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[00:00:00] Hey everyone. Welcome back to The Testing psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m Dr. Jeremy Sharp, your host, a licensed psychologist, group practice owner, and private practice coach.

Today’s episode is all about returning to in-person testing. This is slowly but surely becoming a reality for some of us around the country, and it is worth chatting about as some of us get back to in-person assessment.

This is not meant to be a comprehensive, super detailed look at in-person assessment. That’s a huge topic. And we could probably spend entire podcast episodes just on types of PPE or what to do before the appointment or how to [00:01:00] sterilize your equipment and things like that. It is meant to be a nice overview of processes and procedures, things that are floating around the web, things that we are doing in our practice, and strategies that have come from the Facebook group. So we’ll dive into it.

The way I’ve organized it is things to do before the appointment, things to do during the appointment, and then a little bit about what to do after the appointment. I hope that you enjoy this content. And without further ado, let’s get to it.

Okay, everybody. Welcome back here. We are talking about [00:02:00] returning to in-person assessment and trying to decide, one, if this is a viable option for you, and two, if you decide to go that direction, how can you protect yourself and your clients, and the clinical validity of your assessment? So, trying to find the place where all of those intersect.

All right, so let’s dive into it. As I said, I’m going to start by talking about things to consider before your appointment. There are a few bullet points here to talk through.

The first one as far as I’m concerned is deciding if in-person appointments are even an option for you. There are two tools out there to help figure this out. The one that I’ve found that has been most prescriptive [00:03:00] and helpful is the Johns Hopkins risk management toolkit. Is it’s a two-part thing. It’s got an Excel spreadsheet where you have to answer certain questions pertaining to your level of risk, contact with people, and so forth. And then it assigns you a risk rating. And then you take that back to the second part of the spreadsheet and it talks about how to mitigate that risk or adjust that risk. And then you can plug that information into a flow chart that they have to find your ultimate level of risk for reopening.

When we walked through it or when I walked through it for our practice, the initial risk level was moderate. And then [00:04:00] after going through the questions to mitigate that risk, it turned out that we have a high level of flexibility and options to mitigate the risk and the overall risk turned out to be low. So it starts at very low and then goes to low, and on up from there. So, that was encouraging.

And then again, it provides even more guidelines or a checklist almost for how to address specific areas to mitigate your risk. So this might be cleaning procedures or limited contact with people or opening up your office, things like that. So that tool was really helpful. And can give you some peace of mind in terms of whether or not you should even consider reopening based on your practice setting.

The other component [00:05:00] that I found a lot of folks are looking to, of course, is some combination of guidelines from the CDC coupled with state and local guidelines, coupled with your risk management agency or your liability insurance and what they might say.

So of all these things, I think you want to go with the most conservative option and the one that protects yourself and your clients the most. It varies from state to state and city to city, honestly. So that’s why things can really vary. Even if your business comes up as low risk in the Johns Hopkins tool but you’re in a say, Arizona or certain parts of Texas right now, state and local guidelines would suggest [00:06:00] that you probably should not be doing in-person testing.

So, a combination of all those factors, all those tools can hopefully lead you in the right direction to decide if you are able to do in-person assessments or not. And if you’re not, there are plenty of other options out there. There’s been a lot of discussion and many resources available to talk through the in-office hybrid model, for example. Even direct at-home testing. There’s been a lot of discussion about that. And some folks out there are moving to a model of testing outdoors, either at the client’s home or at an outdoor space that is otherwise private and secure. So there are options out there if you can’t do in-person testing. And I would imagine that the majority of us probably are not doing a lot of in-person assessments right now. So,[00:07:00] before you do anything, you really just have to decide if this is viable for you.

Now, before again, before the appointment, and this is outside of the testing appointment, but at least as far as we’re concerned, we are still doing intakes and feedbacks completely remotely. I want to throw that out there that the only thing that might be happening in person is the testing appointment.

Now, one of the factors involved in protecting yourself and your client is limiting contact. I filed this under before the appointment because it technically does happen before the appointment, but using electronic forms is a great way to limit a little bit of contact. That way, you are cutting down on the amount of paper that is being passed back and forth between people.

