VA Mental Health Provider Venting / Problem-solving / Peer Support Thread

[Fan_of_Meehl]

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Schroeder RW, Bieu RK. Exploration of PCL-5 symptom validity indices for detection of exaggerated and feigned PTSD. J Clin Exp Neuropsychol. 2024 Mar;46(2):152-161. doi: 10.1080/13803395.2024.2314728.

And Shura’s 2023 article that initially developed the indices studied are god reads. A CAPS or PSSI5 would be ideal but sometimes the best I get when doing an assessment involving reviewing others work is a single or a few PCL-5s. I’m glad they’re exploring this.

Thank you!

I had been aware of (and recently messaged by another psychologist regarding) the original Shura article on the embedded symptom validity indices in the PCL-5. I developed a brief 'scoring sheet' for it and have used it at work (just casual observations at this point as I work on cases). Would be really cool to have a study where the same treatment seeking veterans were examined in light of their scores on these embedded indices plus MMPI-2-RF plus CAPS, especially if followed by a trial of an EBP protocol (PE/CPT/EMDR) and response.

Which raises the question...since we have so many treatment outcome studies where response to PE/CPT/EMDR protocols include weekly PCL-5 data...where the hell is the analysis of how participants' scores on the embedded validity indices on the PCL-5 impacts treatment response? The obvious hypothesis would be of course that those scoring higher would tend to show little/no improvement. Though I'd suggest at least the possibility of a more complex picture. I have seen cases where people show dramatic response to PTSD treatment in terms of symptom reduction but equally dramatic return of symptoms 2-3 months later (sometimes with scores elevated more than they were pre-treatment) and the re-present for care. So examination of impact on medium to long-term maintenance of gains would be necessary. In any case, a good litmus test of the intellectual honesty of the field will be if they examine the data they already have on the PCL-5 (from these treatment outcome studies) using the new validity indices. I'm not holding my breath.

 

[Fan_of_Meehl]

In my experience, it doesn't even take a sophisticated dissimulator to "game" the CAPS, given its format/structure. But it's better than the PCL and, for many providers (particularly those unfamiliar with PTSD), better than just their standard clinical interview. It helps to get at the concept that just because a person may be experiencing symptoms of a condition doesn't actually mean they have a mental health disorder. The measure itself also gives the evaluator an opportunity to rate the overall response validity, which I've always taken to mean as based on whatever information you have available.

But yeah, I take much extant PTSD research with a grain of salt, especially if the diagnosis is based on self-report rating scale(s), brief telephone or internet survey, and/or chart review. It's one of the few MH conditions from a compensability standpoint that has a (theoretically) straightforward link to a causal event (although that's not as much of an issue in the SC world), meaning involvement of secondary gain may play a role in a higher proportion of cases.

I mean, a pretty simple 'test' for whether or not symptom validity/ overreporting aspects should be considered in the context of an evaluation for a particular disorder would be the degree to which patients tend to get upset when you tell them that they DON'T have the disorder.

I think I've had about 0.02% of veterans get upset (moderately) when I told them that based upon my evaluation I think they have PTSD (one or two former special forces Delta operator types). On the other hand, it is extremely frequent for the average veteran to get upset when I have to tell them I think they don't have PTSD (sometimes QUITE upset). The situation is clearly reversed for SUDS or psychotic disorders, for example. And then, of course, if they want a diagnosis of 'traumatic brain injury' or ADHD, they get upset if you try to critically examine and potentially rule out those conditions, as well. Again, a very straightforward commonsense approach but to the degree a population tends to 'want' a diagnosis and tend to become upset when you don't 'give' them the diagnosis they want...yeah...examination of response bias is pretty damn important.

 

[Shiori]

I have tried to reach out to a community care provider system for a few weeks about a consult error on their end with no success. I don't look forward to doing this more.

 

[summerbabe]

The list of VHA employees who are ineligible for the deferred resignation program just dropped.

Is anybody in VHA even eligible for this offer? MSAs, canteen workers, physical plant folks and seemingly every category of clinical personnel were included on the ineligible list.

So hopefully this means job security at VHA, including for probationary folks who have likely been stressed out recently, will remain solid.

Then again, I heard some rumblings that some job offers that were re-extended following the brief hiring freeze lift are back in some type of paused status so who knows what the future holds.

 

[cara susanna]

Well, it's good to know that we're ineligible.

 

[Fan_of_Meehl]

Well, it's good to know that we're ineligible.

VA to psychologists: "Nooo! You can't leave!!!!! I NEEEEED YOU!"

Psychologists to VA: "great"

 

[Sanman]

The list of VHA employees who are ineligible for the deferred resignation program just dropped.

Is anybody in VHA even eligible for this offer? MSAs, canteen workers, physical plant folks and seemingly every category of clinical personnel were included on the ineligible list.

