Rehab contract sparks fresh battle between veterans and the Liberal government

by Arkangel Sun 12 Feb 2023, 1:27 pm

Rehab contract sparks fresh battle between veterans and the Liberal government

Published Feb. 12, 2023

Rehab contract sparks fresh battle between veterans and the Liberal government Canadian-veterans-1-6270510-1676208016506

OTTAWA - A multimillion-dollar contract between Ottawa and a private company around the provision of mental and physical health services for veterans is sparking a new fight between the Liberal government and Canada's community of veterans.
The contract had already been heavily criticized by the union representing Veterans Affairs Canada employees, including hundreds of case managers charged with helping the most ill and injured recover from their service-related wounds.

But now others, including veterans and frontline health-care professionals, are also starting to speak up with questions and concerns about the deal.

Veterans Affairs Minister Lawrence MacAulay has repeatedly defended the $570-million contract with Partners in Canadian Veterans Rehabilitation Services, saying it will ultimately deliver better services to former service members.

Yet officials have also confirmed the rollout of the PCVRS's services is taking longer than expected, with the second phase now delayed.

Officials say they are taking their time to get things right, but critics say the whole enterprise is in trouble.

PCVRS, which is a joint venture between Toronto-based private health-care company Lifemark Health Group and an Australian-owned job training firm known as WCG Services, referred questions to Veterans Affairs.

The government is now facing calls to tear up the contract amid broader warnings from the union and its newfound allies about the privatization of veterans' care.

Awarded to PCVRS in June 2021, the contract came into effect last November and involves the company connecting veterans to physical, mental and occupational rehabilitation clinics and providers in their local communities.

Veterans Affairs says the deal replaces two previous contracts, one for the provision of physical and mental rehabilitation and the other for job training. Officials say the new deal will save veterans and overworked case managers time and energy.

The department also insists that the role of case managers, who are responsible for helping the most ill and injured veterans come up with and follow plans for successfully transitioning into civilian life, will remain largely unchanged.

In fact, it says that the contract will ease the administrative burden on the department's 450 case managers, most of whom continue to struggle with large caseloads despite repeated government promises to address the problem.

Yet those reassurances have done little to assuage the Union of Veterans Affairs Employees, while a growing number of veterans and health-care providers are starting to speak out as well.

On Feb. 2, the union hosted a one-day conference in Ottawa involving former service members, veterans' organizations and medical professionals whose stated aim was to discuss ways to address the many challenges facing the community.

Those include ongoing delays and backlogs in the processing of disability claims from veterans, the need for better training for health-care providers and Veterans Affairs staff, and gaps in benefits and services.

"Are we just going to talk through the same things repeatedly with nothing happening and no change?" said Scott Maxwell, executive director of Wounded Warriors, which provides mental-health programs for veterans, first responders and families.

"The excitement and energy in that room today for people, either in person or online, around coming together as one to effect change was a huge positive takeaway."

Many participants had also been invited due to their concerns and personal experiences with the PCVRS contract. Among them was retired sergeant Chris Banks, who served in Bosnia and Afghanistan before being diagnosed with post-traumatic stress disorder.

"I was told I would get a call in (from the company) in early January. It's now February," Banks said.

"I do not have any faith that they are ready to tackle the challenge they have signed themselves up for. And I do not have any faith that they care about the welfare of veterans. They care about their profit."

The lack of information and understanding about the new arrangement has emerged as a common theme, with the union, veterans and health-care providers also complaining about a lack of consultation before the deal was drawn up.

The government has said it consulted stakeholders, but those discussions took place between January and May 2022 -- six months after PCVRS was awarded the contract.

Psychotherapist Alisha Henson, who works with veterans and their families in the Ottawa Valley, said the new arrangement took mental-health providers in her area by surprise.

"People who have been doing this work way longer than I have had zero understanding of it and didn't even know it was coming," Henson said on the sidelines of the union-organized conference.

While PCVRS has since asked her to join its network of health-care providers, which Veterans Affairs says includes 9,000 professionals in 600 clinics across the country, Henson said she has many unanswered questions and concerns.

Henson and nearly two dozen other mental-health providers from her area recently released an open letter laying out numerous "red flags" about the arrangement, based on their interactions with Lifemark, in particular.

Those include added administrative requirements on providers, uncertainty over what happens if those now working with veterans don't want to join PCVRS and reductions on current remuneration rates and assessment times.

Henson and the others also flagged what they saw as Lifemark's failure "to consider the complex nature of this client population" by failing to mention "trauma" or "PTSD" in documents sent to practitioners asking them to join PCVRS.

"We're working with veterans. These people have complex trauma, and there's not one trauma word in this document," Henson told The Canadian Press.

