Variation in practices and attitudes of clinicians assessing PTSD‐related disability among veterans

Abstract

One hundred thirty-eight Veterans Affairs mental health professionals completed a 128-item Posttraumatic Stress Disorder (PTSD) Practice Inventory that asked about their practices and attitudes related to disability assessment of PTSD. Results indicate strikingly wide variation in the attitudes and practices of clinicians conducting disability assessments for PTSD. In a high percentage of cases, these attitudes and practices conflict with best-practice guidelines. Specifically, 59% of clinicians reported rarely or never using testing, and only 17% indicated routinely using standardized clinical interviews. Less than 1% of respondents reported using functional assessment scales.

Racial Differences in Veterans’ Satisfaction With Examination of Disability From Posttraumatic Stress Disorder

“…In addition, examiners completed a paper questionnaire (17), consisting of questions about examiners' training to conduct PTSD Compensation examinations, years conducting PTSD Compensation examinations, and attitudes towards claimants. Examiners were asked separate questions about whether they had received formal training in each of seven PTSD examination-related topics.…”

Why we should worry about malingering in the VA system: Comment on Jackson et al. (2011)

“…In support of their conclusion, Jackson et al (2011) cite Dohrenwend et al's (2006) landmark reanalysis of data from the National Vietnam Veterans Readjustment Study (Kulka et al, 1990). Using archival data for corroboration, Dohrenwend et al found almost no evidence of fabricated trauma histories among the subset of 90 veterans diagnosed with war‐related PTSD by structured clinical interview.…”

“… Abstract In a recent survey, Jackson et al (2011) found that clinicians who evaluate veterans for service‐connected disability pensions rarely use recommended best practices to assess for posttraumatic stress disorder (PTSD) within the Department of Veterans Affairs (VA). We share their dismay, and we hope that their article will help foster evidence‐based assessments for diagnosing PTSD in veterans.…”

“…Jackson et al (2011) found that clinicians evaluating veterans for disability pensions rarely use recommended best practices to assess for posttraumatic stress disorder (PTSD) within the Department of Veterans Affairs (VA) system. In discussing threats to the validity of compensation and pension evaluations, they concluded that concerns about veterans who fabricate trauma histories and PTSD to obtain disability pensions are largely unfounded.…”

Introduction to Practice Matters Special Section on VA Compensation and Pension Exams for PTSD and Other Mental Disorders

“…Worthen and Moering acknowledge time and political pressures on C&P PTSD and mental disorders examiners, though opt for a scientifically and factual based approach to these examinations. Indeed, a recent survey of mental health C&P examiners by Jackson, Sinnott, Marx, et al (2011) found that the examiners rarely use structured diagnostic interviews for PTSD, and only 12% of the examiners administer the MMPI-2. These statistics are especially intriguing given that the VA's Best Practice Manual for Posttraumatic Stress Disorder (PTSD) Compensation and Pension Examinations (Department of Veterans Affairs, 2002) specifically recommends using a structured diagnostic interview for PTSD and psychological testing with the MMPI-2.…”