So hopefully this means job security at VHA, including for probationary folks who have likely been stressed out recently, will remain solid.

Then again, I heard some rumblings that some job offers that were re-extended following the brief hiring freeze lift are back in some type of paused status so who knows what the future holds.

Well, it's good to know that we're ineligible

So we are ineligible to get forked (or at least current VHA admin is requesting that). Let's see what Trump and Collins say. I am not convinced we are safe.

 

[AcronymAllergy]

Maybe they realized the political cliff they were about to jump off if they suddenly dropped a significant portion of the VA workforce. At least until Hegseth can start chopping away at C&P benefits.

 

[Sanman]

Maybe they realized the political cliff they were about to jump off if they suddenly dropped a significant portion of the VA workforce. At least until Hegseth can start chopping away at C&P benefits.

Reading Project 2025, they seem to want a slow burn to avoid political blowback, but the long term plan seems to be cut benefits to the younger folks and shrink the footprint replacing old hospitals with CBOCs as the Vietnam veterans die. I think they are interested in more automation on the VBA side for processing disability claims as well.

 

[cara susanna]

Reading Project 2025, they seem to want a slow burn to avoid political blowback, but the long term plan seems to be cut benefits to the younger folks and shrink the footprint replacing old hospitals with CBOCs as the Vietnam veterans die. I think they are interested in more automation on the VBA side for processing disability claims as well.

I mean, replacing old hospitals with CBOCs isn't the WORST idea...

 

[Sanman]

I mean, replacing old hospitals with CBOCs isn't the WORST idea...

Here's the problem. They are using a for profit playbook. They talk about partnering with AMCs and private hospitals, but their plan is to pull out of the same smaller and rural areas that the private sector already has. The result is there are simply no doctors in the area. I have worked in many of these areas. There are few docs available and many that are poorly trained or unethical. You are going to have healthcare deserts under this plan.

 

[WisNeuro]

Here's the problem. They are using a for profit playbook. They talk about partnering with AMCs and private hospitals, but their plan is to pull out of the same smaller and rural areas that the private sector already has. The result is there are simply no doctors in the area. I have worked in many of these areas. There are few docs available and many that are poorly trained or unethical. You are going to have healthcare deserts under this plan.

People get what they vote for. And, they voted for poorer health outcomes than we already have. Let them have what they want.

 

[Sanman]

People get what they vote for. And, they voted for poorer health outcomes than we already have. Let them have what they want.

It's not like there is anything I can do to stop it.

That said, as an employee, I always found the slower pace of rural health clinics to be nice if you could deal with a rural population. I am lucky to be at the point in my life and career where I have the flexibility to open up my own shop. I would not want to be an early career person or a student in this environment.

 

[cara susanna]

Does anyone know what Best Medical Interest actually means within the context of community care getting approved? Because every time I think it should apply, they tell me it doesn't. Does it even exist?

 

[Sanman]

Does anyone know what Best Medical Interest actually means within the context of community care getting approved? Because every time I think it should apply, they tell me it doesn't. Does it even exist?

I thought it meant VA has no comparable option for care.

 

[cara susanna]

I thought it meant VA has no comparable option for care.

I believe that is covered under "service not offered by VA"

 

[Sanman]

I believe that is covered under "service not offered by VA"

While I am not 100% sure. I believe that is if no one in the system offers the care. However, if the main hospital is, say, 60 miles away and the cboc does not offer the service than it is in the best medical interest to get community physical therapy locally. At least that is how we have used it in the past.

 

[cara susanna]

See, I've always used "service is not locally available at VA" for that. I've never, ever seen BMI approved.

 

[WisNeuro]

"Example 5: Your best medical interest

You have a certain health condition that your VA provider doesn’t have experience treating. But you live near an in-network community provider who specializes in this condition. If you and your VA provider agree that it’s in your best medical interest to get care from the community provider, you’re eligible for community care for this condition."

 

[SunshinePsych]

Found out today that with the RTO mandate that I will likely be loosing my office in the near future. The plan we are being told is they are currently looking at leasing trailers for us to do our therapy in until they can determine a more permanent solution. Not sure how leasing trailers saves the government money.

The offices are going to go to management that are now returning to the office.

 

[AcronymAllergy]

Found out today that with the RTO mandate that I will likely be loosing my office in the near future. The plan we are being told is they are currently looking at leasing trailers for us to do our therapy in until they can determine a more permanent solution. Not sure how leasing trailers saves the government money.

The offices are going to go to management that are now returning to the office.

Because it makes all the sense in the world for managers, who may have few if any clinical responsibilities, to have separate offices while clinicians who actively provide care are sharing space and/or are being shipped out to trailers.

That said, I can understand that managers need space that non-managerial staff can't access, such as for keeping records. But why can't managers share space...?

