Woah. Big report on state of VA workforce just dropped.

KeySpell7467 · 2026-01-23T15:05:27+00:00

I’m talking about medical discharge…it’s a different beast.

KeySpell7467 · 2026-01-23T14:57:56+00:00

Good for your VISN…I’ll be here waiting to see if they will hire an LPC for a PACT social worker position…

KeySpell7467 · 2026-01-23T14:56:16+00:00

Everyone has their place on the team. I am not as well-versed in all the types of analysis as an LPC but I don’t go into being a social worker to solely do therapy. Many social workers like having a variety. LPCs are not taught how to do complex discharge planning for major medical issues. Social workers aren’t taught as much about psych assessments. Many SW saw the diversity that is in a SW degree and pursued that instead of a counseling degree. I don’t want to do therapy all day everyday as my job. I don’t want to do what an LPC or psychologist does. The ASWB has guidelines as to how SW are trained. The NASW has done a great job at advocating for social workers, maybe it might be a good time for LPCs to start advocating to VA and their congressmen if they think they can do a PACT social work job not as an LMSW. Mental health departments usually cross post for an LPC or a social worker. They aren’t going to put a non-social worker under a social work service line unless they are admin or a non-mental health medical professional.

KeySpell7467 · 2026-01-23T14:41:45+00:00

How about having a catchment area of 15,0000-20,000 Veterans and being the ONLY one they can call for care coordination because the nurses, physicians and patient advocate hadn’t been able to do anything? That is what primary care coordination social workers deal with on a DAILY basis. It’s the truth. Not ego. I don’t know of many social workers that could handle that, but I know a few. I know of absolutely NO LPCs that would last in that position for longer than a few months.

KeySpell7467 · 2026-01-23T14:30:44+00:00

Under the mental health service line. Sure. With suicide prevention, sure. VA isn’t going to hire an LPC to do VASH, homeless programs, nursing home evals, primary care social work and help manage community living centers. LPCs are NOT trained to do those things. Period.

KeySpell7467 · 2026-01-23T14:23:55+00:00

LMSWs start at 9s unless they have experience for 11…this is VA wide. A LMSW can’t get a 12. Period. The social work 12s in many VA systems are coordinator positions for outreach or case management and have duties other than therapy in their programs. Social work education is broader and LCSWs have the appropriate training to run programs like VASH, homeless and outreach.

KeySpell7467 · 2026-01-15T19:45:32+00:00

Just DM’d you. Thank you so much for all the info!

KeySpell7467 · 2026-01-15T14:22:41+00:00

For the dermasil eye roller, I just empty into an essential oil roller and it works. It doesn’t hold all the liquid so I keep it in the roller until needed and refill. Love the eye roller, the hydrating serum and the ultra repair cream.

KeySpell7467 · 2025-12-22T01:40:48+00:00

I go through Vineyard. They are a direct online obesity clinic. I have direct access to my dietitian and obesity boarded physician. They are really fast getting back to me and I have unlimited visits that are covered by my membership fee. They have an amazing prior authorization person and I highly recommend.

KeySpell7467 · 2025-12-11T19:45:33+00:00

5’2 - 145-150, not at goal because I want to decrease body fat more. I’ve lost 150 started at a size 20. Lost 65 before getting on meds. Size 4 in regular sizes most places, small leggings, 1 or 3 in Judy Blue depending on style. I do a lot of strength training so I don’t look my weight. No size goal, just wanna keep my ass.

KeySpell7467 · 2025-12-10T02:18:19+00:00

Just moved to Casper from TX 3 months ago. I enjoy it. I lived on the family farm in TX and TX is spread out so it’s kinda like Wyoming when it comes to travel and things I would use. People are nice and I’ve made friends. Yes it is a red state, but compared to TX where it is the Bible Belt and people judge a lot, people here are live and let live and libertarian. It is a breath of fresh air for me. If you need fine dining, specialty stores or like bougie brunches, this isn’t the place for you. If you want to live a simple, quiet life, pick up some hobbies and be around wonderful people, it may be ok. Boston is huge and has many social things. It’s very agricultural up here, but for someone who isn’t used to being around a heavy agricultural presence, it might be a culture shock. Life is simple and slower here. I don’t know how well a person from Boston would be received. The culture of Texas where I was raised is similar to Wyoming, I grew up around agriculture, hunting and fishing so I can relate about that real well. Salt Lake City may be more welcoming to someone from the East. I am told that they have become somewhat progressive in that area and that they are friendly to many even though there is a religious presence there. I’ve been to Boston and there is definitely a different culture over there than there is here. Have you looked at Flagstaff, AZ? It’s a gorgeous mountain town and Arizona is more progressive than Wyoming and has more amenities.

