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The downsides of the CAPS in clinical practice are never acknowledged. Also, the cold hard absolute fact is that--at least in my organization and all CBOCs in our division (half of an entire state)--I have NEVER seen the full CAPS used (according to the manual) and the scores reported on in a clinical report or progress note. NEVER. There are reasons for that empirical observation (though I have reviewed many thousands of charts at VA).The CAPS unfortunately is pretty unwieldy in practice in my opinion in a BHIP ..they say it takes 45-60 min....maybe I'm missing something
In our PCT, the head of it mandated that we sit through a training from a former fellow PCT psychologist who left PCT for another position. That psychologist basically went over the CAPS with us. It was the PCT psychologists and the interns in there. One of the interns asked about scoring and writing up the results of the CAPS. At which point, the truth came out, lol. After an uncomfortable pause, the trainer had to admit that she didn't actually administer the CAPS (per the official instructions/procedures), score it, and write it up in her notes. No. She does (sometimes) what she refers to as a 'CAPS-informed' interview. I mean, I do the same thing (have been for years) called a semi-structured, detailed psychiatric interview of symptoms of PTSD (per DSM criteria) and I write up the results in my notes. So, the person training us on the CAPS had never (and does not) actually use the CAPS per the manual, or score it, or write it up as a CAPS administration. Nor does the head of PCT who mandated the training. Is anyone else hearing that carnival music in the background? Meanwhile, I have yet to see evidence in the record (despite being exposed to thousands of charts in my time) that ANYONE here has EVER actually used the so-called wonderful, gold-plated, can't be praised enough by all the people who don't see patients, instrument called the CAPS-5. But we mandate training on it. And, people mouth (chant?) the words 'gold-standard' like they are compelled to repeat this moniker every time the CAPS is mentioned. What is it about this organization (cult?) that is so damned averse to the truth? Is anyone else noticing this? Is 'dedication to the practice of hypocritical self-contradiction a rating criterion on interviews for promotions at VA? 'Double-plus-good, anyone?'
The CAPS also does absolutely nothing to deal with the issue of overreporting of symptoms if you're dealing with a semi-competent patient trying to appear to be more significantly impaired than they actually are. In fact, if you're dealing with a semi-intelligent malingerer who has thought things out in the slightest and can think on their feet a bit, the CAPS will actually provide page after page of detailed symptoms of PTSD that you now are obligated (of course) to report were endorsed at that high level of detail. So, you'd better also give an MMPI-2-RF to at least take a look at response bias. Now, the CAPS' detailed questions will 'catch' (flatfooted) people who haven't thought through in any detail (or researched) what symptoms they are going to recite and what details they are going to give. Those folks scrunch up their brow, tilt their head to the side, get this exasperated 'WTF' expression on their face and give you the business because you're asking questions that they haven't pre-thought through their answers for and they, predictably, attack you and attack the question. THESE 'CAPS' informed interviews (or whatever people are calling it) will take more than two hours if you try to slog through the interview with these patients.
All these things (PCL-5, CAPS-5, semi-structured detailed psychiatric interview, observations, chart review, comparing what you're seeing in the patient (and what they're reporting) with the empirical literature as well as your own clinical experiences over the years) are mere tools and options within the context of a multi-method approach to assessment and differential diagnosis (what is really the standard of care/practice, whether it is often followed or not). There is no single tool or measure or procedure that can be used with every patient in a brief period of time that just 'spits out' a reliable/valid diagnostic determination. That's the work of the doctoral-level clinician to do and there are no magic bullets.
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