Saturday, November 8, 2008

The New President and Healthcare - Part II - Medical Services

Before wholesale changes are made to US healthcare system, Mr. Obama should fix the two health systems that federal government controls. The Military Health System and the Veterans Administration are two of the largest health systems in the United States and have serious problems.

The critical problems with these entities are led by incompetent, indifferent and anti-scientific management. Mr. Obama should immediately request the Bush Administration remove S. Ward Casscells, M.D. and Ellen Embrey. These two individuals are directly responsible for the lack of progress in the treatment of mental illness, mild-traumatic brain injury, traumatic brain injury, suicide and PTSD. They have led a campaign to continue the Bush Administration policy to underreport casualties in the Iraq and Afghanistan conflicts. Further, these individuals have aided and abetted the US Army’s program to deny benefits to wounded and disabled service members. Finally, they will babble endlessly about what we don’t understand about these injuries so it will require years of research. In fact, much more is known about these injuries then they would like Congress to believe. However, these scientific facts fly in the face of their political objectives so they have let contracts to friends of the US Army who will confuse the issue for years.

What to do following the dismissal of Dr. Casscells and Ellen Embrey.

First, quickly review all contracts let by these individuals for contract irregularities and pursue criminal prosecution. Next, remove the US Army from all leadership positions in programs related to mental health and brain injury. The US Army personnel should be replaced by officers from the Air Force and the Navy. The Air Force and Navy are more technologically enabled and lack a political agenda as both branches have honored their disability payments. It is not to say the US Army lacks officers with technical expertise in the areas of mental health or traumatic brain injury but they were excluded from the process because they could not get with the program. Instead, the US Army replaced them with people qualified as occupational therapists and physicians’ assistants. It is time to get organized and led by the right talent. Mental health and traumatic brain injury issues can be solved and could have been largely avoided if it had not become political. Finally, embrace the civilian medical sector. Much of the most advanced research in mental health and traumatic brain injury is at specialized centers such as the Kessler Institute in New Jersey. Civilian entities were willing an able to take a leading role in solving these problems but were denied participation by the hacks running MHS and the VA.

With regard to the VA, Mr. Obama should immediately remove the entire senior management. Dr. Jim Peake is the former US Army Surgeon General. When in uniform, he was part of the program that left the nation unprepared to deal with mental health and traumatic brain injury issues. He not only failed for active service members but also rewarded with even greater responsibility so he could fail them once of service members became veterans. Since the VA is evolved into a system to treat geriatric patients, the surge in younger service members should be guided to civilian medical resources at government expense. The major exception is in PTSD where the VA and CDC did some of the most distinguished work both scientifically and clinically. The VA needs to get some younger more aggressive leadership in this area and capitalize on the VAs expertise. It should also embrace private psychologists to screen and treat the less serious cases locally and triage the most complex cases to VA centers of excellence.

Again, the medical failure at MHS and the VA is not as much a monetary problem as it is a management problem. Last year $2,1B was distributed by Congress to the VA and MHS to treat wounded with TBI and mental health issues. Nonetheless, the leadership is unable to account for much of the spending and the results have been almost nonexistent. With little doubt, the bulk of our service members could have been identified and started treatment. It does and will require funds but funds well spent. Let’s fix the problem and stop the talk.

1 comment:

BAM said...

Let me just say you are partially right.
Many of the problems are not as much from a lack of funding as to where this new funding is going or not. It is often diverted into programs other than what it was intended or withheld or partially discounted by receiving facility. Part used for under funding the intent, the other part to support the good ole boys.

Let me first say I'm a clinical social worker (therapist) who works for the VA.

The VA requires all social workers hired to be Clinical Social Workers (psychotherapists) Which is appropriate.

But the problem is that in (some) facilities psychologists/psychiatrists/Nurses feel threatened. That is part of the problem (foundation).

Clinical Social Workers are trained as well if not better to do the same job as Psychologist it takes 9-10 years some times longer to be lic as an LCSW. That is at the MSW level. That does not include the extra years for acquiring a DSW/Ph.D.

We have similar licensing with a little different focus of training. Psychologists are trained more in statistics and to interpret some psych tests that (some) LCSW's are not. LCSW's are also trained in Statistics just not at same level.
That's the difference in a nut shell. Essentially we do the same job except (some) of the testing. Psych testing is important only in limited cases it is still very controversial.

So all that aside, that is the bases of why some facilities feel it necessary to "protect certain ways of doing business" (the good ole boys club is very active in the VA. Often times Clinical Social Workers are on the losing end of this system. We often carry the highest case loads with the least support and lowest pay. Psychologists are often hired in at GS-13.

There are many good new therapies available and currently being researched. BUT the VA in (some facilities) restricts therapy to ONLY certain realms. Many doctors do not understand it and they frankly discount it. "If a pill wont fix it it can't be fixed) concrete thinking.

Many times pills wont fix complex issues. In fact pills can became the problem not the solution (try telling a doctor that).

Some of the facilities don't understand therapy so that creates fear so they refuse to go forward with therapy programs. Even though they are being told
(by Congress)they have to develop these therapy programs (evidence based solutions). These are fully researched and PROVEN to work.

The other problem is that the monies being given to hire new Clinical Social Workers are being withheld by the facilities (not all). Its that simple!

Many are being hired in as GS-9/11 Even though the VA is funding the facilities for GS-12 Clinical Social Workers LCSW's. The facility then takes the difference and uses it for their "pets".

Some VA's are on board and very supportive of their therapists.
Others have created very hostile work environment and the therapists are seen as a threat to all.
In these cases they often create HUGE/impossible case loads at the cost of patient care.

Clinical Social Workers are not a threat to psychologists/psychiatrists/Nurses we all have our place at the VA.

We LCSW's need help from the Public & the VA to stop the protectionist of some and discounting of others all at the cost of the patient. Hire qualified clinical (LCSW) social workers at the appropriate levels GS-12 with appropriate case loads and the problem is solved.

What is a LCSW? --------

The American Board of Examiners in Clinical Social Work (ABE) sets national practice standards, issues an advanced-practice credential, and publishes reference information about its board-certified clinicians.

Clinical Social Work Defined
Clinical social work is a practice specialty of the social work profession. It builds upon generic values, ethics, principles, practice methods, and the person-in-environment perspective of the profession. Its purposes are to:
Diagnose and treat bio-psycho-social disability and impairment, including mental and emotional disorders and developmental disabilities.
Achieve optimal prevention of bio-psycho-social dysfunction.
Support and enhance bio-psycho-social strengths and functioning.
Clinical social work practice applies specific knowledge, theories, and methods to assessment and diagnosis, treatment planning, intervention, and outcome evaluation.
Practice knowledge incorporates theories of biological, psychological, and social development. It includes, but is not limited to, an understanding of human behavior and psychopathology, human diversity, interpersonal relationships and family dynamics; mental disorders, stress, chemical dependency, interpersonal violence, and consequences of illness or injury; impact of physical, social, and cultural environment; and cognitive, affective, and behavioral manifestations of conscious and unconscious processes.
Clinical social work interventions include, but are not limited to, assessment and diagnosis, crisis intervention, psychosocial and psycho-educational interventions, and brief and long-term psychotherapies. These interventions are applied within the context of professional relationships with individuals, couples, families, and groups. Clinical social work practice includes client-centered clinical supervision and consultation with professional colleagues.
Adopted 12 Feb. 1995
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