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

[Fan_of_Meehl]

The CAPS unfortunately is pretty unwieldy in practice in my opinion in a BHIP ..they say it takes 45-60 min....maybe I'm missing something

The downsides of the CAPS in clinical practice are never acknowledged. Also, the cold hard absolute fact is that--at least in my organization and all CBOCs in our division (half of an entire state)--I have NEVER seen the full CAPS used (according to the manual) and the scores reported on in a clinical report or progress note. NEVER. There are reasons for that empirical observation (though I have reviewed many thousands of charts at VA).

In our PCT, the head of it mandated that we sit through a training from a former fellow PCT psychologist who left PCT for another position. That psychologist basically went over the CAPS with us. It was the PCT psychologists and the interns in there. One of the interns asked about scoring and writing up the results of the CAPS. At which point, the truth came out, lol. After an uncomfortable pause, the trainer had to admit that she didn't actually administer the CAPS (per the official instructions/procedures), score it, and write it up in her notes. No. She does (sometimes) what she refers to as a 'CAPS-informed' interview. I mean, I do the same thing (have been for years) called a semi-structured, detailed psychiatric interview of symptoms of PTSD (per DSM criteria) and I write up the results in my notes. So, the person training us on the CAPS had never (and does not) actually use the CAPS per the manual, or score it, or write it up as a CAPS administration. Nor does the head of PCT who mandated the training. Is anyone else hearing that carnival music in the background? Meanwhile, I have yet to see evidence in the record (despite being exposed to thousands of charts in my time) that ANYONE here has EVER actually used the so-called wonderful, gold-plated, can't be praised enough by all the people who don't see patients, instrument called the CAPS-5. But we mandate training on it. And, people mouth (chant?) the words 'gold-standard' like they are compelled to repeat this moniker every time the CAPS is mentioned. What is it about this organization (cult?) that is so damned averse to the truth? Is anyone else noticing this? Is 'dedication to the practice of hypocritical self-contradiction a rating criterion on interviews for promotions at VA? 'Double-plus-good, anyone?'

The CAPS also does absolutely nothing to deal with the issue of overreporting of symptoms if you're dealing with a semi-competent patient trying to appear to be more significantly impaired than they actually are. In fact, if you're dealing with a semi-intelligent malingerer who has thought things out in the slightest and can think on their feet a bit, the CAPS will actually provide page after page of detailed symptoms of PTSD that you now are obligated (of course) to report were endorsed at that high level of detail. So, you'd better also give an MMPI-2-RF to at least take a look at response bias. Now, the CAPS' detailed questions will 'catch' (flatfooted) people who haven't thought through in any detail (or researched) what symptoms they are going to recite and what details they are going to give. Those folks scrunch up their brow, tilt their head to the side, get this exasperated 'WTF' expression on their face and give you the business because you're asking questions that they haven't pre-thought through their answers for and they, predictably, attack you and attack the question. THESE 'CAPS' informed interviews (or whatever people are calling it) will take more than two hours if you try to slog through the interview with these patients.

All these things (PCL-5, CAPS-5, semi-structured detailed psychiatric interview, observations, chart review, comparing what you're seeing in the patient (and what they're reporting) with the empirical literature as well as your own clinical experiences over the years) are mere tools and options within the context of a multi-method approach to assessment and differential diagnosis (what is really the standard of care/practice, whether it is often followed or not). There is no single tool or measure or procedure that can be used with every patient in a brief period of time that just 'spits out' a reliable/valid diagnostic determination. That's the work of the doctoral-level clinician to do and there are no magic bullets.

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[WisNeuro]

The CAPS unfortunately is pretty unwieldy in practice in my opinion in a BHIP ..they say it takes 45-60 min....maybe I'm missing something

If you already have a background clinical interview done, the addition of the CAPS alone can definitely be done in less than an hour. If you need to do both a full background, clinical interview, AND a CAPS, then no, an hour is not going to cut it unless you are cutting corners.

 

[Sanman]

If you already have a background clinical interview done, the addition of the CAPS alone can definitely be done in less than an hour. If you need to do both a full background, clinical interview, AND a CAPS, then no, an hour is not going to cut it unless you are cutting corners.

Time is always the biggest issue with the untimed 90791 codes. PCL is faster.

