Veterans Affairs Committee on Sept. 26th, 2012

[The Chair, Conservative, Greg Kerr]

We will begin our meeting.

Today we want to welcome members of the department, some of whom have been here before, I might add. We're looking at case management.

I want to welcome Charlotte Stewart, who is no stranger to the process. Certainly Raymond Lalonde we've seen both in Montreal and here on occasion. It's nice to have you back. Charlotte Bastien is a little newer to the process, but she's certainly been part of it as well.

Welcome to all three of you.

You know the process. We'll have your presentation for 10 minutes, and then we go to questions and answers. If there are questions at the end of the meeting that can't be responded to, if you would prepare written answers for us, that would be appreciated.

We're ready to go with today's session.

I welcome you.

I understand you're splitting your time, Charlotte? Okay, please go ahead.

[Charlotte Stewart, Director General, Service Delivery and Program Management, Department of Veterans Affairs]

Thank you, Mr. Chair.

Good afternoon, and thank you for the opportunity to participate in the session.

As the chair mentioned, my name is Charlotte Stewart. I'm the director general responsible for service delivery and program management with Veterans Affairs Canada. With me this afternoon are Charlotte Bastien, our regional director general for the Quebec and Ontario region, and Raymond Lalonde, director general, operational stress injuries national network.

We are here today to discuss a topic that is at the heart of what we do at Veterans Affairs Canada in case management. More specifically, we are here to talk about strengthening case management.

I will discuss the national service delivery perspective for case management, Charlotte Bastien will provide the regional and front-line perspective, and Raymond Lalonde will be able to give us his views from the perspective of the operational stress injury network.

I'll begin by describing what the case-managed veteran population looks like. Veterans Affairs Canada's full client profile includes survivors, Canadian Forces veterans, war service veterans, and RCMP. The case-managed client profile is slightly different, mainly because survivors are not generally case-managed, but also because Canadian Forces veterans, who make up 34% of our total population, represent over 80% of our case-managed group. This statistic reinforces the demographic shift the department is experiencing. Furthermore, of the case-managed veterans we serve, the majority, 55%, are afflicted with a combination of mental and physical health problems; 30% have a diagnosed physical condition; and the remaining 50% have a diagnosed mental health condition. It is this complexity of cases that has driven the department's transformation agenda to ensure that we continue to meet the needs of these veterans and their families.

Case managers are the face of the department for many veterans. They're the cornerstone for the delivery of services and benefits. The transformation agenda has affected case managers' work in a positive way by providing them with the tools they need to succeed. For example, three workload intensity tools have been introduced by Veterans Affairs Canada. They include a risk tool designed to evaluate risk factors in veterans; a case need and complexity tool, which identifies levels of need, complexity, and intensity of cases; and a workload tool, which effectively measures workload effort associated with each case-managed veteran, ensuring that the department is able to distribute workload equitably amongst its employees.

These tools make it easier for our employees to objectively identify levels of risk, need, and complexity to ensure that veterans receive appropriate services in a timely way. The tools support the effective management of individual cases and overall caseloads. Most importantly, these tools provide a mechanism to monitor veterans' progress and identify when and if veterans are ready to transition out of the case management process. By using these tools, front-line staff and managers evaluate caseloads based on the number of active cases and on the level of complexity and intensity associated with each. The result is a well-balanced caseload for case managers across the country.

This suite of tools was rolled out nationally in February 2012, and our recent reviews indicate that employees are buying in. The vast majority of our case managers are using these tools effectively as they have been designed. Since the introduction and training of VAC staff on the use of the risk tools, over 80% are using these in accordance with the tools' guidelines. This information is encouraging, because it shows that there is an appetite for change and that the tools are useful, which is, of course, very important to us. This ensures as well that we know the workload is being distributed equitably between case managers and that we are able to identify those veterans who need priority attention. We will continue to support staff through the transformation process in an effort to improve these statistics even more.

The department is also developing a new national learning strategy for case managers, developing core competencies and supporting the further delegation of additional authority to front-line staff. These processes will be implemented in an environment that continues to adjust to the changing demographics of the veteran population, and as we move forward we will continue to maintain average caseloads of no more than 40 veteran clients per case manager.