And yeah, just another example of why the RTO mandate has little to nothing to do with patient care and worker productivity, and much more to do with basically trying to make federal work so unappealing that most people just quit.

 

[PsyDWannabe]

Found out today that with the RTO mandate that I will likely be loosing my office in the near future. The plan we are being told is they are currently looking at leasing trailers for us to do our therapy in until they can determine a more permanent solution. Not sure how leasing trailers saves the government money.

The offices are going to go to management that are now returning to the office.

How shameful.

 

[DoubtfulDoc]

Thank you!

I had been aware of (and recently messaged by another psychologist regarding) the original Shura article on the embedded symptom validity indices in the PCL-5. I developed a brief 'scoring sheet' for it and have used it at work (just casual observations at this point as I work on cases). Would be really cool to have a study where the same treatment seeking veterans were examined in light of their scores on these embedded indices plus MMPI-2-RF plus CAPS, especially if followed by a trial of an EBP protocol (PE/CPT/EMDR) and response.

Which raises the question...since we have so many treatment outcome studies where response to PE/CPT/EMDR protocols include weekly PCL-5 data...where the hell is the analysis of how participants' scores on the embedded validity indices on the PCL-5 impacts treatment response? The obvious hypothesis would be of course that those scoring higher would tend to show little/no improvement. Though I'd suggest at least the possibility of a more complex picture. I have seen cases where people show dramatic response to PTSD treatment in terms of symptom reduction but equally dramatic return of symptoms 2-3 months later (sometimes with scores elevated more than they were pre-treatment) and the re-present for care. So examination of impact on medium to long-term maintenance of gains would be necessary. In any case, a good litmus test of the intellectual honesty of the field will be if they examine the data they already have on the PCL-5 (from these treatment outcome studies) using the new validity indices. I'm not holding my breath.

Still pretty hot off the press, just found it in the recent CTU.

Touponse SC, Guo Q, Ma T, Maples-Keller JL, Rothbaum BO, Dunlop BW. Effect of agreement between clinician-rated and patient-reported PTSD symptoms on intensive outpatient treatment outcomes. Psychiatry Res. 2025 Jan;343:116287. doi: 10.1016/j.psychres.2024.116287. Epub 2024 Nov 22. PMID: 39613511.

From CTU: “
Consistent with prior research, the PCL-5 was 17.5 points higher than the CAPS-5, even though both have a 0-80 scale.


Patients were categorized as congruent reporters (baseline PCL-5 3.3 points lower than CAPS-5; n=75), limited over-reporters (PCL-5 17.6 points higher than CAPS-5; n=325), and extensive over-reporters (PCL-5 36.2 points higher than CAPS-5; n=83).”

From article: “Patients who most over-report their PTSD symptoms compared to trained clinicians show steepest declines in PTSD symptom severity with treatment. Personalizing treatment for PTSD may benefit from understanding the mechanisms contributing to these differences.”

I’m guessing those over reporters probably would spike on these new embedded indices, but apparently would show larger treatment gains? Would be great to snag their data and run it through the indices. The CTU goes on to discuss how the PCL-5 is likely acting like a general distress measure and will show good improvements. This tracks with the broad overlap with the numbing, dysohoria, arousal with many other conditions, with avoidance and intrusion being the most specific to PTSD, but representing less than half the item content. Consistent with our alternative nosologies about general meta and higher order factors of pathology and distress (see HiTOP). The IDAS-II author Watson really does a nice job elaborating on this in his wonderfully written book on the IDAS-II.

 

[Fan_of_Meehl]

Still pretty hot off the press, just found it in the recent CTU.

Touponse SC, Guo Q, Ma T, Maples-Keller JL, Rothbaum BO, Dunlop BW. Effect of agreement between clinician-rated and patient-reported PTSD symptoms on intensive outpatient treatment outcomes. Psychiatry Res. 2025 Jan;343:116287. doi: 10.1016/j.psychres.2024.116287. Epub 2024 Nov 22. PMID: 39613511.

From CTU: “
Consistent with prior research, the PCL-5 was 17.5 points higher than the CAPS-5, even though both have a 0-80 scale.


Patients were categorized as congruent reporters (baseline PCL-5 3.3 points lower than CAPS-5; n=75), limited over-reporters (PCL-5 17.6 points higher than CAPS-5; n=325), and extensive over-reporters (PCL-5 36.2 points higher than CAPS-5; n=83).”

From article: “Patients who most over-report their PTSD symptoms compared to trained clinicians show steepest declines in PTSD symptom severity with treatment. Personalizing treatment for PTSD may benefit from understanding the mechanisms contributing to these differences.”

