ACSWA is committed to learning from VA clinical social workers so we can be helpful in influencing the process of VA reform, as required by the new federal law. Ten recent responses to our questionnaire, selected randomly, have produced the following results:
Regarding clinicians’ settings, 7 people work in mental health; 2 work in mental health and PTSD, and 1 works in homes care/geriatrics/community services. Almost all provide some degree of psychotherapy, but only one exclusively; and five spend more time in other areas (administration, case management, supervision, suicide outreach) than in psychotherapy.
Their VA sites promote good behavioral healthcare through peer review, team meetings, JCAHO meetings, and one noted that most of the staffers are veterans. Suggested improvements in the sites’ provision of services included: foster collaboration, develop more innovative programs, and provide more training and administrative assistance; also, form more small rural teams (3-5 staffers)—“bigger is not better”; also, allow more psychodynamic psychotherapy for PTSD and less reliance on EBT models; also, give clinical social workers their own mental-health team leaders (as the psychologists have) rather than imposing a leader from medical social work “who knows nothing about what we do.”
Only two report that a clinical social worker heads up Mental Health Services at their sites; two more mention psychologists, and the rest psychiatrists. Three report that they had never heard from the national VHA office, and seven say that the union had not helped clinical social workers. Five say they had never been provided with information about Special Advancement for Achievement, the program under which clinical social workers are eligible for professional pay.
Several make other suggestions about improving behavioral healthcare at their sites: “more female therapists;” “get rid of unethical management;” “give us a real chief, not an acting chief from the community;” “allow clinical social workers to work per diem so that clients on the waiting list can get care;” and “give us more freedom to practice/manage caseload.”
Clinical social workers are the majority provider of behavioral healthcare in America. They feel that the VA needs to respect their training, education, capabilities, and competence, especially in the area of treatment of PTSD, in which only 20% of clinical social workers are allowed to provide services to those with PTSD, per the responses of the 200+ clinical social workers who have answered our questionnaire. Effective use of clinical social workers will save hundreds of veterans’ lives and will increase the well-being of tens of thousands of veterans and their families.