Mission, Vision, & Values

James A. Haley VA was established in 1972 with the goal of providing a full range of patient care, in addition to operating as a teaching hospital. The VA conducts itself with the overall agency mission in mind, to “honor American’s Veterans by providing exceptional health care that improves their health and well-being,” with the vision to “honor those we serve by providing 5-star primary to quaternary health care,” (Veterans Affairs, 2019).

The VA is also unique in that its Social Work department has its own mission, vision, and values that coincide with the overall goals of the agency. The Social Work’s mission is to “eliminate psychosocial complications as significant barriers to healthcare interventions for veterans and families. This is accomplished by developing and maintaining integrated, quality programs to patient care, research, education and prevention,” (James A. Haley Veterans’ Hospital, n.d.). The department’s vision states, “in return for the investment of veterans’ trust and institutional support, VA Social Work will provide the foremost leadership in the psychosocial care of veterans and their families,” (James A. Haley Veterans’ Hospital, n.d.). VA Social Work values are “to place at the center of our concern the dignity and worth of the individual, to incorporate into practice an understanding of the veteran within his or her family and sociocultural environment,, to value and respect the distinctive role and expertise of each member of the multi-interdisciplinary team, to identify gaps in services/resources and to advocate for systems changes that are responsive to veteran’s changing needs, to create within the discipline a learning environment that fosters new knowledge, enhances clinical social work practice and promotes administrative excellence, to be ethical in fulfilling responsibilities, and to be conscientious stewards of institutional and community resources essential to our mission,” (James A. Haley Veterans’ Hospital, n.d.).

Comprehensive health care through James A. Haley includes primary and tertiary care, as well as long term care in medicine, surgery, psychiatry, rehabilitation, spinal cord injury, neurology, oncology, geriatrics, and extended care (Veterans Affairs, 2019). Social workers can be seen on various teams throughout each of these hospital departments. In addition to the extensive health care provided, the VA offers programs such as homeless veteran services, post-deployment and re-integration support, women veteran services, LGBTQ specific veteran care, and supportive services for caregivers. For the purpose of this evaluation, the primary focus will be on the homeless veteran services offered through James A. Haley, with special attention on one specific program.

The homeless veteran area holds the largest section of social workers within the agency, ensuring needs are met thoroughly and efficiently. Specific services provided in this section include HUD-VASH (Housing and Urban Development – VA Supportive Housing), SSVF (Supportive Services for Veteran Families), GPD (Grant and Per Diem), DCHV (Domiciliary Care for Homeless Veterans), CWT (Compensated Work Therapy), and VJO (Veteran Justice Outreach).

The HUD-VASH program works closely with the Tampa Housing Authority, combining rental vouchers with intensive case management through the VA to assist veterans and their families in finding and maintaining permanent housing. The program prioritizes chronically homeless veterans, veterans with families and minor children, and other vulnerable veteran populations. According to data released from Veterans Affairs (2019), HUD-VASH services the largest number and percentage of Veterans who have experienced enduring or repeated homelessness.

It is not uncommon for many veterans enrolled in HUD-VASH to remain in the program long-term, as disability and other circumstances make employment unfeasible. However, it is possible for veterans to be successfully discharged from case management services as a result of their accomplishments while in the program and their abilities to maintain their housing and keep up with their payments. A successful discharge from case management is regarded as a positive discharge and is an overall goal for all enrolled in the program.

Veterans that do find employment may remain in the program should they still meet the income requirements, but often those veterans find themselves desiring to rent or buy a home without the assistance of HUD-VASH, which is also considered a positive discharge. The VA analyzes data pertaining to the rate of veterans exiting housing programs as employed individuals. According to data from the 2017 fiscal year, “7,000 veterans exited residential programs with employment, with the employment rates of HUD-VASH specific veterans exceeding the national target by four percent,” (Veterans Affairs, 2019). These numbers support the consistency of an upward trend for the last four year. A table indicating percentage outcomes from 2014-2017 can be found in Table 1 for a visual reference.

The James A. Haley HUD-VASH program is currently implementing the analysis of positive versus negative discharges against the total amount for each fiscal year to gain further understanding of why veterans are being discharged from the program and what can be done to prevent negative discharges. According to the current available numbers, the total amount of discharges from the program appear to be increasing. The themes surrounding the discharges must be considered to determine effectiveness and future direction.

Additionally, data pertaining to individual client progress is collected via individual service plans and the PHQ9 inventory, which is a ten-item depression-anxiety scale. Individual service plans are reviewed annually to determine if veterans are meeting the outlined goals and PHQ9 inventories are given every six to twelve months. The PHQ9 is given to every veteran in HUD-VASH, despite the program not being primarily clinical in nature, due to common mental health diagnoses seen among this population. Such diagnoses include depression, anxiety, adjustment disorder, and post-traumatic stress disorder. The leadership team uses both assessments as success indicators reported to the board monthly to assess program effectiveness. The board and James A. Haley believe that when a veteran is successfully houses, they can accomplish goals in other areas of their life.

Monthly reports are pulled by the section chief to assess units of services for employee productivity and reimbursement services and are reviewed by the board. Ensuring all applicable ICD-10 codes and billing procedures are properly applied enables the department to receive adequate funding to keep the program functioning. The rate of clinic notes indicating face-to-face home visits are also pulled monthly to ensure case managers are meeting the number of visits required by the program for each level of care. For example, a veteran flagged at level 1 must be seen face-to-face once a week, a level 2 twice a month, a level 3 once a month, a level 4 quarterly, and a level 5 twice a year. The level noted also provides some insight into how well a veteran is progressing in the program which impacts a potential increase in funding and the approval for hiring more staff.

Currently, the only measure taken to determine program goals are being met is the tracking of how many veterans are presently housed under the HUD-VASH program. The number of veterans currently housed under the program is not available at this time. Additional treatment goals specific to individual veterans are not monitored, only the primary goal of maintaining stable housing. It can be argued that individual treatment goals can be considered met if a veteran is successfully discharged from case management, however, these goals vary widely across caseloads and there is currently no process in place to monitor this. It is unknown if any prior evaluation efforts have been made regarding individual treatment goals.

The process of evaluation could be made more accurate by recruiting a team to pull data from various areas, rather than just the section chief, as this individual is solely responsible for the multiple reports being compiled. Sporadic chart reviews would also be beneficial and would facilitate cohesiveness in terms of documentation and coding. It appears there has been confusion surrounding what codes can be used with certain notes. A telephonic clinical note, for example, cannot be coded with a suicide risk assessment code even if one was performed by the clinician. Coding guidelines come directly from the board and, unfortunately, changes with the coding procedures. However, offering training refreshers and proper education for newer employees would combat these errors.