Healthcare Inspection – Review of the Operations and Effectiveness of VHA Residential Substance Use Treatment Programs

In the Joint Explanatory Statement to accompany the fiscal year 2015 omnibus appropriations bill, Congress requested the OIG review the operations and effectiveness of VA substance abuse inpatient rehabilitation programs and report: (1) the current number of inpatient rehabilitation programs, (2) the annual number of veterans who participate and their average length of treatment, (3) the average length of time for VA treatment compared to non-VA residential treatment, (4) the rate of recidivism for both types of programs, (5) the process used to refer patients to VA treatment, (6) the degree of supervision of patients in VA programs and how often drug tests are performed, and (7) how well mental health and substance abuse treatment are integrated for veterans with comorbidities. We recommended Mental Health Services: Liaison with internal and external entities regarding standardized data collection from screening processes to core outcome measures to improve program monitoring and by which Mental Health Services can develop collaborative treatment initiatives; ensure system-wide use of the 596 stop code; review the consistency of current processes and provides specific guidance on reducing inflow of contraband into residential substance use treatment programs; consider requiring programs to document patients’ physical status in addition to presence when completing physical bed checks; clarify the intent of the requirement for and use of closed circuit television with respect to residential substance use programs; review and evaluate whether reversal agents such as naloxone are readily available at each residential substance use treatment program; encourage more widespread incorporation of programming with a specialized focus on mental health comorbidities; encourage discussion of addiction focused pharmacotherapy with residential substance use treatment program patients; ensure that active mental health comorbidities are addressed in residential substance use rehabilitation treatment program interdisciplinary treatment plans; and ensure documentation of post-discharge aftercare appointment arrangements for mental health comorbidities.