Study Shows Variation in Attitudes and Practices among VA Clinicians Conducting Disability Assessment for PTSD
BACKGROUND:
PTSD is the most common psychiatric condition for which Veterans apply for disability. Disability ratings are determined by trained disability raters in the Veterans Benefits Administration, who rely on the disability examination provided by clinicians as a major component of evidence for their determination. This study examined the beliefs and practices of VA mental health professionals performing PTSD examinations as part of VA’s Compensation and Pension (C&P) Program. Investigators assessed data from 138 VA mental health professionals who completed a PTSD Practice Inventory, which asked about their practices and attitudes related to disability assessment of PTSD. This survey had been refined with input from C&P and PTSD experts at VA’s National Center for PTSD and VA/HSR&D’s Mental Health Quality Enhancement Research Initiative (MH-QUERI). The finalized survey also included questions pertaining to demographics, employment, education, and experience. Survey data was collected from clinicians at 75 VA facilities from June through December 2008.
FINDINGS:
- There was wide variation in the beliefs and practices of individuals conducting PTSD examinations, primarily in two areas: 1) preferences and practices related to psychological assessment, and 2) beliefs related to symptom under-reporting and exaggerating.
- In a high percentage of cases, attitudes and practices conflicted with recommended best practices. For example, 59% of clinicians reported rarely or never using testing, and only 17% indicated routinely using standardized clinical interviews. Less than 1% of clinicians reported using functional assessment scales. [Note: VA does not require use of standardized testing; it is an option.]
- Standardized interviews were seldom employed, with 85% and 90% reporting that they “never” or “rarely” used the Clinician Administered PTSD Scale or the Structured Clinical Interview for DSM IV Axis I Disorders, respectively. Less than half of clinicians reported having received training in administering diagnostic interviews for PTSD.
- Nearly all clinicians (96%) believed that they were qualified in the skills needed to conduct a PTSD examination. On the other hand, clinicians held varying opinions about the authenticity of Veterans’ psychiatric conditions. For example, 25% of respondents reported that at least 15% of Veterans exaggerate PTSD symptoms, while 25% of respondents also reported that at least 15% of Veterans minimize or under-report their symptoms.
LIMITATIONS:
- Clinicians who responded to this survey may not be representative of non-responders.
- This sample included few psychiatrists and social workers, though individuals from both disciplines perform PTSD examinations (social workers perform review examinations only).
- These findings are limited to self-report and are not collaborated by other external measures.
- Data were collected in 2008; major system changes have since occurred with unknown impact on issues discussed here.
AUTHOR/FUNDING INFORMATION:
This study was funded through VA/HSR&D’s Quality Enhancement Research Initiative (QUERI: SDP 06-331). Dr. Speroff (PI) is affiliated with the Tennessee Valley Healthcare System, Nashville, and Dr. Sinnott (co-PI) is part of HSR&D’s Health Economics Resource Center in Palo Alto, CA.
Jackson J, Sinnott P, Marx B, et al….and Speroff T. Variation in Practices and Attitudes of Clinicians Assessing PTSD-Related Disability among Veterans. Journal of Traumatic Stress September 12, 2011;e-pub ahead of print.
