Interventions in Committee
 
 
 
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Michel Doiron
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Michel Doiron
2018-03-20 12:31
Absolutely it has improved services. People can now go to a local office and get the services locally instead of having to travel. I was quite happy to open them, and we added one, and they're doing great.
Michel Doiron
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Michel Doiron
2018-03-20 12:40
Yes. We are now going to the three territories on a rotational basis. That has been, actually, quite successful. We weren't sure what the demand would be. The numbers don't sound like much, maybe 14 in Iqaluit who now have case management, but the reality is that there are 14 getting help now.
We're now exploring a second tier to this, doing northern Quebec and northern Labrador. As you look at the territories, they're also up there. How can we serve those communities?
We have to remember that we have Rangers who actually work up north and are entitled to some of our programming. It's a bit touchy, what they're entitled to and not entitled to, but they are entitled. On a monthly basis, I have a team that goes up to Whitehorse, Yellowknife, or Iqaluit—they alternate. It's actually been going quite well. We have a lot of people. We work with the Legion's service in Canada, and they publicize it. When we arrive the appointments are made, but we still take walk-ins. Actually, the numbers are higher than we anticipated. They're not off the charts, but they're higher than we anticipated.
Michel Doiron
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Michel Doiron
2016-12-08 16:47
I look forward to your report on service delivery. I'm not sure when it will be tabled, but I do look forward to it. The last time ACVA tabled a report, there was stuff that we did use and it was very useful, so I'm looking forward to it.
For sure it is known, not just with suicide but in treating mental health in general, that the faster we can get them into treatment, the faster we can get them the care they need and the better it is for the individual. It's probably true for all illnesses. With any delays in approvals or getting them into treatment, there's an impact. That's why we're working so hard on the service delivery review that the department has been doing, but also on how to modernize our systems, get more stuff online—eliminating some of the bureaucracy is maybe the best word to use—to move it forward.
Understanding that we are governed by a multitude of acts and regulations that are laws, I can't just decide that I'm going to do X. There's a law that I have to comply with. That said, we are doing some work on that. The health care provisions are one we're starting to look into, and the financial benefit suite that we have. At the end of the day, where we're trying to go, and we've really undertaken this in the last little bit, is focusing on the veteran's well-being. You'll hear a lot about veteran-centricity, veteran-centric not program-centric, and not just making sure all the boxes in the system are.... What does the veteran need, when, and how? Let's get to it and let's get them trained.
Unfortunately, we're still heavy on the administration, and I don't mean staff when I say that, please. I mean the documentation and some of the stuff that we need to do, and sometimes it's to comply with acts. People like to say, that's what the act says. I am not a lawyer. I've been in the public service a long time, so I ask them to show me in the act where it says that. Often, over time, and this is my eighth department, people start adding requirements because of one bad apple somewhere throughout the years, and all of a sudden that becomes the policy.
Let's eliminate that policy, and our minister and deputy minister have really challenged the department to get rid of these areas, ensuring though that we don't break laws and we follow what we're supposed to. We have to or the OAG will come in and give recommendations, but let's take care of our veterans. The bottom line is care, compassion, and respect, and not just saying those words but getting them there.
In mental health, with 16 weeks, okay, I'm meeting my service standard but it's a long time to get your diagnosis and treatment. We know that and we're trying to do that much faster. For some other stuff, maybe it's acceptable.
Michel Doiron
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Michel Doiron
2016-04-14 12:30
I'm going to start and then turn it over to Dr. Courchesne.
I think the first part has to do with when the OAG talked about 32 weeks. We have to recognize that during the first 16 weeks a lot depends on the delay. There is some interpretation that comes into that 16 weeks. Needless to say, there is a delay before we get a completed application and it's entered into the system. We've had lots of discussion with the OAG about the 16 weeks. Some of the data they were taking was from the get-go of the first phone call. It's hard to open a claim when you only have a phone call.
That said, we accept the fact that it's long. We accept the fact that we had to simplify. What we have done since the OAG report is to accelerate our disability process for mental health. We have done it for many other items, not just mental health. But since we're talking mental health, I will specifically talk about it.
If they have a diagnostic and they come in to us and they've served, especially if they've been in any SDAs or special duty areas, they are in the club. To really decrease...whether it's 32 or 16, to me at this point is not important. The important thing is to get that down. While they're waiting for this, there are avenues for them. We can't forget that we have the 1-800 network. We'll give the veteran 20 sessions with a psychiatrist or a psychologist within 24 to 72 hours. We pay for that. There is no adjudication process.
