defined in 42 CFR Section 72.6(j) and in compliance with 42 CFR 73.4 and 73.5; 7 CFR 331.3 and 7 CFR 121.3. Each position must have a designated sensitivity or risk level and appropriate background investigations must be accomplished and adjudicated prior to the placement of appointees or employees in these positions. In addition, a security risk determination of the employee must be completed in accordance with the following laws or policies: 42 CFR 73.8 (d); 7 CFR 331.10 (h); 9 CFR 121/11(h); VADirective and Handbook 0710; and VHA Directive 2002-075. This may require the establishment of temporary positions that do not require the above duties. See Public Law 107-56, Section 817, October 26, 2001, 115 STAT. 385.
On December 17, 1997 Richard Salas was charged by the Tarrant County Sheriffs Office with engaging in sexual contact and indecency with a child younger than 17 years old. LawEnforcement Authorities believed that Salas fled the United States shortly after the warrants were issued. Deputy Marshals and local officers participating on Falcon II conducted extensive research of Salas and suspected relatives. Team members identified the residence of his common law wife. Team members established surveillance and arrested Salas as he returned to the residence. Intelligence was also received and verified by officers that Salas had utilized the attic to hide from lawenforcement authorities in the past. Salas was arrested previously in 1990 by the Fort Worth Police Department for Indecency with a Child- Sexual Contact (Fondling).
c. Among USB devices, “thumb drives” clearly pose one of the highest data security risks. To further enhance the VAsecurity posture, only USB thumb drives that are Federal Information Processing Standards (FIPS) 140-2 certified can be utilized. This requirement is applicable to all VA employees, contractors, business partners, or any person who has access to and stores VA information. Utilization of personally-owned USB thumb drives within the Department is prohibited. Transition to this posture must occur over the next sixty (60) days. The OI&T community, under the direction of the Chief Information Officer (CIO), will effect this transition.
e. The security controls must be designed, developed, approved by VA, and implemented in accordance with the provisions of VAsecurity system development life cycle as outlined in NIST Special Publication 800-37, Guide for Applying the Risk Management Framework to Federal Information Systems, VA Handbook 6500, Information Security Program and VA Handbook 6500.5, Incorporating Security and Privacy in System Development Lifecycle. f. The contractor/subcontractor is required to design, develop, or operate a System of Records Notice (SOR) on individuals to accomplish an agency function subject to the Privacy Act of 1974, (as amended), Public Law 93-579, December 31, 1974 (5 U.S.C. 552a) and applicable agency regulations. Violation of the Privacy Act may involve the imposition of criminal and civil penalties.
launched. Implementation research and training has been pioneered by the VA as part of the Quality Enhancement Research Initiative (QUERI) . The VA Center for Imple- mentation Practice and Research Support (CIPRS), a Los Angeles-based resource center established in 2008, offers annual training in D&I science through its Enhancing Im- plementation Science (EIS) program, individualized consult- ation through a helpline and Implementation Research Clinic, an Implementation Research Cyber Seminar series, individual seminars and workshops, and various tools and resources to foster development and growth of implementa- tion research capacity. Two of the NIH supported Clinical and Translational Science Award (CTSA) programs offer specialized training and infrastructure support for D&I sci- ence: Washington University’s CTSA program has a Dis- semination and Implementation Research Core (DIRC), and the University of California San Francisco’s CTSA offers an Implementation and Dissemination Science (IDS) Certificate Program, a Master’ s Program in Clinical Research, and a Ph. D. in Epidemiology and Translational Science whose con- ceptual framework, training domains, courses, and compe- tencies are described in an article by Gonzales et al. . The Canadian Knowledge Translation (KT) training initia- tive began as a KT Summer Institute in 2008, and its conceptualization, core competencies, and ‘lessons learned’ are described in several recent publications [28-31]. Straus et al. note their inability to find national training strat- egies which their program could model, reflecting the need for a literature on implementation science training—a litera- ture to which the present paper contributes, as does the Stamatakis et al.  paper on insights from recent imple- mentation science trainees, one of whom is an IRI ‘alum’.
