA estimate that the crisis line handles half a million calls a year — in addition to texts and emails — space requirements in upstate New York and recruitment pool limitations created the decision to expand to a second site.  In a statement delivered to an April 27 Senate hearing on preventing veteran suicide, Missal said that bringing Atlanta up contributed to a delay in developing procedures, including deferring annual lethality-assessment training for responders. Lethality assessments gauge a caller's potential for suicide.  "Lack of formal planning and inaccurate forecasting resulted in more than 16,000 hours of Canandaigua FTE (full–time equivalent) employees being temporarily redirected to the Atlanta call center for training and operations," Missal said. That's the equivalent of 100 employees working 40 hours a week for four weeks to train Atlanta staff. "This led to an increase in the number of calls that rolled over to backup centers and delays in the development and implementation of VCL processes, policies, and procedures," he said. The report showed that the crisis line's November rollover rate, the number of inbound calls that staff did not answer, was close to 30%. "Backup call centers historically have placed VCL rollover calls into a queue without immediately providing service or risk assessment," the VA Office of Inspector General found. Veterans Affairs' acting under secretary for health, Dr. Poonam L. Alaigh, agreed with the latest report and all 16 inspector general recommendations. She outlined a list of responses with target dates from May to December of this year.

^ The VA and the suicide-prevention hotline are clearly failing the veterans they are supposed to be helping. If the VA can not get its act together and start saving lives then someone else needs to step-in and get the job done. Veterans risked their lives to protect us and we should not forget them when their service is over and they need help. To do so is a disgrace. ^

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