July 7, 2016
To Whom It May Concern:
I am writing this letter to advocate for the patients I serve, the program I work in, and my fellow co-workers. I would like to explain my individual circumstances as well as my coworkers and the barriers we have faced. Specifically, I know that the right legislation can approve the means to get things done as long as the work is necessary and the qualifications meet the need. I know this because a Major General approved my ability to work as a Behavioral Health Specialist in charge of a Detainee Medical Clinic in Al-Asad, Iraq with the absence of my supervising Psychologist.
After a yearlong wait, I am the first recognized Licensed Independent Practitioner in a position known as a Licensed Professional Mental Health Counselor (LPMHC). There is an executive order in place mandating the Veterans Administration to hire Mental Health Professionals. The executive order was signed into law on August 31, 2012. I have a copy of the order for your review at your request. While the executive order was an important step in the right direction, many local VA’s aren’t adhering to the law. Another issue with the legislation is that it does not include a “grandfathering” clause for individuals that have been working in the field and did not attend a CACREP accredited program.
The designation was changed to Addiction Therapists for my coworkers. I would like to take this opportunity to offer an alternative option that would best serve our patient population, the Substance Abuse Rehabilitation Program (SARP), and my co-workers. The name of the reclassification we are asking for is known as the Social Science Specialist for my co-workers. There are several reasons for this designation in lieu of the proposed designation Addiction Therapist which I will address. As SARP Therapists, we are asking for three Social Science Specialist positions. My co-workers possess Master’s degrees and several of them hold clinical licensure. The problem we are running into is that they did not attend a CACREP accredited school at the time of their graduation. This is a requirement for the LPMHC position that I have in my favor. Their skill set, knowledge base, and experience in the substance abuse field is unmatched but unfortunately “grandfathering” them into the Licensed Professional Mental Health Counselor position has not been explored an option nationally. However, I know it to be true that “grandfathering” has worked in the past for Psychologists, Social Workers, and other providers in different professions. In previous examples those were not licensed providers that were still allowed to continue practicing. The reverse is true for three of my co-workers.
The Social Science Specialist position is a GS-11 position. That position has been used to classify employees in the Houston, TX VISN 16 Veterans Health Care Administration, Bay Pines VA Healthcare System in Florida, William Jennings Bryan Dorn Veterans Affairs Medical Center in Columbia, SC, and the Minneapolis VA Medical Center in Minneapolis, MN. It should be noted that the Houston VHA reclassified their employees that did not all have Master’s degrees or licensure standards. Several of their employees were Bachelor’s level, some were licensed, and some of them weren’t. Another consideration regarding the Social Science Specialists in Houston was that they were transferred into their positions as opposed to having to re-apply for their employment status. This decision was classified at the VISN level, not a local decision.
The Social Science Specialist position description accurately describes the work that we do in the SARP Program. They would be happy to start at a GS-9 target 11 position to demonstrate their capacity to fulfill the position requirements. My concern is that as an Addiction Therapist, this position is a GS-9 position, as is our current position. There is no upward mobility, and no transferability within the VA system. The Psychology Technician position they were previously assigned does not allow for Evidenced-Based Training which is particularly problematic for the population we serve in SARP. The SARP program is always evolving and Evidenced-Based Practices such as Motivational Interviewing are vital to the delivery of care to the patient population we serve. Interestingly, the Substance Abuse Rehabilitation Program is based on Evidence-Based Practice known as Rational Emotive Behavioral Therapy, a Psychological Theory developed by Dr. Albert Ellis.
There are many job titles within this VA that pay as well or better than a GS-9 that do not involve the complexity or clinical assessment that we do every day. Namely, there are Peer Support Specialists that are a GS-9 who are not expected to do any clinical work whatsoever and their position does not call for any education. I find Peer Support Specialists to play a vital role in patient care, however as a Veteran, I have difficulty with the fact that I have a Master’s degree and clinical experience in direct patient care. Next, there is a designation of SUD Social Worker. This is a GS-12 position. My question is what that position entails that I do not do in a day aside from a degree in Social Work? For information purposes, a Licensed Professional Mental Health Counselor is equivalent to a Licensed Social Worker. Other GS-11 positions that are available to employees such as my coworkers include Vocational Rehabilitation Counselors. The last person to leave SARP left for one of these positions. Several of the last employees to leave SARP have left for GS-11 positions elsewhere in the VA.
