Fast Facts

The Department of Veterans Affairs operates 300 Vet Centers throughout the U.S. that provide counseling services to military veterans and their families.

The agency has changed how it assesses Vet Center counselors' productivity and its expectations for the number of clients that the counselors see each week. But the VA hasn't evaluated how these new expectations may affect veteran care or counselor practices. For example, counselors told us these changes could negatively affect client care, such as spending less time with them to be able to fit more clients into their schedules.

Our 4 recommendations address these and other issues.

Vet Centers serve veterans and their families.

vet center

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Highlights

What GAO Found

The Veterans Health Administration's (VHA) Readjustment Counseling Service (RCS) provides counseling through 300 Vet Centers, which can be found in community settings and are separate from other VHA facilities. RCS has set expectations for counselor productivity at Vet Centers. For example, one expectation is for counselors to achieve an average of 1.5 visits for each hour they provide direct services. However, RCS officials told GAO that they have not conducted, and do not have plans to conduct, an evaluation of the expectations.

VA Vet Center Productivity Expectations for Counselors

Although most counselors met the productivity expectations in fiscal year 2019, counselors GAO spoke with said the expectations led them to change work practices in ways that could negatively affect client care. For example, counselors at one Vet Center told GAO that, to meet productivity expectations, they spend less time with each client to fit more clients into their schedules. Without an evaluation of its productivity expectations, RCS lacks reasonable assurance that it is identifying any unintended or potentially negative effects of the expectations on counselor practices and client care.

RCS officials told GAO that by the start of fiscal year 2021 they plan to implement a staffing model to identify criteria for determining staffing needs at Vet Centers. The model incorporates data on counselors' productivity (work hours and number of visits), and total clients to determine criteria for adding or removing a counselor position from a Vet Center. However, the model does not fully address key practices in staffing model design GAO identified in previous work. For example, the model does not include the input of Vet Center counselors, or client data associated with directors, who also provide counseling. As a result, RCS is at risk of making decisions about Vet Center staffing that may not be responsive to changing client needs. Shortages of mental health staff within VHA coupled with the increasing veteran demand for mental health services highlight the critical importance of ensuring appropriate Vet Center staffing.

Why GAO Did This Study

VHA's RCS provided counseling (individual, group, marriage, and family) and outreach services through Vet Centers to more than 300,000 veterans and their families in fiscal year 2019. In 2017, RCS implemented changes to expectations that it uses to assess Vet Center counselor productivity, setting expectations for counselors' percentage of time with clients and number of client visits.

GAO was asked to review Vet Center productivity expectations for counselors and staffing. Among other issues, this report examines the extent to which VHA (1) evaluates its productivity expectations; and (2) assesses Vet Centers' staffing needs. To do this work, GAO reviewed RCS documentation regarding counselors' productivity expectations and analyzed RCS data on counselor productivity expectations and staffing, for fiscal year 2019. GAO interviewed RCS leadership, including district directors, and directors and counselors from 12 Vet Centers, selected for variation in geographic location and total number of clients, among other factors.

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Recommendations

GAO is making four recommendations, including that VHA (1) evaluate Vet Center productivity expectations for counselors; and (2) develop and implement a staffing model that incorporates key practices. The Department of Veterans Affairs concurred with GAO's recommendations and identified actions VHA is taking to implement them.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Veterans Affairs The Under Secretary for Health should ensure the RCS Chief Officer evaluates Vet Center productivity expectations for counselors, including (1) obtaining systematic feedback from counselors on any potentially negative effects on client care, and (2) determining whether directors and counselors need additional training or guidance on how the expectations are calculated. (Recommendation 1)
Open
VA concurred with this recommendation and, in March 2021, provided an update on efforts to address it. VA Readjustment Counseling Service (RCS) officials stated that they had entered into an agreement with the Veterans Experience Office to modernize their customer feedback program, which has included interviews with staff, clients, and stakeholders. RCS officials also described its agreement to obtain a needs assessment for the counselors' clinical training, with the intention of creating a training curriculum for staff cohorts. Finally, RCS officials noted that they are incorporating the results of the 2020 and 2021 VA All Employee Survey into these efforts, and provided a projected completion date of September 2021. RCS' actions related to client/customer feedback and training needs are useful towards fulfilling the intent of the second half of our recommendation (on determining whether additional training or guidance is needed). However, in order to fully implement this recommendation, RCS officials need to address the first part of our recommendation, which is focused on evaluating the expectations for counselor productivity, including collecting systematic feedback from counselors on any potentially negative effects on client care that result from those expectations. As stated in our report, the All Employee Survey does not include questions that address RCS counselor productivity expectations, so these survey results are of limited usefulness in assessing counselors' views on potentially negative effects of the expectations. RCS officials need to ensure that the Veterans Experience Office's interviews with RCS counselors include obtaining their feedback about any potentially negative effects of the productivity expectations.
Department of Veterans Affairs The Under Secretary for Health should ensure the RCS Chief Officer develops a plan and time frames for periodically reassessing its productivity expectations for counselors, and implementing any needed changes as appropriate. (Recommendation 2)
Open
VA concurred with this recommendation, and in March 2021, provided an update on efforts to address it. VA RCS officials stated that they were in the process of establishing a workgroup that will recommend performance improvement and quality assurance activities related to counseling to RCS' Governance Board. The target completion date for these actions is September 2021. To implement this recommendation, RCS officials need to ensure that the workgroup develops a plan and time frames for periodically reassessing productivity expectations for counselors and implementing any needed changes as appropriate.
Department of Veterans Affairs The Under Secretary for Health should ensure the RCS Chief Officer develops and implements a Vet Center staffing model that incorporates key practices in the design of staffing models. (Recommendation 3)
Open
VA concurred with this recommendation and, in March 2021, provided an update on its actions to address it. Specifically, VA RCS officials stated that they are working to ensure that their draft staffing model is compliant with applicable VHA standards and accepted practice, with a target completion date of January 2022. In line with our recommendation, RCS should also ensure that the draft model incorporates key practices in the design of staffing models as described in our report.
Department of Veterans Affairs The Under Secretary for Health should ensure the RCS Chief Officer establishes a plan and time frames for assessing and updating its staffing model regularly, and for implementing any needed changes as warranted. (Recommendation 4)
Open
VA concurred with this recommendation and, in March 2021, provided an update on its actions to address it. Specifically, VA RCS officials stated that they are working to ensure that their draft staffing model is compliant with applicable VHA standards and accepted practice, and includes appropriate plans and time frames for re-evaluation, with a target completion date of January 2022. We will continue to monitor RCS officials' progress toward implementing this recommendation.

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