This week’s blog was contributed by Carrie Champ Morera, PsyD, NCSP, LP. Carrie is a licensed school psychologist and the lead project and content director at PAR.
The increased use of telehealth—including teleassessment—has changed psychological assessment practices. Although many of us have adjusted our assessment practices to keep up with the times, we have to keep in mind that, when engaging in teleassessment, our practices must be ethical—just as if we were providing in-person assessment services.
Here are 10 ethical considerations for practitioners to consider when providing services via teleassessment.
1. Obtain informed consent. Just as you would do with in-person assessment practices, obtain informed consent prior to providing telehealth services. Informed consent is more than a form—it’s a process.
2. Train and practice. Carefully review standardization procedures for the assessment. Practice the assessments several times using the technology and platforms with which you plan to administer them.
3. Consult with colleagues. Talk about ethical dilemmas with colleagues, consult the literature, and continue to update your ethical guidelines. It’s important to lean on one another for practice, support, and guidance.
4. Follow the publisher’s guidelines. PAR developed a statement on telehealth that addresses test security and measurement concerns. The integrity and security of the tests must always be maintained.
5. Keep forms and data secure. Make sure paper protocols and electronic forms are stored securely. Consider password protections, encryption, and malware protection and keep backups.
6. Establish and maintain professional boundaries. It can be tempting to relax your professional boundaries in a telehealth setting. Dress professionally, reduce distractions, and set clear expectations with your clients.
7. Consider cultural factors. Consider the implications for clients from traditionally marginalized backgrounds or various socioeconomic and ethnic backgrounds or those with less computer experience.
8. Document the use of digital and remote assessments. Include a statement in your report that assessment was conducted via telehealth. Record any technical issues, and disclose any modifications or alterations of standardized procedures.
9. Consider the psychological effects of the pandemic in digital and remote assessment. We’ve seen a general increase in anxiety, depression, grief and loss, and isolation. Go beyond scores and evaluate individual item responses. Stressors all contribute to these psychological effects, perhaps now more than ever.
10. Take advantage of PAR resources. We have many teleassessment resources and a wide selection of products available for administration, scoring, and/or interpretation on PARiConnect—and we are always adding more! Need to brush up on your teleassessment skills? Check out this video from PAR’s Director of Customer Support, Daniel McFadden, or visit the PAR Training Portal for more insight. You can use PAR products via telehealth technology while retaining the integrity and security of the measures. PAR has several tools available to help you navigate this challenge.
We’re excited to announce the publication of another instrument to add to your digital tool kit! The Identi-Fi Remote, a digital adaptation of the paper-and-pencil version, is an appealing and accurate test of visual organization designed specifically for testing your clients when you’re apart.
Related article: Now available: Identi-Fi
The Identi-Fi Remote has several distinct advantages:
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.
The past 18 months have been a rollercoaster for all of us. It seems like a lifetime ago when we got the news that my then-seven and eight-year-old children would NOT be going back to school after spring break in March 2020. I remember thinking, “Okay, we can get through this for a couple of months...things will be back to normal in the fall.” But no! Things were definitely NOT back to normal in the fall for us or for most families in the U.S.
There are many implications for kids being out of school or partially attending school for the better part of a year. I’d like to focus on the implications for practitioners who may be seeing increased referrals for issues like ADHD and learning issues.
Although some data suggest that mental health utilization (both psychotherapy and assessment) went down during the pandemic, this frankly does not match the anecdotal evidence from around the country. It seems like every practitioner I talk to is completely full—with longer waitlists than ever. Our practice has seen a huge increase in referrals for assessment of ADHD and learning disorders, and I think there is a direct link to the pandemic. Here are a few reasons why:
Instability in the environment. Kids do well with stable, consistent environments. Speaking for myself, other parents, and practitioners around the country, there was very little stability or consistency over the past year. Here are just a few examples of environmental changes: kids transitioning from in-school to in-home learning, parents transitioning to working from home, parents transitioning to being an in-home teacher, and cancellation of after-school programs and activities. Many families experienced variation or reduction in income. Marginalized groups and lower-income families may have experienced food insecurity. The list goes on and on. Increased instability = increased anxiety, acting out, distraction, or withdrawal.
Parents getting a firsthand look at kids’ behavior and academic skills. During the pandemic, many parents transitioned into the role of in-home teacher or a facilitator of education. For those parents who previously relied primarily on teacher comments or conferences to gauge their kid’s academic performance, this was an eye-opening experience. Parents suddenly got to see just how distractible, unfocused, fidgety, and (sometimes) disruptive our kids could be throughout the school day. If any parents of kids with ADHD were in denial about their children’s symptoms, those symptoms quickly became clear. Were they likely worsened by the instability mentioned above? Definitely. But many parents acknowledged and sought support once their kids were home all day trying to learn.
Parents being more burned out than usual. Not only were kids under more stress, but parents were also struggling during the pandemic. As mentioned previously, the world was turned upside down for us, too! It was challenging to juggle work (if you were still employed), finances, kids being home, spouses suddenly being home together more than usual, and any number of other things. When parents get stressed, it’s easy to focus on the negative or undesirable aspects of your child’s behavior. These might include not sitting still, interrupting the teacher, not doing their work, blurting things out, and so forth. Even if these behaviors are occurring with typical frequency, a stressed-out parent may notice them more often and perceive them to be more severe.
