Vietnam Veterans: A Profile of VA's Readjustment Counseling Program

Highlights

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.

Recommendations

Matter for Congressional Consideration

Matter	Status	Comments
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.	Closed – Implemented	Public Law 100-322, approved May 20, 1988, repealed the transition requirement that vet centers be relocated to existing VA facilities.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.

Recommendations for Executive Action

Agency Affected	Recommendation	Status
Veterans Administration	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.	Closed – Implemented 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.
Veterans Administration	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.	Closed – Implemented 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.
Veterans Administration	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.	Closed – Implemented A teletype implementing this recommendation has been sent to the field.
Veterans Administration	The Administrator of Veterans Affairs should direct the Chief Medical Director to emphasize the need for regional officials to make their required site visits.	Closed – Implemented As of July 1987, vet centers have been visited once per quarter.
Veterans Administration	The Administrator of Veterans Affairs should direct the Chief Medical Director to monitor whether regional officials are making site visits as required.	Closed – Implemented Each region furnished VACO a monthly report on compliance with the visit requirement.
Veterans Administration	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.	Closed – Implemented Each region furnishes VACO a monthly report on compliance with the visit requirement.
Veterans Administration	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.	Closed – Implemented SCEN's for use in SERP surveys have been completed. Surveys will begin during the first quarter of FY 1988.
Veterans Administration	The Administrator of Veterans Affairs, through the Chief Medical Director, should require medical center directors to include vet centers in their systematic internal reviews.	Closed – Implemented 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.
Veterans Administration	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.	Closed – Implemented 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.

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Topics

Veterans

Community health servicesFederal facility relocationHealth care planningHealth resources utilizationHealth services administrationMental health care servicesProgram managementRehabilitation counselingVeteransVeterans hospitals