Central Texas Veterans Health Care System

Program

Phone

Dialysis/Organ Donor Coordinator

 254-743-2787

End-Stage Renal Disease (ESRD) patients experience multiple losses and psychosocial risks associated with the diagnosis and treatment of ESRD and require comprehensive psychosocial services at various stages throughout the course of their illness and treatment. Coordinator develops coordinates, tracks, completes reports/audits, case manage/provide discharge planning to inpatient dialysis patient when admitted for continuity of care.

Homeless (HCHV) Program Outreach Coordinator 

 254-743-1261 

Identifies homeless Veterans through community outreach and referrals.  Assess mental health needs and provide direct service and referrals to VA and community resources to meet identified needs and overcome homelessness.  Establish contracts with community agencies and provide follow-up services to Veterans placed for care.

Grant and Per Diem Community Coordinator

 512-389-6769

Provides the development and provision of supportive housing and case management services with the goal of helping homeless Veterans achieve residential stability, increase their skill levels and obtain greater self determination.

OIF/OEF/OND - Ft. Hood Outreach Coordinator 

  254-534-4342 

Is the liaison between the VA and Ft Hood for OIF/OEF/OND. Coordinates assessment, enrollment and transfer of health care of combat Veterans from Ft. Hood to CTVHCS and VHA facilities nationwide. Conducts mental health and social assessments, provides case management services, educates military personnel and their families on VHA benefits and services and provides linkage to VA and community resources.

Spinal Cord Injury (SCI)  Coordinator 

  254-721-9550 

Completes comprehensive psychosocial history on each Veteran admitted into the SCI Clinic; has collateral contact with significant other or spouses, coordinates transfers to SCI Centers, liaison with PVA (local and national), coordinates telemedicine with SCI Centers, schedules all training/education for SCI staff, follows SCI patients admitted to acute medicine for continuity of care, facilitates support groups, updates SCI data base.

Women’s Veteran Program Manager 

  254-398-0656 

Offers services especially designed with the needs of women Veterans in mind. Includes: pap smears, breast screening, mammography, birth control, menopause treatment, sexual trauma counseling and fee basis maternity care. Eligible Veterans can be provided with substance abuse treatment, surgical, mental health, HIV counseling and primary care services.

Community Residential Care Program (CRCP)

  254-297-3616

Screens patients who require supervision for placement; provides assessment and follow-up contact; support in community utilizing community resources; conducts facility evaluations and case supervision while patient is in the program.

Hospice/Palliative Care Coordinator

   254-743-0521

Provides both in the hospice and palliative care to Veterans with terminal illnesses.   The Palliative/ Hospice Care program at provides comfort care and pain management for Veteran with end stage medical conditions and support and assistance for their families. Emphasis is on the comfort management of pain and other physical symptoms, the management of psychosocial issues, and the provision of spiritual comfort to the patient and the patient's family or other primary care person.  Services are provided by the team.

Community Care Coordinator (thru Geriatrics Service)

 254-743-0922

Provides the administrative coordination for community care programs. Responds to inquiries and refer or obtain information and provides information related to variety of community care programs related to community nursing home, HHA, and ADHC. Coordinates follow-up tracking, budgets and census for those on contract is such programs.

SWS Supervisors/Service Recovery

Phone

Temple and CBOC Social Work Programs

254-743-1312

Homeless (HCHV), Grant/Per Diem, Dom HMP

254-743-1261

Waco Social Work Programs

254-297-3557