 

[cara susanna]

If you already have a background clinical interview done, the addition of the CAPS alone can definitely be done in less than an hour. If you need to do both a full background, clinical interview, AND a CAPS, then no, an hour is not going to cut it unless you are cutting corners.

I can knock out a CAPS-5 (by itself) in about 30 minutes. I used to do like 3 per week in my old job, so I got VERY efficient.

 

[WisNeuro]

I can knock out a CAPS-5 (by itself) in about 30 minutes. I used to do like 3 per week in my old job, so I got VERY efficient.

Yeah, once you get into the triple digits of those, you don;t really even need the sheets anymore to do it. In legal settings it can get a little more challenging depending on the level of coaching that the claimant has received.

 

[Shiori]

I would love to do the CAPS-5 more regularly, but I am usually stuck spending the first sessions gathering everything the Joint Commission wants, clearing the million clinical reminders for suicide, IPV, MAPS, etc, and putting in PGOI to appease the systems. If I thoroughly collected everything the VA and I wanted to collect, especially for a new patient, it would take four sessions to get started on real treatment planning and therapy.

 

[Harry3990]

How long is too long for a cover letter for a VA position? Anyone been on search committees or have insight? The listing notes that a cover letter is not even required (just transcript and CV) but is accepted. I'm at almost 2 pages and am worried it is too much.

 

[Shiori]

I have never been sent the cover letter when interviewing. Even better, I have had to ask for the CV on occasion. At our site, most of the weight was given to the interview. If you're personable, generally enthusiastic, and halfway know what you're talking about, you'll be fine! Good luck!

I am at a smaller site, so your mileage may vary.

 

[Sanman]

How long is too long for a cover letter for a VA position? Anyone been on search committees or have insight? The listing notes that a cover letter is not even required (just transcript and CV) but is accepted. I'm at almost 2 pages and am worried it is too much.

Keep it to a page.

 

[WisNeuro]

Yeah, no one gives a **** about your cover letter. I never saw, nor asked for one when interviewing multiple applicants across VAs over the years for staff positions. Keep it fairly focused on the site, but generic, and no more than a page.

 

[Shiori]

Intakes have officially become a pretty miserable experience. They were never great, but I have so many things to keep up with now. I am constantly having to rework my template to accommodate all the new things that are being added.

 

[Fan_of_Meehl]

This damn song haunted me in the 1990s' (as a 20 year old). Acoustic is always better.

 

[Fan_of_Meehl]

Intakes have officially become a pretty miserable experience. They were never great, but I have so many things to keep up with now. I am constantly having to rework my template to accommodate all the new things that are being added.

How many opportunities have you had think of 'the moonlit floor' as a VA psychologist? I know that me and Sanman (honorable fellow that he is) are disenchanted.

 

[Fan_of_Meehl]

If we are to help folks in the face of universal disenchantment...we have to have a source

 

[Fan_of_Meehl]

Orange tabbies tend to snuggle underneath your armpits. Which makes them smile upward to you awkwardly.

As awkward as an orange tabby can manage.

 

[Fan_of_Meehl]

This damn song haunted me in the 1990s' (as a 20 year old). Acoustic is always better.

This is a feminine dream (obviously) but even a dude can respect the truth and craft of it.

 

[cara susanna]

Anyone else see that email praising the Access Sprint initiative outcomes and become filled with rage?

 

[Sanman]

Anyone else see that email praising the Access Sprint initiative outcomes and become filled with rage?

Wait, you are not thankful to the hard working team that led the access sprint and did the the hard work of telling you to work harder?

 

[Fan_of_Meehl]

Love you, dude. Carry on.

I am just here to squat on the VA and its cowardly 'leadership' in case it was not obvious.

 

[cara susanna]

If they're gonna make us watch an ICARE video every year, can they at least make a new one at some point?

Hey, I found a new nitpick: How did he get into the provider's office if she was finishing up with her group?

 

[WisNeuro]

If they're gonna make us watch an ICARE video every year, can they at least make a new one at some point?

Or at least bring back the cowboy one.

 

[Fan_of_Meehl]

Or at least bring back the cowboy one.

This is why I come here, lol.

To hear Cara Susanna publicly debate the meaning of existence with WisNeuro. Both parties are awesome, and I want to hear it.