For its part, the Union of Veterans Affairs Employees alleges that key responsibilities are being taken from case managers. Not only is this hurting the relationship between case managers and veterans, it says, but the deal is also reducing accountability and adding bureaucracy.

Veterans started being transitioned over to PCVRS in November, but the department has confirmed that the second phase of the rollout that was supposed to start on Feb. 3 has been delayed.

"We consulted with VAC operations and PCVRS and decided to modify the rollout schedule to make sure phase A participants are fully transitioned over before continuing with phase B," said Veterans Affairs spokesman Marc Lescoutre.

The union's national president Virginia Vaillancourt, who has called on Prime Minister Justin Trudeau to fire MacAulay and cancel the PCVRS contract, said a delay isn't enough and the government needs to stop contracting out veterans' care.

And she's hoping that enlisting other voices will help highlight the problem and get the government to start listening not just on the contract, but other issues as well.

"We wanted to look at having that collective voice with veterans and veterans' organizations and service providers, because we hear from them as well," she said. "And we know what those concerns are."

This report by The Canadian Press was first published Feb. 12, 2023.

The Canadian Press

by Fascinator Thu 23 Feb 2023, 4:45 pm

Veterans join with union to urge Veterans Affairs Canada to put brakes on rehab contract

Feb 22. 2023

CHARLOTTETOWN, P.E.I. — Chris Banks says Veterans Affairs Canada has left him, and other veterans like him, in the dark.

The retired Canadian Forces sergeant has battled post-traumatic stress disorder after having served in Afghanistan and Bosnia. He has enrolled in a Veterans Affairs Canada-funded vocational rehabilitation program, intended to allow veterans to pursue career training as part of their transition to civilian life.

Banks has been told a new, sub-contracted provider, Partners in Canadian Veterans Rehabilitation Services (PCVRS), has taken over management of his vocational program. He received one email in December from PCVRS informing him they would be beginning his intake process in January.

Two months later, he’s still wondering what this will mean for him.

"One of the big problems is there is not enough information for even the (Veterans Affairs Canada) case managers," Banks told SaltWire Network on Feb. 13. "There's a lot of unanswered questions with the contract."

Banks’ concerns echo those of a growing number of veterans who have received emails from PCVRS. Veterans Affairs staff and their union have also raised concerns about the new provider, as have several mental health providers who have served veterans for years.

A Feb. 2 meeting of veteran advocates – including Banks – union members, veteran service providers and clinicians concluded with agreement on a recommendation that the federal government “pause” its roll-out of the PCVRS contract. A media release from the group described the contract as “problem-plagued.”

PCVRS is a joint venture between the Loblaw-owned Lifemark Health Group and the Australian-owned workforce development company WCG International Consultants Ltd. Both Lifemark and WCG were the recipients of a five-year $560 million contract for rehabilitation services from Veterans Affairs Canada (VAC) in July 2021. The implementation of that contract began in late November of 2022.

Veterans Affairs Minister Lawrence MacAulay has said the new contract will provide veterans with shorter wait times for vocational and rehabilitation services, while cutting down on administrative workload for VAC staff. The new contract will replace the role of Medavie Blue Cross in administering medical and psychosocial rehabilitation supports.

Virginia Vaillancourt, president of the Union of Veterans Affairs Employees, said the early stages of the PCVRS contract meant more administrative burden for case managers, not less. She has described the early stage of the new contract as “chaos,” and has said the department would have more success in reducing wait times by hiring case managers than by sub-contracting the service to a for-profit corporation.

Her union has collected complaints about the implementation of the contract from 230 case managers – close to half the total – since VAC began transitioning veteran clients to PCVRS.

"The clients are stating that they feel blind-sided,” Vaillancourt told SaltWire on Jan. 13. “One client actually endured a three-and-a-half hour interview with a rehab service specialist from the new contract and proceeded to say 'this is not worth it.'"

Many case managers say PCVRS has told veterans to complete an assessment that is nearly identical to the one case managers have already completed with them. Some worry this could discourage veterans from seeking the care and support they need from these programs.

Some of these concerns have prompted the parliamentary standing committee on veterans affairs to begin a study of the PCVRS contract.

‘Nothing short of traumatic and reinjuring’
Banks spoke before this parliamentary standing committee in December. He told members he had experience with Canadian Veterans Vocational Rehabilitation Services (CVVRS), a past program operated by PCVRS parent company WCG International.

Banks had hoped to enrol part-time at Carleton University or the University of Ottawa to study public policy. He was dismayed to later be approved to instead take a full-time office administration program at Algonquin College, contrary to the requests for accommodation made by his psychologist.

He was told by CVVRS staff that if he did not agree to this program, he would lose access to his benefits, including his medical pension.

