Improving the Delivery of Mental Health Services for Veterans

Prepared for
U.S. Department of Veteran Affairs, Veterans Health Administration

Meeting the needs of veterans who are homeless, have serious mental illness, and suffer co-morbidities such as substance abuse and posttraumatic stress disorder, is a national policy concern. The U.S. Department of Veterans Affairs (VA) developed a strategic transformation plan for improving its mental health services and standardizing the way services are delivered in its mental health residential rehabilitation treatment programs. Mathematica worked with the VA to provide high quality, comprehensive, and timely assessments of how this plan is working to meet the needs of these veterans.

Mathematica conducted on-site quality reviews at each residential rehabilitation treatment program to determine whether they were meeting the transformation plan goals and the requirements specified in the Veterans Health Administration Handbook. These requirements seek to improve veterans’ access to and quality of care; their safety, security, and privacy; and program operations. We completed on-site reviews of 185 programs at 101 VA facilities based on assessment protocols developed by Mathematica and reviewed by VA and a technical advisory panel. We then conducted follow-up assessments of 150 programs to provide additional consultation on handbook implementation and to assess the extent to which programs’ implementation of handbook requirements had improved since the initial review. Reviews used multiple data collection methods, including interviews with program leaders, web surveys, direct observation of the program environment, policy and document review, and medical record review using VA’s Computerized Patient Record System. Our quality review teams also provided on-site consultation to VISN, facility, and program management on strategies to improve operational performance.

Reports were prepared for each initial and follow-up review. In addition, we prepared interim and final reports summarizing findings across facilities and developed recommendations for improvements. We also produced a compendium of promising practices that included a detailed explanation of the promising practices identified during the initial and follow-up quality reviews, related materials, and the program location where the practices were implemented.