Measurement-Based Care for Psychotic Disorders in the Veterans Health Administration: Current Practices and Future Directions.

Objective: Measurement-based care (MBC) improves patient outcomes. However, there has been minimal focus on MBC for psychotic disorders. This study examines the use of patient-reported outcome measures (PROMs) in the Veterans Health Administration (VHA) to characterize their use among Veterans with psychotic disorders and to inform candidate measures for psychosis-related MBC.Methods: Data on Veterans with and without ICD-10 psychotic disorders and at least 1 PROM during fiscal years (FYs) 2016-2019 (FY16-FY19) were collected. The sample included 3,935,504 PROM administrations among 1,192,897 Veterans. Included PROMs spanned multiple symptom and non-symptom domains. Percentages of total PROM administrations were calculated by aggregating across time and diagnosis. Facility-level statistics were also calculated. Absolute change in the percentage of unique Veterans administered a particular and repeated PROMs over time were calculated.Results: The core PROMs for VHA MBC (Patient Health Questionnaire-9 [PHQ-9], General Anxiety Disorder-7 Scale, PTSD Checklist-5, and Brief Addiction Monitor) accounted for the majority of PROMs for Veterans with (88.18%) and without (92.56%) psychotic disorders. The PHQ-9 accounted for the largest proportion (psychotic disorder: 45.89%; other diagnosis: 46.70%). The absolute changes in percentages of repeated PROM administration were similar over time across groups.Conclusions: The use of PROMs in VHA mental health care increased during FY16-FY19 for Veterans with and without psychosis. The rates of PROM use were similar for both groups, and PROM use predominately consisted of the core measures. While the similar rates of PROM administration are encouraging, these findings highlight the need for psychosis-specific measures to tailor MBC for Veterans with these diagnoses.

Psychology trainee and supervisor perspectives of multicultural supervision.

The development and dissemination of multicultural competence in the field of clinical psychology is garnering increased attention. Providing multicultural supervision enhances multicultural competence and benefits the supervisor, supervisee, and client. However, there is little research on how multicultural supervision is provided and how it could be improved. The purpose of this study was to evaluate multicultural supervision and identity-related harassment within two cohorts of interns (N = 18) and 40 psychology supervisors from a large New England Veterans affairs (VA) Healthcare System. Response rates were 72.2% for trainees and 42.5% for supervisors. Respondents indicated there is significant variability across supervisors in the types and frequency of supervision techniques used. Trainees identified behaviors they would like supervisors to offer more; the most common were "discussion of client's cultural or ethnic background as it relates to clinical presentation or client perspective of challenges" and "discuss how aspects of diversity, power, privilege could influence the therapy relationship." Supervisors also indicated what behaviors they would like to offer more, with the most common being "provide examples of conceptualization or theory that directly incorporate identity" and "provide time/opportunity in supervision for my own self-reflection and examination." A majority of trainees and supervisors (76.9% and 68.8%, respectively) reported experiencing harassment based on an aspect of their identity, most commonly originating from clients. We discuss recommendations for improving multicultural supervision and addressing harassment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Veterans' satisfaction and perspectives on helpfulness of the Veterans Crisis Line.

OBJECTIVE: Crisis hotlines are an important part of a public health approach to suicide prevention. The Veterans Crisis Line (VCL) provides hotline services to Veterans. There is a paucity of research concerning the effectiveness of the VCL. The current work describes efforts to establish groundwork for VCL effectiveness research. METHODS: 155 VCL users who were referred to a Veterans Affairs Medical Center Suicide Prevention Team completed interviews including open-ended and closed-ended questions. Outcomes are reported for suicidal participants, non-suicidal participants, and those who had emergency intervention. Thematic analysis was used for open-ended questions. RESULTS: Eighty-seven percent of interviewees expressed satisfaction with the VCL, 81.9% reported that the VCL was helpful, and 72.9% said that the VCL helped keep them safe. Of those with suicidal thoughts, 82.6% said the contact helped stop them from killing themselves. Themes are described concerning user identified reasons for VCL contact, most and least helpful aspects of the contact, and suggestions for improvement. DISCUSSION: This project demonstrates that this group of people who used the VCL overwhelmingly finds the service to be helpful and a barrier to suicide. Further, implications of user feedback for application to VCL operations and future research are discussed.

Public servant, silent servant: A call to action for advocacy training in public service settings.

Views on what is important in training for psychologists are evolving, reflecting a broadening understanding of the role psychologists can and should play in societal change. Since the development of the scientist-practitioner model after World War II, arguments around training have focused on the appropriate balance between training in the practice of psychology versus training in research related to psychology. Recent calls reflect more radical change to include an advocacy emphasis within the formal coursework of psychology doctoral programs, well articulated by Mallinckrodt, Miles, and Levy (2014) as the tripartite model of Scientist-Practitioner-Advocate. In this paper, we present the argument for expanding a model that incorporates advocacy training into clinical psychology internships and postdoctoral programs and describe why we believe voices for advocacy have been largely silent in public-sector clinical psychology training and practices. We outline how this may be accomplished in public sector training settings, and we articulate a call to action for public servants to speak out so their voice can ignite a passion for advocacy within public sector psychology service and training. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The association of recovery orientation and stigmatizing beliefs.

BACKGROUND: Although mental health advocates and providers have promoted both recovery-oriented care and the de-stigmatization of mental illness, no studies have examined the interrelation of these two specific constructs. AIMS: This study aimed to evaluate this association, with the hypothesis that stronger perception of programmatic recovery orientation would be associated with less stigmatizing beliefs towards mental illness. METHOD: Veterans (N = 122) and mental health clinicians (N = 98) at a large Veterans Affairs Medical Center completed an assessment of recovery orientation and a measure of beliefs about mental illness. RESULTS: Stronger endorsement of programmatic recovery orientation was associated with less stigmatizing attitudes in both groups. Each of the five factors on the recovery measure was significantly and negatively associated with each of the four factors on the stigma measure. CONCLUSIONS: Perspectives of recovery orientation and stigma are significantly, but negatively, associated. Future research should investigate the direction of causality behind these observed relationships, as this will provide the opportunity to identify potential interventions to increase recovery-oriented mental health care and reduce stigmatization.

Obtaining employment as an anchor for estimating the minimum clinically important difference on the Positive and Negative Syndrome Scale (PANSS) in schizophrenia.

Statistical differences on clinical scales are often used to compare the effectiveness of treatments. However, statistical significance does not necessarily indicate clinical significance. The minimum clinically important difference (MCID) refers to clinically meaningful treatment differences. This study estimates the MCID of the Positive and Negative Syndrome Scale (PANSS) by anchoring the change in scores to an objective clinical outcome: employment. This secondary analysis compared PANSS score change from baseline among 1049 non-working individuals with schizophrenia, who were followed and categorized as either having not worked, worked 1-10 days, or worked >10 days at 15 or 18 months. The difference in change in average PANSS Total scores between participants who did not work and those who worked 1-10 days (4.25 points) and >10 days (8.30) were statistically significant. This study estimates the MCID for the PANSS to be between 4.25 and 8.30 Total points. This study revealed significant differences in PANSS score changes between participants who did and did not work. Using employment, an objective and clinically meaningful change in health status, to determine the MCID of PANSS resulted in estimates lower than previously reported. MCID estimates vary across methods but using objective anchors increases face validity.