This week’s blog was contributed by Jeremy Sharp, PhD, licensed psychologist and clinical director at the Colorado Center for Assessment & Counseling and the host of the Testing Psychologist Podcast. Dr. Sharp earned his undergraduate degree in experimental psychology from the University of South Carolina and earned his master’s degree and doctorate in counseling psychology from Colorado State University. He specializes in psychological and neuropsychological evaluation of children and adolescents and provides private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. He lives in Fort Collins, Colorado with his wife (also a therapist) and two kids.
First, what IS trauma? The DSM-5 definition is easy to find, but the very first requirement for a PTSD diagnosis (“Exposure to actual or threatened death, serious injury, or sexual violence…”) does not capture the broad range of experiences that may lead to a trauma response. Right away, we find the categorical nature of the DSM-5 may not adequately conceptualize or capture the huge continuum of traumatic experiences. I think we can all agree that not all “traumatic” experiences involve exposure to death, serious injury, or sexual violence. What about neglect? What about emotional or psychological abuse? It is necessary to further define trauma and the many ways it can occur. One way to break it down a little further is to distinguish between acute (“Big T”) trauma and developmental or complex (“little T”) trauma.
Acute trauma refers to a discrete event that occurs at a single point in time. With acute trauma, one can generally identify a clear change in functioning from before the event to after the event. An acute trauma may be something like a sexual assault, a car accident, or being held up at gunpoint. Complex trauma is more complicated and refers to ongoing, recurrent traumatic experiences. When these recurrent traumatic experiences happen during childhood, the collective experience is called developmental trauma.
Related post: Assess the impact of the pandemic on kids—the PASS-12 is now available!
Why is this distinction relevant for us as clinicians? Because it affects how we assess and treat individuals. We know that individuals with acute trauma typically may have a quicker path to recovery, while individuals with complex trauma tend to show more chronic symptoms. Acute trauma is also easier to assess in the sense that we are only gathering information about one event, with a relatively clear before and after, while complex trauma tends to be multilayered.
Regarding the assessment process specifically, detailed questions about trauma should be included in nearly all diagnostic interviews. As mentioned earlier, many parents and individuals can overlook or downplay potentially traumatic experiences. Kids also may not share their traumatic experiences with their parents or others unless asked directly. There are a couple of ways to get at these concerns without coming across as too heavy-handed. One is to say something like, “Tell me about some of the most important events in your life” or “What are the top three hardest/worst things that you can remember?” or “Have you held any secrets for a long time that you’d like to share?” Note that forensic interviewing is a clear subspecialty in our field. Do NOT practice outside the scope of your expertise! Another way to explore these questions is to use a broadband questionnaire as a guide for topics/events to inquire about. If your client shares anything that warrants further exploration, you can integrate a narrower questionnaire to drill down on specific trauma symptoms.
Moving further down the path of the assessment process, it is important to think through the relationship between trauma and other mental health diagnoses. A question that comes up often is, how to separate trauma from ADHD/autism/anxiety, etc. As Dr. Maggie Sibley and Dr. Julia Strait noted on past Testing Psychologist podcast episodes, maybe we don’t. Maybe we need to stop thinking about how to separate these diagnoses, because it is nearly impossible to do so, particularly in the case of developmental trauma. Even going by the DSM-5 definition of PTSD or acute stress disorder, there are many PTSD symptoms that occur in other diagnoses. These symptoms include repetitive play (autism), intrusive memories/thoughts (OCD), distress when exposed to certain cues (specific phobia), poor memory (ADHD), and alterations in cognition (depression, anxiety, ADHD), just to name a few. Unless we have a clear picture of functioning before the trauma started, it is extremely challenging to know if these symptoms “belong” to the trauma or something else. In these (and all) cases, gathering an accurate history is crucial to establishing context to interpret an individual’s symptoms and assessment results.
In cases when an accurate history is not available from the primary caregiver, clinicians may need to expand the scope of the evaluation and incorporate a broader record review or interviews with additional people in the client’s life. Even then, we sometimes must simply do our best with what we’ve got to come up with meaningful conceptualization and recommendations.
Ultimately, we want our assessment to guide treatment and provide helpful recommendations for our clients. By conducting a thorough clinical interview; utilizing well-standardized assessment instruments; and providing realistic, evidence-based recommendations, testing psychologists play a vital role in helping individuals identify and heal from their adverse experiences.
