Cheif of V.A. Mental Health ordering no more psychological testing?

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edieb

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I was wondering if this is even congruent with the ethics code. At my V.A., the chief of mental health, is forbidding any of the licensed psychologists from conducting any more psychological testing, including MMPIs. This despite the fact that each psychologist may have conducted 2-3 MMPIs/week. In my opinion, it is unethical for the chief to forbid testig since we are all licensed practitioners and testing definitely does not fall out of the expected realm of practice. Furthermore, it saddens me to see the mainstay of our profession being further devalued. Anybody heard of this happening and/or have any suggestions on how to handle this?

I, for one, have found working at the V.A. to be tremendously disappointing on a myriad of levels.

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Did the chief provide any sort of rationale/explanation for the moratorium? It'd be the first of me hearing it happen, but I haven't been particularly involved in the VA until this past year. I can say that nothing of the sort has come into place (or been hinted at) where I'm interning. Additionally, I know that cultures can differ substantially from VA to VA, with my personal experience having been very rewarding in multiple respects. I can definitely see how some things would be frustrating, and how the experience as a whole could be irritating/disappointing if psychology were essentially ostracized rather than embraced as we (fortunately) are here.
 
I, for one, have found working at the V.A. to be tremendously disappointing on a myriad of levels.

I'm sorry to hear it, edlieb. Would you be willing to say more about what else you've found disappointing about the VA? If not here, perhaps if I PMed you? If you're not comfortable of course I understand.
 
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Is no one allowed to test or just psychologists? Either way, it's infuriating.
 
Before the moratorium, only psychologists were doing testing. It was really never embraced as important at this V.A. but when I started, I began testing more. Partly because my Ph.D. program really emphasized it and partly because it really helped diagnostically. The chief states that 1) he wants more people in treatment and fewer in assessment and 2) that psychological testings, particularly MMPIs, tell us little (???).

I don't really think he can order us to stop testing, especially since I am now independently licensed. Am I wrong? I am unsure of whether or not to fight this. On one hand, this is another step in homogenizing the "therapy" professions, esp. since testing is unique to psychology. On the other hand, I am 6 months away from completing my post-doctoral master's in psychopharmacology and plan on opening a private practice where I provide medication management, so I don't plan on working here much longer anyway
 
Before the moratorium, only psychologists were doing testing. It was really never embraced as important at this V.A. but when I started, I began testing more. Partly because my Ph.D. program really emphasized it and partly because it really helped diagnostically. The chief states that 1) he wants more people in treatment and fewer in assessment and 2) that psychological testings, particularly MMPIs, tell us little (???).

I don't really think he can order us to stop testing, especially since I am now independently licensed. Am I wrong? I am unsure of whether or not to fight this. On one hand, this is another step in homogenizing the "therapy" professions, esp. since testing is unique to psychology. On the other hand, I am 6 months away from completing my post-doctoral master's in psychopharmacology and plan on opening a private practice where I provide medication management, so I don't plan on working here much longer anyway

Maybe it is because MMPI's are expensive? I would imagine there is a funding crunch there just like anywhere else...

Oh, there are non-psychologists that are beginning to test now (See vocational therapists and S/L pathologists). I don't think it is right for these folks to test when they have not been trained to do so, but it is happening. Also remember...physicians can do anything they want.
 
I would assume the VA uses computer scoring for the MMPI. This can be expensive ($30+ per test, from what i understand), but is really a minimal amount of time for the psychologist and be helpful in formulating a clinical dx. Sounds strange.


Before the moratorium, only psychologists were doing testing. It was really never embraced as important at this V.A. but when I started, I began testing more. Partly because my Ph.D. program really emphasized it and partly because it really helped diagnostically. The chief states that 1) he wants more people in treatment and fewer in assessment and 2) that psychological testings, particularly MMPIs, tell us little (???).

