John Kehoe, LISW
Health Care for Re-Entry Veterans Specialist
Veterans Health Administration, VISN 18
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VISN 16 – South Central Health Care Network
 East Texas (Houston, Beaumont, Lufkin)
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VISN 17- Heart of Texas Health Care Network
 North Texas HCS (Dallas & Ft. Worth)
 Central Texas HCS (Waco/Temple/Austin)
 South Texas HCS (San Antonio & Kerrville)
 Valley/Costal Bend HCS (Harlingen, Laredo, & CC)
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VISN 18 – Southwest Health Care Network
 West Texas (Amarillo, El Paso, Big Spring, Abilene)
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Health Care for Re-Entry Veterans Program
– State/Private/Federal Prisons
– Educate and Enroll Eligible Veterans
– Resource Referrals
– Appointments for Care After Release
– Case Management until connected with VA
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Veterans Justice Outreach Program
– County/Local Jails Re-Entry Outreach
– Liaison with local Courts
– Educate local Law Enforcement
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Must have Honorable or General Discharge
 OTH discharges
OEF/OIF/OND have full eligibility for 5 years
Service-Connected Condition(SC)
Co-Pays at Higher Incomes Unless SC
Eligibility Restrictions for VHA Care while
incarcerated
▪ Outreach (HCRV/VJO)
▪ VBA benefits reduced/stopped
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Outpatient Mental Health Clinics
Acute Inpatient MH Services
Residential Rehabilitation Treatment
Programs
– Homeless Domiciliary, PTSD, Substance Use, MST
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Community-based MH Specialty Care
– PTSD & Military Sexual Trauma
– MH Intensive Case Management
– Homeless Programs
– Vocational Programs
– Tele-health & Home Health Care
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Building Motivation/Education in PCC &
MHCs
Outpatient SUD Program
Intensive Outpatient Care (9hrs/wk)
Residential Treatment Programs (30-90days)
Medication/Opioid Treatment Programs
Inpatient/Outpatient Detox
Talk therapies: MET, CBT, Yalominterpersonal group therapy
Work Therapies
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Voc. Rehab Benefits (SC at least 20%)
Incentive Work Therapy (IWT)
Compensated Work Therapy (CWT)
Supported Community Employment
Job Search Assistance
Assistance with VBA/SSDI Claims
(VSOs)
Peer Support
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Mental Health Uniform Services Plan
Mental Health in Primary Care
Psychosocial Recovery & Rehabilitation
Tele-Mental Health Services
Evidence-Based MH Therapies
Services for Women Veterans
Suicide Prevention
Ending Homelessness
Electronic Medical Record
Performance Measures to Improve Quality
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Based on President’s MH Commission
Supports Recovery Model
Emphasis on MH/PCC and Suicide
Prevention
Mandates Core MH Services at Each Site
Standardized MH Care Throughout USA
Significantly Enhanced MH Staff/Capacity
Mandates Evidence-Based MH Services
Tracks MH Outcomes and Staffing
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Co-located Mental Health Services in Primary
Care Clinics
 Reduces Stigma for Seeking MH Care
 Rapid Access for MH Screening/Services
 Treatment for Mild MH issues
▪ Adjustment Issues/Life Stress
▪ Uncomplicated Depression & Anxiety
▪ Harm Reduction for Substance Use Issues
 Referral to MHC/Specialized Treatment Programs
▪ Up to 80% of Cases Managed in PCC
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Healthy Behaviors/Disease Management
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Routine Outpatient MH Care
Primary Mental Health Provider
Holistic Coordinated Care
Psychotropic Medications
Gender & Cultural Sensitive Care
Evidence-based Psychotherapies
 Depression, Mild PTSD, Anxiety Disorders,
Psychosis and/or Marital/Couples/Family
Counseling
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Recovery is possible for everyone
It is the Veteran’s Recovery Plan
– Uses Understandable Language
– Based on Veteran’s Strengths & Personal Goals
– Peers as Role Models
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Include Family Support in MH Planning
Meaningful Work is the Best Therapy
Building Support Systems in the
Community
Educating to Reduce Stigma/Facility
Recovery Coordinators
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Tele-Mental Health Services
 Hospitals to Remote Clinics
 Cross coverage for Smaller Clinics