Substance Abuse treatment is considered a standard benefit for the patients we serve. The following statistics are specific to the SARP program in Danville:
It is estimated that by 2017, VA will be treating 30% more patients than were being served in 2010 (Zeiss). According to local OIF/OEF personnel, at least 70% of all returning OIF/OEF vets are screening positive for alcohol abuse at post-deployment screenings, which is likely an underestimation of the true figure and does not take into consideration those abusing drugs other than alcohol.
The SARP program offers a truly unique treatment paradigm, which does not follow the traditional 12-Step model of treatment found in virtually all other treatment programs. The SARP program is modeled from a Rational Emotive Behavioral Therapy concept which is based on Psychological Theory. Another consideration is that the SARP program is not limited to chemical dependency. We also treat patients with a range of disorders known as Process Addictions which include gambling and eating disorders to name a few.
In FY ’10, Illiana Health Care System (IHCS) treated 32,606 unique outpatients. 18% had a diagnosis of a substance use disorder.
From an inpatient perspective, the top DRG (diagnostic related group) treated at IHCS has for years been psychotic disorders. The 2nd most common DRG had been chest pains for 5 consecutive years, but in FY ’08, substance use disorders took over 2nd place from chest pains. Since then, substance use disorders has maintained the position of 2nd most common DRG at IHCS, and in FY ’10, was the top DRG for 2 of the 12 months.
- In FY ’10, psychotic disorders accounted for 11% of the DRGs, while substance use disorders accounted for 8%. According to a representative from local fiscal service, substance use disorders “continues to be one of our big movers.”
2002 – 2009
- 1640 sarp admissions
- 359 (22%) were readmissions
- Those 359 accounted for 526 (32%) of all admissions to sarp
2011 – present
- 529 sarp admissions
- 157 (30%) were readmissions
- Those 157 accounted for 231 (44%) of all admissions to sarp
To demonstrate the workload that we typically have in our program for Veterans diagnosed with Substance Use Disorder.
BACKGROUND: A 2006 law enables the Veterans Administration to hire LPCs/LMFTs. More than a year and a half ago, the Veterans Administration adopted LPC/LMFT occupational standards. An Executive Order signed on August 31, 2012 requires the Veterans Administration to hire 1,600 mental health professionals by June, 2013. My co-workers are licensed and qualified providers. However, they do not fit the criteria since they did not attend a CACREP accredited school at the time of graduation. I am requesting a compromise that would give my co-workers an opportunity to work within their scope of practice, provide better access to care to the patient population, and fair pay for the services provided.
NEED FOR SERVICE: Nearly half of all veterans wait more than 50 days to be screened by the Veterans Administration to receive services. Every 80 minutes a U.S. veteran commits suicide. Twenty two Veterans take their own lives every day. Our veterans need greater, quicker access to effective mental health care. Many veterans (and LPMHCs) live in these rural communities where LPMHCs are not actively hired as mental health service providers by the Veterans Administration.
WHY HIRE LPCs/LMFTs: ● Licensed Professional Counselors and Marriage and Family Therapists in Illinois WANT to help our Veterans heal. ● LPMHCs/LMFTs are specifically trained to provide a variety of counseling services including the diagnosis and treatment of mental health and emotional disorders. ● LPMHCs/LMFTs hold at least a master’s degree in mental health counseling and must pass the NCE prior to completing 2,000 hours of supervised, post-graduate training. These requirements are set by the state in which providers are licensed. The Veteran’s Administration is the only health care system requiring a CACREP accreditation.
One thing I can say for certain is that morale will be negatively impacted if they remain in a sub-clinical position with no opportunities for advancement, training, or transferability. This is a recipe for complacency. I am not ok with that. My co-workers and I bring compassion, creativity, and a strong work ethic to the SARP program and the Veterans we serve. Turnover will also continue to be problematic as a GS-9 Addiction Therapist or Psychology Technician. Please give this decision strong consideration, and your attention to this matter is greatly appreciated. Thank you for your time.
Mickensy L. Ellis, M.S., L.C.P.C.
Licensed Professional Mental Health Counselor
Substance Abuse Rehabilitation Program
VA Illiana Health Care System
1900 East Main Street Building 103/Ward 2
Danville, IL 61832
Office: (217) 554-3674