Catch up with the Testing Psychologist podcast on their website, via Apple Podcasts, Google Podcasts, or on Spotify.
Are you doing research with a PAR product and think it could help others? We are looking to gather additional data on our existing tests with the goal of further validating our instruments, identifying and developing product enhancements, or adding features that allow our Customers to better meet the needs of those they serve.
We are inviting clinicians, researchers, and other professionals to partner with us to advance the scope of solutions we can provide, especially focusing on better helping underserved populations.
Could your data help others? We would love to talk to you about it!
School social workers have always played a pivotal role in our schools and communities. Their important role has really come into the spotlight this year, more than ever. With National School Social Work Week occurring this week, we at PAR would like to publicly express our gratitude and thanks for everything school social workers are doing to make our schools better places for all. The theme of this year’s awareness week is “Beacon of Hope: School Social Workers—Lighting the Way.” Thank you to our school social workers for being that beacon of hope during this very unusual time. The work of school social workers goes beyond students, helping administrators, teachers, educators, parents, and the greater community to thrive.
Resources to promote National School Social Work Week
The School Social Work Association of America provides members resources, including posters, images, downloadable materials, and more.
Need some ideas on how to celebrate and acknowledge school social workers? The Illinois Association of School Social Workers provides a downloadable list of fun suggestions as well as a list of ways school social workers can increase the visibility of the field.
The New York State School Social Workers’ Association has put together a list of activities as well as downloadable posters to help school social workers get out the message about the important work they do.
To learn more about PAR products that can be useful in school settings, visit our School Resources page.
February 14-21 is Alzheimer’s and Dementia Staff Education Week. This week brings awareness to the importance of properly training individuals from a variety of fields. Whether you are a health care provider, 911 operator, first responder, clergy member, elder care attorney, or have another role working with the elderly, this week focuses on the importance of comprehensive dementia education.
Beyond educating individuals beyond those in mental and physical health care about the importance of dementia education, the week also shines a spotlight on caregivers supporting individuals with these diagnoses.
Some resources for Alzheimer’s disease and dementia care
The National Institute on Aging is the primary government agency conducting research on Alzheimer’s disease.
The Alzheimer’s Association is the leading voluntary health organization in Alzheimer’s care, support, and research. The association’s website offers resources for caregivers as well as those living with Alzheimer’s.
The National Council of Certified Dementia Practitioners (NCCDP) provides resources, including seminars and training. NCCDP members may download a free Alzheimer’s and Dementia Staff Education Week toolkit from their website.
Need help assessing for neurocognitive impairment?
Patients with neurocognitive impairment such as dementia are often unreliable reporters of their symptoms. An observer—such as a family member, friend, or home health care nurse—can often provide valuable insight into an individual’s functioning. The Older Adult Cognitive Screener™ (OACS™) is a quick informant rating scale that helps provide information on a patient’s mental status and determine if there is a need for more in-depth testing. Learn more about the OACS.
The Dementia Rating Scale–2™ (DRS-2™) measures mental status in individuals with cognitive impairment. It assesses an individual’s mental status over time.
PARiConnect is already the most reliable platform in the industry, but our new improvements make it even easier for you to navigate the transition to remote administration.
Manage your digital assets easier! With centralized storage provided by the digital library, all e-Manuals you have purchased from PAR are now available in one convenient location. Simply log into your PARiConnect account to access your materials. With this added flexibility, you can now access your manuals from most internet-connected devices—no matter where you are!
Interactive bell curve
Use the interactive bell curve to quickly assess and visually capture scores and see how they relate to others. This tool is a great way to help explain assessment results to clients.
Both the digital library and the interactive bell curve can be accessed within the PARiConnect Quick Links section.
Don’t have a PARiConnect account? Register for free!
Have you found forms from outdated assessments taking up space your office? Many Customers are unsure what to do with unused or obsolete test protocols or materials from prior versions of an instrument. Rather than letting old forms collect dust on a shelf, PAR recommends that you destroy and discard these materials in a secure manner.