I don't really think he can order us to stop testing, especially since I am now independently licensed. Am I wrong? I am unsure of whether or not to fight this. On one hand, this is another step in homogenizing the "therapy" professions, esp. since testing is unique to psychology. On the other hand, I am 6 months away from completing my post-doctoral master's in psychopharmacology and plan on opening a private practice where I provide medication management, so I don't plan on working here much longer anyway
 
I was wondering if this is even congruent with the ethics code. At my V.A., the chief of mental health, is forbidding any of the licensed psychologists from conducting any more psychological testing, including MMPIs. This despite the fact that each psychologist may have conducted 2-3 MMPIs/week. In my opinion, it is unethical for the chief to forbid testig since we are all licensed practitioners and testing definitely does not fall out of the expected realm of practice. Furthermore, it saddens me to see the mainstay of our profession being further devalued. Anybody heard of this happening and/or have any suggestions on how to handle this?

I, for one, have found working at the V.A. to be tremendously disappointing on a myriad of levels.

From what I understand, the VA as a whole leases the rights to the MMPI from the UMN Press and Pearson, so I'm not sure if it could actually be an expense issue!? It's possible, I guess, but would makes no sense. Otherwise, this seems like it infringes upon each practitioners right to practice within the scope of their license and using their own clinical judgment, so long as that it is both ethical and legal.

Om interested in your dissappoitment with the VA, as I feel the psychology service at mibe to be amazing. The rest of the services, and the the VA model of rewarding (encouraging?) illness and disability indefiniently (the service connection system thing) is a whole other matter though. 😀
 
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Well, what about testing that doesn't cost money to score? The PAI doesn't have a per-use scoring fee, for instance.
 
How odd.

Personality assessment was required for any C&P we did....so I'm not sure how a proper evaluation can be done without some objective assessment. In addition to Dx specific assessments, I'd typically administer the MCMI, PAI, or sometimes the CPI. I like the MMPI-2, but it has a higher rate of invalid findings w. Veterans (particularly those w. PTSD). I can understand some hesitancy to want to give it to everyone who walks through the door, but to toss it out is just short-sighted. I regularly gave psych measures (in addition to SVTs) during my neuro evals if there was any hint of confounding data or funky details from the intake interview.
 
How odd.

Personality assessment was required for any C&P we did....so I'm not sure how a proper evaluation can be done without some objective assessment. In addition to Dx specific assessments, I'd typically administer the MCMI, PAI, or sometimes the CPI. I like the MMPI-2, but it has a higher rate of invalid findings w. Veterans (particularly those w. PTSD). I can understand some hesitancy to want to give it to everyone who walks through the door, but to toss it out is just short-sighted. I regularly gave psych measures (in addition to SVTs) during my neuro evals if there was any hint of confounding data or funky details from the intake interview.

Those assessment measures may be required for Psychology C&P, but they aren't for anyone else's evals (psychiatry, Social workers). Which makes sense.

I guess the question I'd ask is - how does an MMPI-2 (for example) tell you if someone is disabled, and whether their disability was caused or worsened by their service history? Does it really tell you Anything objectively to support or refute a service connection status?
 
From what I understand, the VA as a whole leases the rights to the MMPI from the UMN Press and Pearson, so I'm not sure if it could actually be an expense issue!? It's possible, I guess, but would makes no sense. Otherwise, this seems like it infringes upon each practitioners right to practice within the scope of their license and using their own clinical judgment, so long as that it is both ethical and legal.

Om interested in your dissappoitment with the VA, as I feel the psychology service at mibe to be amazing. The rest of the services, and the the VA model of rewarding (encouraging?) illness and disability indefiniently (the service connection system thing) is a whole other matter though. 😀

Disappointment on many fronts:

1 - PhDs are paid barely anymore than a social worker. In fact social workers in the homeless programs are paid more than PhDs. In fact, PhDs are paid less than master's level nurses...

2 - Despite what was stated in the last APA Monitor about psychologists having "similar salary structures" to MDs in the V.A. system this is not even remotely the case. The psychiatrists at my facility make $150/hour, have their rents paid for, etc. I make barely $30/hour

3 - PhDs receive inferior benefits to physicians and nurses, both of whom receive more time off/vacation leave, etc.