"The experience I had under CVVRS was nothing short of traumatic and reinjuring. The level of apathy – just profit-mindedness that were coming off of them. Like they were stinge-ing with everything," he told SaltWire Network in a Feb. 13 interview.

Banks became suicidal again but managed to appeal the decision through Veterans Affairs. He has since recovered but remains worried about the impact the new provider will have on his life and the lives of other veterans.

“I'm scared. I'm scared I'm going to be forced into another program that will not help me succeed and will only put me at new risk,” Banks told the committee.

Sean Bruyea, a retired Canadian Forces captain, says there are “very strong warning signs” about the PCVRS contract.

One of these, he said, is that veteran groups and VAC case managers were not adequately consulted.

Bruyea also worries staff with PCVRS will lack the training and cultural competency needed to work with veterans.

“This is not just a workforce, this is not just a workplace safety rehabilitation program. This is for a very unique population that is very dependent on the Government of Canada," Bruyea said.

'More manageable workload and fewer administrative tasks'
In December, MacAulay told the standing committee his department did consult with about 60 veterans and their families between January and June of 2022.

MacAulay said case managers have asked for a “more manageable workload and fewer administrative tasks.”

“Under this contract, they will no longer have to help veterans find providers in the community, write rehab plan goals, or chase providers for reports that are supposed to come in every 30 days,” MacAulay said.

SaltWire Network asked VAC to provide a list of who the department consulted with prior to the roll-out of the new contract. A representative of Veterans Affairs Canada said the consultations were confidential and could not be provided.

The department has said PCVRS has a network of over 9,000 providers that can help veterans access rehabilitative services from coast to coast.

Steven Harris, VAC’s assistant deputy minister for service delivery, told SaltWire Network the department began a first phase in November, transitioning 3,000 “low baseline” veteran clients to PCVRS. Most of these veterans, he said, had previously accessed vocational or rehabilitation services through VAC but did not need access to a psychologist or psychiatrist.

The beginning of a second phase of transition, involving 12,000 veterans in need of medical or psychosocial rehabilitation services, was to begin in early February. This has been delayed for 4-6 weeks.

Harris said the delay was due to feedback from veterans and staff as well as “a discussion” with PCVRS.

"Based on that we decided to up our training, make sure that we've got everybody well settled from that Phase A transfer," Harris told SaltWire Network on Feb. 13.

“We want to make sure that the transition goes as smoothly as possible."

Harris said 97 per cent of the first 3,000 veterans that have transitioned to PCVRS have been assigned a rehabilitative service specialist. He described this as an indicator of the program’s success.

Performance and quality assurance measures are also being used to assess the performance of PCVRS, such as participant outcomes and costs.

Staff with PCVRS are required to undertake training related to working with veteran populations that will be part of a trauma-informed approach, the department says.

Nathalie Pham, Veterans Affairs Canada’s senior director for operational and strategic affairs, told the standing committee the department does not expect care providers with PCVRS to have previous experience working with veterans.

“As to the other providers, their expertise is in rehabilitation. We do not expect them to have experience with veterans, but rather to understand their needs,” Pham told the committee on Nov. 17, 2022.

Stu Neatby is a political reporter with the SaltWire Network in Prince Edward Island. He can be reached by email at stu.neatby@theguardian.pe.ca and followed on Twitter @stu_neatby.

Saltwire

by **Lincoln** Tue 28 Mar 2023, 7:54 pm

Opinion: Veterans Affairs Canada is letting down its clients

The federal government's agreement with an outside contractor makes it harder to provide effective trauma-focused treatment in a timely way.

Dr. Alisha Henson, Marie Josée Hull, Shannon Rutledge, Julie Clarke
Published Mar 28, 2023

As registered mental health clinicians from Renfrew County and Ottawa, we are seeking to inform Canadians about changes in services delivered by Veterans Affairs Canada. Together, we have more than 35 years of combined experience providing mental health treatment services to veterans diagnosed with Operational Stress Injuries (OSIs), including Post Traumatic Stress Disorder, Generalized Anxiety Disorder, Major Depressive Disorder and soon.

In June 2021, Veterans Affairs Canada changed the way it does business when providing rehabilitation services to veterans. It awarded a contract for $560 million to Partners in Canadian Veterans Vocational Rehabilitation Services (PCVRS) to be the go-between with clients and service providers such as ourselves. Prior to this contract we dealt directly with case managers at the department who would intake the veterans and direct them to the rehabilitation services they needed.
In November 2022, Veterans Affairs Canada finally started implementing this new contract. That’s when the problems started, for us and the veterans who want our services. The problems include the contract’s impact on veterans’ mental health; loss of access to adequately trained and experienced clinicians; and lack of cultural competency. Despite our best efforts to get answers or to resolve these issues, the rollout has continued and our concerns have only increased.