If you or your institution does not have access to a secure recycling program, PAR is happy to help! Simply e-mail firstname.lastname@example.org or call our Customer Support line at 1.800.331.8378 and a specialist will help you obtain a prepaid return label so we may discard the materials through our own corporate recycling program. This program is available only to our Customers in the U.S.
Earlier this year, PAR welcomed A. Jordan Wright, PhD, for a webinar concerning best practices in teleassessment. Dr. Wright is the Director of the Center for Counseling and Community Wellbeing at New York University's Steinhardt School of Culture, Education, and Human Development, where he also coordinates the psychological assessment curriculum in the Counseling Psychology program. He is the author of the upcoming Essentials of Psychological Tele-Assessment. As teleassessment has become an increasingly important part of many clinician’s lives, we are republishing selected questions posed by webinar attendees looking for ways to incorporate teleassessment into their practices. For a full list of the questions asked of Dr. Wright and his responses, click here.
Q: What are your thoughts about using personal protective equipment (PPE) during assessments? If we use PPE, is it okay to change the order in which subtests are administered?
A: Currently, we have absolutely no research into the potential impact of using PPE on the data that emerge during an assessment. Remember, the more you veer off from standardized administration, the greater the threat to validity. So, changing the order of subtests adds one large variable that changes standardized administration procedures. PPE adds another (and in a way that is likely to be quite significant).
Q: My school district is asking us to only report confidence intervals due to breaking standardization with PPE during in-person testing. What are your thoughts on only reporting confidence intervals?
A: Because we know there are not systematic effects of teleassessment, confidence intervals are helpful (they can remind us and readers that scores are imperfect). However, with PPE, we don’t have research studies to confirm where children's scores would likely fall, so even confidence intervals can be misleading.
Q: Is there a disclaimer about teleassessment that could be used in reports? Is there specific language that should be used to make it more legally defensible when doing teleassessment?
A: Mine is evolving. Here's the gist of the language I include: 1. It should be noted that the evaluation was conducted using teleassessment (remote) procedures. 2. It is known that administering tests in this way may have some effects on the validity of the data that emerge from the tests. 3. However, the teleassessment was conducted in alignment with the best and most current research evidence to elicit data that constitute a valid representation of the client's functioning.
Q: In your experience, how are teleassessment reports received by schools, testing boards like ETS, etc.?
A: Many school districts have developed their own rules. Check with your school district and the state psychological associations in your state. Advocacy is a role that we as psychologists need to take on so kids can get resources they need. If a school district or company has a blanket statement that they will not accept teleassessments, work toward educating them about the evidence base of conducting teleassessments.
Q: What information can we share with parents, families, and schools about equivalence and validity?
A: We have reviewed the current state of equivalence/validity research across all tests for the Essentials of Psychological Tele-Assessment book. It is of course fair and ethical to discuss the limitations of the evidence base with the interested parties. But you can also summarize the current state of support (for the most part, across IQ and achievement tests, research has shown very little, if any, impact of conducting testing remotely on scores that emerge).
Q: What’s your best advice when remote testing ELL students with chaotic settings at home (lots of siblings, distractions, limited ability from parent to support)?
A: This is really tough, and it's a social justice issue. Obviously, we cannot only provide services to those with “perfect” home environments. A remote, in-office setup is one way that we can balance the safety of tele-assessment with better controlling the environment. If you set up an office with a laptop, any manipulatives and response booklets, etc., and have students come into that office to do their remote assessment, this provides a much more controlled environment. This is also the solution when students/clients do not have access to the necessary technology (e.g., a stable internet connection).
Want help with remote and teleassessment? We can help here!
Want to view the entire webinar? Visit the PAR Training Portal!
This week’s blog was written by Lindsey O’Brennan, PhD, a licensed psychologist and owner of Morningstar Wellness.
In March 2020, the majority of Americans were faced with the stressful and uncomfortable task of transitioning work to be entirely remote. No more were the days of enduring the rush hour commute or booking flights for work conferences. Instead we spent our energy buying and learning new online platforms and software. The titles of mom and dad were suddenly synonymous with teacher, coach, and classmate. We carved out space for a home office and, if possible, a sense of privacy from family members (our new coworkers). The after work happy hours were replaced with Netflix binging (thank you “Tiger King” and “Ozark” for your life lessons!), learning how to make sourdough bread, or taking our dogs for yet another walk to get out of the house.
