# Presentation: 685345

## Clinical Needs of Rural Veterans:  

**Clinical Needs of ****Rural Veterans:**

**Providing Mental Health Care**
** ****in CBOC’s**

**Kathy L. Henderson, MD**
**April 18, 2008**

## Mental Health Services in CBOC’s

- VHA Directive 2001-060
- Establish minimum standards for CBOC’s, 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

## Map of Mental Health in CBOC’s

***( 9/01)***

## Mental Health in CBOC Plan

- Initiated by MHPL in FY02
- Conducted VISN-wide population-based analysis
- Established 3 priority levels of CBOC’s
- 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

## Mental Health in CBOC Plan

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

## National Mental Health in CBOC Performance Measure

- Established in FY05 – FY07
- CBOC’s serving > 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

## Mental Health in CBOC Initiative Funding

|  | FTEE | FUNDING |
| --- | --- | --- |
| FY06 | 13 | $1,434,120 |
| FY07 | 26.5 | $3,123,315 |
| TOTAL | 39.5 | $4,557,435 |

**Total MH CBOC Staffing FY07 = 169.5 FTEE**

## Telemental Health Initiative Funding

|  | FTEE | FUNDING |
| --- | --- | --- |
| FY06 | 5 | $728,283 |
| FY07 | 3.4 | $273,910 |
| TOTAL | 8.4 | $1,002,193 |

|  | UNITS/MAINTENANCE | FUNDING |
| --- | --- | --- |
| FY07 | 56 | $178,996 |

## Mental Health in CBOCWorkload (Uniques)

| SITE | FY03 | FY04 | FY05 | FY06 | FY07 |
| --- | --- | --- | --- | --- | --- |
| Alexandria | 872 | 1247 | 1580 | 1634 | 1718 |
| Biloxi | 7792 | 8725 | 8704 | 8328 | 8966 |
| Fayetteville | 1330 | 2075 | 2382 | 3088 | 3668 |
| Houston | 2465 | 2752 | 4150 | 4524 | 5311 |
| Jackson | 762 | 1642 | 1234 | 1436 | 1652 |
| Little Rock | 360 | 672 | 994 | 1088 | 1323 |
| Muskogee | 3107 | 3685 | 3879 | 3771 | 3850 |
| New Orleans | 1550 | 1634 | 2693 | 4763 | 5148 |
| Oklahoma City | 114 | 856 | 1621 | 1824 | 1576 |
| Shreveport | 1021 | 1385 | 1832 | 1781 | 1772 |
| VISN 16 | 19,363 | 24,642 | 29,036 | 32,175 | 34,922 |

-           **80% ****↑ in uniques FY03-FY07****	****             117% ↑ in encounters FY03-FY07**

## Telemental Health Workload

|  | FY03 | FY04 | FY05 | FY06 | FY07 |
| --- | --- | --- | --- | --- | --- |
| Uniques | 913 | 2,715 | 2,819 | 3,314 | 3,692 |
| Encounters | 1,178 | 4,811 | 7,940 | 11,478 | 13,338 |

**304% ****↑ in uniques FY03-FY07****	****1032% ↑ in encounters FY03-FY07**

## Map of VISN 16 CBOC’s

## CBOC’s by Parent Facility

| Alexandria
Lafayette
Jennings | Biloxi
Mobile
Pensacola
Panama City
*Eglin AFB | Fayetteville
Mt. Vernon
Ft. Smith
Harrison
*Branson | Houston
Beaumont
Lufkin
Galveston/Texas City
Conroe | Jackson
Meridian
Hattiesburg
Kosciusko
Greenville
Natchez/
Meadville
Columbus |
| --- | --- | --- | --- | --- |
| Little Rock
Mountain Home
El Dorado
Hot Springs
Mena
Pine Bluff | Muskogee
Tulsa
McAlester | New Orleans
Baton Rouge
Houma
Hammond
Slidell
St. John | Oklahoma City
Lawton
Wichita Falls
Ponca City
Ardmore
Konawa
*Stillwater | Shreveport
Texarkana
Monroe
Longview |

*******To be activated in FY08**

## FY08 CBOC Activation

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

## 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

## Accomplishments from FY02 – FY07

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

## 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

## Uniform Services Package for Mental Health (CBOC’s)

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

## Uniform Services Package for Mental Health (CBOC’s)

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