 

[Fan_of_Meehl]

You gotta love this and the wisdom of the universe.

 

[Fan_of_Meehl]

You gotta love this and the wisdom of the universe.



Orange tabbies make everything okay (and they fight, too)

 

[cara susanna]

I don't know why I hate the ICARE video so much. I think it just feels so fake. Like who starts a new patient mental health appt (pretty sure it's an intake?) with "tell me about your MOS!"

I've probably already posted that here, which just shows how mind-numbingly repetitive watching that video is.

 

[Fan_of_Meehl]

I don't know why I hate the ICARE video so much. I think it just feels so fake. Like who starts a new patient mental health appt (pretty sure it's an intake?) with "tell me about your MOS!"

I've probably already posted that here, which just shows how mind-numbingly repetitive watching that video is.

Like all things VA...

 

[Fan_of_Meehl]

In other news, show us 'sand the floor' (intern) [an actual decent lesson]:

 

[Sanman]

I don't know why I hate the ICARE video so much. I think it just feels so fake. Like who starts a new patient mental health appt (pretty sure it's an intake?) with "tell me about your MOS!"

I've probably already posted that here, which just shows how mind-numbingly repetitive watching that video is.

First of all, she didn't ask for a full name and date of birth or Last 4. Let the floggings begin!

 

[Fan_of_Meehl]

First of all, she didn't ask for a full name and date of birth or Last 4. Let the floggings begin!

"Always LOOK EYE!"



This scene is just seared into my childhood. Sorry, Sanman.

 

[Sanman]

"Always LOOK EYE!"



This scene is just seared into my childhood. Sorry, Sanman.

No apologies necessary. The man was a genius. He taught karate and got free housework done. Personally, I have been thinking about firing my lawn service and charging Crossfit folks a membership fee to do my weeding and put some mulch down. It's a great workout!

 

[WisNeuro]

No apologies necessary. The man was a genius. He taught karate and got free housework done. Personally, I have been thinking about firing my lawn service and charging Crossfit folks a membership fee to do my weeding and put some mulch down. It's a great workout!

Only if you give the a ridiculous name like Agnes, and make it quantifiable so they can talk about their PR in it for the next week to anyone who will/is forced to listen to them.

 

[Fan_of_Meehl]

No apologies necessary. The man was a genius. He taught karate and got free housework done. Personally, I have been thinking about firing my lawn service and charging Crossfit folks a membership fee to do my weeding and put some mulch down. It's a great workout!

LOL love you, brother.

 

[Fan_of_Meehl]

"Kiss me down by the broken treehouse."

You have to respect that line/lyric. It's so perfectly sad.

 

[Fan_of_Meehl]

 

[Shiori]

I spent 10 minutes trying to get into a required 25 minute training for e-911, which I have been using since Covid. I think the Teams migration was causing issues. I gave up and will wait another month to take it. So...many....checkboxes.

 

[Fan_of_Meehl]

I spent 10 minutes trying to get into a required 25 minute training for e-911, which I have been using since Covid. I think the Teams migration was causing issues. I gave up and will wait another month to take it. So...many....checkboxes.

The VA is hell. To hell with it.

 

[Fan_of_Meehl]

I spent 10 minutes trying to get into a required 25 minute training for e-911, which I have been using since Covid. I think the Teams migration was causing issues. I gave up and will wait another month to take it. So...many....checkboxes.

They took my saddle in Houston. Broke my leg in Santa Fe.

 

[Fan_of_Meehl]

Kiss me on the moonlit floor (or, at least regard the stars with me).

 

[cara susanna]

Oh, no, I totally forgot about that training. And I was registered.

First of all, she didn't ask for a full name and date of birth or Last 4. Let the floggings begin!

She also did not obtain informed consent. This would not pass psychologist peer review!

 

[Fan_of_Meehl]

"In the process, I got messed up too"

- Jim Croce (immortal)

 

[Behaviorismiscool]

Anyone else see that email praising the Access Sprint initiative outcomes and become filled with rage?

I treat those emails the same as internet trolling and the never ending news cycle - hard ignore and keep scrolling (I mark as read without opening the email)

 

[Fan_of_Meehl]

"Always LOOK EYE!"



This scene is just seared into my childhood. Sorry, Sanman.

The loving attention of a decent father figure will always be cool.

