VA Vet Centers: Opportunities Exist to Help Better Ensure Veterans' and Servicemembers' Readjustment Counseling Needs Are Met
After combat, many veterans can readjust to civilian life, and servicemembers to continued military service, without major difficulties. For others, trauma experienced during combat leads to challenges such as mental illness or substance abuse. Veterans Health Administration Vet Centers provide eligible veterans and servicemembers—and their families—with counseling services.
But, VHA could better assess Vet Center services. For example, it isn't measuring the extent to which Vet Centers are meeting clients' needs, and it doesn't know whether it is minimizing barriers to Vet Center care. Our recommendations address these issues and more.
What are some examples of Vet Center clients' counseling needs in FY 2021?
What GAO Found
The Veterans Health Administration's (VHA) Readjustment Counseling Service (RCS) provides counseling (individual, group, couples, and family) through 300 Vet Centers to help eligible veterans, servicemembers, and their families readjust to civilian life or to continued military service.
RCS and Vet Centers use psychosocial assessments and feedback surveys to assess individual client needs and whether those needs are being met throughout the course of counseling. However, RCS does not assess the extent to which Vet Centers are meeting the needs of clients collectively, including client subpopulations that may experience different readjustment challenges. For example, RCS has not analyzed information from psychosocial assessments or feedback surveys to assess what proportion of Vet Center clients is making progress in having their needs met. Periodically assessing the extent to which Vet Centers are meeting the needs of clients collectively would help RCS identify whether any actions are needed to help ensure clients achieve successful readjustment.
Vet Centers also conduct outreach activities to inform eligible individuals and their family members about available services. Vet Centers use information they collect from outreach activities, such as the number of contacts made, to try to assess their effectiveness. However, there are limitations to using this information, according to officials from RCS and the Vet Centers in GAO's review. For example, these officials told GAO the number of outreach contacts may not be an appropriate way to assess the effectiveness of activities that do not generate a lot of contacts, such as those tailored to specific communities (e.g., Native Americans) with which it can take time to develop trust. Vet Center officials told GAO it would be helpful if RCS provided them with guidance that includes metrics and targets for assessing the effectiveness of their outreach activities. RCS officials told GAO they were in the early stages of developing such metrics. After their development, guidance for using these metrics and targets would help Vet Centers ensure their outreach is effective in increasing awareness among those who are eligible for services.
Officials from RCS and the five Vet Centers in GAO's review identified barriers to Vet Center care. Officials also identified steps they have taken to address barriers, including outreach to local veterans service organizations to increase awareness of services and providing care during non-traditional hours (e.g., evenings) and via telehealth to increase access. However, GAO found that RCS does not know the extent to which barriers to Vet Center care remain, because RCS does not have processes for assessing their extent. For example, RCS does not know approximately how many veterans experience challenges getting to Vet Centers during their hours of operation. RCS officials told GAO they have begun to develop efforts to assess the extent to which barriers remain but are in the early stages. Periodically assessing this would improve RCS's understanding of the magnitude of barriers. Such assessments would also improve RCS's understanding of whether additional steps are needed to mitigate or reduce any remaining barriers.
Why GAO Did This Study
Some veterans and servicemembers experience challenges, such as mental illness, when readjusting to civilian life or to continued military service. This can be due to trauma experienced during military service. VHA's Vet Centers provide services to eligible veterans, servicemembers, and their families.
The Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 included a provision for GAO to review VHA's RCS. This report examines (1) how VHA assesses whether Vet Centers are meeting clients' needs, (2) how Vet Centers assess the effectiveness of their outreach, and (3) barriers to Vet Center care VHA has identified and steps it has taken to address them. GAO reviewed VHA policies and interviewed officials from RCS and counselors and outreach staff from five Vet Centers. GAO selected Vet Centers for variation in geographic location and other factors. GAO also interviewed representatives from two veterans service organizations.
GAO is making five recommendations, including that VHA (1) develop a process to assess the extent that Vet Centers are meeting the needs of clients collectively; (2) provide Vet Centers guidance to assess the effectiveness of their outreach; and (3) develop a process to assess the extent of barriers to obtaining Vet Center care. The Department of Veterans Affairs concurred with GAO's recommendations and identified actions VHA is taking to implement them.
