Question Period Note: CASE MANAGEMENT

• Our Government places the highest priority on ensuring Veterans and their families have the support and services they need, when and where they need it.

• Case Managers work directly with Veterans facing complex challenges to identify needs, set goals, and create a plan to help clients achieve their highest level of independence, health and well-being.

• We have increased funding for case management services, in response to meet the demand, with now approximately 14,000 Veterans being case managed.

• We have improved the overall case management approach, recognizing it is a unique service for each Veteran and more than simply a case manager-to-Veteran ratio.

• We have improved our tools and processes to reduce administration, allowing frontline staff to spend more time in direct service to Veterans and their families.

BACKGROUND – CASE MANAGEMENT

As of October 31, 2022, the Veteran-to-case manager ratio is 30:1 (source: Number of Veterans with an active case management SSI indicator in CSDN divided by the number of funded case managers).

Veterans Affairs Canada provides Case Management Services to support those facing complex challenges. It is a collaborative process between the client and Case Management Team to identify needs, set goals, and create a plan to help clients achieve their highest level of independence, health and well-being.

Our case management efforts are aimed at ensuring all Veterans receive the support they need, when they need it. Over the last number of years, we have approximately doubled the number of case managers in order to meet the increasing demands for Case Management Services.

In Budget 2018, as part of Service Excellence (Surge) we received temporary funding for additional case managers. Currently, there are 482 case managers (funded positions: 432 permanent and 50 temporary. Of the 432 permanent positions, 6 of them are under the new Mental Health Benefit Initiative).

However, we recognize simply increasing staff numbers will not meet the increased demands for these services. As such, we implemented several initiatives which will improve efficiencies and case management practices, while ensuring the appropriate level of service is provided to Veterans and their families.

The implementation of Guided Support in December 2018 ensures Veterans with moderate needs have the appropriate supports in place provided by Veteran Service Agents, allowing Case Managers the capacity to focus on Veterans with more complex needs.

A screening tool implemented in January 2019 improves our ability to identify Veterans’ level of risk, needs and complexities so they can be triaged to an appropriate level of support.

In April 2021, we launched a new case management assessment, which uses digital initiatives to reduce administrative burden for case managers, thereby increasing their capacity to work directly with Veterans and their families.

A Case Management Renewal initiative creates a more balanced delivery model for case management services to Veterans. In April 2022, the initiative introduced a new team approach, and improved tools and features to sustain the quality of Case Management Services by ensuring an interdisciplinary team works with Veterans so they receive the appropriate level of service based on their needs, risk and complexity.

On 20 October 2022, the Government of Canada confirmed $43million in funding over three years to support Veteran Affairs Canada’s (VAC) case management services. This funding will maintain the total number of frontline VAC staff, including Case Managers, maintain the Case Manager to Veteran ratio, and improve the tools Case Managers use – freeing up more time for them to work directly with Veterans. This funding will help maintain our current ratio and case management level of service, while we also have other initiatives such as RSVP and Case Management Renewal to support us in achieving our outcomes in reducing the workload – especially administrative tasks associated to the caseloads.
Change of this magnitude takes time to implement. All of these strategies aim to create a more sustainable approach to Case Management Services, leading to a decrease in the ratios over the next few years. That said, fiscal year 2021-2022 demonstrates a decrease in ratio.

Additional Information on Case Management Trends

2015-16 2016-17 2017-18 2018-19 2019-20 2020-21 2021-22

Case Managed Veterans 9,989 13, 076 14, 356 14, 801 15, 150 16,140
15,508

Ratio
33:1 35:1
March 2017 36:1
March 2018 32:1
March 2019 32:1
March 2020 34:1
March 2021 31:1
March
2022

(Source: Archived Facts & Figures Book)
The story is that Afghanistan Veterans, in 2015, were predicted to start coming forward to us for benefits and services over a number of years. These Veterans reported difficulty adjusting to civilian life and poorer mental health compared to other Veterans we serve. Increased demands for our case management services continue and since 2015 have grown by over 6000 Veterans. Incidentally, of the approximately 14,000 case managed Veterans, approximately 6000 case served in Afghanistan.