(CEPEP) was charged with evaluating process and impact of PCC innovations at COIs. A broad goal of qualitative evaluation is to understand the meaning of experiences from participants’ perspectives. To do so, we used participatory approaches (e.g., guided tours) to engage patients and families in data collection. In this paper, we present the results from guided tours conducted with Veterans receiving care at two VA COIs, to learn more about their experiences and preferences with receiving VA care, and guide next steps in implementation of PCC.
information obtained by DoD and VA to be more easily federated with VA and DoD health information. Since more than 50 percent of health care in both VA and DoD is provided in the private sector, this open approach is critical to providing a comprehensive seamless patient health record. As part of the DHMSM strategy, the DoD intends to have a robust testing strategy that ensures the system meets operational requirements for effectiveness, suitability and
First, we need to do a better job of tying implementation science to more effective implementation. This means going beyond "basic discovery" about the implementa- tion process to demonstrating and communicating how these insights produce better interventions and more rapid improvements. We now have a number of theoreti- cal implementation models that enumerate specific aspects of the implementation process and identify critical mediators and moderators of success [19-25]. A more compelling test of their value is to show that implementa- tion strategies based on these models are more effective or efficient than those developed without them. A limited number of such studies have been published , and QUERI investigators are now developing proposals to directly compare enhanced theory-based strategies to more traditional methods used by the VA healthcare sys- tem for implementing new programs.
a. All clinicians and staff who provide clinical services to transgender Veterans need to become more knowledgeable about transgender health issues. Everyone needs to be aware that transgender Veterans deserve to receive health care at VA and need to be treated with dignity and respect. Primary Care and Mental Health providers need to be encouraged to consult with specialty physicians on any aspect of management for which they need advice or for ongoing management, as they would for any other complex patient. The initial VA prescription for cross- sex hormone therapy need to be restricted to facility-designated providers experienced with the use of cross-sex hormone therapy (e.g., women’s health specialist, endocrinologist, psychiatrist, or other local designee).
Implementation studies seek to understand factors influencing a pro- gram and their underlying relationships. A theoretically-driven ap- proach to evaluation offers comprehensive, context-specific results with actionable recommendations for programmatic leaders. The Consolidated Framework for Implementation Research (CFIR) pro- vides an organized, flexible structure and a common language to fa- cilitate knowledge-building and generalizability of findings across implementation science studies. Patient-Centered Care (PCC) is per- sonalized health care that considers a patient ’ s circumstances and goals. While the Department of VeteransAffairs (VA) is working to- wards implementing PCC throughout its healthcare system, com- prised of many interventions with the long-term goal of cultural transformation, little is known about the factors influencing its imple- mentation. We discuss three key analytic processes that emerged while using CFIR to evaluate a broad-scale system change and dem- onstrate how use of CFIR resulted in methodologically-sound, com- prehensive, rapid, and actionable results to key leadership for use in future efforts.
more complex organizational changes (e.g., introduction of a new care model). In contrast, if practices were too small, they suffered from inadequate staffing and limited local autonomy for decision-making (i.e., had to wait for direction, were not able to identify a local champion). If they were too large, they suffered organizational inertia or required more organizational supports for coordination across departments or services. These barriers were some- times overcome with sufficient leadership support and allocation of additional resources. Organizational control of those resources also is important. In the VA, like other large health care systems, resource control was sometimes one or more levels above the practice in which the QI intervention was being implemented. This required nego- tiation with senior leaders with varying levels of aware- ness and understanding of frontline needs or culture, and repeated marketing messages to different stakeholders at each level. Control of how care was organized also was important but did not always operate in expected ways. Practice autonomy emerged as a facilitator of more rapid implementation (i.e., faster penetration among providers in a practice); however, their speed appeared to under- mine sustainability. Further work is needed to validate these findings for more QUERI conditions among increas- ingly diverse practice settings and in organizations outside the VA. For example, do the same findings hold true for depression as they do for diabetes? Varying levels of sup- porting evidence were noted for many organizational structures and processes in relation to quality of imple- mentation. While the VA is most generalizable to large health systems, including U.S. regional systems like Kaiser Permanente and national health systems, such as those in the UK and Australia , many of the organizational fac- tors studied also have correlates in smaller practices. At this juncture, QUERI implementation research studies are progressing from local to regional to national in scope . In parallel, methodologically – and along the lines of the QUERI steps – they are moving from variations studies to tests of intervention and implementation effec- tiveness to evaluations of spread, and then to policy devel- opment . It is incumbent on us to contribute to bridging the gap between research and practice by consid- ering the potential for accelerating implementation suc- cess by explicitly addressing organizational factors in our work.
