I 

116TH CONGRESS 

2D SESSION H. R. 8107 

To direct the Secretary of Veterans Affairs to submit to Congress a report 

on efforts by Department of Veterans Affairs to implement safety planning in emergency departments, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

AUGUST 25, 2020 

Mr. LEVIN of Michigan (for himself and Mr. STIVERS) introduced the 

following bill; which was referred to the Committee on Veterans’ Affairs 

A BILL 

To direct the Secretary of Veterans Affairs to submit to 

Congress a report on efforts by Department of Veterans 

Affairs to implement safety planning in emergency departments, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘VA Emergency De5 partment Safety Planning Act’’. 


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1 SEC. 2. REPORT ON EFFORTS BY DEPARTMENT OF VET2 ERANS AFFAIRS TO IMPLEMENT SAFETY 

3 PLANNING IN EMERGENCY DEPARTMENTS. 

4 (a) FINDINGS.—Congress makes the following find5 ings: 

6 (1) The Department of Veterans Affairs must 

7 be more effective in its approach to reducing the 

8 burden of veteran suicide connected to mental health 

9 diagnoses, to include expansion of treatment deliv10 ered via telehealth methods and in rural areas. 

11 (2) An innovative project, known as Suicide As12 sessment and Follow-up Engagement: Veteran 

13 Emergency Treatment (in this subsection referred to 

14 as ‘‘SAFE VET’’), was designed to help suicidal vet15 erans seen at emergency departments within the 

16 Veterans Health Administration and was success17 fully implemented in five intervention sites beginning 

18 in 2010. 

19 (3) A 2018 study found that safety planning 

20 intervention under SAFE VET was associated with 

21 45 percent fewer suicidal behaviors in the six-month 

22 period following emergency department care and 

23 more than double the odds of a veteran engaging in 

24 outpatient behavioral health care. 

25 (4) SAFE VET is a promising alternative and 

26 acceptable delivery of care system that augments the 


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1 treatment of suicidal veterans in emergency depart2 ments of the Veterans Health Administration and 

3 helps ensure that those veterans have appropriate 

4 follow-up care. 

5 (5) Beginning in September 2018, the Veterans 

6 Health Administration implemented a suicide pre7 vention program based on the findings of SAFE 

8 VET, known as the SPED program, for veterans 

9 presenting to the emergency department who are as10 sessed to be at risk for suicide and are safe to be 

11 discharged home. 

12 (6) The SPED program includes issuance and 

13 update of a safety plan and post-discharge follow-up 

14 outreach for veterans to facilitate engagement in 

15 outpatient mental health care. 

16 (b) REPORT.— 

17 (1) IN GENERAL.—Not later than 180 days 

18 after the date of the enactment of this Act, the Sec19 retary of Veterans Affairs shall submit to the appro20 priate committees of Congress a report on the ef21 forts of the Secretary to implement a suicide preven22 tion program for veterans presenting to an emer23 gency department or urgent care center of the Vet24 erans Health Administration who are assessed to be 

25 at risk for suicide and are safe to be discharged 


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1 home, including a safety plan and post-discharge 

2 outreach for veterans to facilitate engagement in 

3 outpatient mental health care. 

4 (2) ELEMENTS.—The report required by para5 graph (1) shall include the following: 

6 (A) An assessment of the implementation 

7 of the current operational policies and proce8 dures of the SPED program at each medical 

9 center of the Department of Veterans Affairs, 

10 including an assessment of the following: 

11 (i) Training provided to clinicians or 

12 other personnel administering protocols 

13 under the SPED program. 

14 (ii) Any disparities in implementation 

15 of such protocols between medical centers. 

16 (iii) Current criteria used to measure 

17 the quality of such protocols including— 

18 (I) methodology used to assess 

19 the quality of a safety plan and post20 discharge outreach for veterans; or 

21 (II) in the absence of such meth22 odology, a proposed timeline and 

23 guidelines for creating a methodology 

24 to ensure compliance with the evi25 dence-based model used under the 


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1 Suicide Assessment and Follow-up 

2 Engagement: Veteran Emergency 

3 Treatment (SAFE VET) program of 

4 the Department. 