Now, I know the research is mixed about whether it’s being transmitted on [00:08:00] surfaces or not, and if so, how long it can survive and so forth. But for being conservative, electronic forms can come in really handy. In our practice, we use IntakeQ. A lot of folks are using IntakeQ. At the same time, a lot of electronic health records like SimplePractice or TherapyNotes also provide the capability for electronic forms. So you can certainly go that route, but using electronic forms in some form or fashion, no pun intended, is important.

Now, if you decide that you’re going to do some in-person testing, you’re going to need to acquire some personal protective equipment or PPE and maybe some other items. The dominant theory or way of operating right now seems to be a combination of PPE with an air purifier, with a HEPA filter.

As far as PPE goes, [00:09:00] you can likely sign up for an Amazon business account as a psychologist, you enter your NPI, and you should be able to verify your ability to purchase PPE through Amazon business. If you have any trouble, you can contact customer support. Some people are having trouble, but you can go that route and they should be able to hook you up with a business account and validate your ability to purchase PPE.

As far as the actual PPE that we are using, many of us are doing a combination of masks, traditional masks over the face, along with plastic barriers between ourselves and the clients. So they are, again, plastic, just plastic shields that you can put up on a table. Many of them are moveable [00:10:00] or portable. Some of them either come with or without a slot in the middle to slide things back and forth. And then some of us are also using face shields.

All of these things are just aimed at cutting down the transmission of the virus, obviously. There’s some decent research out there that says that the use of masks is really cutting down on the amount of virus in the air and then the face shields and the plastic barriers are, I think, really just to protect against any like truly airborne huge droplets that might be transmitted with sneezing or coughing and so forth.

I think this is a good place to say that at least the last time I checked, which was within the last two days, there is not any good research on the impact of masks and all this PPE on test [00:11:00] validity. So, it’s hard to speak to that. That’s hard to speak to that.

I think the question that’s been floating around a lot is the trade-off of doing testing in person with PPE. Is it a greater concern or does it make a greater impact than doing testing without masks and PPE but over telehealth? We just don’t know that yet. If anyone is aware of any of that research that might provide some clarity, please either let me know or post in the Facebook group or comment on the blog post for the episode here. So, that’s the question.  A lot of us though are moving to in-person with masks, face shields, plastic barriers, and so forth.

Now, I [00:12:00] mentioned the air purifier with a HEPA filter. There is some evidence that these devices have been effective in the past against similar viruses and that they hopefully are protective here as well. They’re plenty out there. They might be in short supply. I listed the one that we use in the show notes.

I’ll give a shout-out to the Facebook community member, Rebecca MurrayMetzger who recommended the Germ Guardian brand. So we are using those. But there are a variety of air purifiers out there. Just make sure they have a HEPA filter. We got ones that have UV light as well. So I think the combination of those two can be quite helpful.

Another component that needs to happen before the appointment is informing the client of the changes and really making sure that they know what to expect. This really speaks to the informed consent component. [00:13:00] We do this in a couple of different ways. We are talking with our clients at the end of the intake to let them know what to expect from in-person testing. There is quite a process involved and it’s very different than just your normal show up to the office and going to your appointment.

Some of the things that we talk with folks about include: having a “virtual waiting room” which means clients come and they pull into the parking lot, and then they contact us either via email or phone to let us know that they’re there, they’ve arrived and that they can then walk up to the office where we’ll meet them at the door. We’re not allowing anyone in our waiting room at this point.

If you do have to have clients or parents in your waiting room or family members for whatever reason, what we’ve done is, [00:14:00] instead of putting them in the general waiting room, we have an extra office that’s down the hall that we can sequester people in if they need to hang out and wait for a bit and actually stay in our office suite. I know that the hospitals are doing the same thing in co-opting additional space for more isolated waiting rooms.

We also talk with clients about the hygiene procedures upon arrival. So this is your standard hygiene process that has been out there for a long time. So wearing a mask, washing hands upon entry, hand sanitizing upon entry, some people are doing temperature checks. We’re not doing temperature checks. You can, certainly but we are not specifically, but that is a possibility as well.

[00:15:00] As far as logistics, the clients, like I said, are informed. We talk about this at the end of the intake. And then there is a pretty lengthy email that we send after the intake in preparation for the in-person testing appointment that details all of these procedures.