I’m guessing those over reporters probably would spike on these new embedded indices, but apparently would show larger treatment gains? Would be great to snag their data and run it through the indices. The CTU goes on to discuss how the PCL-5 is likely acting like a general distress measure and will show good improvements. This tracks with the broad overlap with the numbing, dysohoria, arousal with many other conditions, with avoidance and intrusion being the most specific to PTSD, but representing less than half the item content. Consistent with our alternative nosologies about general meta and higher order factors of pathology and distress (see HiTOP). The IDAS-II author Watson really does a nice job elaborating on this in his wonderfully written book on the IDAS-II.

1) thank you for the heads-up on Watson, the IDAS-II and his book--I hadn't run across these resources and they are exactly what I'm looking for to continue my quest of better understanding how to conceptualize/intervene with the patients who present at VA, this will be an awesome resource. If I have to read another report considering scores on the PHQ-9 as some sort of infallible pure measure of major depressive disorder...well...I'll need another cup of coffee or something

I'm definitely getting Watson's book. Here is a link to a summary of his chapter on PTSD symptom specificity ('The Structure, Validity, and Specificity of PTSD Symptoms') which provides actual empirical/scientific evidence supporting a practice I've developed over time (focusing more on intensive interviewing around the re-experiencing and avoidance symptoms, specifically, when there is limited time to do the evaluation):

https://academic.oup.com/book/1155/chapter-abstract/138234583?redirectedFrom=fulltext

This chapter explicates the properties of posttraumatic stress disorder (PTSD) symptoms. It focuses on four basic types of PTSD symptoms: intrusions/reexperiencing, avoidance, hyperarousal, and dysphoria/numbing. Indicators of intrusions/reexperiencing showed the strongest overall criterion validity and impressive diagnostic specificity vis-à-vis PTSD diagnoses; they also displayed significant incremental predictive power in logistic regression analyses. Avoidance symptoms behaved similarly and also appear to have a relatively strong and specific association with PTSD diagnoses. The data for hyperarousal symptoms were more mixed: They tended to exhibit moderate to strong criterion validity, with inconsistent evidence of diagnostic specificity and incremental validity. Finally, although dysphoria/numbing symptoms displayed some criterion validity, they actually showed diagnostic specificity to major depression—not PTSD—and demonstrated virtually no incremental predictive power in the logistic regression analyses. Thus, these symptoms were neither specific to PTSD nor necessary in predicting the diagnosis.


2) I think that we need to start at least considering the possibility that a not insubstantial subset of veterans presenting with PTSD-related symptoms at VA are 'playing the role' (smile/frown-for-the-camera) of someone with PTSD such that they may be prone to demonstrating 'remarkable' and 'stunning' or even 'miraculous' short-term recovery (after first presenting with extremely severe symptoms that have been ongoing for decades upon decades) only to present--weeks or months later--with a full return of their severe symptoms (e.g., at their next primary care appointment, appointment with their new MH provider, or at their next C and P evaluation). I'm reminded of the small-n studies on Stellate Ganglion Nerve Block for PTSD where they included anecdotes in the write-up of miraculous sudden cures of lifelong crippling PTSD symptoms and suicidality (but no followup). I think they later demonstrated that saline injection did the same thing. I hate to be so cynical, but years and years of VA practice has made me so. And I'm not even kidding in the slightest when I say that I really do need to see MMPI-2-RF protocols on these veterans and/or examine their PCL-5 scores at their next mental health C&P review exam to conclude anything. I mean, I'd love to be wrong (empirically). But I'd suspect that many of those initial 'overreporters' with PCL-5's in the 65-80 range would be right back in that range (if not higher) at their next C&P exam, even if it was just a few weeks later. Again, love to be proven wrong. We should do the study.

 

[Fan_of_Meehl]

Still pretty hot off the press, just found it in the recent CTU.

Touponse SC, Guo Q, Ma T, Maples-Keller JL, Rothbaum BO, Dunlop BW. Effect of agreement between clinician-rated and patient-reported PTSD symptoms on intensive outpatient treatment outcomes. Psychiatry Res. 2025 Jan;343:116287. doi: 10.1016/j.psychres.2024.116287. Epub 2024 Nov 22. PMID: 39613511.

From CTU: “
Consistent with prior research, the PCL-5 was 17.5 points higher than the CAPS-5, even though both have a 0-80 scale.


Patients were categorized as congruent reporters (baseline PCL-5 3.3 points lower than CAPS-5; n=75), limited over-reporters (PCL-5 17.6 points higher than CAPS-5; n=325), and extensive over-reporters (PCL-5 36.2 points higher than CAPS-5; n=83).”

From article: “Patients who most over-report their PTSD symptoms compared to trained clinicians show steepest declines in PTSD symptom severity with treatment. Personalizing treatment for PTSD may benefit from understanding the mechanisms contributing to these differences.”

