STATEMENT OF STEVE YOUNG
DEPUTY UNDER SECRETARY FOR HEALTH FOR OPERATIONS AND
MANAGEMENT
BEFORE THE
HOUSE COMMITTEE ON VETERANS’ AFFAIRS
APRIL 4, 2017

Good morning Chairman Roe, Ranking Member Walz, and Members of the
Committee. Thank you for the opportunity to discuss the Department of Veterans
Affairs (VA) Office of the Inspector General’s (OIG) report on the Veterans Crisis Line
(VCL). I am accompanied today by Matthew Eitutis, Acting Veterans Health
Administration (VHA) Member Services Executive Director.

Introduction
VA recognizes the importance of VCL as a life-saving resource for our Nation’s
Veterans who find themselves at risk of suicide. Of all the Veterans we serve, we most
want those in crisis to know that dedicated, expert VA staff, many of whom are Veterans
themselves, will be there when they are needed. The primary mission of VCL is to
provide 24/7, world class, suicide prevention and crisis intervention services to
Veterans, Servicemembers, and their family members. However, any person
concerned for a Veteran’s or Servicemember’s safety or crisis status may call VCL.

Positive Actions Taken to Date

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 Since 2007, VCL has answered nearly 2.6 million calls and dispatched
emergency services to callers in crisis over 67,000 times. Consistent with our mission,
we have implemented a series of initiatives to provide the best customer service for
every caller, making notable advances to improve access and the quality of crisis care
available to our Veterans, such as:
•

Launching “Veterans Chat” in 2009, an online, one-to-one chat service for
Veterans who prefer reaching out for assistance using the Internet. Since its
inception, we have answered nearly 314,000 requests for chat.

•

Expanding modalities to our Veteran population by adding text services in
November 2011, resulting in nearly 62,000 requests for text services.

•

Opening a second VCL site in Atlanta in October 2016, with over 200 crisis
responders and support staff.

•

Implementing a comprehensive workforce management system and optimizing
staffing patterns to provide callers with immediate service and achieve zero
percent routine rollover to contracted back-up centers.
VCL is the strongest it has been since its inception in 2007. VCL staff has

forwarded over 416,000 referrals to local Suicide Prevention Coordinators on behalf of
Veterans to ensure continuity of care with their local VA providers. Initially housed in
2007 at the Canandaigua VA Medical Center in New York, it began with 14 responders
and two health care technicians answering four phone lines. In the past 6 months, VCL
has nearly doubled the capacity to ensure appropriate access to Veterans. Today, the
combined facilities employ more than 500 professionals, and VA is hiring more to
handle the growing volume of calls. Atlanta offers 200 call responders and 25 social

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 service assistants and support staff, while Canandaigua houses 310 and 43,
respectively. Despite all this, there still is more that we can do.

VA Office of Inspector General (OIG) Report
VA OIG published a report on February 11, 2016, Healthcare Inspection—
Veterans Crisis Line Caller Response and Quality Assurance Concerns Canandaigua,
New York (Report No. 14-03540-123) and a follow-up on March 20, 2017, Healthcare
Inspection—Evaluation of the Veterans Health Administration Veterans Crisis Line
(Report No. 116-03985-181). These reports detailed issues and subsequent
recommendations for VCL. The March 2017 report made 16 recommendations
associated with the review that occurred June 2016 through December 2016. We take
these reports very seriously. VHA concurred with all of the new recommendations and
developed action plans. In fact, we were addressing many of the recommendations
even before receiving the recent OIG report.

Response
Action plans have been developed to address all of the recommendations for the
March 2017 Report. We expect to begin implementation in May, and to be completed by
December 2017. These actions include:
•

Incorporating a new Customer Relationship Management (CRM) system so caller
information is automatically populated with the phone number of the caller.

•

Evaluating policies and procedures related to VCL call recordings, and ensuring
all staff are educated on policies, to include roles and responsibilities.

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 •

Developing and implementing a training plan for educating staff on the use of call
recordings and how to walk a caller through any concerns regarding the
recording of calls.

•

Establishing a governance structure to ensure cooperation and collaboration
between program offices and appropriate responsibility for clinical and
administrative functions.