We have two extra forms that go out when we’re planning for the in-person appointment. One of those is consent to treatment in person during COVID-19. There are some samples out there. I’ve linked to one in the show notes for you to check out if you are curious about a sample form. Clients have to sign that. And then there’s also an example of a screening form for COVID-19 symptoms in the show notes. This is a form that clients fill out as close to their appointment as possible [00:16:00] with the idea being that they would disclose any symptoms that might prohibit them from coming into your office space.

Now, there are some other pieces here that you want to take care of before the appointment. One of those is just prepping your space. Again, like I mentioned, that we do not have our waiting area open. We have moved to spread out the seating in our waiting area so that if someone does come in for whatever reason, they’re socially distanced within the waiting area.

Another piece is just defining the cleaning process so that you know exactly what’s happening in the offices. Any area where the client is going to be, but specifically, your testing office. So, setting up your space, knowing [00:17:00] where everything goes, having your cleaning supplies right there, having your hand sanitizer available, all of those things. You also need to define your cleaning process for what happens during the appointment and after the appointment. And I’ll talk a little bit about that as we go along.

Let’s see. Defining and arrival process for the clients is also important. And by this I mean, be very clear about what they will do when they actually get to the space. So if this is an adult, it might be a little easier. You can just tell them directly. But if you’re working with kids, a lot of this happens after the parent has dropped them off. So, just make sure you know exactly what to do for the kids, like where they wash their hands and how they’re going to dry their hands. And do you have a touch-free trash can that they can use? When do you take them back to the testing office? What do you tell them when they [00:18:00] get back to the testing office? Where do they sit? What do they touch or not touch, and so forth?

Another piece that at least for me falls somewhat under prepping the space is making sure that your appointment times are staggered throughout the day. Again, just to limit the number of people in the office at the same time. It doesn’t have to be drastic, but even just offsetting arrival by a half hour or so can help quite a bit.

Let’s move to talking about what happens during the appointment. During the appointment is maybe a little more familiar and a little easier to anticipate than all of the prep that has to happen before the appointment. So basic social distancing. Do as much as you can to stay far away from your testing clients. That might sound [00:19:00] counterintuitive, but I think we know, there are certain subtests that are much more easily administered with social distancing than others.

Our setup these days is that we are basically doing social distancing for all of the subtests that do not require manipulatives or do not require us to truly be looking over the client’s shoulder at the work that they’re doing. So, these might be specific response booklet items where we have to be ready to correct them if they make a mistake or we have to monitor which items they’re getting correct or not to know when to end the subtest.

We’re social distancing as much as possible, staying six feet away. We have our air purifiers running in the room like I said. If you do not have an air purifier, you can take breaks to air out the room. You can certainly run a fan [00:20:00] if you have one available, opening windows is a great option as well. Anything you can do to get the air circulating is going to be helpful for you.

So, one thing that a lot of practices are doing is designating “clean and dirty areas” for materials that have been touched and need to be cleaned. So having a space in your office where you can put the things that the client has touched and the things that you’re going to need to sanitize after the appointment. And that could just be as simple as a little bucket or a Tupperware or a tray, like a litter tray. We’ve used those. Any of those things could work, but you need to have them handy and just make it very clear what goes where.

Now, of course, you’re doing frequent hand sanitizing. There was some back and forth about gloves and how appropriate those might be. [00:21:00] Some people can use gloves very well, and it actually cuts down on transmission, but for a lot of folks, it almost becomes more cumbersome. Anytime you would need to wash your hands, you would have to change the gloves. So, it’s just an extra step for, for a lot of folks. And we have opted not to use gloves for that reason. We just instead do frequent hand sanitizing and hand washing.

So just two other tips and ideas for during the appointment. One thing obviously, wear your masks at all times unless it’s going to compromise the clinical info or understanding the client or the understanding you. There have been just a few times when articulation was affected and comprehension was affected by the masks. And we’ve taken the masks off just [00:22:00] briefly to articulate again, of course, when clinically appropriate and within standardization.

Let’s see. Separate pens and pencils, that’s one of those little things that you may not think about, but having a container with client pencils and writing utensils and clinician writing utensils can be helpful. So that way you’re not handing them back and forth.