I’m guessing those over reporters probably would spike on these new embedded indices, but apparently would show larger treatment gains? Would be great to snag their data and run it through the indices. The CTU goes on to discuss how the PCL-5 is likely acting like a general distress measure and will show good improvements. This tracks with the broad overlap with the numbing, dysohoria, arousal with many other conditions, with avoidance and intrusion being the most specific to PTSD, but representing less than half the item content. Consistent with our alternative nosologies about general meta and higher order factors of pathology and distress (see HiTOP). The IDAS-II author Watson really does a nice job elaborating on this in his wonderfully written book on the IDAS-II.

I need to read the study but just by reading the abstract, two things pop out at me:

1) it was a 2-week IOP (intensive outpatient program) so they were immersed in a group assessment/treatment setting and were likely getting continuous feedback from other veterans and multiple clinicians that would, of course, help 'correct' their initial over-reporting of their symptoms.
2) given the above, it would seem equally plausible to conceptualize their reduction of PCL-5 scores over time as a 'reduction in over-reporting' of their symptoms as much as conceptualizing it as 'steep declines in PTSD severity.' I'll have to check the study but are they saying that the massive discrepancies in PCL-5 (self-report) were simply reduced back to be more in line with CAPS-5 (clinician-rated severity) scores pre-post? Again, how is it not plausible that these veterans aren't simply learning to 'tone down' their over-reporting of their symptoms based on constant (daily?) feedback? Maybe the CAPS scores came down in direct, linear proportion to the PCL-5 score reductions during treatment. I mean, that would be more compelling. But if the CAPS scores came down very little while the PCL-5 scores just came down over time to align with the CAPS scores, I'd say that they simply learned to stop over-reporting, not that their actual PTSD symptoms exhibited a 'steep decline.'

 

[aim-agm]

I need to read the study but just by reading the abstract, two things pop out at me:

1) it was a 2-week IOP (intensive outpatient program) so they were immersed in a group assessment/treatment setting and were likely getting continuous feedback from other veterans and multiple clinicians that would, of course, help 'correct' their initial over-reporting of their symptoms.
2) given the above, it would seem equally plausible to conceptualize their reduction of PCL-5 scores over time as a 'reduction in over-reporting' of their symptoms as much as conceptualizing it as 'steep declines in PTSD severity.' I'll have to check the study but are they saying that the massive discrepancies in PCL-5 (self-report) were simply reduced back to be more in line with CAPS-5 (clinician-rated severity) scores pre-post? Again, how is it not plausible that these veterans aren't simply learning to 'tone down' their over-reporting of their symptoms based on constant (daily?) feedback? Maybe the CAPS scores came down in direct, linear proportion to the PCL-5 score reductions during treatment. I mean, that would be more compelling. But if the CAPS scores came down very little while the PCL-5 scores just came down over time to align with the CAPS scores, I'd say that they simply learned to stop over-reporting, not that their actual PTSD symptoms exhibited a 'steep decline.'

I suspect that the more accurate description of study results would be "Don't trust the conclusions of Touponse SC, Guo Q, Ma T, Maples-Keller JL, Rothbaum BO, and Dunlop BW; they aren't good researchers". They don't appear to have even assessed a post-treatment CAPS.

 

[DoubtfulDoc]

1) thank you for the heads-up on Watson, the IDAS-II and his book--I hadn't run across these resources and they are exactly what I'm looking for to continue my quest of better understanding how to conceptualize/intervene with the patients who present at VA, this will be an awesome resource. If I have to read another report considering scores on the PHQ-9 as some sort of infallible pure measure of major depressive disorder...well...I'll need another cup of coffee or something

I'm definitely getting Watson's book. Here is a link to a summary of his chapter on PTSD symptom specificity ('The Structure, Validity, and Specificity of PTSD Symptoms') which provides actual empirical/scientific evidence supporting a practice I've developed over time (focusing more on intensive interviewing around the re-experiencing and avoidance symptoms, specifically, when there is limited time to do the evaluation):

https://academic.oup.com/book/1155/chapter-abstract/138234583?redirectedFrom=fulltext

This chapter explicates the properties of posttraumatic stress disorder (PTSD) symptoms. It focuses on four basic types of PTSD symptoms: intrusions/reexperiencing, avoidance, hyperarousal, and dysphoria/numbing. Indicators of intrusions/reexperiencing showed the strongest overall criterion validity and impressive diagnostic specificity vis-à-vis PTSD diagnoses; they also displayed significant incremental predictive power in logistic regression analyses. Avoidance symptoms behaved similarly and also appear to have a relatively strong and specific association with PTSD diagnoses. The data for hyperarousal symptoms were more mixed: They tended to exhibit moderate to strong criterion validity, with inconsistent evidence of diagnostic specificity and incremental validity. Finally, although dysphoria/numbing symptoms displayed some criterion validity, they actually showed diagnostic specificity to major depression—not PTSD—and demonstrated virtually no incremental predictive power in the logistic regression analyses. Thus, these symptoms were neither specific to PTSD nor necessary in predicting the diagnosis.


