VA Emergency Department Safety Planning Act

I 116TH CONGRESS 2D SESSION H. R. 8107 To direct the Secretary of Veterans Affairs to submit to Congress a report on efforts by Department of Veterans Affairs to implement safety plan- ning in emergency departments, and for other purposes. IN THE HOUSE OF REPRESENTATIVES AUGUST 25, 2020 Mr. LEVIN of Michigan (for himself and Mr. STIVERS) introduced the following bill; which was referred to the Committee on Veterans’ Affairs A BILL To direct the Secretary of Veterans Affairs to submit to Congress a report on efforts by Department of Veterans Affairs to implement safety planning in emergency de- partments, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘VA Emergency De- 4 partment Safety Planning Act’’. 5 VerDate Sep 11 2014 01:39 Sep 04, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H8107.IH H8107 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 8107 IH SEC. 2. REPORT ON EFFORTS BY DEPARTMENT OF VET- 1 ERANS AFFAIRS TO IMPLEMENT SAFETY 2 PLANNING IN EMERGENCY DEPARTMENTS. 3 (a) FINDINGS.—Congress makes the following find- 4 ings: 5 (1) The Department of Veterans Affairs must 6 be more effective in its approach to reducing the 7 burden of veteran suicide connected to mental health 8 diagnoses, to include expansion of treatment deliv- 9 ered via telehealth methods and in rural areas. 10 (2) An innovative project, known as Suicide As- 11 sessment and Follow-up Engagement: Veteran 12 Emergency Treatment (in this subsection referred to 13 as ‘‘SAFE VET’’), was designed to help suicidal vet- 14 erans seen at emergency departments within the 15 Veterans Health Administration and was success- 16 fully implemented in five intervention sites beginning 17 in 2010. 18 (3) A 2018 study found that safety planning 19 intervention under SAFE VET was associated with 20 45 percent fewer suicidal behaviors in the six-month 21 period following emergency department care and 22 more than double the odds of a veteran engaging in 23 outpatient behavioral health care. 24 (4) SAFE VET is a promising alternative and 25 acceptable delivery of care system that augments the 26 VerDate Sep 11 2014 01:39 Sep 04, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H8107.IH H8107 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 8107 IH treatment of suicidal veterans in emergency depart- 1 ments of the Veterans Health Administration and 2 helps ensure that those veterans have appropriate 3 follow-up care. 4 (5) Beginning in September 2018, the Veterans 5 Health Administration implemented a suicide pre- 6 vention program based on the findings of SAFE 7 VET, known as the SPED program, for veterans 8 presenting to the emergency department who are as- 9 sessed to be at risk for suicide and are safe to be 10 discharged home. 11 (6) The SPED program includes issuance and 12 update of a safety plan and post-discharge follow-up 13 outreach for veterans to facilitate engagement in 14 outpatient mental health care. 15 (b) REPORT.— 16 (1) IN GENERAL.—Not later than 180 days 17 after the date of the enactment of this Act, the Sec- 18 retary of Veterans Affairs shall submit to the appro- 19 priate committees of Congress a report on the ef- 20 forts of the Secretary to implement a suicide preven- 21 tion program for veterans presenting to an emer- 22 gency department or urgent care center of the Vet- 23 erans Health Administration who are assessed to be 24 at risk for suicide and are safe to be discharged 25 VerDate Sep 11 2014 01:39 Sep 04, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H8107.IH H8107 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 8107 IH home, including a safety plan and post-discharge 1 outreach for veterans to facilitate engagement in 2 outpatient mental health care. 3 (2) ELEMENTS.—The report required by para- 4 graph (1) shall include the following: 5 (A) An assessment of the implementation 6 of the current operational policies and proce- 7 dures of the SPED program at each medical 8 center of the Department of Veterans Affairs, 9 including an assessment of the following: 10 (i) Training provided to clinicians or 11 other personnel administering protocols 12 under the SPED program. 13 (ii) Any disparities in implementation 14 of such protocols between medical centers. 15 (iii) Current criteria used to measure 16 the quality of such protocols including— 17 (I) methodology used to assess 18 the quality of a safety plan and post- 19 discharge outreach for veterans; or 20 (II) in the absence of such meth- 21 odology, a proposed timeline and 22 guidelines for creating a methodology 23 to ensure compliance with the evi- 24 dence-based model used under the 25 VerDate Sep 11 2014 01:39 Sep 04, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8107.IH H8107 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 8107 IH Suicide Assessment and Follow-up 1 Engagement: Veteran Emergency 2 Treatment (SAFE VET) program of 3 the Department. 