I can only speak from my experience. I was in a CBOC for 2 ½ years in Lawton, OK. I was the only psychologist. I was part-time- 4 days a week. We had one social worker- whose time was split between MH and medical social work, and one full time psychiatrist. Whenever one of the team members went on leave, their clinics were closed for that time period. If I had to call in sick, there was no coverage for my clinics, nor for the psychiatrist or social worker. We worked well together to anticipate coverage issues, including quickly rescheduling veterans. We had a great program support/clerk. We were able to set up a process where we could get assistance from military police for emergency orders of detention. Lawton OPC is located on a military installation- Fort Sill. OKC VA MH did send social worker to provide SAT services- maybe one day a week-if I am correct. I recall that the Lawton social worker left the position and some coverage of his responsibilities were covered by OKC VA MH social worker for a period of time, but not all of his responsibilities- such as medical social work. These referrals were sent back to the VA social work medicine to manage. It takes a little over a hour to travel to the Lawton OPC from Oklahoma City. I actually lived in Oklahoma City and traveled four days a week to Lawton. My duty station was Lawton, OK so I was not granted to access a GSA vehicle. The psychiatrist also traveled from Oklahoma City. I can say that we were pretty self-sufficient. Prior to the psychiatrist coming on board, psychiatry was managed by tele-mental health- again this was over 6 years ago and OKC/Lawton was using tele-mental health. The mental health program has grown quite significantly since I left over 4 years ago and hence there is greater coverage from within the Lawton team. My current Chief of Psychology is William Leber. Please feel free to give him an email. I think the team is pretty solid. Hope this helps. Sherri Edwards, PhD Program Director, MHICM Oklahoma City VAMC (183J) 921 NE 13th Street Oklahoma City, OK 73104 "Most of the shadows of this life are caused by standing in one's own sunshine." Ralph Waldo Emerson From: avaplmembers-bounce@xxxxxxxxxxxxx [mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of Herman, Steve Sent: Thursday, August 05, 2010 7:11 AM To: members1@xxxxxxxxx; VHA National Psychology Chiefs Subject: [AVAPL Members] coverage at very small CBOCs? We are about to move the mental health services of one of our CBOCs into new space, two doors away from the rest of the CBOC (located in a strip shopping center). The medical side of the CBOC is run by contract workers, so we have very little say or control over them. The mental health providers of the CBOC are VA employees. The mental health staff are one APN, one LCSW, a full-time clerk, and one part-time LCSW. We have been trying to figure out procedures in the event that someone should be out sick, or in the unlikely event that only one person should be in (e.g., if one person is on vacation, the part-time person is scheduled off and someone else calls in sick). Do we send someone in from another CBOC? Do we divert patients to another CBOC? Do we send someone down from our Medical Center or divert patients up to the Medical Center? Does anyone else have a small CBOC in a similar situation, with any suggestions of how to handle such problems? Thank you. Steven M. Herman, Ph.D., HSPP Director, Psychiatry Ambulatory Clinic Lead Psychologist Richard L. Roudebush VAMC Associate Professor of Clinical Psychology in Clinical Psychiatry Indiana University Medical Center 1481 West 10th Street (116P) Indianapolis, IN 46202 phone 317-988-2770 fax 317-988-2884