As long as they're a veteran or a veteran's family, we take care of the bill. There is no delay. There is no waiting. You call that number. You need help. Somebody referred to the crisis line earlier. If you need help, we will help you. We'll get you into mental health. It is not the OSI clinic, I agree, but at least you can get help immediately, pending a lot of this stuff. We pay. There's no billing. It's with Health Canada. They bill my division directly and we take care of it.
I'll turn it over to Mr. Courchesne or Dr. Ross.
Michel Doiron
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Michel Doiron
2016-04-14 12:33
They're not covered under that program. But if the veteran is accepted into the disability, they are covered by the department.
Michel Doiron
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Michel Doiron
2016-04-14 12:36
I can probably answer all of those.
First of all, it is no longer 63%, but an 83.3% approval rate, on first applications. That has increased by 20 percentage points.
I have to back up to answer part of the question.
Army people—and I think a lot of people here have mentioned and Mr. Clarke has spoken of it—have this ethos that when you're serving with your group of people, you do not fill out the famous form, something 98, to say that you've been injured. It doesn't go into your medical file because you want to be a contributing member of your team and you want to support your partners and your colleagues. I think Mr. Clarke spoke to it well earlier.
Our legislation is written in such a way that two or three years ago we would go in to try to find proof that you were injured. That means we had to look over 500, 600, 700 pages of medical files to try to identify when you injured your knee and if you filled out a form that said you had injured your knee.
Now serious injury cases are not an issue. When we are talking serious injuries, there is a medical file. It is more about these injuries that happen over time, so what we've done is undertaken a review. Actually that started before the OAG came in, but we put a lot of effort after the OAG came in to move that from... Somebody at the OAG talked about the burden of proof, but shifting the burden of proof from the veteran to Veterans Affairs in the sense that, for an injury... I'm not talking illness, as I think I referred to last time. I'm really talking injury here. Illness is a little bit more complex.
If you were a SAR tech and you've jumped out of helicopters and planes for 30 years—who knows how many jumps you've had?—you're going to have bad knees. You're going to have a bad back; you're going to have a bad something. So we've done a lot of work with the institute of research that's over at the military site to say what the injuries are related to. Is it a certain trade? And if you come in, you have to have a diagnostic. I still need a diagnostic. A doctor has to say that your knees are gone.
Michel Doiron
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Michel Doiron
2016-04-14 12:39
Okay, so first of all, employees in Veterans Affairs are not paid per widget or whatever the right terminology is. They are at salary. They do get overtime and that. Executives, like other executives in the federal government, do have performance pay, but the employees do not.
The employees are held accountable. We have a quality assurance program that ensures that they are meeting the requirements of the program.
Michel Doiron
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Michel Doiron
2016-04-14 12:39
Yes, executives and directors have performance pay. That's like all employees in the public service, by the way. But our managers and our employees are not on performance pay. They're on salary and they do get overtime and things like that.
Work is tracked. People are held accountable for delivering their work. There is a quality assurance program that is relatively new, but there is a quality assurance program to ensure that the work performed by the employees is meeting the criteria or requirements of the acts. We have to remember that this is all in law, right? Our stuff is in law.
I forget if I answered all your points.
Michel Doiron
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Michel Doiron
2016-04-14 12:40
Absolutely, and we have gone even further. We have restructured that division and now have what I call “tech advisers” and managers. That used to be one position. I have split that position now, to have more accountability and to make sure that the performance is being managed.
The technical side—because there are some very technical cases here.... It's on them that the daily learning occurs, and people are held accountable.
Michel Doiron
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Michel Doiron
2016-04-14 12:46
We're looking at it. I was aware that there was nothing in Saskatchewan, and as you know, we're opening a new office in Saskatoon, and we're going to look at all the services and how we can improve those services.
Michel Doiron
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Michel Doiron
2016-04-14 12:47
We have an internal audit shop. I call it A and E, and I'm trying to remember what A and E stands for.
Michel Doiron
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Michel Doiron
2016-04-14 12:48
Thank you, ma'am. Audit and evaluation come in and do function audits. I've asked them to come in. I've asked them to audit our case management, do a tiger team, go out and see, and the same with our VSAs, veteran service agents. They also do work within to make sure that we are complying with the rules and following what we're supposed to be following.
Michel Doiron
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Michel Doiron
2016-04-14 12:48
No, this is an internal organization that reports directly to the deputy minister.
Michel Doiron
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Michel Doiron
2016-04-14 12:48
In the case here, A and E would come in and do it, and the OAG, when they come in and do an audit, as they did in 2014, will either say yea or nay, right? You're doing it or you're not.
Michel Doiron
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Michel Doiron
2016-04-14 12:49
To me, right now it's opening the offices, and I can explain why. I'll try to do it very quickly.