As these factors change, we will adapt in order to maintain a consistently high level of service. We have district offices throughout the country, 24 integrated personnel support centres located on or near Canadian Forces bases and wings. VAC will ensure case managers are located in the areas of the country where they are needed the most and the department will continue to provide face-to-face services to meet the requirements of veterans. All of this will be done with the pillars of transformation in mind.

Strengthening case management supports two major themes in our transformation agenda: improving service delivery, and continuing to adapt to changing demographics of veterans by reorganizing the department for optimal service delivery to both veterans and employees as our consumers of internal services.

We are confident that our continued efforts will improve the services and benefits the department offers to veterans and their families. As their needs change, we will remain committed to providing the right people, in the right places, doing the right things at the right time.

Thank you again, Mr. Chair. I will now turn things over to my colleague, Charlotte Bastien.

[Charlotte Bastien, Regional Director General, Ontario and Quebec Region, Service Delivery Branch, Department of Veterans Affairs]

Thank you, Charlotte.

Thank you, Mr. Chair.

My name is Charlotte Bastien and I am the Regional Director General for Ontario and Quebec at Veterans Affairs. I am pleased to be here to support this committee's study on transformation.

I would like to provide some front-line context of how the case management function is strengthened by the transformation agenda.

As my colleague mentioned, case management is the cornerstone of the service and benefit delivery system. Veterans Affairs Canada relies on the integrity of the system to ensure that the relationships our staff have fostered with veterans aren't compromised because of a shift in business practices.

We have to be cognizant of the fact that, to a veteran suffering from a mental health condition, the transformation agenda is of little importance. This is not to say that they aren't aware of the changes, but their main goal is to stay focused on their rehabilitation. These are the scenarios the department considers when a realignment of staffing resources is made. As demographics shift, whether those demographics are based on age, sex or geography, the department must adapt quickly. Veterans Affairs Canada is committed to positioning resources in the areas of the country with the most need.

I would also like to discuss the level of service our case managers provide. Our case managers are selected on a wide range of criteria and are very skilled at what they do. That being said, they are sometimes faced with difficult situations that require a different skill set. As a department, we have created a support system that gives them added confidence when they are working with veterans who have more complex needs. They have access to case management experts and rehabilitation experts who can guide them through complex issues. Rehabilitation experts, mental health experts, standards training and evaluation officers, health professionals and others are all part of the support network available to case managers. This diverse range of expertise ensures that case managers can customize a plan for each veteran.

Recently, we have seen more and more case managers seeking assistance from the experts who are there to support them in achieving the best possible outcome for the veteran. The department encourages this practice because it is in the best interest of our veterans.

Veterans Affairs Canada recognizes that the key to successful outcomes for veterans begins with the department’s ability to identify needs and levels of risk in order to refer them to the most appropriate member of the client service team. For those who require case management services, the support provided will always be focused on specific outcomes and engaging veterans in the case planning process.

Engagement is the key word here. The process doesn’t work without the buy-in of the individual. Our case management practices are world class but, at the base level, we case manage people.

Case managers use a variety of techniques, such as motivational interviewing, to help veterans recognize problems and commit to changes that will help them.

At the base level, we work with veterans to achieve their goals. Our case managers work with veterans on their goals so that the veterans see the value, for example, of accepting treatment for addiction or mental illness, attending medical care and therapy, going to school so that they can move back into the workforce, or going to family counselling sessions to strengthen the family unit. These are significant commitments and life goals. Case managers are there to help veterans move through the change and goal-setting process.

It is important to note that the veterans are and must be the owners of their plans to change. If they plan an active role, our success rate will increase. If there are stumbling blocks on the road to recovery, Veterans Affairs will be there with a robust support system to help them achieve the mutually agreed upon goals they develop with their case managers.

As I said, the veteran is the owner of the plan. If they play an active role, our success rates will increase. If there are stumbling blocks on the road to recovery, we have a system in place to help them achieve their goals.

If you have questions about the clinics or the support network, Raymond Lalonde is also with us and will be able to answer your questions, together with Charlotte and I. Thank you very much for your attention. We are open to any questions you may have.

[The Chair, Conservative, Greg Kerr]

Thank you very much.

We'll begin our questioning. Mr. Stoffer will begin the five-minute round.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Thank you very much, Mr. Chair, and thank you all very much for being here.

