Veterans Affairs Committee on Sept. 26th, 2012

[Charlotte Bastien]

I don't have the exact number. There are more than 50 in the regional offices or district offices. The network of OSI clinics also has clinical experts who can provide support. Experts from the head office in Charlottetown can also guide people. This number does not include health professionals, be they doctors or nurses in the local district offices, in regional and national offices or in the network of OSI clinics.

[Manon Perreault, NDP, Montcalm, QC]

That's fine.

Since I don't seem to have much time left, could you tell me what “OSI” stands for?

[Raymond Lalonde, Director General, Operational Stress Injuries National Network, Department of Veterans Affairs]

It is an operational stress injury. In our 10 clinics that have been set up—and whose number has doubled since 2007—our clinicians are part of an interdisciplinary team. They are specialized in treating operational stress or post-traumatic stress. One of their responsibilities is to work closely with case managers in district offices. They can also act as experts and assist managers when a case is not handled in a clinic. Managers can get the opinion of a psychiatrist, psychologist or social worker. There are also about 90 clinical nurses available across the country.

[Manon Perreault, NDP, Montcalm, QC]

Okay, that is fine.

Thank you.

[The Chair, Conservative, Greg Kerr]

Thank you.

Now to Mr. Lizon for four minutes, please.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you very much, Mr. Chair.

To begin, I would like to join my colleagues in thanking you for your great work and for coming here this afternoon.

The first question I have is to Madam Bastien. In your presentation, you indicated, and I quote:

Recently we have experienced a cultural shift in the mind set of Case Managers. More and more they are seeking assistance from the experts who are there to support them. The department encourages this practice because it is in the best interest of our clients.

Can you maybe elaborate a little bit more on this and on how it happened? Did it come from within the department? Was it a sudden idea? It's very interesting.

[Charlotte Bastien]

It's part of developing the culture of a team approach and having an interdisciplinary team to assist the veteran. Also, we've been seeing a growing complexity of the issues over time. Individuals requiring case management 20 years ago, 15 years ago, and some of the complex cases we see today, an individual with physical or mental issues, addiction, family issues, financial issues, transition issues from military to civilian life.... They don't necessarily have all the expertise or the knowledge to assist with some of these very complex issues or to assist somebody with several issues to address. That's where we're seeing the culture shift into seeking assistance, so they can best help the client in achieving the outcome of their case plan, their rehabilitation, or in doing the transition.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Are the experts you're referring to experts within the department, or are you reaching out to experts wherever they're available?

[Charlotte Bastien]

The first step is within the department, but if we need to seek expertise outside of the department and in the community, in the provincial system, and through the clinics, through other means, we will in order to assist.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

The second question I have is on veterans' transition to civilian life. Many of the CF members who are about to retire or be released from the military sometimes want to start a new career in civilian life. Many of them have a challenge because they have skills that do meet criteria for different jobs, but sometimes they have difficulties finding an employer. How does the case management work in this particular problem?

[Charlotte Stewart]

Very importantly, the discussion starts to happen before they release. The individual who's releasing will be engaged within the Canadian Forces, having discussions around their aspirations and expectations as they begin to transition. At that point, even before their release, they will likely meet a case manager from Veterans Affairs Canada. For instance, at one of the integrated personnel support centres, that's where our partnership with DND really starts on the ground, when the two case managers can engage around a releasing veteran, identify with them their aspirations, what their current aptitudes and vocational strengths are, and then make a plan for them. Depending on the individual, if they have skills that are easily transferred into civilian life, as they move over into a Veterans Affairs Canada environment, they may not need very much more assistance in that area, but if they do need retraining, they can be part of our vocational retraining programs.

Also within the department, as part of a recent announcement, there's an organization called Helmets to Hardhats. That applies to the building, trades, and construction sector, but it's an important model for showing the willingness of the public sector, the private sector, and unions to work together to create opportunities for releasing veterans. That's a fairly unique—it wasn't made in Canada, but it was recently adopted in Canada—approach to assisting veterans in finding a new career.

It really comes down to the individual identifying their needs with our help, and we have various programs that can assist them in making that transition.

[The Chair, Conservative, Greg Kerr]

Thank you very much. I actually got an extra minute out of all of that. It was very intense and very good.

Mr. Chicoine, go ahead for four minutes, please.

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

Thank you, Mr. Chair.

I have also read in the report that some clients were getting no follow-up in the 90 days after a meeting with a case manager. What steps have you taken to improve contact with the clients who were not being followed up within 90 days?