2) I think that we need to start at least considering the possibility that a not insubstantial subset of veterans presenting with PTSD-related symptoms at VA are 'playing the role' (smile/frown-for-the-camera) of someone with PTSD such that they may be prone to demonstrating 'remarkable' and 'stunning' or even 'miraculous' short-term recovery (after first presenting with extremely severe symptoms that have been ongoing for decades upon decades) only to present--weeks or months later--with a full return of their severe symptoms (e.g., at their next primary care appointment, appointment with their new MH provider, or at their next C and P evaluation). I'm reminded of the small-n studies on Stellate Ganglion Nerve Block for PTSD where they included anecdotes in the write-up of miraculous sudden cures of lifelong crippling PTSD symptoms and suicidality (but no followup). I think they later demonstrated that saline injection did the same thing. I hate to be so cynical, but years and years of VA practice has made me so. And I'm not even kidding in the slightest when I say that I really do need to see MMPI-2-RF protocols on these veterans and/or examine their PCL-5 scores at their next mental health C&P review exam to conclude anything. I mean, I'd love to be wrong (empirically). But I'd suspect that many of those initial 'overreporters' with PCL-5's in the 65-80 range would be right back in that range (if not higher) at their next C&P exam, even if it was just a few weeks later. Again, love to be proven wrong. We should do the study.

I hear ya, so I have a manuscript submitted related to this question. Do RF profiles differ or show any validity scale patterns between c&p referred folks v assessment for non c&p reasons.

Previous studies haven’t pulled apart these two groups, just grouped them by stop codes or diagnosis, which aren’t always reliable ways to ID why someone obtained testing (neruo v non neuro v medical-legal).

Abstract:
“The purpose of this investigation is to provide descriptive information on Veteran response styles for compensation and pension evaluations (C&P) VA referral types using the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2- RF), which has well-supported embedded validity scales capturing invalid response styles. The sample included 356 Veterans from a single VA psychological testing clinic who were administered the MMPI-2-RF during a broader neuropsychological
evaluation, with 201 Veterans neuropsychological evaluations for C&P determination. This study examines frequencies of protocol invalidity based on the MMPI-2-RF’svalidity scales and provides comprehensive descriptive findings on validity scale scores across appointment types (i.e., C&P and non-C&P). Three distinct trends emerged: (1) Veterans generally produced valid MMPI-2-RF profiles, (2) when more than one elevation emerges, it is likely to be thematically consistent (e.g., overreporting scales), and (3) over-reporting generally captured the highest frequency of validity scale elevations relative to underreporting or noncontent-based invalid responding. Implications and limitations for practice and the utility of the MMPI-2-RF within VA testing clinics are discussed.”

Problem is we didn’t follow up with them and SCID results are inconsistently available. Would be a good study, agreed. I wasn’t the lead in the study, just did some of the grunt work haha, but if you have time and experience in this type of research I can definitely help with the IRB piece. I don’t have access or coding training in SQL to use VINCI sadly, but if you did we could be in great shape. We only have old local data here from years of C&P exams, but sadly we stopped doing them here at my site for, you guessed it, bookability! They can get poorly trained and uninterested contractors to do 3 a day.

 

[Fan_of_Meehl]

I suspect that the more accurate description of study results would be "Don't trust the conclusions of Touponse SC, Guo Q, Ma T, Maples-Keller JL, Rothbaum BO, and Dunlop BW; they aren't good researchers". They don't appear to have even assessed a post-treatment CAPS.

This is my main problem with most of the research literature on PTSD these days. The researchers, in this study refer to the extremely elevated PCL scores pre-treatment as 'overreporting,' then turn around and refer to a drop in scores as a 'steep decline in their PTSD severity' and conclude that treatment is 'more effective' for those who overreport symptoms on the PCL. The fundamental interpretation/conceptualization of extremely elevated PCL scores somehow magically transmutes over the course of treatment from 'overreporting' (response bias/distortion) pre-tx to 'steep decline in (bona fide) PTSD symptoms' post-tx and the vast majority of folks will interpret this as "people who overreport PTSD sxs respond better to PTSD treatment than those who report honestly." I mean, I'll know more when I read the study but I won't be surprised if these are the conclusions

 

[WisNeuro]

I need to read the study but just by reading the abstract, two things pop out at me:

1) it was a 2-week IOP (intensive outpatient program) so they were immersed in a group assessment/treatment setting and were likely getting continuous feedback from other veterans and multiple clinicians that would, of course, help 'correct' their initial over-reporting of their symptoms.
2) given the above, it would seem equally plausible to conceptualize their reduction of PCL-5 scores over time as a 'reduction in over-reporting' of their symptoms as much as conceptualizing it as 'steep declines in PTSD severity.' I'll have to check the study but are they saying that the massive discrepancies in PCL-5 (self-report) were simply reduced back to be more in line with CAPS-5 (clinician-rated severity) scores pre-post? Again, how is it not plausible that these veterans aren't simply learning to 'tone down' their over-reporting of their symptoms based on constant (daily?) feedback? Maybe the CAPS scores came down in direct, linear proportion to the PCL-5 score reductions during treatment. I mean, that would be more compelling. But if the CAPS scores came down very little while the PCL-5 scores just came down over time to align with the CAPS scores, I'd say that they simply learned to stop over-reporting, not that their actual PTSD symptoms exhibited a 'steep decline.'