4 + - There is no access to any research articles, books, etc. There are no real clinical meetings other than a meeting once/week to go over bureaucratic red tape or case management issues. The V.A. where I work is completely devoid of any intellectual stimulation. Also, despite the fact that the DoD is actively recrutiing prescribing psychologists and paying them equivalent to psychiatrists (as they should be) the V.A. still resists medical psychologists. This despite the fact of an 8 month (Literally) wait to see a prescriber at my facility

I recently interviewed at several medical schools for faculty positions and faculty at each school said something to the sort of 'unless you are at the beginning of your career or you move to the V.A. at the end of your career, you must be either a problem employee [VA employees never get fired] or an inferior clinician. I was skeptical but, at least at my V.A., I can now see this is true...


4:5 psychologists at my facility are almost all done with our clnical psychopharmacology degrees so I think this speaks to the fact that I am not isolated in my unhappiness with my V.A. experience.
 
Those assessment measures may be required for Psychology C&P, but they aren't for anyone else's evals (psychiatry, Social workers). Which makes sense.

I guess the question I'd ask is - how does an MMPI-2 (for example) tell you if someone is disabled, and whether their disability was caused or worsened by their service history? Does it really tell you Anything objectively to support or refute a service connection status?

The MMPI-2 is an excellent measure to see is someone is possibly malingering, especially by look at the F-K raw score among other things. This is why The C&P Service, run by a psychologist (who calls himself a neuropsychologist but has no fellowship or boarding) requires an MMPI-2 on everybody who walks in the door.
 
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The MMPI-2 is an excellent measure to see is someone is possibly malingering, especially by look at the F-K raw score among other things. This is why The C&P Service, run by a psychologist (who calls himself a neuropsychologist but has no fellowship or boarding) requires an MMPI-2 on everybody who walks in the door.

But not necessary. The MMPI-2 is overkill if all you're screening for is malingering. Use a Rey-2 or something non-proprietary.
 
The MMPI-2 is an excellent measure to see is someone is possibly malingering, especially by look at the F-K raw score among other things. This is why The C&P Service, run by a psychologist (who calls himself a neuropsychologist but has no fellowship or boarding) requires an MMPI-2 on everybody who walks in the door.
Doesn't seem like a particularly useful policy to me. The MMPI-2 and RF version have many limits. It is a good measure for some cases, but I am personally against any kind of fixed battery perspective, particularly one that costly. Inappropriate overuse of a measure might be part of why the Chief sees little utility for it if it does not add enough to make a significant difference in diagnosis or care for enough of the entire population.
 
But not necessary. The MMPI-2 is overkill if all you're screening for is malingering. Use a Rey-2 or something non-proprietary.

it's not just about malingering; it's more useful to see if neurological complaints are pyschogenic in nature.
 
it's not just about malingering; it's more useful to see if neurological complaints are pyschogenic in nature.

You could get information about that from an interview in combination with less expensive measures, such as the PAI or a combination of other existing scales. I am assuming that not every coming in has neurological complaints that are suspected to be psychogenic, either.
 
You could always give a Rorschach to see if they're malingering!

*runs away*

(Disclaimer: I am kidding. I absolutely hate the Rorschach. 😉)
 
But not necessary. The MMPI-2 is overkill if all you're screening for is malingering. Use a Rey-2 or something non-proprietary.

Giving one assessment is never sufficient, and the Rey 15/II in particular has some significant limitations in regard to certain neurological conditions. I don't believe in "screening" for malingering per se, but I will give some measures on the front-end of an assessment if I have any concern. As for the MMPI-2 and malingering...it isn't bad in conjunction with other measures, though I would need a good clinical reason to take that kind of time for the assessment.
 
Giving one assessment is never sufficient, and the Rey 15/II in particular has some significant limitations in regard to certain neurological conditions. I don't believe in "screening" for malingering per se, but I will give some measures on the front-end of an assessment if I have any concern. As for the MMPI-2 and malingering...it isn't bad in conjunction with other measures, though I would need a good clinical reason to take that kind of time for the assessment.

Exactly. Doing it as a standard battery mindlessly just encourages practice without critical thinking, IMHO. A parallel would be how ED's do CT's on everyone that walks through the door. Waste of time, $$, and radiation.
 
