Promoting measurement-based care and quality measure development: The APA mental and behavioral health registry initiative.

Measurement-based care has important implications across multiple avenues in mental and behavioral health care, including clinical care, quality improvement, and accountability. Using measurement-based care to demonstrate that quality care is being provided within the context of cost-efficient care could strengthen the position of mental and behavioral health providers as critical members of the health care system. Yet when measurement-based care is used to assess performance of providers, and then that performance influences reimbursement, it must be done with great care and deliberation so as not to result in unintended consequences such as punishing providers. Given psychology's expertise in measurement, the American Psychological Association (APA) and its members are uniquely suited to be leaders in promoting measurement-based care to assess quality and value. In this policy analysis paper, we examine the importance of measurement-based behavioral and mental health care across a variety of public service populations. We describe the increased federal regulatory focus on promoting quality and cost efficient care, the importance of defining and measuring quality care, and introduce an important resource being developed by APA to promote provider engagement in measurement-based care and effective participation in payment reform efforts in health care. We conclude with specific recommendations for how the field can move forward with using measurement-based care to assess accountability. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Keeping psychologists in the driver's seat: Four perspectives on quality improvement and clinical data registries.

Performance accountability-also frequently referred to as quality improvement in the fields of medicine and public policy-is under growing scrutiny in mental and behavioral health care. As one high-profile example, psychologists and other mental health providers will be deemed "eligible clinicians" under the 2015 Medicare Access and Children's Health Insurance Program Reauthorization Act starting in 2019. This will incentivize psychologists to track their Medicare patients' clinical outcomes and report them in data registries, and those who do not will suffer a reimbursement penalty. However, many psychologists are not aware of these developments or prepared for this change. The goal of this article is to provide information to psychologists about quality improvement and clinical data registries from four distinct, though overlapping, vantage points: professional governance, quantitative research, qualitative research, and clinical practice. We review recent regulations and research in this area, with an emphasis on exploring both the potential benefits and challenges of quality improvement. We conclude by providing recommendations for the field of psychology. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The evaluation of sexual harassment litigants: reducing discrepancies in the diagnosis of posttraumatic stress disorder.

Relatively few targets of sexual harassment cope with the psychological sequelae of their experiences by engaging in litigation. Those who do are often subjected to forensic examination to evaluate their history of psychological distress or disorder and to determine whether such a condition could be reasonably attributed to the alleged harassment, as opposed to some other cause. An unbiased approach to such examinations is critical to all parties, as well as to the profession itself. This study investigates the relationship between the clinical and restructured clinical scales of the Minnesota Multiphasic Personality Inventory-2, the Trauma Symptom Inventory subscales, the Crime-Related Posttraumatic Stress Disorder (CR-PTSD) scale, and an American Psychiatric Association diagnosis (APA, Diagnostic and statistical manual of mental disorders; DSM-IV-TR; 4th ed., text rev., 2000, Washington, DC, Author) of PTSD in a sample of sexual harassment plaintiffs. All measures performed well independently, but together provided improved predictive accuracy, suggesting that the use of multiple validated measures as well as structured diagnostic interviews may help us better understand litigants' experiences and reduce bias in evaluations.

Encouraging legal help seeking for victims of intimate partner violence: the therapeutic effects of the civil protection order.

Civil protective orders (CPOs) are the most widely used justice system remedy for intimate partner violence (IPV), and were implemented to ensure safety and increase victim participation in the justice system. Limited data exists regarding the effectiveness of CPOs; however, theories of therapeutic jurisprudence argue that legal interventions in and of themselves can improve mental health outcomes. To test this hypothesis, we examined the effectiveness of having a CPO issued against one's abuser at improving the psychological sequelae of exposure to trauma. We used a longitudinal sample of female residents of battered women's shelters who had experienced IPV (N = 106; 55% African American). One-way analyses of variance using gain scores indicated that PTSD symptoms (effect size η(p)(2) = .16) and incidents of sexual revictimization (effect size η(p)(2) = .09) decreased from baseline to 6-months postshelter for women who had a CPO against their most recent abuser compared to women without a CPO. These results support theories of therapeutic jurisprudence, suggesting that having a CPO can improve mental health outcomes. Limitations and clinical implications of our findings are discussed, including arguing for a coordinated service system that incorporates both legal and psychological assistance to improve the mental health of victims of IPV.

The attenuating effect of empowerment on IPV-related PTSD symptoms in battered women living in domestic violence shelters.

Intimate partner violence (IPV) is associated with significant psychological distress, including posttraumatic stress disorder (PTSD). However, factors that attenuate the impact of IPV on PTSD remain largely unknown. Using hierarchical regression, this investigation explored the impact of resource acquisition and empowerment on the relationship between IPV and PTSD. Empowerment demonstrated greater relative importance over resource acquisition. Specifically, empowerment was found to attenuate the impact of IPV severity on PTSD at low and moderate levels of violence. The importance of fostering empowerment and addressing PTSD in addition to provision of resources in battered women is discussed.

The Mediating Role of Empowerment for African American Women Experiencing Intimate Partner Violence.

Intimate Partner Violence (IPV) is a significant societal problem associated with Posttraumatic Stress Disorder (PTSD) and depression, which in turn can cause impairment in a variety of areas. Previous research suggests that African American women experience more frequent and severe IPV than White women, yet report fewer PTSD symptoms related to their abuse. One proposed explanation for this relationship is that African American women are more resilient due to internal coping methods such as empowerment; however, this relationship has yet to be empirically tested. The current study investigates the role of empowerment in mediating IPV-related psychological distress in a sample of African American and White battered women (N = 204). As hypothesized, personal empowerment mediated the relationships between race and PTSD and race and depression, suggesting that empowered African American women may demonstrate greater resiliency when faced with IPV. Results are discussed in terms of their implication for developing culturally-sensitive empowerment-based interventions for battered women.

Correlates for legal help-seeking: contextual factors for battered women in shelter.

Legal redress can play a critical role in interrupting the pattern of domination and control inherent in intimate partner violence (IPV), yet it remains an infrequent strategy among battered women. The current study employed a contextual framework for investigating the correlates for engagement in the criminal justice system for a sample of 227 sheltered battered women. Results indicated that individual, relational, and system-level factors were all associated with two legal help-seeking behaviors: having a civil protection order and criminal prosecution. In particular, posttraumatic stress disorder (PTSD) symptomatology, social support, and prior experience with police officers were significant correlates for legal help-seeking. Results highlight the need for a coordinated community response to IPV, addressing both legal needs and psychological needs simultaneously.

Correlates of joining a sexual harassment class action.

Researchers have proposed a variety of factors that influence the decision to seek legal relief in response to sexual harassment, but have generally failed to test these proposals empirically. The present study aims to address this gap by investigating the decision to join a class-action lawsuit. Participants were female professionals at a nationally based financial services firm, who either participated in or opted out of a sexual harassment class-action proceeding against the company. Five variables emerged as significant correlates of joining the class: organizational climate, turnover, financial dependence, PTSD, and primary appraisal. Dominance analysis identified contextual factors as the most important correlate. Theoretical and practical implications for the role of these factors in joining a class action are discussed.