BACKGROUND/RATIONALE:
Solicitation/Targeted Area: Evaluation of PTSD Assessment Tools
The Request for Proposal announcement seeks to 1) Determine the feasibility of incorporating structured screening instruments such as the Clinician Assessment of PTSD Symptoms (CAPS) and structured functional assessment tools such as the World Health Organization Disability Assessment Schedule II (WHODAS-II) into the rating examination, and 2) Assess and compare screening and diagnostic characteristics of the Clinician Assessment of PTSD Symptoms (CAPS) to current individual psychiatric interview techniques most commonly used by VA's mental health providers.
OBJECTIVE(S):
Our objective is to compare the process and outcomes of C&P exams for PTSD conducted with CAPS and WHODAS-II interviews versus the PTSD exams conducted without the CAPS and WHODAS-II interviews. This project will 1) demonstrate the feasibility of conducting program evaluation and intervention studies on the PTSD C&P examination process, 2) develop research tools, instruments and methods for C&P evaluation, 3) provide data on the value-added contribution of CAPS and WHODAS-II to the PTSD assessment process and examination report, and 4) inform the business case of utilizing the CAPS and WHODAS-II in the PTSD C&P process. The ultimate aim is to improve the reproducibility, consistency and validity of the PTSD examination process while maintaining a level of efficiency and cost restraint that provides veterans with an exam process that is fair, accurate and equitable across VHA.
METHODS:
This project will conduct a randomized controlled trial on 688 veterans to evaluate the effects of the CAPS/WHODAS instruments on the initial PTSD C&P examination process. Study outcomes include variation in assessing the DSM-IV components of PTSD, diagnostic accuracy, veteran perception of the exam process, VBA rater utility and resource utilization.
Study hypotheses include:
The interviews for conducting PTSD examinations using the CAPS/WHODAS will be more complete and accurate than the interviews by the control group.
The perceptions of the PTSD interview will be the same or more positive for veterans undergoing the CAPS/WHODAS examinations.
The utility of the initial PTSD C&P examination reports from the perspective of VBA raters will be greater with the CAPS/WHODAS interviews.
The CAPS/WHODAS interviews will consume more resources and thus be more costly than the control group interviews.
Quantitative information will be complemented with a qualitative analysis on perceived value, barriers and facilitators to the CAPS/WHODAS interview strategy. We will convene a meeting charged with formulating recommendations for the PTSD examination and then disseminate findings by conducting a Collaborative for implementing and spreading recommend practices.
FINDINGS/RESULTS:
Early stages of our study; no results at this time.
IMPACT:
Impact on Veterans' Healthcare. This project will provide C&P examiners with evidence and guidelines for the best practice conduct of PTSD examinations and the tools for quality improvement within their organization. Congress and the public are feeling a deep responsibility to those who have suffered not only bodily but also mental injury while they have borne the battle in our recent and past military operations. This project helps the VA in being responsive to the public's concern by promoting accurate diagnosis of PTSD, fair compensation, and access to care.
PUBLICATIONS:
Journal Articles
- Marx BP, Marshall PJ, Castro F. The moderating effects of stimulus valence and arousal on memory suppression. Emotion (Washington, D.C.). 2008; 8(2): 199-207.
- Sloan DM, Marx BP, Epstein EM, Dobbs JL. Expressive writing buffers against maladaptive rumination. Emotion (Washington, D.C.). 2008; 8(2): 302-6.
