VA Vet Centers: Opportunities Exist to Help Better Ensure Veterans' and Servicemembers' Readjustment Counseling Needs Are Met
Fast Facts
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?
Highlights
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.
Recommendations
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
| Agency Affected | Recommendation | Status |
|---|---|---|
| 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) |
VHA concurred with this recommendation, and in May 2023, RCS officials provided documentation of their plan to use RCS's Vet Center feedback survey to periodically analyze how well Vet Centers are meeting the needs of individuals served both collectively across the organization, including subpopulations of clients. RCS also provided documentation of its analyses of the survey data that included results for clients collectively and for subpopulations of clients, such as for those who served in different military branches. We consider this recommendation implemented.
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| 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. As of March 2024, RCS officials said that RCS had taken steps to address this recommendation. Specifically, RCS officials stated that they worked with VA's Office of Information Technology to develop a software solution to access the Veterans Affairs/Department of Defense's Identity Repository, which contains the demographic information on veterans who recently transitioned from active service by zip code. RCS officials reported a planned implementation date of June 2024 for the software solution, but noted the need to complete union notifications and staff training before going live with the new system.
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| 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. As of March 2024, RCS officials said that the RCS Governance Board's Stakeholder Relations Council identified the need to pilot new outreach measurement processes in response to our recommendation. Officials stated that they planned to use the software solution being developed for recommendation 2 from our report to pilot this new outreach measurement process. A 6-month pilot at a selection of sites is estimated to be completed by September 2024. The council then plans to evaluate the results of the pilot and any changes needed to policy or measurement methodology. We will continue to follow up with RCS on its progress in implementing this recommendation.
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| 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. As of March 2024, RCS officials have taken steps to address this recommendation. Specifically, RCS Specifically, RCS provided documentation showing that they fielded a Vet Center Awareness survey from September to November 2023. The survey included questions to understand barriers eligible individuals experience when accessing Vet Center services, including awareness of Vet Center services and any challenges accessing those services, as we recommended. As such, we are closing this recommendation as implemented.
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| 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 March 2024, RCS officials provided documentation of the survey of Vet Center staff fielded in December 2023, as well as an operational memorandum describing plans to repeat this survey annually. Officials stated that they used this survey to address this recommendation as well as a related requirement in the James M. Inhofe National Defense Authorization Act for Fiscal Year 2023. As of July 2024, GAO has work examining the feedback RCS obtained from Vet Center counselors in this survey. As we undertake that work, we will assess whether the agency's actions have fully addressed this recommendation.
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