Quite a number of years ago, the APA Practice Directorate had a project with Atlantic Bell South which showed a significant reduction in costs when psychological assessments (objective testing like MMPI) were used with those who were covered under insurance by them.  The savings came from proper diagnosis and follow-up treatment recommendations,  with significant reduction in psychiatric hospitalizations, in particular. 

  Unfortunately, when I have tried to track down anything published or even a summary report, I have been informed that the data were proprietary and it is not a published finding.  I would like to see the Denver VA study (or have the reference), if you could please forward that to me.  Thank you.

It would be great if we had some efforts from OMHS to coordinate a study across VA MHSs to do a large scale study, where psychological assessments were included in Intakes to make diagnostic decisions, and then utilization and/or costs for things such as: medications, hospitalizations, and subsequent number of visits to each of the various MH  provider groups (psychologist, psychiatrist, social worker, counselor) over a two year period could be tracked.  I think our resources would be well spent. 

Kathleen M. McNamara, Ph.D., ABPP

Lead Professional, Psychology

Staff Psychologist, Maui VA CBOC

808-871-2454

Right, but how much money does it save when you use it? J

I think that’s the question the people making the decisions are asking, unfortunately.

Now, is anyone in our field working on answering that question?

Well said, William. 

There is an  empirically well supported treatment method called Therapeutic Assessment (TA) developed by Dr. Stephen Finn in Austin which integrates psychological assessment and treatment.  There was even a study done at the Denver VA successfully using TA with suicidal veterans. If anyone is interested, I would be glad to send information next week.

What sets psychologists apart and makes them valuable is their training and ability to conduct research and do assessments. Many psychologists seem to have ignored these assets in favor of developing things like manualized training which opens the door for other disciplines to do our work.  In many VA settings research and assessment are discouraged as time consuming and less important than therapy, case management  and documentation.  Instead psychologists should develop protocols which emphasize both assessment and research as guides to treatment.  This could greatly improve treatment over generic style manualized treatment and demonstrate the value of psychologists.

William Crisp, Ph.D.

Clinical Psychologist

Substance Treatment Employment Program

Central Texas Veteran’s Health care System

Temple, TX

In my opinion just another failure by psychology to demonstrate empirically the value of what we offer over and above the value of what other mental health professionals offer, if indeed that value exists.  I’d like to think it does because I’m a psychologist, but to say it does without empirical evidence would indicate bias more than anything else in my opinion.

It’s time to get to work and demonstrate the value.  Who wants to do the work?

Edgardo, you sound the way I feel at times like these.

It is very difficult to see so much of what one has worked for (developing skills, making what contributions you can, getting doctoral and postdoctoral training) over a professional career to have much of that devalued, denied, dismissed.

Thank you, Edgardo.  I value your viewpoint on all the issues you raise!

Tom

By interesting, I’m sure you mean discouraging.  After 20+ years in the VA, I continue to be astounded at how so many other professions continue to have sufficient advocacy to increase their grade levels commensurate with their responsibilities (case in point, Social Workers continue a juggernaut rise in grade with each new “position” created (most now seemingly needing GS-12 grades) while psychologist have an almost insurmountable task getting approvals at the GS-14 level.  The data notwithstanding (that we have increased the number of GS-14 positions), the success of our Hybrid T38 and Professional Standards Boards have been underwhelming. 

This is not to start an old argument about our glass ceiling as psychologists in the VA; but it is to say that this new initiative to bring in and somehow “Qualify” Master’s Level Counselors is a lobbyist win by Master’s Level Counselors and Counseling Programs to establish their niche in the VA.  And it will ultimately be to the detriment of Psychology.  A system of lower entry pay entry “counselors” who can rise to the GS-13 by taking on greater responsibility means fewer Psychologists will be needed as they become overseers of a cadre counselors doing more of the supposed “drone” work of fully manualized and technicalized therapy.  What a Brave New World.  Anyone who thinks this is not the case should look at the private sector and see how lower level “Assistants” are replacing part of the work (and the pay) of their more educated colleagues. 

Let me clarify here that I have nothing against Master’s Level Counselors, we have used them in Cleveland ever since I have been here.  I don’t know who is trying to kid whom whey they say that this is a “new position” of Mental Health Counselor, but we have had GS101-11 Readjustment Counselors in the VA for well over thee decades. They have limitations, but have worked out well in the areas we have used them.  But what I do know is that not a single one has ever shown that they have some secret knowledge or facility or skill and foundational learning that is different from, greater than, or particularly more technical in nature that Psychologists.  Usually, they have less.  The only difference now is that some accreditation body (CACREP) can now be added as a profession lobbying body in the VA.  Personally, I am not amused.  

So, maybe we as Psychologists are too educated, maybe manualized, evidence  based protocols are making our “therapy” work too rote and straightforward for the amount of pay we are demanding, maybe what we do, with a good cookbook here and an evidence based therapy there, can be done by cheaper labor.  I’m not sure; but I will say that with this cannon shot of promoting our Master’s Level colleagues, we will find out.  End of rant.  

It is interesting to me that the LPC who is a program manager can be a GS 13 – the grade level that many psychologists who manage programs and have years of experience cannot move beyond.

Fax:     405-456--5956

Colleagues,

As many of you have been awaiting the Qualification Standards for Mental Health Counselors, we wanted to share these with you when we first received it.

George Shorter, Ph.D.

President, AVAPL