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Health Services Research & Development

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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1041 — Variation in Practices and Attitudes of Mental Health Professionals Assessing PTSD-Related Disability among Veterans

Jackson J (VA Tennessee Valley Healthcare System (VA-TVHS)), Sinnot P (Health Economics Resource Center (HERC), VA Palo Alto Health Care System), Marx B (VA National Center for PTSD, VA Boston Healthcare System), Murdoch M (VA Minneapolis), Sayer N (VA Minneapolis), Alvarez J (Vanderbilt University School of Medicine), Greevy R (Vanderbilt University School of Medicine), Schnurr P (VA National Center for PTSD, VA Boston Healthcare System), Shane A (HERC), Speroff T (VA-TVHS)

Objectives:
This current investigation sought to describe the variation in practices of VHA mental health professionals engaged in PTSD disability examinations and to characterize the relationships between relevant examiner variables and clinician practices as they relate to the assessment and diagnosis of PTSD.

Methods:
We constructed a 128 item survey comprised of questions pertaining to experience, use of assessment instruments, beliefs and preferences, training, interview styles and clinician demographics and characteristics. A total of 190 inventories were distributed to 115 VHA facilities to clinicians engaged in Compensation and Pension (C and P) Exams.

Results:
Responding clinicians (N = 142) reported never or rarely using psychological testing (59%). They described infrequent use of standardized clinical interviews for assessment of PTSD, with 69% and 85% reporting that they “never” use the CAPS PTSD interview and SCID respectively. A cluster analysis revealed that individuals who were less experienced examiners tended to use psychological testing in the context of their evaluations (p = .006), while also using standardized approaches to interviewing more often (p < .001). A quarter of clinicians endorsed the belief that at least 15% of veterans exaggerate and 25% of clinicians reported that at least 15% of veterans underreport (minimize) their symptoms.

Implications:
Our findings suggest that there is considerable variation in the characteristics, practices, beliefs, and attitudes of clinicians conducting disability examinations. Although clinicians infrequently rely on psychological testing or standardized assessments for the diagnosis of PTSD, clinicians with less experience are more predisposed toward using formal assessment approaches. Attitudes vary widely with regard to the veracity of veteran’s claims related to PTSD symptoms. Our current study represents an important starting point in understanding psychologists within the VA (who are presumably representative of psychologists in the larger community) and how their characteristics and attitudes impact their practices as they related to the assessment of PTSD.

Impacts:
This study has the potential to impact VA practice with regard to the conduct of C and P exams for PTSD. Findings suggest that a significant proportion of PTSD claimants may not use best practices for PTSD assessment in the context of disability evaluations. Whether this impacts the quality of PTSD disability examinations is the focus of ongoing research.


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