1. PATIENT ALIGNED CARE AND GROUP SCREENING OF CHRONIC PAIN IN VETERANS Roslyn E. Feierstein, Ph.D., A.B.P.P. and Britany E. Canady, Ph.D., A.B.P.P. Veteran’s Administration, VAMC Bay Pines and Marshall University
Background and Significance
An increasing number of veterans with pain are untreated and referred without facilitating sustained treatment or evidence of recovery e.g., change in pain behaviors, beliefs or rating of pain.
The literature cites treatment outcomes as fair to poor, for individuals with chronic co-morbid mental health and chronic pain disorders. Outcomes indicate co-morbidity of mental health disorders as follows: 68% for depression and 84% for PTSD. Treatment drop-out rates are high in all groups.
Universality, guidance, altruism, and cohesiveness facilitated by the group process , even in psycho-educational groups are observed and defined as effective change agents.
Primary Objectives
Assessment of individual vs. group evaluation process for chronic pain.
Compare number of sessions for two types of assessment paths.
Evaluate the impact of this method of evaluation on attitudes and skill development.
Discussion and Conclusions
This project evaluation showed a significant impact on treatment longevity and likely commitment. (8+ sessions tabulated for both groups; group orientation sustained treatment 69% vs. 29%). The two models offered e.g., group screening clinic vs. individual consult clinic (1:1 assessment) indicated that Group Screening is more effective producing sustained treatment and may have an impact on commitment to treatment and/or changes in attitudes central to coping with pain e.g., change in beliefs.
Veterans (per review of number of sessions attended in group therapy following the evaluation) demonstrated sustained treatment greater than the individual consult clinic.
Project Evaluation analysis indicated that group driven assessment and orientation facilitated increased commitment and resulted in sustained treatment (consecutive sessions greater than 8).
Use of a Screen Clinic Model of brief assessment, pain orientation and treatment planning resulted in sustained engagement in treatment for pain.
Future Directions
Assessment of change in treatment e.g., Pain Catastrophizing Scale pre-, post-group treatment and comparison of the two groups e.g. individual consults vs Group screening consults.
Create a VA-wide Screening, Evaluation and Pain Orientation Group aimed at sustaining treatment and increasing adaptive coping skills for pain management.
Pre- and Post-testing utilizing a variety of pain outcome and pain belief scales is thought to be the next phase of this project.
Results
A majority of individuals indicated to the referent that an individual appointment was preferred (68%); but clinical parameters were used to identify best fit for the assessment.
Of Veterans who were seen individually, 31% sustained treatment for 8 or more sessions, whereas 69% of Veterans who attended group screen clinic appointments sustained treatment for 8 sessions (t= 7.50 p < .05).
Personality Disorders and a history of trauma often found in the pain population was reviewed as part of the evaluation and could be a mediating factor with regard to sustained treatment. No difference was noted between groups when data reviewed.
Methods
Participants. Participants were 276 veterans referred for multidisciplinary pain management at a Southeastern VA Medical Clinic.
Measures. Routine case management data including individual or group assessment, length of treatment for MH Pain Psychology patients at a Southeastern VA Medical clinic.
Procedure.
Both Individual and Group Screening clinics participants were identified by a consult or intake referral, which is received by the psychologist.
Consults were assigned to Group Screening or an Individual Appointment based on clinical parameters and at times preference.
An identical Biopsychosocial questionnaire administered prior to beginning both group screen and individual appointments.
Both clinics include a psychoeducational presentation, discussion, and treatment planning session following the first appointment and the same type of follow-up treatment is offered.
Analysis. Outcome evaluated for length of treatment being 8 or more sessions, which defined sustained treatment following initial assessment for each participant.
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