If we don't have somebody to do that first assessment, a case manager on the ground or a VSA to identify and promote that, to actually be able to refer them, there's a step missing in the process. But it does not preclude.... I don't want to sound as if mental health is not important, because absolutely, the mental health component is very important; it's hard to really rank them. But they need somebody to do that initial assessment before they send anyone to our professionals, because it's on a referral basis.
Michel Doiron
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Michel Doiron
2016-04-14 12:56
On the centres of excellence, the mandate letter of the minister mentioned two, right?
Mrs. Cathay Wagantall: I understand that.
Mr. Michel Doiron: One of them was mental health/PTSD. I'll let Dr. Courchesne talk about this, because we think we are very close to having that.
Michel Doiron
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Michel Doiron
2016-04-14 12:58
I want to emphasize that the services are available. We're opening an office. There will be two, one in Regina and one in Saskatoon. But whether we open an OSI clinic in Saskatchewan or not, I want to emphasize that the services are available. Mental health services from our OSI clinics are available in Saskatchewan. I really want to emphasize that.
I believe that during one of my previous appearances here, you raised the issue of a psychiatrist or psychologist in Saskatchewan, or the lack of—
Michel Doiron
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Michel Doiron
2016-04-14 12:59
We take it very seriously, extremely seriously, to ensure that it doesn't matter where the veteran resides: the services are available whether they come from Edmonton, Calgary, or somewhere else.
But I've been given the finger, or the hand, so—
Voices: Oh, oh!
Mr. Michel Doiron: I apologize.
Michel Doiron
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Michel Doiron
2016-04-14 13:00
I don't want to presuppose the outcome of the pilot. However, we do know, as it has been proven, that when you involve the family in any treatment, whether it is mental health or anything else, it's more beneficial for the individual. But we'll have to see how the pilot goes.
We have implemented the pilot. The MFRCs are open. There hasn't been a national announcement around it, but there have been local announcements that they're ongoing. We have funded them and are partnering with the CAF to have them running. That is going along, and I am meeting with some of the MFRC managers or directors individually in the near future to ask how it's going, because I'm concerned about whether they're getting the traffic they should be getting.
Michel Doiron
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Michel Doiron
2016-04-14 13:01
I don't remember off the top of my head. I probably have it here somewhere, but I can send that to you.
Michel Doiron
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Michel Doiron
2016-04-14 13:02
Yes, we can provide that to you. I have it here somewhere, but I just don't remember.
Michel Doiron
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Michel Doiron
2016-04-12 12:18
The 10 offices, in addition to the one we will open—the office in the north will not be permanent—will be based on the demand of that region's clientele, just like our current offices. People will be able to meet with their case manager.
Each office will be mixed in nature. What they will have will be based on the number of clients in that location. There will be case managers, veteran service agents, nurses and other stakeholders to provide our veterans with comprehensive services. Those are not mental health clinics. They are offices just like the ones in our current network.
Michel Doiron
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Michel Doiron
2016-04-12 12:43
I can provide a lot of insight on that. In respect of the case managers, it doesn't matter if you're in a rural or an urban area. The case managers will travel to serve you in your location. In the north, it may be a bit more problematic, but we're taking steps to fix that. They will go to your residence. They will talk with you on the phone. It's the same thing for our nurses.
We have over 4,000 people working to provide specialized services in locations across the country. We've taken a lot of steps to ensure that the services, whether they're psychosocial, medical, or vocational, are available where the veteran lives. Some rural areas are more difficult to get to than others, but the case managers do go and serve.
When we were running 40:1, the time the case manager had to dedicate to the veteran was problematic. Now that we're going to no more than 25:1, the case managers have more time to dedicate to individual cases. This will greatly improve the service. In any event, I want to be clear that our case managers do travel to the location if that's what the veteran wants.
Michel Doiron
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Michel Doiron
2016-04-12 12:46
Depending on where they live, some veterans are happy to come into an office because they go downtown that week or something. If not, we send occupational therapists to the home to evaluate the home. Is it safe for the veteran? What do you need? Do you need a ramp? We do go out to visit.
Michel Doiron
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Michel Doiron
2016-04-12 12:46
Absolutely. We do the 20-60-20 rule: 20% complex, 60% more in the middle of the road, and 20% easy. I say we try because it's not always 20-60-20, but we try to manage that so they have a mental break. If you deal with a homeless veteran, you may be spending three days on that, and it's very difficult.
Michel Doiron
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Michel Doiron
2016-04-12 12:48
That's part of the adjudication process. The member will supply evidence of what they think, and we will adjudicate it. Often cases like that are more complex. We'll rely on jurisprudence. Is this something we've paid before? Where was the onset of the symptoms? There are certain rules regarding that.
