VA Vet Centers: Evaluations Needed of Expectations for Counselor Productivity and Centers' Staffing

GAO-20-652 Published: Sep 23, 2020. Publicly Released: Sep 23, 2020.
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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)
Closed – Implemented
VHA concurred with this recommendation and has provided updates on its progress toward implementation. As of April 2022, VHA RCS officials completed administering and evaluating a survey of its counselors and their experience with RCS's productivity expectations, as we recommended in 2020. RCS officials provided us with a copy of the survey instrument and their analysis of responses received. The survey asked counselors about possible negative impacts on client care as well as their training needs, as we recommended. We consider this recommendation implemented.
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)
Closed – Implemented
VHA concurred with this recommendation, and in January 2022, RCS officials provided documentation of their plan and time frames for periodically reassessing the productivity expectations. Officials assigned a council within RCS's recently established Governance Board structure to, among other things, recommend periodic updates to productivity expectations. RCS officials provided documentation of the council's charter and a memo outlining the biannual process for evaluating and updating counselor productivity expectations. Because RCS has developed a plan and time frames for periodic reassessments of the productivity expectations, we are closing this recommendation as implemented.
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
VHA concurred with this recommendation and has provided periodic updates on its progress toward implementation. As of April 2022, RCS officials stated that they were working with VHA's workforce office to finalize an updated staffing model and planned to address our recommendation by July 2022. RCS has not stated whether its plans for a revised staffing model for Vet Centers will incorporate key practices in staffing model design, as we recommended in September 2020. In order to implement this recommendation, RCS will need to demonstrate that its revised staffing model fully address the four key practices we found lacking in our report: (1) involve key stakeholders; (2) incorporate work activities, their frequency, and the time required to conduct them; (3) ensure the quality of data used in the model to provide assurance that staffing estimates are reliable; and (4) incorporate risk factors.
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
VHA concurred with this recommendation and has provided periodic updates on its progress toward implementation. As of April 2022, RCS officials reported that they planned to draft guidance to establish recurring reviews of the Vet Center staffing model once it is implemented, with a planned completion date of July 2022. We will continue to follow up with RCS on their progress in implementing this recommendation.

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