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Challenges in VA’s Substance Use Disorder Treatment Staffing Initiative

The Department of Veterans Affairs (VA) has faced significant hurdles in its initiative to enhance staffing for substance use disorder treatment at medical centers, according to a recent inspector general report. Despite plans to improve veteran access to care, the actual hiring outcomes fell dramatically short of expectations.

A September 4 report from the Office of Inspector General (OIG) revealed that after the Veterans Health Administration (VHA) recognized that fewer than 30 percent of approximately 520,000 veterans diagnosed with substance use disorders received appropriate care, a hiring initiative was launched in fiscal year 2022. This initiative was supported by $96 million in funding, with the goal of recruiting at least 1,062 new staff members by the end of that fiscal year. However, the reality was starkly different, as only 310 new hires were made, and just $8 million of the allocated funds were utilized.

In fiscal year 2023, an additional $171 million was earmarked for the same hiring initiative, yet the VHA managed to recruit only 527 more staff members. Compounding the issue, $156 million in potential funding was left unspent, with the OIG estimating that it was either redirected towards other program needs unrelated to hiring or returned to the VHA’s finance office.

While the VA continues to pursue its hiring objectives, the OIG cautions that without substantial changes, the department is likely to face recurring challenges. The report warns that if the issues outlined are not resolved and the full $465 million requested for fiscal years 2024 and 2025 is granted, there is a risk that funds intended for hiring behavioral health staff will again be diverted to other uses.

The report attributes the difficulties primarily to poor planning and vague timelines, which impeded the ability of facility leaders to meet hiring targets in a timely manner. For instance, out of 46 VA medical centers that had been allocated funds to hire 450 personnel, only 71 new staff members were recruited. The delay was partly due to three centers not beginning their recruitment until the fiscal year had already closed.

Challenges were compounded by the simultaneous execution of five other hiring initiatives within the VA, including those focused on suicide prevention, without clear priorities established among the various programs. This created ambiguity over which initiatives should take precedence in recruitment efforts.

Furthermore, the report suggested a lack of effective communication from VHA leadership regarding the urgency with which the medical centers needed to act on the hiring initiative funding, with guidelines only vaguely instructing the centers to proceed “expeditiously.”

In response to the findings, the OIG made three key recommendations: a review of the $14 million retained by medical centers to ensure proper allocation, strengthened control mechanisms over the specific purpose funds, and a clear definition of roles and responsibilities at all levels for achieving the hiring goals of the substance use disorder initiative.

The VA has concurred with these recommendations and expressed commitment through detailed plans to implement the necessary changes.

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