5 (B) An assessment of the implementation 

6 of the policies and procedures described in sub7 paragraph (A), disaggregated by gender and by 

8 race and ethnicity, including the following: 

9 (i) An assessment of the quality and 

10 quantity of safety plans issued to veterans. 

11 (ii) An assessment of the quality and 

12 quantity of post-discharge outreach pro13 vided to veterans. 

14 (iii) The post-discharge rate of vet15 eran engagement in outpatient mental 

16 health care, including attendance at not 

17 fewer than one individual mental health 

18 clinic appointment or admission to an in19 patient or residential unit. 

20 (iv) The number of veterans who de21 cline safety planning efforts during proto22 cols under the SPED program. 

23 (v) The number of veterans who de24 cline to participate in follow-up efforts 

25 within the SPED program. 


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1 (C) A description of how SPED primary 

2 coordinators are deployed to support such ef3 forts, including the following: 

4 (i) A description of the duties and re5 sponsibilities of such coordinators. 

6 (ii) The number and location of such 

7 coordinators. 

8 (iii) A description of training provided 

9 to such coordinators. 

10 (iv) An assessment of the other re11 sponsibilities for such coordinators and, if 

12 applicable, differences in patient outcomes 

13 when such responsibilities are full-time du14 ties as opposed to secondary duties. 

15 (D) An assessment of the feasibility and 

16 advisability of expanding the total number and 

17 geographic distribution of SPED primary coor18 dinators. 

19 (E) An assessment of the feasibility and 

20 advisability of providing services under the 

21 SPED program via telehealth channels, includ22 ing an analysis of opportunities to leverage tele23 health to better serve veterans in rural areas. 

24 (F) A description of the status of current 

25 capabilities and utilization of tracking mechaVerDate Sep 11 2014 01:39 Sep 04, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8107.IH H8107

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1 nisms to monitor compliance, quality, and pa2 tient outcomes under the SPED program. 

3 (G) Such recommendations, including spe4 cific action items, as the Secretary considers 

5 appropriate with respect to how the Depart6 ment can better implement the SPED program, 

7 including recommendations with respect to the 

8 following: 

9 (i) A process to standardize training 

10 under such program. 

11 (ii) Any resourcing requirements nec12 essary to implement the SPED program 

13 throughout Veterans Health Administra14 tion, including by having a dedicated clini15 cian responsible for administration of such 

16 program at each medical center. 

17 (iii) An analysis of current statutory 

18 authority and any changes necessary to 

19 fully implement the SPED program 

20 throughout the Veterans Health Adminis21 tration. 

22 (iv) A timeline for the implementation 

23 of the SPED program through the Vet24 erans Health Administration once full 


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1 resourcing and an approved training plan 

2 are in place. 

3 (H) Such other matters as the Secretary 

4 considers appropriate. 

5 (c) DEFINITIONS.—In this section: 

6 (1) The term ‘‘appropriate committees of Con7 gress’’ means— 

8 (A) the Committee on Veterans’ Affairs 

9 and the Subcommittee on Military Construc10 tion, Veterans Affairs, and Related Agencies of 

11 the Committee on Appropriations of the Senate; 

12 and 

13 (B) the Committee on Veterans’ Affairs 

14 and the Subcommittee on Military Construc15 tion, Veterans Affairs, and Related Agencies of 

16 the Committee on Appropriations of the House 

17 of Representatives. 

18 (2) The term ‘‘SPED primary coordinator’’ 

19 means the main point of contact responsible for ad20 ministering the SPED program at a medical center 

21 of the Department. 

22 (3) The term ‘‘SPED program’’ means the 

23 Safety Planning in Emergency Departments pro24 gram of the Department of Veterans Affairs estab25 lished in September 2018 for veterans presenting to 


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1 the emergency department who are assessed to be at 

2 risk for suicide and are safe to be discharged home, 

3 which extends the evidence-based intervention for 

4 suicide prevention to all emergency departments of 

5 the Veterans Health Administration. 

Æ 


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