In a fit of propaganda, VA asserted it fixed the Veterans Crisis Line problem while in reality only fixing one of a myriad of problems.
Immediately after VA OIG released a scathing report about its Veterans Crisis Line last week, the agency released a press release saying it fixed the problem.
This assertion that the agency fixed the problem is pure propaganda because it actually resolved only one problem of many to grab headlines.
For the past three years, VA has repeatedly had numerous problems highlighted both in the press and by VA OIG.
VA asserts it fixed the problem by resolving call rollover to non-VA call centers, but this was only one of many problems that likely still persist. But, by stating that it fixed the Veterans Crisis Line in the headline, headline readers will believe VA resolved all problems when it likely did not.
So, the title of the press release only serves to deceive the public similar to former President George W Bush announcing that the Iraq war was over in 2005.
Background Of Press Release
The IG previously investigated whether VA had implemented the changes agreed to that were necessary for the Veterans Crisis Line (VCL). Those changes were agreed to February 2016. By November 2016, those changes were not implemented and included within an IG report issued this month. This was the final month of the audit released 3 months later.
VA issued a crafty press release asserting the agency fixed the call center issue one month after the field audit concluded, December 2016. But the assertion is deceptive.
VA Press Release – Veterans Crisis Line
In a press release issued immediately after the IG report, VA asserts it fixed the VCL December 2016, but the supposed fix only addressed one of a myriad of problems. The press release is titled, “VA fixes Veterans Crisis Line”:
In response to the recently released VA Office of Inspector General (OIG) report that reviewed processes from June 6 through Dec. 15, 2016, of the Veterans Crisis Line (VCL), the Department of Veterans Affairs (VA) released the following statement: “The Department of Veterans Affairs is proud to announce that the challenges with the Veterans Crisis Line have been resolved. Prior to the opening of our new Atlanta call center, our call rollover rate often exceeded 30 percent. Our current call rollover rate is less than 1 percent, with over 99 percent of all calls being answered by the VCL.
However, incoming call rollover to the VCL was only one of numerous problems previously addressed in the February 2016 audit report not to mention the March 2017 audit report.
I highlighted these last week and wanted to separately write about the press release to highlight the propaganda nature of how VA misuses titles and its public affairs office to deceive the public about veteran suicide prevention services.
VETERANS CRISIS LINE DEFICIENCIES
According to the IG report, present deficiencies include:
- VCL failed to collect data regarding attempted or completed suicides following contact with VCL
- VCL staff and supervisors failed to respond adequately to veterans’ urgent needs resulting in missed opportunities to help.
- Mandatory documentation of calls was insufficient to allow retrospective assessment of services provided by the responder to the caller.
- Clinical decision makers were largely excluded from decisions made by VCL governance resulting in a failure to appropriately consider clinical perspectives.
- No permanent director has been appointed to oversee the program.
- VCL still lacked enough staff to answer calls resulting in calls rolling over to backup call centers contracted by an external vendor who were not properly trained.
VETERANS CRISIS LINE IGNORED RECOMMENDATIONS
In addition, let’s not forget the recommendations IG made in February 2016 that VHA agreed to but failed to implement. These were:
We recommended that the OMHO (now VHA Member Services) Executive Director ensure that issues regarding response hold times when callers are routed to backup crisis centers are addressed and that data is collected, analyzed, tracked, and trended on an ongoing basis to identify system issues.
Appropriate VHA leaders did not demonstrate the use of the Link2Health data to improve performance. Although we found evidence that VCL staff reviewed
Link2Health data, we did not find that they used the data systematically to provide feedback to backup centers regarding performance parameters such as queue times, abandonment rate, and call answer rate. At the time of this report, VHA had not completed the necessary actions to close this recommendation.
We recommended that the Member Services Executive Director ensure that orientation and ongoing training for all VCL staff is completed and documented.
We found that VHA did not ensure that orientation and ongoing training for all VCL staff was completed and documented. At the time of this report, VHA had not completed the necessary actions to close this recommendation.
We recommended that the Member Services Executive Director ensure that silent monitoring frequency meets the VCL and American Association of Suicidology requirements and that compliance is monitored.
We found that VHA had not yet ensured that the VCL establish a requirement for silent monitoring frequency of VCL calls and therefore could not have monitored compliance with such a requirement. VHA requested an extension until March 2017, and this recommendation remains open.
We recommended that the Member Services Executive Director establish a formal quality assurance process, as required by VHA, to identify system issues by collecting, analyzing, tracking, and trending data from the VCL routing system and backup centers, and that subsequent actions are implemented and tracked to resolution.
The VCL lacked key components of a formal quality assurance process necessary to comply with VHA requirements. Specifically, the VCL had not designated individuals with appropriate background and skills to provide leadership to promote quality and safety of care. VCL policies did not incorporate relevant existing VHA directives outlining the key elements of a successful QM program. The VCL also lacked a committee that regularly reviewed data, information, or risk intelligence, and that ensured that key quality, safety, and value functions were discussed and integrated into VCL processes. VHA requested a deadline extension of March 2017 to implement this recommendation.
We recommended that the Member Services Executive Director consider the development of a VHA directive or handbook for the VCL.
VHA concurred in the original response to this recommendation and stated it would establish a VHA directive for the VCL. We found that while VHA had made significant progress, it had not completed a VHA directive for operating the VCL (such as outlining the VCL purpose, roles and responsibilities). VHA requested a deadline extension of March 2017 to complete the VHA directive for the VCL.
We recommended that the Member Services Executive Director ensure that contractual arrangements concerning the VCL include specific language regarding training compliance, supervision, comprehensiveness of information provided in contact and disposition emails, and quality assurance tasks.
We found that while VHA established a new contract in April 2016 with a goal of improved quality assurance monitoring, VHA did not ensure compliance with the quality assurance surveillance plan for VCL backup center performance. VHA planned to extend the current contract for 6 months and requested an extension for implementation of this recommendation until September 2017.
We recommended that the Member Services Executive Director consider the development of algorithms or progressive situation-specific stepwise processes to provide guidance in the rescue process.
VHA stated that they were developing standard work processes for all caller types including SSA responsibilities during emergency dispatch. We found that VCL managers developed standard situation-specific progressive stepwise processes to provide guidance in the rescue processes. However, VHA needs to demonstrate the training and competence of SSAs on the current protocol to achieve closure. VHA requested a deadline extension of March 2017 to implement this recommendation.
So who do we believe? IG said the problems were massive. VA says it fixed the VCL one month later, but only highlights one of many problems yet unaddressed.