Vietnam Veterans:

A Profile of VA's Readjustment Counseling Program

HRD-87-63: Published: Aug 26, 1987. Publicly Released: Aug 26, 1987.

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In response to a congressional request, GAO provided information on the Veterans Administration's (VA) Readjustment Counseling Program, specifically: (1) the need for retaining centers in community-based locations; (2) the characteristics and problems of clients who have sought counseling; and (3) program management issues.

GAO found that: (1) relocation of centers to existing VA facilities would probably not reduce program costs or improve veterans' access to quality counseling services; (2) most of the veterans who sought counseling served during the Vietnam era and appeared to have motivational or behavioral problems; and (3) there has been no significant change in the personal characteristics of clients since the program began. In addition, GAO found that the centers: (1) offer an array of services, including individual and group counseling and assistance with employment and VA benefits; (2) have established extensive community networks for outreach and referrals; and (3) are staffed by personnel with the academic, military, and professional experience that VA considers relevant, although many have been in their positions for less than 1 year. GAO also found that: (1) site visits are a critical mechanism for monitoring the centers' activities, but are not always conducted because of staff shortages and time demands; (2) data on client contact is incomplete and inconsistent; and (3) VA has not reviewed the quality of the counseling provided.

Matter for Congressional Consideration

  1. Status: Closed - Implemented

    Comments: Public Law 100-322, approved May 20, 1988, repealed the transition requirement that vet centers be relocated to existing VA facilities. It also required that the Administrator submit a national plan specifying, on a case-by-case basis, whether the Administrator proposes to relocate, close, or expand each existing vet center.

    Matter: Congress should consider permitting VA to decide on a case-by-case basis whether to relocate vet centers from storefront locations to existing VA facilities.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: Regional officials were furnished instructions to establish suspense files to ensure that 90-day visits are conducted. Site visit reports are to be monitored for compliance.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to: (1) clarify the importance of client follow-up; and (2) if follow-up is considered important, monitor regional officials' site visit reports to determine whether follow-up has been adequately conducted.

    Agency Affected: Veterans Administration

  2. Status: Closed - Implemented

    Comments: Instructions transmitted to all VA facilities, including medical centers, clinics and vet centers directing that proximate VAOPCS, even though not the support facility, provide training and clinical support to the vet center, and also that the same types of support should be provided from the vet center to the OPC. Instructions were transmitted on November 2, 1987.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to determine whether any outpatient clinic located closer than the current support facility could better provide clinical and training support to a vet center.

    Agency Affected: Veterans Administration

  3. Status: Closed - Implemented

    Comments: A teletype implementing this recommendation has been sent to the field.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to strengthen collaboration between vet centers and post-traumatic stress disorder units by requiring these facilities to establish formal communication concerning all clients referred from one to another.

    Agency Affected: Veterans Administration

  4. Status: Closed - Implemented

    Comments: As of July 1987, vet centers have been visited once per quarter.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to emphasize the need for regional officials to make their required site visits.

    Agency Affected: Veterans Administration

  5. Status: Closed - Implemented

    Comments: Each region furnished VACO a monthly report on compliance with the visit requirement.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to monitor whether regional officials are making site visits as required.

    Agency Affected: Veterans Administration

  6. Status: Closed - Implemented

    Comments: Each region furnishes VACO a monthly report on compliance with the visit requirement.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to request that the support facilities monitor the administrative and clinical activities at the centers where not enough site visits are being made.

    Agency Affected: Veterans Administration

  7. Status: Closed - Implemented

    Comments: SCEN's for use in SERP surveys have been completed. Surveys will begin during the first quarter of FY 1988.

    Recommendation: The Administrator of Veterans Affairs, through the Chief Medical Director, should require Department of Medicine and Surgery regional offices to include the vet centers in their systematic external review programs.

    Agency Affected: Veterans Administration

  8. Status: Closed - Implemented

    Comments: VA has stated that medical centers are not responsible for vet centers. New SERP protocol specifies requirements for internal reviews and states that a vet center's team leader should conduct such reviews. SIR specifications are being implemented on a recurring annual basis in conjunction with administrative site visits.

    Recommendation: The Administrator of Veterans Affairs, through the Chief Medical Director, should require medical center directors to include vet centers in their systematic internal reviews.

    Agency Affected: Veterans Administration

  9. Status: Closed - Implemented

    Comments: Regional officials' reviews are now routinely conducted in the case of the Associate Regional Manager for counseling clinical site visits. In the case of other officials' administrative site visits, a new standardized protocol including the recommended specifications has been sent to the field. As of December 1987, specifications for Team Leaders' reviews of records have been implemented.

    Recommendation: The Administrator of Veterans Affairs, through the Chief Medical Director, should establish specific requirements for regional and team leader reviews of vet center clinical files, including specifying the minimum frequency, magnitude, and documentation requirements, as well as requiring the reviewers to comment on quality of care provided to clients.

    Agency Affected: Veterans Administration

 

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