 “Health Buddies” to Monitor SMI at Home
 Home-based Videophones for Highly Rural
 Reduces Barriers of Distance & Stigma
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Future Directions
 Anonymous Chat Rooms (Suicide Hot Line)
 Peer Support Networks
 Secure Email with MH Providers
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Several VA Utilized Evidence-Based Treatments
– Prolonged Exposure (PE) and Cognitive Process Therapy (CPT)- PTSD
– Acceptance and Commitment Therapy (ACT)-PTSD, Depression,
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Anxiety, Substance Use, Chronic Pain, Smoking Cessation, Diabetes
Management
Yalom-based Interpersonal Group Therapy – PTSD, Substance Use
Cognitive Behavioral Therapy (CBT)- Depression, Anxiety, Substance
Use, PTSD
Motivational Enhancement Therapy (MET)- Substance Use
Medications
Couples/Marital Therapy
National Training Program in Evidence-Based Treatment
– One-week intensive workshop (national experts)
– 6-12 Months of weekly case supervision
– Train the Trainer Model for future staff
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National Suicide Hotline 1-800-273-TALK
(8255)
– Staffed by Trained MH Providers 24/7
– Arrange for Immediate Help
– Live Hand Off to Local VA Facilities
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Facility Suicide Prevention Coordinators
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Maintain List of High Risk Patients/Chart Flags
Develop/Implement Suicide Safety Plans
Investigate Suicide Attempts/Completed Suicides
Educates Staff and Community
Around-the-Clock MH Services
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VA Secretary’s 5-Year Plan
From 160K to ZERO Homeless Veterans!
Enhancing Existing Homeless Services
– New HUD-VASH Vouchers
– VA SUD and MH Capacity
– Residential & Contract Beds
– Court/Jail/Prison Outreach
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New Initiatives/Services
– Homeless Hot Line
– Emergency Funding to Prevent Homelessness
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Health Care for Homeless Veterans
Contract Emergency Shelters
Homeless Domiciliaries
Grant and Per Diem Transitional Housing
HUD/VASH
Emergency Cash Assistance to prevent
Homelessness
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Follows Veterans Across Sites/Locations of
Care
Digital X-Rays, Consults, Medications, Labs,
etc.
Flags High-Risk Conditions
Clinical Reminders for Better Care
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Smoking Cessation
Obesity
Diabetes
Hypertension
Tracks Quality of Care (Performance Measures)
Integration of Department of Defense Medical
Records
The VA uses the data gathered in its computers to
pinpoint problem areas, such as medication errors.
The network also allows it to track how closely the
medical staff is following evidence-based treatment
and monitor deficiencies. Such tracking pays off.
When Rand did an extensive study comparing
quality of care at the VA with private-sector
hospitals, it found that performance measurement
played an important role in helping the VA score
higher in every category except acute care, where it
came in about even.
Business Week, 2006
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www.texvet.com
– Supports Texas Military, Veterans & Family
– Health & Wellness, Employment, Education, Crisis,
Legal, Claim Support Services, etc.
– Statewide Peer-to-Peer Counseling
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211 Texas
– Just Dial 211
– 24/7 Information Line
– Services for Veterans/Active Duty
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Vet Centers
– Storefront locations, walk-in service
– Veteran and Family Counseling
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Moving from Hospitals to the Community
CPRS & Performance Measures
 Improved Access to Care
 Improved Quality of Care & Outcomes
 Improved Cost Effectiveness
 Improved Patient Satisfaction
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Holding VA Staff Accountable
 Managers’ Performance Plans
 Providers Performance Plans/Incentive Pay
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Contact your VISN MH Lead
– VISN 16: [email protected]
– VISN 17: [email protected]
– VISN 18: [email protected]
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Meet your local VJO and Re-Entry
Specialists
Work to Establish Veteran Dockets & Courts
Ask your clients if they ever served in the
US Military and give VA a chance to help
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VA Mental Health Services