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Fidelity to Best Practices of Psychiatric Assessments in Army Behavioral Health Settings

WILLIAMS, JUINELL B.; TOBLIN, ROBIN L., MPH, PhD; DUFFY, FARIFTEH F., PhD; SHANNAHOFF, MOLLY E., MPH; WILK, JOSHUA E., PhD

Journal of Psychiatric Practice®: March 2019 - Volume 25 - Issue 2 - p 103–117
doi: 10.1097/PRA.0000000000000365
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While civilian and military psychiatric clinical practice guidelines (CPGs) exist for psychiatric assessments, data are lacking on providers’ adherence to these criteria. This study evaluated the use of psychiatric CPGs’ assessment criteria by Army behavioral health providers (BHPs). In a weighted cross-sectional survey, 348 BHPs were evaluated on their assessment of a systematically selected patient on 15 total domains recommended by the Departments of Veterans Affairs and Defense CPGs for substance use disorders, posttraumatic stress disorder, and major depressive disorder. The proportion of BHPs providing high-quality assessment and the association between high-quality assessment and BHP and patient characteristics were examined. Using the weighted sample, 80% of BHPs provided a high-quality assessment. BHPs who saw ≥20 patients per week were significantly more likely to provide high-quality assessments compared with BHPs who saw <20 patients per week [odds ratio (OR)=1.72, 95% confidence interval (CI)=1.01-2.92]. Patients diagnosed with generalized anxiety disorder [adjusted OR (AOR)=0.42, 95% CI=0.18-0.96] or whose BHPs did not assess patients’ current overall physical health (AOR=0.26, 95% CI=0.07-0.97) or lifetime duration of treatment for mental health (AOR=0.03, 95% CI=0.01-0.20) were less likely to receive high-quality assessments. A majority of Army BHPs are conducting high-quality assessments for the 3 most common mental disorders in military populations. If recommendations to increase fidelity to assessment could be implemented, more patients could receive optimized care.

WILLIAMS, DUFFY, SHANNAHOFF, and WILK: Walter Reed Army Institute of Research, Silver Spring, MD

TOBLIN: US Public Health Service, Silver Spring, MD

Funding for this project came from the Military Operational Medicine Research Area Directorate, US Army Medical Research and Materiel Command, Ft. Detrick, MD.

Material has been reviewed by the Walter Reed Army Institute of Research. There is no objection to its presentation and/or publication.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official, or as reflecting true views of the Department of the Army or the Department of Defense. The investigators have adhered to the policies for protection of human subjects as prescribed in AR 70–25.

The authors declare no conflicts of interest.

Please send correspondence to: Juinell B. Williams, Department of Psychology, East Carolina University, 104 Rawl Hall, Greenville, NC 27858. (e-mail: williamsjui18@students.ecu.edu).

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