Preference Letters – Veterans can create VA letters for a variety of purposes, including Civil Service Preference, Commissary (DoD Identification Card), Service Verification, and Benefit Verification. The letter templates automatically include the user’s name and current Compensation and Pension address.
For former Corinthian student veterans, the error warranting a remedy is the VA decision to approve the use of benefits at Corinthian schools. The VA acts as a gatekeeper between schools and veterans desiring to finance an education with these benefits. It determines what schools are eligible to enroll veterans, see generally 38 U.S.C. §§ 3670–3679, and it also decides whether to approve each individual veteran’s application to attend a school. With respect to veterans’ education benefits, “[t]he Secretary shall not approve the enrollment of an eligible veteran or eligible person in any course offered by an institution which utilizes advertising, sales, or enrollment practices of any type which are erroneous, deceptive, or misleading either by actual statement, omission, or intimation.” 38 U.S.C. § 3696(a). VA regulations further provide that “[i]f an educational institution uses [such practices], VA will not approve” any enrollment in that institution. 38 C.F.R. § 21.4252(h).
The Association of County Veterans Service Officers through a pilot program proposed a Senate Bill that would provide extra money to the County Veterans Service Offices. Senate Bill 1100 was approved and is administered and funded through the Oregon Department of VeteransAffairs budget. This money is to be used for expansion and enhancement of the County Veterans Service Office. The money can be used for the hiring of staff and staff training, and for the purchase of equipment, software and furniture. It is also to be used for outreach to veterans in the community.
99. Administration and Support Services. Provides administra- tive services required for effective operation of the State’s vet- erans’ memorial homes, including general management, pur- chasing, accounting, budgeting, personnel, payroll, and clerical services. It also comprises the planning, management, and operation of the physical assets of the Department and its subordinate activities including veterans’ memorial homes, ar- mories, buildings and equipment of all kinds, as well as alter- ation, expansion, construction, rehabilitation and improve- ment, and custodial services.
lack of patient-level VA cost data. The creation of two such databases, the Health Economics Resource Center (HERC) average cost data sets and the Decision Support System (DSS) National Data Extracts, now enable researchers to study encounter-level rehabilitation costs in VA facilities. These two cost databases use different methods to estimate the cost of rehabilitation care. In the HERC data, the cost of a stay is calculated by multiply- ing each patient’s length of stay (LOS) by a national per diem cost estimate. The HERC cost does not depend on patient or clinical characteristics such as age, sex, diag- nosis, comorbidities, initial functional status, or func- tional gain during rehabilitation. DSS costs for inpatient stays are estimated using direct measurement, also known as activity-based costing. DSS cost estimates should reflect patient and clinical characteristics to the extent that these factors affect the type and quantity of services provided.
Three schools of thought exist within Security Theory, commonly referred to as the Paris, Copenhagen and Welsh Schools. For the sake of clarity and brevity, within this literature review the Welsh School will not be discussed in any depth, in part because as Floyd (2007) has pointed out, the differences between the Welsh and Copenhagen Schools lie not at a mechanical or even conceptual level. The difference between the two boils down to one (Welsh) concerning itself with a normative aspect of security and securitization, whereas the other (Copenhagen) avoids any normative statements on principle. Floyd contends that the two schools are compatible in the sense that significant common ground can be found between them “It can be concluded that securitisation and desecuritization are neither always good, nor always bad. Because this is so, both the Copenhagen School and the Welsh School are valuable in analysing security issues and answering the problem of why and when to make/not make normative statements regarding its practice” (Floyd 2007: 349). Floyd bases her claim in part on quotes taken from various works of Copenhagen School scholar Ole Wæver, noting: “Wæver’s assertion that the two schools might be complementary is crucial (…) it implies that a strategy in which the two approaches were combined would be a good thing” (Floyd 2007: 336). The point Floyd argues isn’t that there no distinction exists between the Welsh and Copenhagen Schools, rather, save for the willingness to make or not make normative statements about securitization, the two can be considered complimentary rather than adversarial.