The initial phase of lockdown was difficult on even the best of days. Yet there was a sense of unity during those early months. I felt closer to my neighbors who now became the only other people I physically saw beside my immediate family. I relished our neighborhood walks and time spent in the backyard as a family. I frequently saw “We’re in this together” and “Kindness matters” signs in the windows of closed-up shops or spray painted along my neighborhood streets. There was a sense of hope that America was going to get through this. There was also an underlying optimism that we would be waving goodbye to COVID by summer.
Well hindsight is 2020 (not sure that saying holds up anymore). Despite our desires for a quick vaccine, COVID remained ever steady in our world through the summer and fall months. However, noticeable things were changing across the nation in terms of the reopening of businesses and school districts and the growing need for mental health services.
Related Article: ASSESS THE IMPACT OF THE PANDEMIC ON KIDS
As a psychologist who works both in private practice and with local school districts, I had to decide how and when I was going to return to work following quarantine. During the initial lockdown, I moved my entire business over to telehealth. Because of this, about 25% of my clients—particularly school-aged clients—decided to take a break from therapy until they could be in-person again. I frequently heard from parents that kids were “simply Zoom-ed out” and didn’t want to stare at a computer screen while yet another adult talked to them. I also noticed I was not bringing my best self into the telehealth therapy sessions. I would catch myself glancing down at the clock more frequently. I hated knowing that my inbox was one click away from the telehealth browser window, thus requiring me to mentally refocus more often.
Part of what I love so much about therapy is creating a sacred space for the client where they can unload their emotional baggage. But with telehealth, we did not share the same physical space, so the distractions of the real world felt ever present for me and my clients. It came to a point where for me, the benefits of telehealth (ease, safety, convenience) were not outweighing the risk of contracting COVID-19. My focus was then to develop a plan for how I could safely offer therapy to clients in person and via telehealth depending on their needs and comfort level.
Related Article: E-MANUALS: CONVENIENT DIGITAL TOOLS TO HELP YOU
I want to point out that my decision to return to my office full-time was a personal one. I’ve talked with a multitude of colleagues—some of whom returned to their office months before me and others who continue to solely provide telehealth services. No matter where you land on the spectrum of remote versus in-person work, here is some food for thought on how to navigate the path to a new normal:
Related article: Read Dr. O’Brennan’s blog on her initial shift to telehealth services.
Mark Ruiz, PhD, ABPP, is a licensed psychologist at the James A. Haley Veterans’ Hospital and coauthor of the Personality Assessment Inventory Interpretive Report for Correctional Settings (PAI-CS). He specializes in competency to stand trial, mental state at the time of offense, violence and sexual recidivism risk assessment, and sentencing mitigation. In today’s blog, PAR Project Director Sierra Iwanicki, PhD, talks to him about the use of the Personality Assessment Inventory™ (PAI®) in forensic evaluations, how he became drawn to the field, and where he thinks forensic psychology is going in the future.
How did you become involved in forensic evaluations?
It happened by accident. During my undergraduate and graduate training, I had brief experiences working with juvenile and adult offenders. I took some workshops about competency and sanity evaluations through the University of South Florida. Following the workshops, some opportunities to do court-ordered evaluations opened in the county I was in and it took off from there.
Why is it helpful to include a measure of personality in these evaluations?
Psychological testing that can address multiple clinical issues in an objective manner adds credibility to any evaluation. Judges, juries, and law enforcement often are not reassured when a clinician makes an opinion based solely on the words that came out of the client’s mouth. “Because he told me so” is not typically a persuasive argument. Psychological testing backed by science tends to be well received in the court of law.
Describe your use of the PAI in forensic evaluations.
I typically use the PAI in risk assessment and sentencing mitigation evaluations. The evidence-based validity scales are important for gauging the client’s approach to the evaluation. The PAI’s broad coverage of mental health and substance use disorders is also helpful in clarifying the diagnostic picture. Additionally, the well-validated Antisocial Features (ANT) and Aggression (AGG) scales are central to opinions of future risk for reoffending and violence.
What makes the PAI unique from other instruments?
The PAI’s ability to measure personality pathology and substance use independently is critical in many forensic evaluations. The growing body of research validating the use of various PAI scales, most notably Negative Impression Management (NIM) and Antisocial Features (ANT), is helpful in generating persuasive opinions in the forensic setting.