Before I read your response, I was thinking pretty much exactly the same thing. I'd want to see this study done, improved, in a sample with little to no secondary gain present.

 

[DoubtfulDoc]

I suspect that the more accurate description of study results would be "Don't trust the conclusions of Touponse SC, Guo Q, Ma T, Maples-Keller JL, Rothbaum BO, and Dunlop BW; they aren't good researchers". They don't appear to have even assessed a post-treatment CAPS.

Good point!

 

[Fan_of_Meehl]

I suspect that the more accurate description of study results would be "Don't trust the conclusions of Touponse SC, Guo Q, Ma T, Maples-Keller JL, Rothbaum BO, and Dunlop BW; they aren't good researchers". They don't appear to have even assessed a post-treatment CAPS.

"Veterans who are extreme over-reporters on the PCL-5 at IOP intake learn to tone it down after 2 weeks of socialization within a mixed sample of veterans, some of whom overreported a bunch, some of whom overreported a little, and some of whom appeared to accurately convey their symptoms on the PCL-5: Film at 11."

Also, check out Table 1 that reports means/sd's of the three groups. Extreme overreporters averaged an almost 70 PCL (68.01) [while avg CAPS was 31.80]. "Congruent reporters'" mean PCL's were a 33.97, lol. Their avg CAPS was 36.97.

Again, overreporters learned to tone down their overreporting on the PCL. I think a conclusion that they "responded better or more robustly to the intervention" is disingenous in the extreme.

 

[Shiori]

Even with all my work in the LGBTQ+ realm, the only pride flag in my office is a small magnet from GLMA. I used it to hang my license in a visible place since they're weird about us hanging things on the wall. I switched it to another rainbow magnet. I'm not big on flags.

It's still disappointing, overall though. It's not about the flag. They're still just sending messages.

 

[Sanman]

https://news.va.gov/press-room/va-dismisses-more-than-1000-employees/

 

[futureapppsy2]

https://news.va.gov/press-room/va-dismisses-more-than-1000-employees/=1

I wonder why probationary employees covered by a union were exempt. Doubt that will last, though.

 

[AcronymAllergy]

https://news.va.gov/press-room/va-dismisses-more-than-1000-employees/

I don't doubt that VA had 1000+ personnel who weren't in "mission-critical" positions, but I do wonder where these particular folks worked. I also wonder just what they mean by "redirect all those resources back toward health care, benefits, and services." I can't see them hiring more healthcare employees. Probably just use that money to give a fat Community Care contract to one or more private companies, the CEOs of which were coincidentally strong (financial) supporters of the current administration.

 

[Fan_of_Meehl]

I don't doubt that VA had 1000+ personnel who weren't in "mission-critical" positions, but I do wonder where these particular folks worked. I also wonder just what they mean by "redirect all those resources back toward health care, benefits, and services." I can't see them hiring more healthcare employees. Probably just use that money to give a fat Community Care contract to one or more private companies, the CEOs of which were coincidentally strong (financial) supporters of the current administration.

I really wish they'd take the approach of eliminating POSITIONS not PEOPLE. What I mean by that is a lot of people who have clinical licenses and who COULD be providing direct services to veterans (psychotherapy, clinical case management) have, instead, duties that we could do without and that didn't even exist a few years ago. Even the non-clinical and non-licensed people (the clerks or anyone else) could be doing things to more directly support the mission. I definitely need more day-to-day administrative support/help in the form of following up with patients on non-urgent issues, making photocopies of forms/manuals, etc. that would decrease my burnout and increase my productivity. Could the rolls be trimmed down a bit and not hurt operations? Probably. Would we be better off re-allocating duties to be more central to the healthcare mission? Certainly.

 

[Sanman]

I don't doubt that VA had 1000+ personnel who weren't in "mission-critical" positions, but I do wonder where these particular folks worked. I also wonder just what they mean by "redirect all those resources back toward health care, benefits, and services." I can't see them hiring more healthcare employees. Probably just use that money to give a fat Community Care contract to one or more private companies, the CEOs of which were coincidentally strong (financial) supporters of the current administration.