Exactly. Doing it as a standard battery mindlessly just encourages practice without critical thinking, IMHO. A parallel would be how ED's do CT's on everyone that walks through the door. Waste of time, $$, and radiation.

:laugh:

+1

You can also tell who has private insurance and uses a boutique practice, as they get everything done. Thorough I guess, but definitely overkill.
 
Giving one assessment is never sufficient, and the Rey 15/II in particular has some significant limitations in regard to certain neurological conditions. I don't believe in "screening" for malingering per se, but I will give some measures on the front-end of an assessment if I have any concern. As for the MMPI-2 and malingering...it isn't bad in conjunction with other measures, though I would need a good clinical reason to take that kind of time for the assessment.

I probably don't need to say it, but I wanted to also point out that there are of course different "types" of malingering, with the MMPI-2 and its validity scales (including FBS) hitting areas that aren't necessarily addressed by a Rey 15/II (in addition to the psychometric issues T4C hinted at). If someone is potentially malingering psychopathology, for example, I might not expect very much to show up on an instrument that mainly looks at memory/cognitive complaints. And even if it did, "failing" one SVT doesn't necessarily allow you to use a blanket statement such as, "this patient is malingering;" at best, you can definitively make that call only with respect to the area evaluated by that particular SVT. Hence one (of many) reasons for multiple malingering measures, especially depending upon the nature of the evaluation.

Personally, I prefer (and am more comfortable with) the PAI, but I'd definitely bristle at being told that I could NEVER administer an MMPI-2 (or any other test). Having to justify its use is one thing, but a blanket moratorium is something else entirely.
 
I think a lot of you guys think people are actively malingering. It's about effort, not everyone is gaming the system.
 
I think a lot of you guys think people are actively malingering. It's about effort, not everyone is gaming the system.


Good point, although I'm not sure anyone here would say that a failed SVT = definitive malingering. As you've alluded to, that's a judgment call that relies on a variety of data, although it's one we're often called on as mental health professionals to make.
 
Most/all of this is generally accepted ideas, though I still think they are worth mentioning because many clinicians still do not regularly use SVTs in their assessments.

Effort is an important consideration for any assessment, so effort testing should be included in every assessment. Malingering involves effort, but poor effort does not always equate to malingering..at least in the construct of how most people view it. There are special populations and external factors that may contribute to a person's failure of a measure, though these are admittedly uncommon in the general population.

The use of multiple measures, with subsequent multiple failures, can provide more creedance to a concern about effort....though the data still needs to be viewed as a whole and not just in the isolation of the normed data. I really like the WMT, but I have seen quite a few cases where "failure" was due to other factors besides effort, so additional SVTs are needed to inform on the case. Reliable digit span is another quick and easy measure that can speak to effort, though there is good data supporting certain populations may present as a false positive (ADHD and certain LDs). The TOMM has been around long enough that its validity can be problematic, particularly in medicolegal cases with less than ethical legal representation. No measure is perfect, but when used together (with other case data) you can get some pretty solid data to support/refute issues of effort and/or malingering.
 
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My assessment prof would automatically fail us on any test if we said that any score on any test indicated malingering. Negative or positive distortion is okay to say, but malingering implies motivation and we can't really know that just from one test score.
 
My assessment prof would automatically fail us on any test if we said that any score on any test indicated malingering. Negative or positive distortion is okay to say, but malingering implies motivation and we can't really know that just from one test score.

I find this to be a stereotypical academic psychology professor answer that is really counter to what are jobs are in the clinical trenches. Infering things and drawing conclusions based on data (and hx, and presentation) is what we are payed to do.

So long as the person is wake, alert, not in advanced stages of AD or in a nursning home, when a person performs grossly below chance on SVT or flunks a test that MR children easily pass, then I am happy to stick my neck out just slightly and infer they are purposely distorting results for some kind of external motivator. I dont feel like i have to know what that is in order to make that call. So, yes, I have seen a TOMM score, and combined with what i gathered in their interview, concluded they were pretty much full of ****. 😀
 
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And who the hell gives the Rey 15? I have actually never seen this used. You might as sell flip a coin in terms of its sensitivity.