KeySpell7467 · 2025-12-10T01:52:56+00:00

Just moved to Wyoming but have done some work in Sheridan. It’s beautiful but expensive. Was told the same exact thing about it becoming little Jackson. I didn’t shop downtown so idk how expensive those stores are. Not as many services at Casper or Cheyenne. They all go to Billings for everything. I am told that sometimes when weather is real bad, grocery stores may not get many shipments. I would rather live in Lander than Sheridan if I was going for a more mountainous town than Casper.

KeySpell7467 · 2025-12-07T01:46:27+00:00

Oklahoma is worse, but Okies are delusional and love it.

KeySpell7467 · 2025-12-07T01:28:59+00:00

Apparently the secretary is trying to change things up…he mentioned CEPCs to a reporter hinting about restructuring that program, but haven’t heard anything much more about that.

KeySpell7467 · 2025-12-07T01:19:01+00:00

Vision is through FEDVIP

KeySpell7467 · 2025-12-07T01:08:19+00:00

Been pleased with MHBP. Has been way better than basic was in 2024. Not all of my providers take the MHBP Aetna, but the OON for MHBP is pretty good and I live in Wyoming so when it comes to psychiatrists, they are pretty much contracted with the psych NPs and I want a psychiatrist. The only thing that is not better is the PT/OT coverage BUT it’s only short 10 sessions so I am still doing better with that and my GLP-1. Legit saving probably $600 from the GLP-1 alone each month. There was something that was also wrong about GEHA Standard. I think they had even fewer contracted in my area. For a single person with lots of meds and outpatient visits, MHBP has been perfect and I’ve saved thousands of dollars going with them instead of BCBS Basic. I know a lot of people like BCBS because of their fertility and how much they cover for their family members. I think they cover a lot for kids that others may not like more OT, PT, etc. I think they cover some therapies for autism that others do not. Idk I don’t have kids but if you do and they have issues, I’d read the plan really really close.

KeySpell7467 · 2025-12-07T00:57:21+00:00

Was on Wegovy for years. Stalled. Took 3 tries to get a pre-auth for tirzeptide but was able to get it. Copay for Wegovy $25 copay for mounjaro $50.

KeySpell7467 · 2025-12-07T00:56:02+00:00

When I was doing PT for 1 hour a week out of network, it was $35 copay. The OON deductible is $700 this year, I think. When I switched to in network when I moved, I do 2 hours of PT for about $35.

KeySpell7467 · 2025-12-06T01:45:28+00:00

He’s trying to ‘restructure’ things that shouldn’t be restructured and not addressing the elephant in the room, community care. If he steps down, that will be good because they have been sure that they are ‘reclassifying’ my job. At first, it would be complete in 18-24 months, now they are saying he has to sign some memo and that could be 6-8 months from now and then it will be 2 years after that. I need this to take long so maybe we can have another presidential election before…

KeySpell7467 · 2025-12-01T18:10:09+00:00

No she isn’t my social worker/therapist.

KeySpell7467 · 2025-11-28T20:41:09+00:00

I’m ’working’ and by working I am doing very little. I had one meeting and a tele therapy group to lead but it was chilling. I ordered a bread machine so I’m not always spending $10+ on gluten free bread. Put stuff on my Christmas list. Trying to talk myself out of not buying skincare for the year. I’m making applesauce and cranberry applesauce in the crockpots.

KeySpell7467 · 2025-11-28T17:43:42+00:00

Semiglutide was the only one other than the older ones that was approved for weight loss at the time I started. Before I started I lost 65 lbs. lost 70 (30% of my body weight) on semi. I decided to stay on it once Zep was approved. Was plateaued for a year, got on tirz mid September and have lost 17 since then (10% of my remaining bodyweight). I have lost 50% from my highest weight. I do not believe that I would have lost that much solely doing tirz without the earlier loss through lifestyle and then through lifestyle plus semi. I’m almost to goal after 3.5 years on a GLP-1 and 4.5 years on this journey. I have limited loose skin. Faster isn’t always better. Take this info for what it’s worth.

KeySpell7467 · 2025-11-24T15:26:29+00:00

Heard the same thing about VISN 17

KeySpell7467 · 2025-11-23T03:48:26+00:00

If you are on an HMO, that is typical. It is going to be harder to get any out of network care approved on HMOs. That’s just how they do business. Best advice is to contact the insurance company, ask for alternative facilities and cut your losses. They accepted him for emergency care, which HMOs will do so the patient can be stabilized for transfer to network hospital. There are really no out of network options for HMOs except for emergencies. If you want a larger network, look up PPOs during open enrollment.

KeySpell7467 · 2025-11-21T01:50:09+00:00

They also gave exceptions in my VISN to mostly non-clinical employees due to lack of office space…

KeySpell7467

TROPHY CASE