Laminate anything that you can. It’s going to be very helpful. So this might include policies in your waiting area. Might include your wifi information if you offer wifi. It could include testing materials, anything that you might hand the client. So, think about, for example, the word reading sheet in the WIAT. That’s already laminated, but similar items like that that you may need to laminate [00:23:00] yourself.

And then one last piece that I might mention is just to choose your battery wisely so that you’re being as efficient as possible. You’re not taking extra time to administer measures that you may not have to administer.

Let’s see. You need to plan for extra time to set up all your materials ahead of time. And what we’ve ended up doing is, like I mentioned earlier, just having a separate area and a separate container with all of the response booklets and manipulatives that the client is going to need to grab at some point. Have that setup and ready to go for them before the appointment starts so that we know that we will not have to touch or hand anything that we don’t have to.

All right. So after the appointment, this can be summed up in one word which is, clean everything. [00:24:00] Two words, clean everything. We have a number of ways of doing this. I’m sure that y’all have thought of creative ways to do this too.

We have a ton of Lysol wipes. We have Lysol spray. We wipe everything down. With some of the bigger things or things that are dishwasher safe, we can actually run them through the dishwasher sometimes. I’m thinking like ADOS toys. It takes forever to wipe all of them down. You can run them through the dishwasher. My gosh, y’all it’s late this afternoon. So yeah, you can run them through the dishwasher if you have one of those in your office. I recognize that’s a privilege to have something like that, but we use that sometimes. We’ll also just dump them in the sink and run a bunch of soapy water. We do it that when we get tired of the Lysol wipes, which can be cumbersome to go through every single [00:25:00] piece of toy or material.

Otherwise, some people advise opening the door, waiting 30 minutes after the client has left, and keeping your air purifier running just to limit your exposure that little extra amount before you go back in and then clean everything. So just give time for those virus particles to settle and hopefully disperse before you spend any extra time in there.

All right. So like I said, this was not meant to be super comprehensive. We could have spent tons of time on any number of these topics, but the good news is that really all I’m doing, to be honest, is summarizing the information that is out there and calling resources and bringing them together for y’all. So, the information is out there. Like I [00:26:00] said, the show notes will have a lot of links to some of the tools that I mentioned, the Amazon business account sign-up, sample forms, things like that.

If you’re looking for resources really on the whole world of telehealth and teleassessment specifically, you can go to the IOPC website in our organizational practice committee. They’re doing a great job of compiling resources, really in real-time, almost to keep up with the telehealth or teleassessment crisis, if you want to use that word.

So tons of resources there. And I would advise you to certainly check that out and spend some time on that website. But ultimately, we’re just trying to balance clinical validity with keeping people safe. We’re all scientists. We are all trained [00:27:00] in being discerning in our research and our decision-making and consuming literature. So do the best you can. Pull these resources together and make your best choice, and don’t be afraid to change it if you need to. Which reminds me, there is one thing, if you notice any signs of a kid being sick or an adult being sick, don’t be shy in that session and send them home. That’s there’s nothing wrong with that. We’re in crazy times. You got to do what you got to do.

Thank you as always for listening to the podcast. This has been fun. A couple of business episodes are under my belt now in this new model. I’m really enjoying it. I have a great content calendar planned out. So as we move forward, let’s see, upcoming content is going to be pretty good. I’ve got an [00:28:00] interview with Dr… Actually, I take that back. I’m getting lost in my own content calendar, you all. You all have already heard the interview with Rita Einstein. Next week, we’re talking about the essentials of traumatic brain injury with Dr.

Katie Scott, which is super fun. She was a former practice student of mine. And now, 10 years later is a neuropsychologist and coming on my podcast, which is amazing.

And then beyond that, I’m going to be really doing a bunch of episodes aimed at advanced practice owners. So, stepping back and how to design what I call a think week, time batching, hiring a VA, things like that. Mixed in there, we’re going to have, I’m finally releasing my international assessment series. So talking with psychologists from Australia, South Africa, and Russia. So, look forward to that as well.

If [00:29:00] y’all have a moment, I’ll be super grateful if you take that moment to rate the podcast. It is pretty easy, pretty quick, and you should be able to do that pretty obviously from wherever you are listening. I really appreciate that. It just helps spread the word and again, increase the exposure for the podcast, which is always a good thing for me and for others. So thank you. Thank you. Thank you. All right. Y’all hang in there. Take care. Talk to you next time.

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