As I said earlier, we have doctors. That's when we will refer the files to our medical experts to say, “This is what the individual is telling us. Does this make sense? Have we seen this before?” That's where we get that information.
Michel Doiron
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Michel Doiron
2016-03-10 11:35
We've hired 180 staff of the 309 that we were approved to hire over a number of years. Of those, we've hired 72 new case managers who have been deployed to the field. You will accept that prior to their being fully up to speed, we have a training program to make sure they're providing the proper services, and they have now started to take on new veterans.
On average, right now across the country, we are meeting no more than 30 to 1. That said, there are parts of the country where we are above that ratio because we were not able to recruit or hire. Everybody we had in the pool, I'll call it, was hired in case management, so we've gone out again to the public to rehire and make sure we bring up those numbers. Our aim is to hire a total of 167 case managers.
Michel Doiron
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Michel Doiron
2016-03-10 11:37
Yes. The people we're hiring now are full-time, but we do have some temporary and casual employees, usually to fill an immediate need or where we do not have the resources to put in an indeterminate employee. I do not have those percentages with me, but I can get them to the committee.
Michel Doiron
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Michel Doiron
2016-03-10 11:43
Your point, sir, is well taken. There are a lot of ways to access us. We have call centres. We have offices. We have agreements with Service Canada where we have services available at Service Canada also. We have the My VAC Account with over 25,000 users. So a lot of information is there, and you can do your applications.
I think one aspect of your question was around whether or they know which services to access. That's where we have to do more work to make the services simpler, easier to apply, easier to understand, and to know they are out there. That is part of the culture shift that the deputy talks about, making that information more available and more understandable. We keep trying to improve our website—there's a lot of information on the website—so that it's understandable and navigable.
It comes back to the veterans' centricity, looking at the services, looking at what we do from the veterans' perspective, not from the bureaucrats' perspective. We still have some work to do on that side.
Michel Doiron
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Michel Doiron
2016-03-10 11:49
We do use a bit more technology in certain realms. If I think about OSIs
In some provinces, our mental health clinics are using technology. In this way, veterans do not have to go to a clinic to receive their psychological treatment. Of course, they must go on site from time to time.
We use Telehealth to accelerate services. We are currently testing the use of similar technology with our case managers so that we may offer certain services to our people in remote areas, since we do not have offices in some regions. Sometimes there are no Service Canada offices either. Speaking to these people by telephone or through a Veterans Affairs Canada account is relevant in terms of safety; we have to make sure these people are monitored.
I don't know how far we will go, but we are testing that possibility now. We are exploring all aspects. These people are there 24 hours a day, 7 days a week, but we are not, except for calls having to do with mental health.
We are attempting to improve the situation so that services are available when clients need them.
Michel Doiron
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Michel Doiron
2016-03-10 11:50
We don't monitor social media sites per se. A case manager doesn't have the time to monitor in that way. Our communications folks do monitor the sites and provide us some input. Our minister's office is also very involved because a lot of veterans or friends of veterans will say, “Wait a minute. Michel's in trouble here,” and send us a note. That's when we get involved. What happens in that realm is in that realm, in the sense that they're sharing, if not private information, their information, so we try not to....
However, once we get the call, whether it's a deputy minister who receives a note, or me who receives an email from someone—people, even in this room, will send me emails that someone is in trouble—we take action immediately. Then we use all means possible to contact them and to help them.
Michel Doiron
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Michel Doiron
2016-03-10 11:54
We made some changes last summer. We had already begun to do so, and now they are in effect. It concerns the Canadian Forces Operations Code. Obviously, and that is understandable, a member of the Canadian Forces will not always document all of his injuries. When we referred to the burden of proof, it meant that we reviewed the file to see if there was anything that stood out.
Regarding injuries, we have not eliminated the burden of proof, but we have simplified the process. We ask what the veteran's duties were. The deputy minister referred to this earlier. Let me give you an example.
It's in the case of an infantryman.
We know that it is normal for veterans who were in active duty in theatre to have knee, hip and back problems. If someone served in the infantry, there are two or three things we look at. That is what is meant by the burden of proof. If a physician says that the person is injured, he belongs to the club. We still have to assess the percentage of disability and the complexity of the injury, but the person's entitlement to benefits is not at issue.
Michel Doiron
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Michel Doiron
2016-03-10 12:13
We have implemented with our clinics, tracking mechanisms to see how long it's taking to be accepted in the clinic and how long before a clinician is seen, and a bunch of matrix.
This is new. We started it after the OAG report. We now have about nine months of information, and we're pinpointing where we have some of these issues and we're addressing them. Those matrix, we're now tracking.
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