How do you see the field of forensic psychology changing in the next 10 years?
The COVID-19 pandemic has placed an emphasis on telehealth. As such, technologies to ensure the availability and integrity of psychological testing will be very important. Forensic clinicians who typically work in correctional or criminal justice settings are hampered by a lack of access to facilities and an inability to do face-to-face encounters due to the infection control protocols in place. Even in situations where access is available, many clients do not have the know-how or computer access to take a psychological test remotely. Having the capacity to administer tests via telehealth and to ensure the validity of the results will be crucial for forensic psychology.
What advice would you give to anyone interested in pursuing forensic psychology?
Forensic psychology is like scotch—you must have a taste for it. Attorneys play by a different set of rules than mental health professionals, with the main goal of the legal system being to sharpen conflict to resolve a particular issue. Unconditional positive regard is not often practiced in the courtroom. Psychologists are not typically comfortable with the baseline level of hostility and conflict present in the courtroom. However, the role of the legal system is to resolve conflicts in pursuit of justice; any psychologist interested in stepping into that forum should be ready for the culture that comes with it.
What is one thing we can glean from psychological science to improve mental health outcomes during the current collective pandemic crisis?
I think psychology has emphasized the importance of human connection, something that has taken a big hit with the social distancing and protective protocols that come with our response to the pandemic. Efforts to maintain connections during this time are more crucial than ever, particularly for the elderly and for vulnerable populations that have been isolated for extended periods of time.
Related article: Mendeley bibliographies available for the PAI!
School psychologists are facing a school year full of unknowns. PAR reached out to three different professionals to find out how they are adapting and what advice they have for others as they embark on a very different kind of school year.
Tamara Engle-Weaver, MS
Certified school psychologist, Lancaster-Lebanon IU 13 Sensory Impaired Program, Pennsylvania
I have classrooms located in more than one school district. Our districts are creating their own plans for the school year. Some are doing hybrid; some are face-to-face. Given that our classrooms are intermediate unit special education classrooms, they will most likely be operating 5 days per week with face-to-face instruction.
I plan to use a lot of technology this year. I will be trying to utilize virtual methodology as much as I can to reduce the amount of time I am in the classroom. I don’t feel the schools will be encouraging additional bodies to be in the classrooms. I will try to create social skill videos for my students that teachers can present at their leisure.
When you are on an airplane, they tell you to take care of yourself before you help the person you are with. I think that will be critical this year because there will be many students and staff who will be struggling with all aspects of coping with this virus. If we are not in a healthy mental state, we will not be able to help others achieve one either. We all need to do our best to care for ourselves and be compassionate and patient with others.
Maria Isabel Soriano-Lemen, PhD, RPsy
Director, Center of Psychological Extension and Research Services, Philippines
We are doing 100% online classes this year here in the Philippines. I usually ask students to work with a partner to come up with a psychological report that includes these areas of functioning: cognitive, psychological, emotional, behavioral, interpersonal, and interpersonal. So that requires them to work with different tests. I am at a loss at how to teach students to score their test results. I’m also concerned with access to testing materials and how students will be supervised. At this time, I really don’t know what to do. Classes will start in November.
Heather Bravener, DEd
School psychologist, Duncannon, Pennsylvania
At this time, parents have been given the choice to enroll in either the district’s cyber program or attend school for face-to-face instruction 5 days a week. We are a small district with three buildings on the same campus with graduating class sizes of approximately 140. The area’s COVID numbers are currently in the low range, which allows for the reopening of school with face-to-face instruction while implementing recommendations to prevent the spread of the virus.
My colleague and I are determining how to best complete assessments with students for the upcoming year in light of the pandemic. Considerations include wearing a mask, use of a plexiglass divider, a pencil for each student to use and then take with them, using a plastic screen to cover the manual, and use of disinfectant wipes. We are also considering the use of digital assessments.
Once schools closed in March, I had to balance completing my job at home while supporting my daughter during remote learning. It was quite a challenge and I can empathize with parents out there who are struggling to assist their child in learning.
As school psychologists, we are in a unique position where our roles may change significantly this fall. Flexibility will be key!
Related: Find out how the Pandemic Anxiety Screener for Students–12 (PASS-12) can help!