Recommendations for Executive Action
|Veterans Health Administration||The RCS Chief Officer should develop and implement a process to periodically assess the extent to which Vet Centers are meeting the needs of their clients collectively, including subpopulations of clients that may experience different challenges readjusting to civilian life or to continued military service. Such client subpopulations could include those who experienced trauma during military service and those who served in different conflicts. (Recommendation 1)||
VA concurred with this recommendation. In April 2022, RCS officials reported that data from RCS's Vet Center client feedback survey can be used to analyze how Vet Center services are meeting the needs of individuals served, and these data can be filtered in several ways, such as by client demographic characteristics (e.g., race, gender, age, branch of service, etc.) and organizational levels (e.g., RCS overall, Districts, Vet Centers). RCS officials stated RCS received enough survey response to conduct a macro-level analyses and more survey responses are needed to analyze demographic subsets of the data. They also stated that RCS will report the results of the analyses quarterly to the RCS Governance Board. VA requested closure of this recommendation. However, RCS has not demonstrated that it has a process in place to periodically assess the extent to which Vet Centers are meeting the needs of their clients collectively. In August 2022,in its 180-Day Update, VA requested closure again. However, it did not provide any additional information or documentation. To implement this recommendation, RCS will need to demonstrate that it has fully implemented such a process by, for example, providing documentation that outlines which staff are involved in the process, which survey questions are being analyzed and how, which subpopulations are being examined, how frequently the analyses will be conducted, how the information will be used, and copies of any findings or results from the analyses conducted. We will continue to follow up with RCS on its progress in implementing this recommendation.
|Veterans Health Administration||The RCS Chief Officer should ensure that Vet Centers have data on eligible individuals in their service area that they can use to tailor their outreach activities. These data could include information on veterans who have recently transitioned back from military service and veterans' demographic characteristics (e.g., age, gender, race, and ethnicity). (Recommendation 2)||
VA concurred with this recommendation. In April 2022, RCS officials reported that they intend to work with the Department of Defense to obtain data on veterans who recently transitioned from active service by zip code and provide it to Vet Centers to use for outreach. RCS officials also reported that they are working to provide Vet Centers with county-level data on their veteran populations and data on the demand for readjustment counseling services in their service areas. As of August 2022, RCS officials reported that they are continuing to evaluate and develop these processes, with a planned completion date of May 2023. We will continue to follow up with RCS on its progress in implementing this recommendation.
|Veterans Health Administration||The RCS Chief Officer should provide Vet Centers with guidance for assessing the effectiveness of their outreach activities. This guidance should include metrics for the outreach activities and targets against which to assess those metrics to determine effectiveness. (Recommendation 3)||
VA concurred with this recommendation. In April 2022, RCS officials reported that they are working to define and measure effective outreach. RCS officials stated they are assessing their current outreach practices and considering practices used by external organizations that have demonstrated outreach success. They also reported that RCS intends to develop metrics and refine its data collection processes for measuring outreach effectiveness and, once finalized, the data will be provided to Vet Centers to use to assess and monitor outreach activities. As of August 2022, RCS officials reported that they are continuing to discuss actions to assess all facets of effective outreach and qualitative and quantitative ways to measure them. RCS plans to complete this recommendation in May 2023. We will continue to follow up with RCS on its progress in implementing this recommendation.
|Veterans Health Administration||The RCS Chief Officer should develop and implement a process to periodically assess the extent of identified barriers eligible veterans and servicemembers may experience to obtaining services, including a lack of awareness about Vet Centers and challenges accessing Vet Center services. (Recommendation 4)||
VA concurred with this recommendation. In April 2022, RCS officials reported that they will use results from RCS's Vet Center client feedback survey to understand barriers eligible individuals experience to accessing Vet Center services. They also provided guidance for analyzing the survey results to RCS District Offices. RCS officials also stated they will explore partnerships with other VA offices and stakeholders to develop and implement a process to assess eligible individuals' awareness of Vet Center services. In August 2022, RCS officials reported that VHA will contract externally to develop a process to periodically assess eligible individuals' awareness of Vet Center services and determine what, if any, access barriers exist. RCS officials stated the contract is to be awarded by the end of fiscal year 2022 for implementation and evaluation in fiscal year 2023. RCS has a planned completion date of September 2023. We will continue to follow up with RCS on its progress in implementing this recommendation.
|Veterans Health Administration||The RCS Chief Officer should develop and implement a process to periodically assess the extent of identified barriers Vet Center staff may encounter to providing services, including challenges obtaining clinical consultations for complex cases. (Recommendation 5)||
VA concurred with this recommendation. In April 2022, RCS officials reported that they currently obtain some information about barriers Vet Center staff may encounter to providing services through existing survey processes, including training needs assessments and an annual employee survey, and from clinical oversight site visits conducted by RCS District Office staff. RCS officials also stated that they plan to evaluate the potential for including more specific questions about barriers to staff providing services in existing surveys. They stated that if doing so is not feasible, they will explore the possibility of creating a specific feedback mechanism to obtain this information. In August 2022, RCS officials reported that RCS is evaluating the processes related to this recommendation, and plan to complete the recommendation in September 2023. We will continue to follow up with RCS on its progress in implementing this recommendation.