 

[cara susanna]

Welp, our new hires are now frozen. But, hey, as long as VBA gets all of the money to pay people to stay sick!

 

[JustNoticing]

I got frozen post-interview for a position while hospital administration publicly says "there is no hiring freeze! Just a re-consideration of the necessity of filling certain positions strategically"

 

[psy.d. 2021]

I got frozen post-interview for a position while hospital administration publicly says "there is no hiring freeze! Just a re-consideration of the necessity of filling certain positions strategically"

Ugh the newspeak is soooo bad it hurts

 

[Harry3990]

Thank you very much to you VA folks willing to answer questions of curious but unfamiliar outsiders like myself.

1) What is the typical length of time from application to interview to hire? I imagine it varies quite a bit, but if anyone can give a couple of data point examples or a range that'd be helpful.

2) In perusing remote jobs on usajobs.gov I came across a listing for a fully remote emergency dept psychologist VA position. Anyone have any knowledge of the logistics of implementing a role like this remotely? Seems doable I suppose, but assessing/mitigating risk fully remotely sounds like it would probably need significant support from the staff that is on location. Any insider info or even speculation about considering a role like this?

 

[summerbabe]

Welp, our new hires are now frozen. But, hey, as long as VBA gets all of the money to pay people to stay sick!

I got frozen post-interview for a position while hospital administration publicly says "there is no hiring freeze! Just a re-consideration of the necessity of filling certain positions strategically"

Just found out that my facility is needing to cut FTEs by over 100 positions to revert to a previous FY standard. Seems like they have already cancelled as many backfills/newly approved positions as they can but looks like further cuts are in order. This next period is probably not going to be so good for people looking to move, including potentially even lateral moves at the same site.

What is the typical length of time from application to interview to hire? I imagine it varies quite a bit, but if anyone can give a couple of data point examples or a range that'd be helpful.

My personal range for hearing back after a posting closes is 1 week to a high of ~6 months, with many other positions that I never heard anything from.

Getting a tentative offer typically moves pretty fast if you're the first choice candidate once interviews finish and names are submitted to HR. Final offers can take a while depending on the HR (but regionalized HR models seem to be helping).

 

[Sanman]

Just found out that my facility is needing to cut FTEs by over 100 positions to revert to a previous FY standard. Seems like they have already cancelled as many backfills/newly approved positions as they can but looks like further cuts are in order. This next period is probably not going to be so good for people looking to move, including potentially even lateral moves at the same site.

My personal range for hearing back after a posting closes is 1 week to a high of ~6 months, with many other positions that I never heard anything from.

Getting a tentative offer typically moves pretty fast if you're the first choice candidate once interviews finish and names are submitted to HR. Final offers can take a while depending on the HR (but regionalized HR models seem to be helping).

We were pretty much told no backfills are being approved at this point despite being told MH was a priority recently.

1. As far as hearing back about an interview; 1-3 months. From verbal offer to hiring, 2-8 mths. Figure the better part of a year for application to hired. Likely longer now as announcements that went out are being frozen until later in the year.

2. That sounds like a facility that is more rural and desperate for staff. I would be skeptical of a good longterm fit. That said, a job is a job with the budgets right now.

 

[PsyDuck90]

Do you all think the outlook for positions will be better next year? I’m a first year neuro postdoc at a VA, and I was really hoping to stay in the VA system (and I’m geographically restricted to an area with doable commute to two separate VAs), and the VAs in this area actually have a higher starting salary (close to $30k difference based on recent job postings) than the AMCs and other community options.

 

[AcronymAllergy]

Do you all think the outlook for positions will be better next year? I’m a first year neuro postdoc at a VA, and I was really hoping to stay in the VA system (and I’m geographically restricted to an area with doable commute to two separate VAs), and the VAs in this area actually have a higher starting salary (close to $30k difference based on recent job postings) than the AMCs and other community options.

The folks here will know better than me if there are any current nationwide mandates. But you can look at the two VAs you're near to perhaps get a bit of an idea: are they still hiring psychologists? How busy are the current neuropsychologists and/or has anyone there talked about planning to hire more neuropsychologists? A facility may still be hiring overall and/or in some areas, but may not be able to add specialty positions (e.g., neuropsychologist), even if they're needed.