RD500 - Report of the Virginia Veteran and Family Support (VVFS) Program Working Group – November 14, 2016


Executive Summary:
• The Virginia Veteran and Family Support (VVFS) program was created in 2008 as the Virginia Wounded Warrior Program (VWWP). It was the first comprehensive state-level program of its kind in the nation, designed to address shortcomings in access to veterans’ behavioral health and rehabilitative services provided by the U.S. Department of Veterans Affairs (USDVA, or “the VA”).

• VVFS provides services throughout the Commonwealth and is operationally divided into five regional areas. The program is comprised of forty-five (45) staff members in total; thirty-four (34) staff employed by contracted Community Service Boards (CSB) and eleven (11) Department of Veteran Services (DVS) staff.

• In 2015 the Virginia General Assembly directed the Joint Legislative Audit and Review Commission (JLARC) to review DVS. The December 2015 JLARC report found a variety of problems with the VVFS program’s design and implementation, and recommended a series of improvements, including a working group.

• The 2016 General Assembly directed the formation of a working group, comprised of the Secretary of Veterans and Defense Affairs, the Secretary of Health and Human Resources, and the Director, JLARC, to review the entire program and submit a report to the JLARC no later than November 15, 2016.

• The workgroup met five times between May and October 2016. Between workgroup meetings, DVS, Department of Behavioral Health and Developmental Services (DBHDS), and JLARC staff conducted research and analysis and held meetings to inform the workgroup deliberations.

• The working group agreed that the new goal of the VVFS program should be to: Conduct outreach to veterans and families; cost-effectively refer them to mental health, physical rehabilitative, and other services as needed; and periodically monitor their progress.

• The workgroup concluded there are two equally important aspects of this goal:

* First, cost-effectiveness is essential because there are likely far more veterans that could benefit from these services than the current budgetary allocation will accommodate.

* Second, referring veterans and monitoring their progress fulfills a needed role to help veterans navigate the complex service provider environment. The role of referring and monitoring---but not directly providing mental health or rehabilitative services—has the benefits of not asking program staff to provide services for which they lack sufficient expertise and qualifications, and not attempting to provide mental health, rehabilitative services, or other services that duplicate existing public and private programs.

• The workgroup concluded the program should achieve this goal by implementing a program that features four types of activities based on lessons learned from operating the current VVFS program, issues identified during the 2015 JLARC review, a working group review of other states’ programs, and working group deliberations: 1) Building program awareness; 2) Veteran intake to “triage” issues; 3) Developing a resource plan and referring the veteran to the appropriate resources; and 4) Monitoring veteran progress.

• The work group identified four structural options for how to achieve the goal of the VVFS
program:

Option: 1
Description: Current service model
# Employees: 11 state, 34 contract
Annual Service Capacity: 2,500 – 3,000
Additional GF $ needed to implement: $0

Option: 2
Description: Change to all state employees – improved service delivery through program standardization
# Employees: 39 state
Annual Service Capacity: 2,300 – 2,800
Additional GF $ needed to implement: $0

Option: 3
Description: Change to all state employees – improved service delivery through program standardization. Increased service capacity
# Employees: 45 state
Annual Service Capacity: 2,800 – 3,300
Additional GF $ needed to implement: $500,000

Option: 4
Description: Change to all state employees – improved service delivery through program standardization. Increased service capacity. Would award grants to community organizations to provide additional services
# Employees: 45 state
Annual Service Capacity: 3,000 – ?
Additional GF $ needed to implement: $800K – $1.7M

• Partnerships with CSBs would continue to be a top priority for VVFS staff in a state-run model. Program staff would continue to work with CSBs regularly to ensure access to community behavioral health services for service members, veterans, and families (SMVF) that lack timely and accessible services in the VA system. VVFS staff would also continue to partner with DBHDS and CSBs to increase military cultural competency among community behavioral health providers and conduct ongoing analysis of CSB demographic and services data to facilitate resource planning for SMVF.

• None of the four options would change the continuity of referrals to the CSBs for clinical treatment, and, as at present, VVFS would continue to contract for clinical services based on availability of non-general fund dollars.

Recommendations:

1. Option 3 represents the best near-term way to achieve the VVFS program goal: the VVFS Working Group recommends Option 3. The proposed program structure, in a totally converted state model, would allow VVFS to meet the needs of its target population by establishing and putting into effect uniform operational and hiring policies to guide program operations and prioritize the work of VVFS staff and services. Additionally, an all-state employee model will create permanence and standardization in VVFS service-delivery which will permit the uniform development and implementation of new metrics to measure the impact and success of VVFS program services.

2. FY17 Funding should be used for one-time costs: Chapter 780, 2016 Acts of Assembly, Item 466, set aside $393,494 from the general fund “for the purpose of implementing the recommendations of the working group for the Virginia Veteran and Family Support program.” The VVFS Working Group recommends that $300,000 be transferred to DVS in FY17 for one-time expenditures associated with implementing Option 3, including costs to co-locate VVFS staff in up to 15 DVS Benefits Services offices and the purchase of new IT equipment and furniture. The balance should be applied to other veterans programs or returned to the Treasury.

3. Revisions should be made to § 2.2-2001.1 of the Code of Virginia: the VVFS Working Group recommends revising the Code of Virginia to update the statute that established the VVFS program. The working group has concluded a revision is important to provide updated guidance to program staff about the program’s purpose and primary activities. The working group has also concluded that new statutory language can be drafted that reflects lessons learned since 2008 when the program was established, and the evolving nature of veterans needs and services.

The language would codify the program’s goal and specify the key program activities related to awareness, intake, planning and referral, and monitoring.

4. The VVFS Working Group should continue to meet periodically: the VVFS Working Group recommends it continues to meet periodically to ensure that the recommendations of this report, as approved by JLARC, are efficiently and effectively implemented. The working group further recommends that the Secretaries of Veterans and Defense Affairs and Health and Human Resources continue their close collaboration on VVFS and on other issues related to the CSBs and behavioral health care for veterans and families.