[Charlotte Bastien]

Are you referring to the 90-day follow-up in the rehabilitation program? Unfortunately, when the case manager had a heavy workload with a very high number of veterans requiring case management services, it was a challenge to contact them all within 90 days to provide them with feedback or a follow-up. With the help of the tools, case managers can now balance their workload and have time to meet with the veterans or to at least contact them and do the follow-up within 90 days. The tool also enables us to make reports and to look at the action plans. For every follow-up, there is an action; it is recorded using the tool in the system. If there is a delay, the case manager's team leader will see if any of the 90-day follow-ups were late. The team leader will then talk to the case manager to see what is happening and why the follow-up with the veteran was not carried out.

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

So this happens a lot less frequently today.

Have you also set up a system for the quality control of decisions and case plans? The report showed that, because of the lack of follow-up, case plans were sometimes inappropriate and a number of files did not have the proper documentation for decisions.

[Charlotte Bastien]

We have quality assurance exercises—I prefer to call them quality assurance, not quality control. Yes, if the follow-ups in the case plan are not carried out, we have to check with the case manager to see why it has not been updated. I must also say that the case plan can change. The situation and the issues facing the individual or the veteran might have since evolved. It is important to do the follow-up and to change the objectives, if necessary. Also, if the individual has achieved their goals, they have to withdraw. And if the veteran is not committed or motivated to pursue the objectives or to follow through on the points in their case plan, we have to check with them and see if they should withdraw from the case management process, because they are not ready. A number of factors can explain why they are not ready or motivated to pursue their objectives. That all falls under the quality assurance program; the team leader will check with the case manager.

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

As for the case managers, do you have a contract with a private company or are they all from Veterans Affairs Canada?

[Charlotte Bastien]

Case managers are employed by the department, but sometimes we may call on clinical case managers. Those are external, contracted resources that we can call. But they are not the ones in charge of case management. If we have to take action in a more... How should I say this? Let's say, for example, that someone with suicidal tendencies is in crisis. In that case, we can ask a resource person to help that client. Sometimes, that means going with the client to an appointment to make sure that the follow-up is done and that the client did go to their doctor's appointment, for example.

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

Thank you, I have no further questions.

Actually, are those people associated with the national case management network? I read that there is a type of national case management network that apparently has a contract with Veterans Affairs Canada. Does that have anything to do with the situation you have described?

[Charlotte Bastien]

That does not ring a bell.

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

It does not ring a bell. We will do a little more research.

Thank you.

[The Chair, Conservative, Greg Kerr]

Thank you very much.

To wrap it all up, Mr. Zimmer, for four minutes, please.

[Bob Zimmer, Conservative, Prince George—Peace River, BC]

That's a lot of pressure, Mr. Chair.

To reiterate, some of my colleagues, on our side, at least, said it's an honour to be here and be a part of this committee.

I think it was Ms. Stewart who said that the transformation agenda has driven the care for veterans. I think all of us feel the same, that we want to do our best for our veterans. I have two cousins who have just served, one in the air force and one in the military. I care about their future, and I think we all do here.

That said, the veteran system is very complex and very big, and I guess it sometimes can be challenging for you as well to keep up to it all. With this much change, what efforts have you made to ensure that all of your case officers or agents have had the necessary training systems to effectively execute their mandate, again with the concern for veterans being the prime driver for delivery?

[Charlotte Bastien]

In the public service, each employee has a learning plan and we do a yearly appraisal. A client service agent or case manager will sit at least once a year with their manager to review their training needs, their performance. If there are areas that need a refresher or need to be improved, or if there are things they want to perfect or they want to acquire an enhanced skill set, that's discussed on a yearly basis. Each employee has a learning plan.

The training regarding programs or getting some of the skill sets is then rolled up at a national level, and we have a national strategy. When we see a need for a refresher on certain programs, we will roll out a national training plan for staff so they can update or refresh their knowledge or skill set, depending on the subject or topic.

[Bob Zimmer, Conservative, Prince George—Peace River, BC]

I'll just change the subject a little bit.

In recent announcements—I think they were mentioned earlier by Ms. Stewart—about the Helmets to Hardhats program...I guess you must have seen other systems. You said that we didn't invent the wheel. We sort of reinvented it here in Canada.

What impact do you see this initiative having for our Canadian Forces veterans specifically? What do you see as the benefit?