The interesting thing that seems to be popping up on reddit is that some of the probationary folks let go were in job roles exempted from the fork buyout. Though they were not direct clinical positions. Someone mentioned being a training specialist (1712).

 

[Shiori]

With how disconnected National is from our day to day operations, it feels really ineffective to have them making hiring and firing decisions. I know that's the point, but it still makes my head hurt. I wouldn't even want them to be involved in making position removal decisions. I only go to my MUCH higher-ups when I need help interpreting the spirit of a policy. I appreciate that they leave the actual implementation to the people doing the work.

As a side note, David Shulkin's book related to this topic was an illuminating read. I did almost throw the book on the ground when he discussed his thoughts on the ESA process.

 

[futureapppsy2]

The interesting thing that seems to be popping up on reddit is that some of the probationary folks let go were in job roles exempted from the fork buyout. Though they were not direct clinical positions. Someone mentioned being a training specialist (1712).

If they were non-bargaining unit, that might have been why?

 

[cara susanna]

There's this adage that you shouldn't remove a fence unless you understand why it was put there in the first place. I've been thinking about it a lot, lately.

 

[Shiori]

If they were non-bargaining unit, that might have been why?

This looks like it is directed as Sanman, but it has my name in the reply. I was freaking out because I didn't remember saying anything about that.

 

[Sanman]

This looks like it is directed as Sanman, but it has my name in the reply. I was freaking out because I didn't remember saying anything about that.

Welcome to the social media vortex. In addition to not knowing what is true, we can't even trust our memory for what we said.

 

[futureapppsy2]

This looks like it is directed as Sanman, but it has my name in the reply. I was freaking out because I didn't remember saying anything about that.

Yeah, sorry—I was deleting a double quote and it looks like the usernames got crossed somehow! Sorry—legit not trying to gaslight you, I promise!

 

[butteredtoast27]

I know this really is an unanswerable question, but I'm curious to hear any thoughts from current VA psychologists about when may be the time to abandon ship, and what signs you personally are looking for before you would consider making a move. I am having a difficult time ignoring the massive flock of canaries in the coal mine, so to speak.

 

[Sanman]

I know this really is an unanswerable question, but I'm curious to hear any thoughts from current VA psychologists about when may be the time to abandon ship, and what signs you personally are looking for before you would consider making a move. I am having a difficult time ignoring the massive flock of canaries in the coal mine, so to speak.

This is a massively personal decision, both due to your personal financial situation and your personal work situation. I am willing to ride out uncertainty due to having a significant financial cushion and a working spouse. I will take a rif before rto or a change in work hours because I need to be home by a certain time to care for my family . I am also not looking for a "job" and will likely move into solo pp at this stage of my life. Others will have different breaking points.

If you are under 3-5 years tenure, little reason to stay at this point if you can find a better job.

 

[summerbabe]

I know this really is an unanswerable question, but I'm curious to hear any thoughts from current VA psychologists about when may be the time to abandon ship, and what signs you personally are looking for before you would consider making a move. I am having a difficult time ignoring the massive flock of canaries in the coal mine, so to speak.

I try to take in all the info but focus on what will directly impact me and whether that will make my job less sustainable.

Does it suck that a bunch of probationary employees just got canned for no reason except to shrink the workforce with more likely changes in the future? Of course.

But is my workload the same or different? Do I feel like I have a reasonable chance of doing good work with my patients? Are admin processes changing drastically in ways that cause significant difficulty or stress?

My program has experienced bunch of changes (virtually all negative) over the past year. But my core work components have still mostly stayed the same.

 

[Shiori]

Yeah, sorry—I was deleting a double quote and it looks like the usernames got crossed somehow! Sorry—legit not trying to gaslight you, I promise!

No worries at all. I definitely questioned myself for a minute.

 

[cara susanna]

I know this really is an unanswerable question, but I'm curious to hear any thoughts from current VA psychologists about when may be the time to abandon ship, and what signs you personally are looking for before you would consider making a move. I am having a difficult time ignoring the massive flock of canaries in the coal mine, so to speak.

I'm in until they fire me.... or maybe if they increase required clinical contact hours (depending on by how much, of course)

 

[Fan_of_Meehl]

I'm in until they fire me.... or maybe if they increase required clinical contact hours (depending on by how much, of course)

All I know is if 'it all blows up and goes to hell...' (referencing the Jimmy Buffett song)...



I'm gonna try to make a killing doing high-quality PTSD evaluations for somebody

 

[WisNeuro]

All I know is if 'it all blows up and goes to hell...' (referencing the Jimmy Buffett song)...



I'm gonna try to make a killing doing high-quality PTSD evaluations for somebody

The only one who is going to pay good money for high quality evaluations are defense counsels. Contractor companies want you to pump out like 10+ of these a day, who cares what quality they are, and plaintiff counsel is only going to pay you if you ignore best practices and empirical literature and write exactly what they want in your reports.