Paul Greens WMT and MSVT are far superior. So is the TOMM and the Victoria...
 
So long as the person is wake, alert, not in advanced stages of AD or in a nursning home, when a person performs grossly below chance on SVT or flunks a test that MR children easily pass, then I am happy to stick my neck out just slightly and infer they are purposely distorting results for some kind of external motivator.

I agree that it is important to acknowledge external factors that may be contributing to sub-optimal effort and/or poor performance. Speaking to intent (an important factor in malingering) is much trickier. The research is pretty clear about the increased occurance of malingering in a patient with an active legal case, but it is much murkier for patients that don't have easily identifiable secondary gain factors in play.

I've worked with quite a few folks who struggled with conversion disorder (paraplegia, psuedo-seizures, etc), and I can honestly say that in the beginning they were not consciously aware of the fact their struggles were purely non-organic in nature. I've also worked with patients who had an odd-ball neurological conditions (e.g. "Alien Hand") that masquaraded as purposeful (non-compliant) movement. I really wish I wrote up a case study for the Alien Hand example, as I'm not sure when I'll see it again.
 
I find this to be a stereotypically academic psychology professor answer that is really counter to what are jobs are in the clinical trenches. Infering things and drawing conclusions based on data (and hx, and presentation) is what we are payed to do.

So long as the person is wake, alert, not in advanced stages of AD or in a nursning home, when a person performs grossly below chance on SVT or flunks a test that MR children easily pass, then I am happy to stick my neck out just slightly and infer they are purposely distorting results for some kind of external motivator. I dont feel like i have to know what that is in order to make that call. So, yes, I have seen a TOMM score, and combined with what i gathered in their interview, concluded they were pretty much full of ****. 😀

Not that it matters in day-to-day clinical trenches, but I am pretty sure DSM-V is eliminating the guesswork about inferring "intent." I haven't read the draft version in over a year, so it may have changed.

But I agree, people want conclusions in clinical settings, not a bunch of wishy-washy academic speak. I think it is good to be decisive when you can, and good to let the truly complicated cases remain complicated (e.g., suboptimal effort due to a variety of factors...which should be addressed in the following order)

Oh and yes...as T4C said, after you get a couple of genuine conversion disorder cases, you view effort testing much differently.
 
Does this include a moratorium on neuropsych testing for returning Iraq/Afghanistan vets? One of the biggest issues when I working at the VA was screening and testing for head injury and attempting to determine differential dx of PTSD vs head injury.
 
I'd be curious if this is hospital specific (sounds like it is), vs. a policy across the VISN or even nationally. Before I left the San Diego VA some psychologists I know were setting up an inpatient testing consultation service. Which was useful when strategically used.
 
I'd be curious if this is hospital specific (sounds like it is), vs. a policy across the VISN or even nationally. Before I left the San Diego VA some psychologists I know were setting up an inpatient testing consultation service. Which was useful when strategically used.

I can say that, at least currently, it's definitely not a national standard; the VA where I work hasn't even hinted at halting any psychological testing.
 
I can say that, at least currently, it's definitely not a national standard; the VA where I work hasn't even hinted at halting any psychological testing.

It is a couple of years back now, but in our VISN we had a 2-3+ months backlog of neuropsych C&Ps and that was before the large influx of troops in the past year.Psych assessment was quite prevalent at the VAs too, though for more specific areas (substance abuse, PTSD/military sexual trauma, etc).
 
It is a couple of years back now, but in our VISN we had a 2-3+ months backlog of neuropsych C&Ps and that was before the large influx of troops in the past year.Psych assessment was quite prevalent at the VAs too, though for more specific areas (substance abuse, PTSD/military sexual trauma, etc).

I'm not sure how our VA's C&P schedule looks as I'm not rotating through there, but I've gotten the sense that it's a similar situation to what you've described. Definitely no word of a psych testing stoppage coming down the pipeline over on that end, either.
 
I recently interviewed at several medical schools for faculty positions and faculty at each school said something to the sort of 'unless you are at the beginning of your career or you move to the V.A. at the end of your career, you must be either a problem employee [VA employees never get fired] or an inferior clinician. I was skeptical but, at least at my V.A., I can now see this is true...

