And there's a lot of overlap with those people who love to talk about people on welfare not deserving it
It's really...interesting. Check out this one ("Use it or lose it").
Speaking of malingering, are any of you routinely using any malingering tests when doing evals/consults?
I utilize the MMPI-2-RF, as needed, as part of a multi-modal psychological assessment process. The validity scales (using proper cutoffs)--especially F(p)-r--can be an indicator of an overreporting (of psychopathology) response set.
I believe that was in there, yes.
All of the time. I see workers comp and legal cases. -2RF most often, though also other standalone and embedded measures, depending on what I’m assessing.
All ABPP-CN neuropsychs I have trained under have used either standalone, embedded, or a combination of the two. It is a widely accepted consensus, at least in the neuropsych world, that measures of performance or symptom exaggeration should be routinely included in clinical and medicolegal/forensic work. Although as a trainee I admittedly still have much to learn, I pause when I see a neuropsych report without PVTs or a psych report without SVTs, as there is no indication that the clinician even considered the possibility of exaggerating (particularly in certain types of evals). I tend to not use the word malingering specifically because I can't extrapolate the intent behind exaggeration, even if I personally think they are malingering, without data to support it.
I've always used PocketTalkers and found them to be pretty helpful.
I hope you're reading the content of the interpretations in addition to looking at the data table. It's a really bad idea to put PVT and SVT scores in the report for patients to read. I make a statement about whether measures of performance/symptom validity were within or below expectations, but I would never tell the patient or anyone else reading the report what their TOMM score was. I don't even like listing the names of PVTs in the report.
I have never listed the names of the PVTs or SVTs in the report and would never expect another clinician to. I'm talking about not trusting reports that don't even mention performance or symptom validity.
Agreed. I mean, I don't really mind taking out my own trash...it's just that we are literally paying someone specifically to do that task but they don't do it. It's the eternal double-standard thing. The perfectionistic micromanaging oversight of every little aspect of the providers' many responsibilities along with the constant "WE ARE A HIGH RELIABILITY ORGANIZATION!!!" messaging is what makes it really annoying.
Right behind you.
I mean, outside of niche specialty practice (neuropsych, forensic) and/or 'all-in' private practice entrepreneurial lifestyle commitment to solo clinical practice, my sense is that replicating the pay/benefits/stability of a VA clinical psych position for your rank-and-file clinical psychologist is gonna be challenging. It seems like the psychiatrist/APRN/PA (prescriber) + LCSW (counselor) setup is the norm.
This. The psychological impact of an up to 25% sudden pay cut in the context of no raises, escalating patient-to-staff ratios, loss of support staff, and additional burden of switching to Cerner amid the ever-increasing administrative/paperwork burdens... cannot be over-estimated.
It’s amazing how the VA can so consistently create BAD policy.
We're experiencing this right now. Like 2-3 evaluation/orientation sessions by separate providers in a row only to be finally referred to a therapist to start therapy in...2-3 months from now...and, after that, follow up sessions every 2-3 months until...they drop out of 'therapy' and go back to step 1, lol. But all of their clinical reminders are up to date including their 'sexual orientation' which is assessed annually for obvious empirically-validated reasons since everyone knows that the highest risk timeframe for spontaneous reversion/change of sexual orientation is about 11-12 months since their last clinical reminder was evaluated...especially after age 50...duh!
I know. As I understand it, they just passed a law or something making it automatic that community care referrals for psychotherapy now last a full year w/o need for review or reauthorization. Meanwhile, they've outlawed 90 min intakes or VA providers scheduling any more than 6 sessions at a time, lol. Okiedokie, there's my 'Best Medical Interest' justification for referring everyone to the community, right there. Last one out turn off the lights on your way out the door...
We're losing ours. I'll be splitting intakes into two appointments if it's in any way not a straightforward case ...which is a good deal of them lol
And when they're 20-30 mins late, you can have a 20-30 min intake, lol.
You're kind. I'm thinking if they're 30 minutes late to a 60 minute intake....you need to reschedule.
Yup. Either reschedule or we give em the ole C-SSRS, PHQ-9, and RTC special.
And your VA supports you in that?
Yes, surprisingly, we have an SOP that details all of this. Finalized last year.
