[AVAPL Members] Re: Data and "Model of Care" for Psychology and MH?
- From: "Pierce, Philip S." <Philip.Pierce@xxxxxx>
- To: "'members1@xxxxxxxxx'" <members1@xxxxxxxxx>
- Date: Mon, 30 Aug 2010 08:51:57 -0400
Walter;
You never cease to amaze me!
From: avaplmembers-bounce@xxxxxxxxxxxxx
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of Walter Penk
Sent: Saturday, August 28, 2010 11:19 AM
To: members1@xxxxxxxxx
Subject: [AVAPL Members] Re: Data and "Model of Care" for Psychology and MH?
Thanks, Steven and Peter, for sharing your thoughts on productivity for
psychologists as measured by various indices, such as counts of Uniques and
Encounters, within the Veterans Health Administration...to which I would like
to add that we must not forget that there are many other approaches to
measurement that we must simultaneously consider, such as those indices that
Rudolf Moos long ago developed with his colleagues PERC to assess influences of
characteristics of treatment, family, and work environments, that Robert
Ellsworth showed to us in developing psychosocial processes and outcome
measures assessing impacts of services, that John Overall and others gave us to
consider as he and his group concentrated on physical and medical measures in
reactions to drugs, that Harold Gilberstadt explored for self-report measures
that now guide so many different kinds of evaluations for specific disorders,
and that Lee Gurel long ago taught us from PEP about models of care which we
now explore in so many different approaches in serving veterans. (It was great
to see Lee Gurel honored at APA annual meeting this year and I was pleased that
Division 18, oft times a partner in many activities with AVAPL, likewise
honored Rod Baker for his many contributions, including his books on the
history of Psychology in VA, a body of work that continues to inspire us all in
measuring our productivity to go beyond Uniques and Encounters to assess, as
well, VA Psychology's impact on personal and social adjustments.).
The point that Steven makes in the message below--that there is not any one
metric to measure workload--inspires us all to continue our search for the many
measures we must assess in order to discover what psychologists indeed may
accomplish through our partnerships with our clients.
________________________________
From: "Lovett, Steven Ph.D." <Steven.Lovett@xxxxxx>
To: members1@xxxxxxxxx; "Graves, Peter K" <Peter.Graves@xxxxxx>
Cc: "Wolfe, Gary R" <Gary.Wolfe2@xxxxxx>
Sent: Fri, August 27, 2010 6:35:12 PM
Subject: [AVAPL Members] Re: Data and "Model of Care" for Psychology and MH?
Peter, thanks for bringing this up. I think a discussion about this might be
worth the email landslide because I think it is, and will remain, one of the
biggest challenges Psychology is facing to keep the field vibrant and valued in
the VA. A couple of general thoughts ….
- It’s hard to imagine any one metric that will be able to accurately
reflect workload across the large variety of activities psychologists (& every
other VA provider) engage in. A hybrid (or multiple indictor) system might be
the most useful, even though it’s the most complicated.
- I think your point 5 is very important. These non-patient
activities seem to be ones that psychologists are heavily involved in and for
which there is no clear metric to capture the work involved. I’ve had the most
luck pointing this out when there were discussions about filling a particular
position and I’ve been able to make a list of all the activities that the
previous staff member was doing and would have to be tasked to multiple other
people if a psychologist isn’t selected to fill the position. Making the case
in a more general way seems to be very much harder.
I’m personally very interested in hearing how others have attempted to keep
management aware of the value of psychologists on staff, especially during
times of economic stress.
Steve
Steven Lovett, Ph.D.
Chief, Psychology, VAPAHCS
650-493-5000 ext 67106
Fax: 650-496-2597
Email: Steven.Lovett@xxxxxx<mailto:Steven.Lovett@xxxxxx>
From: avaplmembers-bounce@xxxxxxxxxxxxx
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of Graves, Peter K
Sent: Friday, August 27, 2010 3:48 PM
To: members1@xxxxxxxxx; Graves, Peter K
Cc: Wolfe, Gary R
Subject: [AVAPL Members] Data and "Model of Care" for Psychology and MH?
Hi all,
As we in VISN 22 become ever more data driven … One thing
we’re noticing is that our leadership may not understand our Model of Care very
well. Often by default, they try to impose models more familiar to them (such
as Primary Care’s “panel size,” “physician extenders,” “teamlets,” etc.).
Those models don’t always fit very well, and lead to further confusion and
frustration for everyone.
In our various Psychology and Mental Health Data and Discipline
groups, we’re struggling with how to develop ways to explain ourselves in ways
that Leadership can better understand. We believe an emphasis on data will
help. Among things we’re generally considering/using to varying degrees are
the following. This email is a request for any input on OTHER things you may
be using or trying out, in hopes of brainstorming ideas that may lead to a more
understood Psychology (and MH) Service generally. Then we’ll work on World
Peace.
Here’s what we’ve been using/considering so far:
1. Uniques and Encounters: the most readily available information, but
with all the pitfalls everyone knows. Our VISN leadership asked us to develop
some minimum/maximum “trigger points” for an average clinician’s unique and
encounters. The idea is that, with many exceptions for good reasons, an
average clinician’s workload should be looked at if it’s below or above the
range of triggers. For example, psychologists were pegged at 250-400 uniques
and 1300-1900 encounters. The data, of course, is all over the map for all
those reasons alluded to, and can be seriously misused. But at least our
Leadership has something as a reference standard.
2. RVU and DSS: some of us are further along than others on this, but we
hope the variable weighting of encounters overcomes some of the above pitfalls.
It’s not clear how available data is on individuals. We have a LOT to learn
here, and are plugging away.
3. Hybrid data: I understand there’s an existing system (which I believe
Russ Lemle and others use) which is kind of middle ground between 1 and 2 ,
where group encounters are separated from individual encounters, offering some
level of refinement.
4. “Carve outs:” Of course, in some programs there are mandated maximum
caseloads (MHICM, VASH, Day Programs, Home Based Care, etc.). And in others
there may be similar rationale for measuring by a different standard, which
would obviously need to be explained and supported.
5. “Extras:” We’re also starting to try to identify and measure “special
extras” we are bringing, such as:
a. Comp and Pen exams
b. Employee Assistance
c. ED backup coverage
d. Police Evals
e. Boards of Investigation
f. Other tasks for which “Psychology is so good,” and so seems to get a
disproportionate share of the load, without full appreciation of the cost in
other workload.
6. Guidance: In all of this we’ve referred to and quoted from the two
very helpful reports from Bob Gresen’s groups (the 2003 revised MH Provider
Workload document and the 2009 PowerPoint about FY08 Productivity and
Staffing), which we believe is the closest material to official guidance.
7. Teaming up: And of course we all lack sufficient resources to make a
serious effort in any of these areas. So by working together in the VISN we’re
hoping to support each other in our collective efforts and get further than any
of us could on our own. We’ll also be able to help our VISN Leadership
understand us better. We hope.
8. Bribery, sweet talking, threats.
Any other ideas you all have been using or are considering will be very
welcome. I’ll recommend NOT using “reply all” to reduce email blizzard, but be
happy to share a summary of what I learn from your replies. We’re betting some
of you are further along this trail than are we, and will very much appreciate
any specific concepts you find helpful.
THANKS!
Peter Graves, Ph.D., J.D.
Associate Chair of Psychology
for WLA Outpatient Programs,
U.S. Dept. of Veterans Affairs
11301 Wilshire Blvd.
Building 257, Room 12B
Los Angeles, CA 90073
(310)268-3771
cel (best) (213) 305-1444
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