I hope you don't take what I'm about to say on a personal level. It's more on a professional level. First, I'm extremely pleased with the documentation we have before us. The motion for this meeting was passed on a Monday afternoon, and the clerk of the committee advised me that your offices were contacted yesterday for a meeting today. Yet we have two reports here. I assume they've been translated, and they would have been proofread before they got here. In my 15 years, I have never seen, in any committee I've ever been on, the speed at which people were able to appear before a committee within 24 hours with the information we have. It's really quite amazing. I'm thanking you for that.

Prior to Monday, were any of you or any of your office staff or anybody related to this meeting today contacted with an indication that there would be a meeting on this subject on Wednesday in the House of Commons?

[The Chair, Conservative, Greg Kerr]

You're never required to answer a question, but if you wish to, that's certainly fair enough.

[Charlotte Stewart]

We received our confirmation that we would be here today. In fact, Monsieur Lalonde received his invitation yesterday as well.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

My question was whether you heard about this from anyone prior to Monday.

[Charlotte Stewart]

As departmental officials, we get engaged in discussing potential committee agendas. That is an evolving process, and we are then informed when the date will be and when we are to appear.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Okay. Is it possible to allow us to know when you got that information?

[Charlotte Stewart]

I can't confirm that.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Okay, that's fine. Thank you.

How many case managers are there in the country right now?

[Charlotte Stewart]

There are 250 case managers.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

There are 250.

Madam Bastien, do case managers assist in family issues as well, when the veteran may not speak or is unwilling to? Or maybe the veteran is divorced from the family situation and a family member would then call up a case manager looking for assistance. Does that happen as well?

[Charlotte Bastien]

We work with the veteran, and if there are family issues that need to be addressed, we will work with the veteran to try to address them. If the veteran is not ready to address them, there are limitations as to what we can do.

Again, the owner of the case plan is the veteran, and the veteran works with us and determines the goal of his or her plan, depending on the situation. It's a case-by-case situation.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Thank you.

My colleague Monsieur Chicoine has a question.

[Sylvain Chicoine, NDP, Châteauguay—Saint-Constant, QC]

I would like to thank my colleague.

I would also like to thank the witnesses for joining us today.

Since 2010, when the new system was implemented, reports have indicated that this new tool was not being used to its full potential. Sometimes, spaces were left blank or things like that. Could you tell me what you have done to improve the situation and whether some things still need to be done to maximize the use of those tools?

[Charlotte Stewart]

I believe you are speaking of the workload intensity tools that I referenced in my opening remarks.

[Sylvain Chicoine, NDP, Châteauguay—Saint-Constant, QC]

Yes, you mentioned them in your speech.

[Charlotte Stewart]

The development of these tools really began toward the end of 2010. It was a national effort that involved front-line staff from across the country who were experts in the field. We went to them to help us develop these tools. They worked extensively as a team for about 12 months to develop the three tools and then began the training.

Although the first year was one of development and testing, there's been a very strong and positive response to the tools since the first training was delivered to the front line. There really hasn't been any delay in their utilization; it's just been a matter of ensuring sufficient training was in place, that everybody who was going to use them had not one but two rounds of training. We're very pleased with the take-up and the success rate.

I believe Charlotte, as a front-line director general, might want to add to that as well from the perspective of her employees.

[Charlotte Bastien]

There are growing pains associated with the implementation of new tools. As it was being developed, it was also being piloted, so there might have been areas where there were gaps because certain aspects were not ready. But since the full implementation, there's been regular monitoring, and we have a robust quality assurance program to make sure the tool is used effectively.

[The Chair, Conservative, Greg Kerr]

Thank you. That's the five minutes.

We'll now go to Ms. Adams for five minutes, please.

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

Thanks very much.

I'm a little astounded by the NDP's line of questioning. This is a party...and these members specifically continue to vote against every estimate we have that comes forward. Every dollar that goes to benefit veterans, every cheque they receive each month, every service provider, every psychiatrist we fund, every member of your staff we fund to serve veterans—these folks on the other side of this committee continue to vote against all that funding.

I wonder if you could perhaps tell me if in the last year they've ever voted for any of the estimates put forward.

[The Chair, Conservative, Greg Kerr]

I'm not sure that's a question the staff can answer.

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

Fair enough. Why don't I go back then to some of the information that was presented today.

I'd like to thank you for coming forward today to present to us on the new tools that make up our new approach to case management at Veterans Affairs.

Can you explain to me when these metrics were developed, and do you have an indication of their success so far?