Increased variability in learning. Again, structure is important. In addition to the big-picture environmental instability discussed earlier, the academic realm itself was quite variable for many kids. Teachers absolutely did their best to develop and implement remote learning options. And yet, many children ended up with multiple platforms or websites to navigate. Many did not have stable internet access, which disrupted video and audio delivery. The remote school day typically looked different than the in-person school day, with many kids completing their work more independently than before. For kids with attention concerns, this was a recipe for disaster.
Related post: Jeremy Sharp on Trauma-Informed Assessment
All of these factors created quite a dilemma. Yes, many clinicians have seen increased referrals for ADHD evaluations, but how does one evaluate ADHD with so many environmental influences? These are just a few strategies that we’ve employed:
Conduct a more thorough intake. Our intakes now include explicit questions to gauge the impact of the pandemic. We ask about changes to the family routine, including parent work schedules, parent involvement in learning, kids’ reactions to the pandemic in general, loss of sports or after-school activities, and the timeline of in-person vs. remote learning.
Pay more attention to history. With a neurodevelopmental disorder like ADHD, history is always important. It should not just emerge out of nowhere. But with many parents now seeing longstanding or acute symptoms of ADHD firsthand, this factor is more important. In the past, we may have gotten by with documenting symptoms within the last year and going on our way with a diagnosis. Now, we must look further back. Were these symptoms present prior to the pandemic? Are they only happening during academic times? Do they vary based on in-person vs. remote learning?
Be less confident. Principle 5 of the American Psychological Association’s guidance on psychological teleassessment during the COVID-19 crisis explicitly states that we should widen our confidence intervals when making conclusions and clinical decisions. This is incredibly important. Most evaluations over the past 18 months have a big, metaphorical asterisk beside the results that says, “We are not as confident in these results as we typically are. Here’s our best guess.” We’ve gotten over the fear of saying, “This is unclear right now,” and have no shame about asking families to come back in 6–12 months for a brief, updated assessment.
In summary, there are many things for us to consider as we see increased referrals for ADHD testing. We must take environmental factors into account, acknowledge that parents and kids are more stressed out than usual, know that certain groups have less access to resources than others, and generally be more diligent and less confident in diagnostic results. It’s a thrilling time, as my colleague Dr. A. Jordan Wright says, to “be brave” with our work as we navigate challenging circumstances to do our best in helping these families.
Catch up with the Testing Psychologist podcast online, via Apple Podcasts, Google Podcasts, or on Spotify.
Already the most reliable platform in the industry, PARiConnect continues to grow by adding features that complement your online practice. One of our newest additions to PARiConnect is the introduction of the interactive bell curve, where you can:
The interactive bell curve can be accessed within the PARiConnect Quick Links section.
Don’t have a PARiConnect account? Register for free and get 3 free assessments and reports.
Although NASP 2021 will not be in person this year, there are still so many opportunities to connect, learn more about your favorite PAR products and authors, and interact with PAR staff members. Join us during one of the following sessions:
LIVE session! Attendees will receive NASP CPD credit
Wednesday, February 24, 1:30–2:30 p.m.
Teleassessment With Children: Strategies for Success
Presented by Carrie A. Champ Morera, PsyD, NCSP, LP; Terri D. Sisson, EdS; and Dan Lee, BS
On-demand sessions! Attendees can claim CPD self-study credit
A Process Oriented Approach for Identifying and Remediating Reading Disabilities
Presented by Steven G. Feifer, DEd, and Jack A. Naglieri, PhD
The Neuropsychology of Written Language Disorders
Presented by Steven G. Feifer, DEd, author of the FAR, FAM, and FAW
Identifying Students with ADHD: Evidence-Based Assessment with the BRIEF2
Presented by Peter K. Isquith, PhD, coauthor of the BRIEF2
Tests and Scales: Evidence for Integrative Assessment of Executive Function
Helping Students Show What They Know: Enhancing Executive Functioning
Presented by Steven C. Guy, PhD, coauthor of the BRIEF2
State of Affairs: Trauma Assessment Practices in Children and Adolescents
Presented by Carrie A. Champ Morera, PsyD, NCSP, LP, PAR Project Director
Visit the booth!
Enjoy our industry-best Customer Support at our virtual booth. Make sure to stop by the virtual booth to download your coupon for 15% off all orders placed February 23 to March 9.
Register for NASP now! We can’t wait to “see” you online!
PARiConnect is the industry’s best online assessment platform. And now it has gotten even better with the introduction of the Digital Library.
What is the Digital Library?
It’s an online location within PARiConnect that stores all e-Manuals purchased from PAR in one convenient place.
How do you access the Digital Library?
Simply log into your PARiConnect account to access all your materials. Once you are logged in, you can find the Digital Library under the Quick Links section.
What are the benefits of the Digital Library?
Additional flexibility! Now you can easily access your materials from most internet-connected devices.
Have digital manuals, but don’t have a PARiConnect account?
Register for free and get 3 free assessments and reports plus easy access to your digital e-Manuals.
Whether you are new or experienced PARiConnect user, Director of Customer Support Daniel McFadden will teach you tips and tricks to help you get the most out of PAR’s online assessment platform.
On Thursday, February 4, new users can get a real-time tour of the platform. This webinar is ideal for users who are just getting started.
On Friday, February 5, users who are looking to delve deeper into the lesser-known features of the platform will get an opportunity to learn time-saving shortcuts and understand advanced settings and options.
Furthermore, both sessions will introduce users to the newest features on PARiConnect—the interactive bell curve and Digital Library!
Register now for these free webinars! Space is limited.
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!
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.