The increased demand has been accompanied by a higher level of need among the Veterans that the Department serves. For the 40,000 Veterans and Members that served in Afghanistan, we are seeing an increased complexity in their level of needs.
1 in 5 of those that served have a service related mental health condition leading to an increased need for services and benefits.

In the broader Veteran population we are also seeing trends that demonstrate a need for additional support. Veterans who rated their physical health as good or very good dropped from 46% to 39% and those that rated their mental health as good or very good also dropped from 56% to 48%. (Life After Service Study) Veterans have a higher rate of suicide than other Canadians. Male Veterans have a 1.4 times higher risk while female Veterans have a 1.9 times higher risk of suicide. (Veteran Suicide Mortality Study).

Demand for case management services is increasing, primarily associated with Afghanistan Veterans releasing, as well as improvements to our Rehabilitation and other associated programs attracting Veterans in need. While the increasing demands for our case management services is not in our control, it is very positive in nature. It demonstrates that Veterans are coming forward seeking help and support as they should.

WHEN PRESSED:

Q1 - How many case managers have reported that their job has had a negative impact on their mental health or taken leave or days off related to stress or mental health concerns?

While taking sick leave, employees do not need to stipulate the reasons for their absence. This data is not captured at Veterans Affairs Canada in order to protect employees’ privacy.

Q2 - What has been the turnover rate for case managers, broken down by month?

The turnover rates are available by year, not by month. In 2019-20, the turnover rate for case managers was 12.8%; and in 2020-21, the turnover rate was 9.1%. On average, a 10% turnover rate is considered normal. For all Veterans Affairs Canada indeterminate positions, the average yearly turnover rate is 7.1%.

Q3 - What specific action has Veterans Affairs Canada done to support the mental health of their case managers?

• Veterans Affairs Canada has increased its focus on employee wellness through local and national wellness committees as well as providing mental health training;
• Veterans Affairs Canada has implemented the Case Management Renewal initiative as of April 2022 which created a more balanced delivery model and improved processes and work tools to reduce the administrative burden for frontline staff;
• Veterans Affairs Canada implemented a new screening tool and a new case management assessment form which improved case managers’ ability to identify Veterans’ levels of risk, needs and complexities;
• Veterans Affairs Canada has improved its staffing and onboarding processes to accelerate and facilitate the recruitment of case managers, to improve our capacity to serve Veterans;
• Veterans Affairs Canada is committed to continue hiring additional case managers, and to improve case management services to the benefit of both Veterans and Case Managers.
• Veterans Affairs Canada has offered the mental health training and education program Road to Mental Readiness (R2MR) to all case managers. The goal is to enhance resilience and increase mental health knowledge. R2MR enhances well‐being, mental toughness, resilience and coping with a focus on prevention by increasing mental health literacy and decreasing stigma and barriers to care.

Q4 - How many and what percentage of case managers are currently responsible for more than the standard of 25 Veterans per case manager?

As of 9 September, 2022, 72% of case managers have a caseload of more than 25 Veterans, with the average caseload per funded case managers being 30.

Q5 - Is there a joint working group between VAC and the Union to address the issue?

VAC and the union have a full structure of meetings and consultations at local, regional and national levels. There are multiple initiatives to collaborate on improving the workplace and address any issues.

Q6 - What are the minister's specific goals with regards to lowering the number of veterans per case manager, including the specific targets as of July 1, 2022 and January 1, 2023?

Veterans Affairs Canada remains committed to delivering high quality case management services for Veterans. Case management is a unique service that is based on the needs of each Veteran, this means improving the overall approach is more than the case manager-to-Veteran ratio. Our efforts are aimed at ensuring all Veterans receive the support they need, when they need it.

Veterans Affairs Canada continues to improve tools and processes for staff to reduce the administrative burden and increase the time that case managers can spend directly with Veterans.

As case management is based on need, and given the significant increase in Veterans who require case management, Veterans Affairs Canada continues to work to improve and evaluate case management ratios. In fact, our ratio has moved from 34.3:1 in 2020-2021 to 31:1 in 2021-2022 despite the fact that demand for case management services continue to increase. Currently, our ratio is at 30:1.

Q7 – What education requirements must case managers have to work at Veterans Affairs Canada?

