Combat veterans from the Vietnam-era through the wars in Iraq and Afghanistan often turn to Vet Center counselors for help with post-traumatic stress or depression. And some of these counselors are themselves feeling stress - in part, they say, because of what they're calling unrealistic productivity requirements.
Ted Blickwedel, 63, is a Marine Corps veteran living in Smithfield, R.I. And recently, when he was working as a clinical social worker at his local Vet Center in nearby Warwick, he began to think about suicide.
"I didn't sit around and ruminate about how I'm going to go about taking my own life or anything," he says, "but nonetheless, it was just this sense that I didn't want to be here anymore."
Blickwedel says his rising sense of hopelessness about his job began a couple of years ago, when the Department of Veterans Affairs changed the way it measured counselor productivity. Instead of asking counselors to track what percentage of their time they spend with clients, the VA asked counselors to meet a minimum head count.
Blickwedel says his focus began to shift.
"I'd be in session, trying to engage someone, but being more worried about getting them out the door to do notes to get the next person in on the hour, every hour," he says.
Blickwedel says if a veteran with PTSD needed an extra-long session, he'd spend more time with that veteran and see fewer clients. That would have consequences.
"I simply wouldn't have met the visit count," Blickwedel says, "and then I would have to complete a performance improvement plan and if this would have continued and if there weren't any adequate improvements being made, then eventually my job could have been on the line."
The VA wants counselors to have 25 visits each week to be "fully successful." The VA says that should take about 17 hours. To achieve the "excellent" rating, counselors must log even more visits per week.
The problem is that even by the VA's own analysis, the average visit takes 77 minutes. That's 32 hours.
"That doesn't leave adequate time to get all your administrative duties done," says Blickwedel, "with your progress notes, your treatment plans, assessments, with staffing, consultation with other providers that are working with the veteran."
Many of the dozen Vet Center employees interviewed for this story say they worked extra hours, often without compensation, to keep up. Some say they went on medication to manage the stress. Others lost weight. And when they suffered, they say, so did services.
A reasonable standard, says the VA
Mike Fisher, chief officer of all the VA's Vet Centers, supports the current requirements.
"When we talk about accounting for 25 encounters in a week, I think that's reasonable given that the vast majority of our staff are already doing that," he says.
He says those who don't make the numbers simply have to create a plan to boost them.
"That plan can include increased outreach. It can include, 'I'm going to try as a clinician this one type of group.' There is complete flexibility in that," he says.
Group sessions can boost a counselor's visit count, since each member of the group is counted individually. But getting enough groups can be tricky, says Rick Stouffer, a Vet Center counselor from Knoxville, Tennessee.
"It would be nice to have a full caseload of clients, but I have no control over how many clients I have," he says.
Stouffer says sometimes clients don't show up for appointments, which can hurt productivity.
Demand for Vet Center services varies by locations. Some are simply busier than others, but the standards are mostly uniform.
There has been no formal survey of how Vet Center social workers feel about these requirements. Ted Blickwedel tried to conduct one by email. The VA told him to stop, and when he didn't, it cut off his email access. The VA says he was using his email in an unprofessional manner. Blickwedel disputes the idea that he acted unprofessionally.
Blickwedel has chosen to retire rather than work under these requirements, which he says need to be reduced to a reasonable level.
"That's number one," he says. "Number two: there needs to be more hiring at higher echelons of people in managerial and leadership positions that have clinical backgrounds so they can make common-sense clinical decisions."
And only then, Blickwedel says, can Vet Center employees stop worrying about metrics and focus more on their clients.
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