Not to take anything away from your appropriate frustration in regards to psychology at your specific VA, I think the med school faculty that made these comments may have their own motives for dissing VA psychologists.
 
Disappointment on many fronts:

1 - PhDs are paid barely anymore than a social worker. In fact social workers in the homeless programs are paid more than PhDs. In fact, PhDs are paid less than master's level nurses...

2 - Despite what was stated in the last APA Monitor about psychologists having "similar salary structures" to MDs in the V.A. system this is not even remotely the case. The psychiatrists at my facility make $150/hour, have their rents paid for, etc. I make barely $30/hour

3 - PhDs receive inferior benefits to physicians and nurses, both of whom receive more time off/vacation leave, etc.

4 + - There is no access to any research articles, books, etc. There are no real clinical meetings other than a meeting once/week to go over bureaucratic red tape or case management issues. The V.A. where I work is completely devoid of any intellectual stimulation. Also, despite the fact that the DoD is actively recrutiing prescribing psychologists and paying them equivalent to psychiatrists (as they should be) the V.A. still resists medical psychologists. This despite the fact of an 8 month (Literally) wait to see a prescriber at my facility

I recently interviewed at several medical schools for faculty positions and faculty at each school said something to the sort of 'unless you are at the beginning of your career or you move to the V.A. at the end of your career, you must be either a problem employee [VA employees never get fired] or an inferior clinician. I was skeptical but, at least at my V.A., I can now see this is true...


4:5 psychologists at my facility are almost all done with our clnical psychopharmacology degrees so I think this speaks to the fact that I am not isolated in my unhappiness with my V.A. experience.

In the thread about the Wright Institute, we got into a VA discussion, where I said that it is good for people to see alternative opinions of the VA, rather than the tacit opinion that seems to emerge on SDN, which is that the VA is a pinnacle achievement or some sort of ideal place for a clinical career. I feel that it is not; and I am glad to see another alternative review.

I think often we (Psychologists) try to fit our profession into a mold that simple won't work.
Rather than doing this, I think that if Ph.D.s moved away from the VA and other institution that do not properly employ/pay us, we will see a free-market correction in our value.
 
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Rather than doing this, I think that is Ph.D.s moved away from the VA and other institution that do not properly employ/pay us, we will see a free-market correction in our value.

If anything, I have seen more clinicians moving towards staff positions at hospitals, most likely due to the growing health insurance costs. Certain specialities can make significantly more in private practice, though there is some risk to hanging your own shingle. It is a much harder sell to accept a GS-11 or GS-12 position, but starting as a GS-13 ($90k or so for a medium-sized city)is not a bad situation when you consider how much health insurance costs for a private practice clinician.
 
If anything, I have seen more clinicians moving towards staff positions at hospitals, most likely due to the growing health insurance costs. Certain specialities can make significantly more in private practice, though there is some risk to hanging your own shingle. It is a much harder sell to accept a GS-11 or GS-12 position, but starting as a GS-13 ($90k or so for a medium-sized city)is not a bad situation when you consider how much health insurance costs for a private practice clinician.

I meant to type IF Psychs move away instead of IS they move away.

You may be right about the trends; likely due to the poor economy.

My point is centered around supply side econ. If we decrease what we supply (less shrinks willing to work there for instance), they need to pay us more to supply the service. This is the balance that needs to take place, rather than psychologists attempting to fit psychotherapy into a frame that might not work.
 
Or they'd just replace us with Masters-level clinicians.
 
:laugh:

(This kind of made my night, sadly. Don't we love projective tests? 😉)

It is sad that more clinicians are not skilled enough to use the Rorschach in a valid way. The evidence for it's reliability and validity in many areas is impressive.
 
It is sad that more clinicians are not skilled enough to use the Rorschach in a valid way. The evidence for it's reliability and validity in many areas is impressive.

It was actually more of an inside joke between cara and me. However, my issue with projective tests--FWIW as a second year, which may not be much--is that they seem very susceptable to confirmation bias. My issue with the Rorschach in particular is the availability of the blots and common responses on Wikipedia.
 
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