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6 Workforce
Pages 105-128

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From page 105...
... requires a large and diverse workforce that is trained and capable of providing the best care available and that is led by effective, engaged, and knowledgeable leaders. But having sufficient numbers of mental health providers is not enough to ensure that patients receive comprehensive care using best practices.
From page 106...
... The committee highlights ways in which each department is attempting to ensure an adequate and competent workforce and the challenges that they face in trying to do so. DEPARTMENT OF DEFENSE In the sections below, the role of leadership in managing and coordinating PTSD programs and services in and between the service branches is discussed, followed by the types and numbers of direct care providers and purchased care providers and their qualifications and training.
From page 107...
... In the last decade, DoD has greatly expanded its mental health services, including those targeting PTSD, but this expansion presents military leaders with many challenges. These include an infusion of new mental health staff on installations, many of whom are civilian contractors or temporary employees who may be unfamiliar with PTSD or military culture; embedding of mental health care providers in line-unit organizational structures; frequent turnovers in leadership at all levels because of deployments and attrition; increased use of TRICARE purchased-care providers to treat active-duty service members; lack of standards for specialized PTSD programs; and the growth of military and civilian programs that address PTSD.
From page 108...
... On site visits, some service members stated that their commanders were supportive of their seeking care for their PTSD, but others acknowledged that though there had been improvements in commanders' attitudes toward PTSD, many commanders were not sympathetic to the issue. Mental Health Care Providers Direct Care Providers DoD health facilities are staffed by nearly 146,400 personnel -- about 60,400 civilians and 86,000 uniformed providers, including about 31,800 officers (TRICARE Management Activity, 2013)
From page 109...
... As of June 2012, the Army had 5,438 mental health care providers (psychologists, psychiatrists, social workers, mental health nurses and nurse practitioners, technicians, counselors, and other licensed mental health providers) , including those who serve primarily in wellness or prevention roles; 1,594 of the providers were in mental health clinics.
From page 110...
... As a consequence, more active-duty service members are being referred to the TRICARE network of purchased care providers. Purchased Care and Contract Providers There are about 478,000 purchased care providers in the TRICARE network, of whom 62,000 are mental health care providers -- psychiatrists, clinical psychologists, certified psychiatric nurse specialists, clinical social workers, certified marriage and family therapists, pastoral counselors, and mental health counselors (IOM, 2010; TRICARE Management Activity, 2013)
From page 111...
... Although DoD pays for direct care staff to be trained in evidence-based therapies, it will not pay for purchased care providers to receive similar training. The DoD Center for Deployment Psychology (CDP)
From page 112...
... also offers educational resources on evidencebased treatments via annual conferences and publicly accessible monthly webinars on specific mental health topics; providers may obtain continuing education credits for both the conferences and the webinars. DCoE has developed toolkits to promote the use of VA/DoD clinical practice guidelines and to enhance training (DCoE, 2013)
From page 113...
... Therefore, it is not clear that their level of training is sufficient to provide evidence-based treatments effectively or with fidelity. Military Culture All DoD direct care and purchased care mental health providers need to be knowledgeable about military culture and the particular contextual issues, such as era of service, that may influence a service member's response to stress or treatment.
From page 114...
... . Although the guidance may ensure that direct care providers are knowledgeable about military culture, it does not address the need for such training for purchased care providers.
From page 115...
... In the sections below, the role of VA leaders is discussed. The remaining sections describe the VA workforce, including direct care providers, purchased care providers, and training efforts in VA (particularly for evidence-based treatments)
From page 116...
... VA leaders face many of the same challenges in recruiting and retaining mental health professionals in a highly competitive environment as does DoD. The OMHO site visit report indicated that 60% of VA medical centers had problems with recruitment or retention of qualified staff, particularly psychiatrists, but also clerical and administrative staff who handle patient scheduling and staff for primary care–mental health integration programs (OMHO, 2013a)
From page 117...
... Mental Health Care Providers Direct Care Providers Most health care for veterans is provided by VA employees. VA employs 3,088 psychiatrists, 3,675 psychologists, 3,966 psychiatric nurses, 5,278 social workers, and 3,142 other mental health care providers (such as licensed marriage and family therapists and licensed professional counselors)
From page 118...
... . In the site visit report, the need for PTSD care providers was noted by 31% of all sites and 34% of CBOCs.
From page 119...
... About one-third of all Vet Center staff served in OEF, OIF, or both. Furthermore, about 60% of direct counseling staff in Vet Centers are licensed and qualified mental health professionals, such as psychologists and social workers (Fisher, 2014)
From page 120...
... . Although purchased care providers must be licensed, VA, like DoD, does not screen or assess the providers to ensure that they are trained in or offer evidencebased treatments for PTSD, that they are familiar with or adhere to the VA/DoD clinical practice guideline for PTSD, or that they are familiar with military culture.
From page 121...
... . Several VA providers reported that in addition to clinical staff, administrative staff who process veterans for intake would benefit from military culture training.
From page 122...
... . Several master's-level programs in social work have established paid clinical field internships in VA mental health clinics and Vet Centers and, to a smaller extent, in DoD medical facilities.
From page 123...
... Many veterans also receive mental health services in Vet Centers, about 60% of which have licensed and qualified mental health care staff. In spite of increased numbers of direct care providers, the number of veterans receiving purchased care services increased 19% from 2008 to 2012.
From page 124...
... Falls Church, VA: Defense Health Board. DoD, TRICARE Management Activity, and Office of the Chief Medical Officer.
From page 125...
... 2014. Burnout in Veterans Health Administration mental health providers in posttraumatic stress clinics.
From page 126...
... 2010. Guidance for mental health care provider training for the treatment of post-traumatic stress disorder and acute stress disorder.
From page 127...
... 2011. Veterans Health Administration Mental Health Program Evaluation: Cap stone Report.


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