4 (B) An assessment of the implementation 5 of the policies and procedures described in sub- 6 paragraph (A), disaggregated by gender and by 7 race and ethnicity, including the following: 8 (i) An assessment of the quality and 9 quantity of safety plans issued to veterans. 10 (ii) An assessment of the quality and 11 quantity of post-discharge outreach pro- 12 vided to veterans. 13 (iii) The post-discharge rate of vet- 14 eran engagement in outpatient mental 15 health care, including attendance at not 16 fewer than one individual mental health 17 clinic appointment or admission to an in- 18 patient or residential unit. 19 (iv) The number of veterans who de- 20 cline safety planning efforts during proto- 21 cols under the SPED program. 22 (v) The number of veterans who de- 23 cline to participate in follow-up efforts 24 within the SPED program. 25 VerDate Sep 11 2014 01:39 Sep 04, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8107.IH H8107 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 8107 IH (C) A description of how SPED primary 1 coordinators are deployed to support such ef- 2 forts, including the following: 3 (i) A description of the duties and re- 4 sponsibilities of such coordinators. 5 (ii) The number and location of such 6 coordinators. 7 (iii) A description of training provided 8 to such coordinators. 9 (iv) An assessment of the other re- 10 sponsibilities for such coordinators and, if 11 applicable, differences in patient outcomes 12 when such responsibilities are full-time du- 13 ties as opposed to secondary duties. 14 (D) An assessment of the feasibility and 15 advisability of expanding the total number and 16 geographic distribution of SPED primary coor- 17 dinators. 18 (E) An assessment of the feasibility and 19 advisability of providing services under the 20 SPED program via telehealth channels, includ- 21 ing an analysis of opportunities to leverage tele- 22 health to better serve veterans in rural areas. 23 (F) A description of the status of current 24 capabilities and utilization of tracking mecha- 25 VerDate Sep 11 2014 01:39 Sep 04, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8107.IH H8107 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 8107 IH nisms to monitor compliance, quality, and pa- 1 tient outcomes under the SPED program. 2 (G) Such recommendations, including spe- 3 cific action items, as the Secretary considers 4 appropriate with respect to how the Depart- 5 ment can better implement the SPED program, 6 including recommendations with respect to the 7 following: 8 (i) A process to standardize training 9 under such program. 10 (ii) Any resourcing requirements nec- 11 essary to implement the SPED program 12 throughout Veterans Health Administra- 13 tion, including by having a dedicated clini- 14 cian responsible for administration of such 15 program at each medical center. 16 (iii) An analysis of current statutory 17 authority and any changes necessary to 18 fully implement the SPED program 19 throughout the Veterans Health Adminis- 20 tration. 21 (iv) A timeline for the implementation 22 of the SPED program through the Vet- 23 erans Health Administration once full 24 VerDate Sep 11 2014 01:39 Sep 04, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H8107.IH H8107 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 8107 IH resourcing and an approved training plan 1 are in place. 2 (H) Such other matters as the Secretary 3 considers appropriate. 4 (c) DEFINITIONS.—In this section: 5 (1) The term ‘‘appropriate committees of Con- 6 gress’’ means— 7 (A) the Committee on Veterans’ Affairs 8 and the Subcommittee on Military Construc- 9 tion, Veterans Affairs, and Related Agencies of 10 the Committee on Appropriations of the Senate; 11 and 12 (B) the Committee on Veterans’ Affairs 13 and the Subcommittee on Military Construc- 14 tion, Veterans Affairs, and Related Agencies of 15 the Committee on Appropriations of the House 16 of Representatives. 17 (2) The term ‘‘SPED primary coordinator’’ 18 means the main point of contact responsible for ad- 19 ministering the SPED program at a medical center 20 of the Department. 21 (3) The term ‘‘SPED program’’ means the 22 Safety Planning in Emergency Departments pro- 23 gram of the Department of Veterans Affairs estab- 24 lished in September 2018 for veterans presenting to 25 VerDate Sep 11 2014 01:39 Sep 04, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H8107.IH H8107 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 8107 IH the emergency department who are assessed to be at 1 risk for suicide and are safe to be discharged home, 2 which extends the evidence-based intervention for 3 suicide prevention to all emergency departments of 4 the Veterans Health Administration. 5 Æ VerDate Sep 11 2014 01:39 Sep 04, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\H8107.IH H8107 pbinns on DSKJLVW7X2PROD with BILLS