We are the clinicians bearing witness with veterans while they disclose and begin to heal psychological wounds. OSIs have a substantial impact on many aspects of veterans’ lives. Frequently, we work with veterans who have been living with significant mental-health symptoms for years owing to their fear of the stigma associated with such diagnoses, which are often career-ending. Living with untreated OSIs for a long time can render disorders more resistant to treatment, and sometimes make symptoms permanent.

The ability to provide trauma-focused treatment is integral to veterans achieving maximum recovery. A safe, trusting therapeutic relationship with clinicians is necessary for healing to occur. Developing trust is difficult for veterans as their experiences have made them quite distrustful of people and institutions, and hyper-vigilant in their environments. Clinicians need to prioritize helping veterans feel safe by doing therapeutic work at the pace required to maintain their sense of safety. Skilled, experienced clinicians will be able to recognize distress in veterans and support them.

Lifemark, PCVRS’s parent company, has a background in physical health rehabilitation services, not mental-health treatment, especially for veterans. Its approach fails to understand the complexity of treating military-related trauma and demonstrates a universal lack of understanding of veterans’ complex mental-health challenges.
There is an overall lack of program transparency, which has led to more questions than answers, increased distress for veterans, and duplication of interviews conducted by individuals without the necessary training to ask about suicidal ideation or traumatic experiences. Veterans report experiencing increased distress during three-hour interviews, while others are choosing to walk away without help. The PCVRS program appears to prioritize administrative processes over client care, being overly focused on timelines and rushing treatments, rather than understanding veterans’ unique needs and the importance of a culturally competent approach.

The inability of PCVRS to hire clinicians locally will result in shifting to predominately online services, with clinicians who may not meet the standards for licensure in their province. The ability to care for psychologically injured veterans is a skillset that requires particular training and education, and years of experience. To expect entry-level clinicians to have the required skills is a remarkable disservice to veterans and clinicians.

While the Canadian inflation rate and prices of office space are skyrocketing, PCVRS has significantly reduced session fees for clinicians while increasing administrative requirements, leading to the potential exodus of those qualified to treat veterans. Veterans will lose access to clinicians who have spent years building therapeutic relationships and gaining additional training to provide the most advanced trauma-focused care.

The people who serve our country take significant risks and sacrifice family time to serve. As mental-health professionals, it is our ethical duty to advocate for responsible treatments and the integrity of our relationships with clients. Often, suffering people struggle to advocate for themselves; veterans are no exception. We want to prevent a sense of hopelessness, failure or, worse, suicide.

The current financial climate requires cost-cutting measures, but are Canadians willing to put veterans at risk in the process? This new program appears to cost Canadians more by duplicating case management services and repeating program requirements already completed. We understand there are transitional challenges, but the “confidential” consultation process appears to have missed the mark by not engaging those on the front lines. We are not saving taxpayers’ money; we are offering less, and lining the pockets of a private company. Veterans are left to work within a counter-therapeutic approach, or go without vocational or monetary support for treatment. We need people like them to serve this country, and we need to take care of them after they are injured.

Dr. Alisha Henson, Ph.D., C. Psych (supervised practice) has provided mental-health services to veterans and their families, military families, and other community members since 2009. Marie Josée Hull, MSW, RSW is a registered social worker who started working full time with veterans and their families in 2011. Shannon Rutledge, MSW, RSW, is a Registered Social Worker providing mental health treatment services to veterans in Renfrew County since 2013. Julie Clarke, MACP, SEP, RP is a Registered Psychotherapist and has provided mental health services and support to those in crisis and uniformed members and their families since 2011.

Ottawa Citizen

by Rigger Mon 05 Jun 2023, 10:04 am

Union gives failing grade to companies handling veterans rehabilitation contract

Published June 5, 2023

OTTAWA - A union representing workers at Veterans Affairs Canada says a deal to privatize rehabilitation services has been a failure.

The $570-million contract with Lifemark Health Group and WCG International Consultants was supposed to take the strain off case managers and help veterans access services.

But the Union of Veterans' Affairs Employees has given the deal a failing grade in a new report card, issued six months after the contract kicked in.

It says instead of streamlined services, case managers are dealing with more paperwork.

The report card says only the least complex files have actually been transferred and delays in getting started have led to backlogs for veterans.

The union is pointing the finger at a lack of training in Veterans Affairs Canada's guidelines, as well as a lack of understanding of what the clients need.

This report by The Canadian Press was first published June 5, 2023.

The Canadian Press

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Rehab contract sparks fresh battle between veterans and the Liberal government

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