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.
During in-person assessment sessions, you're in control of setting up the physical environment to make it conducive to success. When you work with children and adolescents via telehealth, specifically for teleassessment, you provide not only clinical services but also guidance to prepare younger clients for their remote sessions. Failure to do so can interrupt telehealth treatment or teleassessment, decrease remote participation and engagement, and jeopardize the ideal conditions needed to establish rapport and build a therapeutic alliance.
Here are 10 tips to consider as you design and maintain a working teleassessment environment with children and adolescents.
Before your first remote session with your student, let them know what to expect. Replicate what you would do during an in-person session.
Before beginning teleassessment, ensure your client has all the materials they need. We developed a checklist to help you get started, available here.
Provide the client with a moment to adjust after entering the assessment space. Take your time. Children may need some time to orient themselves to the virtual space.
Assess the environment. Ensure your client is in a quiet and comfortable environment, has a clear working space, and has minimal distractions. Be proactive and develop a safety plan.
Establish boundaries and expectations. Expect the child or adolescent to come prepared for the session as if they were meeting you in person.
Consider factors unique to teleassessment—for example, age. For younger children, testing sessions may need to be shorter depending on the type of task the test requires.
Openly discuss technology and platform challenges. Discuss and plan for any challenges with internet connections and anything relevant to the platform you are using.
Discuss any concerns about teleassessment. Though many individuals are comfortable with technology and using devices in general, they may be fearful or lack confidence about engaging in telehealth.
Consider your physical environment and telehealth setup. Mimic your in-person setting as much as you can. Maintain neat dress, minimize distractions, display a clean background, use sufficient lighting, and have your technology devices and materials ready.
Relationship is key! Go back to the basics. What helps you establish rapport when you're in person? Apply some of the same strategies when using telehealth.
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!