•

Developing clear guidelines for clinical and administrative decision-making.
These guidelines will focus on ensuring Veterans who call receive high-quality
care based on clinical judgement and operations are managed with sound
business practices.

•

Collaborating with other VA program offices to provide training to VCL
management staff in core competencies of safe and high quality leadership.

•

Adding to VCL Executive Leadership Council’s (ELC) responsibilities. VCL ELC
is the governance structure responsible for documenting, tracking, and directing
action on clinical quality performance measures.

•

Implementing root cause analysis and corrective action plans to ensure
opportunities for improvement are appropriately implemented.

Progress
Prior to opening the Atlanta VCL call center in October 2016, VCL saw in excess
of 3,000 calls per week roll over to back-up call centers. From January 8-14, 2017, we
maintained rolled over only 58 phone calls. Since then, we continue to keep rollover
calls well below one percent. This means that on average, we answer over 99 percent

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 of calls received on a daily basis by the Canandaigua, New York, and Atlanta, Georgia,
call centers.
VCL implemented a comprehensive workforce management system and
optimized staffing patterns to provide callers with immediate service and to achieve zero
percent routine rollover to contracted back-up centers.
During the time period of the second OIG investigation, VCL actively staffed the
Atlanta call center. New responders were hired and trained over the course of three
months, averaging 40 new responders being deployed per pay period. The standard
training cycle includes three weeks of classroom instruction and two weeks of
preceptorship prior to being released to independent work.
The chart below indicates VCL's progress over the course of the last several
months in offering superior access for Veterans during their time of need. It is worth
noting, the rollover rate has dropped even while the number of calls has increased.
Weekly VCL Access Table
Week for 2016-2017

Total Number of Calls

Total Rollovers

Rollover %

10/30 - 11/5

10558

3309

31.34%

11/6 - 11/12

10485

2274

21.69%

11/13 - 11/19

11344

2484

21.90%

11/20 - 11/26

9508

1363

14.34%

11/27 - 12/3

12477

2097

16.81%

12/4 - 12/10

12,380

1,488

12.02%

12/11-12/17

12,613

1,396

11.07%

12/18 - 12/24

12,257

640

5.22%

5

 12/25 -12/31

12,852

507

3.94%

1/1 - 1/7

14,768

294

1.99%

1/8 - 1/14

12,233

58

0.47%

1/15 - 1/21

14,117

58

0.41%

1/22 - 1/28

12,768

16

0.13%

1/29 - 2/4

13,309

11

0.08%

2/5 - 2/11

13,925

3

0.02%

2/12 - 2/18

12,690

10

0.08%

2/19 - 2/25

12,956

12

0.09%

2/26 - 3/4

13,193

28

0.21%

3/5 - 3/11

13,735

62

0.45%

3/12 – 3/18

13,711

16

0.12%

3/19 – 3/25

13,966

16

0.11%

The No Veterans Crisis Line Call Should Go Unanswered Act (Public Law 114-247)
directed VA to develop a quality assurance document to use in carrying out VCL. It also
required VA to develop a plan to ensure that each telephone call, text message, and
other communication to VCL, including at a backup call center, is answered in a timely
manner by a person. This is consistent with the guidance established by the American
Association of Suicidology. In addition to adhering to the requirements of the law, VCL
has enhanced the workforce with qualified responders to eliminate routine rollover of
calls to the contracted backup center. We also implemented a quality management
system, to monitor the effectiveness of the services provided by VCL. This also will
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 enable us to identify opportunities for continued improvement. As required by law, VA
will submit a report containing this document and the required plan to the House and
Senate Veterans Affairs Committees by May 27, 2017.

Conclusion
We appreciate OIG’s review of VCL. We are committed to strengthening our
governance structure so that VCL, Office of Mental Health Operation, and Office of
Suicide Prevention are fully integrated, in order to ensure optimal clinical services. We
are committed to seamless care from the time the Veteran reaches out to VCL,
arrangements are made to ensure that the Veteran is safe, and we ensure that the
Veteran receives timely care and assistance.
We also are grateful that Congress provides the resources necessary to give
Veterans in crisis access to these necessary services. Thank you and we look forward
to your questions.

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