Our case managers (CM) have diverse educational backgrounds. The educational standard for the job requires they have a degree from a recognized post-secondary institution in the study, understanding, or assessment of human behaviour (the degree program must have also included the completion of a practicum or field placement for graduation) and a minimum of six months previous experience in case management. Or, graduation with a degree from a recognized post-secondary institution and minimum of one year previous experience in case management.

When hiring CMs, priority is given to candidates who have experience in dealing with a military culture, were members of the Canadian Armed Forces, or are experienced as caseworkers in a rehabilitation environment.

Q8 What type of training do case managers receive to work with Veterans with complex needs?

In addition to the education and experience they bring to the job, case managers must undergo extensive training before they can obtain a case load.

We equip our CMs with tools and training to help them support Veterans:

• Introduction to motivational interviewing;
• Guidelines for working with clients experiencing anger;
• Suicidal Prevention protocol;
• VAC Suicide Awareness and Intervention protocol;
• Psychotherapy and evidenced-based treatments for military related PTSD;
• Applied Suicide Intervention Skills Training (ASIST);
• Guidelines for working with clients who are pursing Medical Assistance in Dying with their primary health care provider.
•
Our Case Managers are trained in situations where Veterans are in crisis due to trauma. They must complete the following mandatory training:
• Trauma Informed Support Training
• How to Respond to Sexual Trauma Disclosures

Trauma Informed Support training is a 60 minute online course that provides a basic overview of the principles of trauma informed service, specifically in relation to those who have experienced military sexual trauma/sexual misconduct. To date, 713 Field Operations employees have completed this mandatory training. The remainder of FO employees will complete the training in the near future.
The How to Respond to Sexual Trauma Disclosures training is a 90-minute workshop provides participants with key practice skills and strategies using case scenarios and interactive exercises to support practicing essential skills in a supportive learning environment. This workshop was offered in August 2022. So far, 206 Case Managers have attended. There are more sessions planned this fall.

Case Managers are also trained on VAC tools such as the integrated screening tool which provides a consistent means of identifying the risk levels and unmet needs of Veterans and their families. The case management assessment tool, provides a holistic assessment of the Veteran based on their seven domains of well-being. It identifies their level of complexity and needs to address in addition to the case plan to set goals and monitor their progress towards improvement to their well-being.

Moreover, VAC has modernized and enhanced the role of CMs through:

• A National Case Management Learning Strategy which focuses on practice, skills development and knowledge. This includes for new onboarding case managers an intensive training that is a virtual learner-focused program that provides the opportunity to practice and apply new knowledge and skills in an environment that is psychologically safe. It offers a focus on application and knowledge, to support learners in real-world situations, where they analyze and evaluate client plans;
• Improved national service standards, guidelines and protocols which support consistency in the delivery of case management;
• The development of a national competency profile for VAC case managers; and, extensive training, especially in the area of mental health.

Case Managers also receive support and guidance from various subject matter experts within the organization, including Case Management Practice Consultants, Standards Training and Evaluation Officers and Mental Health Officers on an as needed basis.
It can take up to 6 months before a case manager obtain a full case load.

Q9 The recent $43 million funding announcement to maintain the total number of temporary frontline staff includes who?

Funding to maintain the following temporary frontline positions:
o 25 Veteran Service Agents (VSAs)- WP-02s
o 50 Case Managers (CMs) - WP-04s
o 6 Veteran Service Team Managers (VSTMs) - WP-05s

Veterans’ Access to VAC Offices/VAC Support

Q1 - Which VAC area offices are currently open to in person visits from Veterans?

Beginning in May 2022, Veterans Affairs Canada’s office sites have started to return to the workplace. Locations are occupied in phases based on readiness, location and size. Most of our office sites are currently providing in-person service by appointment.
View the Operational Status of Field Offices report for the most up to date re-occupancy dates. We also continue to serve Veterans and their families by phone, online and face to face using Microsoft Teams. In addition to regular services, Veterans Affairs Canada has reached out to 20, 797 vulnerable clients since the beginning of the pandemic.

Q2 - What percentage of staff who work directly with Veterans are working remotely?

Due to the ongoing pandemic situation across the country, all staff who work directly with Veterans are working in a hybrid model of work. This means that all staff across the country are working remotely, but also have a presence in the office on a scheduled basis to meet operational requirements to ensure Veterans’ needs are met.