Hello, everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp. A licensed psychologist, group practice owner, and private practice coach.
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Hey, everyone. This is Dr. Jeremy Sharp. Welcome back. Glad to have you.
Today is part two of the report writing mini-series. And if you didn’t catch the first part, last week I talked all about making our reports more readable. And this week, I’m going to be talking about what to actually include in our reports.
You might say to yourself, “Oh, that’s pretty easy. I know exactly what to include.” We include that the background, the results, the recommendations, the interpretation, the history, and maybe a few other things depending on your setting. But I would like to challenge you to ask the question of whether all of those things are necessary.
I’m going to be talking largely about Karen Postal et al’s Stakeholders article which I found that our audiences frankly find certain parts of the report a lot more valuable than others to the point that in our practice we have cut out a significant portion of the reports that we used to include.
So listen on to find out what that might be and how you might structure your reports a little bit differently to make them more user-friendly and guarantee that folks are actually reading them.
Now, if you are an advanced practice owner and you are looking for some support in growing your practice, I am launching another section of the Advanced Practice Mastermind Group. The first one filled up quite quickly, and we started a second section. I have about 3 spots left, maybe 2, and I would love to have you reach out if that fits the bill for you.
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All right, let’s get to this discussion on what to include in our report.
All right, let’s dive into it here. This whole topic is something that I’ve been thinking about for quite a while. Probably dating back, I don’t know, 5 years, 6 years, something like that. I talked about in part one here and other times on the podcast that I was trained in the modality of writing lengthy psych reports or neuro-psych reports. I’m talking like 30 to 40 pages of just solid text with some tables thrown in there for a little variety.
And after I was in practice for a few years, I figured out that this is maybe not the best way to do things. And when it really hit home for me is when I was giving a presentation out in the community to non-psychologists or non-testing psychologists rather, and someone raised their hand and asked the question, what is the best way to read a psych report and get the most from it? What is most important? And instinctually, I found myself answering just flip to the end.
Afterward, I was thinking, why in the world are we writing all of this information if I’m telling people to just flip to the end, right? Does that resonate with anyone? And so from that point forward, I’ve been doing a good bit of work trying to figure out what the best way to structure reports is.
I got a nice kick in the pants from the workshop that I attended last summer at AACN 2019, but I mentioned last week, where Dr. Dean Beebe shared some research and summarized the Postal et al’s Stakeholders articles that went into great detail about audience preferences for report style.
Now, if you haven’t checked out this article, I obviously recommend that you really dig in and gather all the details from that and read through and digest that information. But what I’m going to be talking about today is really a summary of that article with some other experience and information thrown in there.
One of the main things that I wanted to highlight from the article which dovetails with my own experience at that community presentation that I just talked about is that only 15% of the neuropsychologists surveyed in this article believe that their referral sources read the entire report. 15%. That is remarkable. So that begs the question, of course, if so few of us feel like people are reading the entire report, why are we writing the entire report?
To go along with that, only half of the referral sources surveyed stated that they are reading the entire report. So let that sink in for just a second. Only half of the referral sources are actually reading the entire report. So just based on those two very simple statistics, I think we’re already creating a compelling argument that it’s worth revising our reports to make sure that we’re only including the most important information.
Related to that, I’m just going to continue to kind of drive this point home, only 30% of referral sources, rather a full 30%, to me, this is quite a bit. A third of referral sources said that neuro-psych reports were minimally effective in communicating the findings. Okay, that’s not good. To me, that speaks to both readability like we were talking about last week, arrangement, and inclusion of content.
With all these statistics as the backdrop, what is emerging from the stakeholders’ article is the idea that more than anything less is more. When it comes to reports, less is more. When the respondents were surveyed, here are the things that they found most important in the report. The most important thing was the diagnostic section. So diagnosis, impressions, and recommendations. These are the sections that other people (audiences or referral sources) found to be the most valuable.
Next in line was the cognitive results. And by cognitive results, I mean scores in tables. Only about 25% of referral sources found the descriptions of cognitive domains helpful.
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All right, back to the podcast.
Then beyond that, just take a guess as to what was the least important part of the report as far as referral sources are concerned. Let me give you just a couple of seconds to think, say it out loud, say it in your mind.
Okay. So in this Postal et al’s Stakeholders article, the history was found to be the least important part of the report with the description of effort and emotional functioning following close behind. So interesting.
Some of you might be saying, well, this goes directly in the face of my experience. And that could be true. I’ve heard the same thing from my referral sources that they really appreciate a lengthy history or that the history really helps them get to know the client. Those examples are out there. I’m merely reflecting on the results from this particular research study.
So, if we just take the first two parts of that and break it down. So diagnosis, impressions, and recommendations were the most valuable. Doesn’t it make sense that we should maybe lead with the most important information front and center in our reports?
I know speaking for myself that we have historically, up until probably two years ago, buried the diagnosis, impressions, and recommendations in the back. That’s why I told people in that presentation to just flip to the back to get to the good stuff. So, doesn’t it make sense that we might lead with the most important information- the information that people find most valuable?
I’ve heard this approach called the inverted pyramid. I’m sure there are other names for it, but that’s the one that I’ve heard used most often in describing that kind of report template where you lead with diagnosis, impressions, and recommendations and include the other stuff beyond that. So in fact, this is the approach that we have adopted in our reports over the last several months or years. And what it looks like very practically is, the first section of the report right up at the top of the header says, The reason for referral. It’s a very brief summary. Right after that, it has the Diagnosis. Right after that, it has the Interpretation/Summary. And right after that, it has the Recommendations.
Then we sign the report. And from that point in subsequent pages, the history and the results and the behavioral observations and the list of tests and all of that stuff is stuck in the back as appendices. So, that’s something to think about.
For a lot of you, if you’re saying, “Wait a minute, what about the results section?” And by results, I mean that whole section that a lot of us probably engage in, that I used to engage in, where we would describe the test that we’re giving. The WISC is a standardized test of intelligence for ages 6 to 16. It measures that dah, dah, dah, dah, dah. And then the descriptions of each of the indexes, the descriptions of each of the sub-tests, the descriptions of the scores and what they mean, and what range they fall in. You might be saying, what about all of that?
Well, research would say that not a whole lot of people find that helpful. So the idea is that anyone who… it’s basically two parts, right? It’s the description of the domain and the subtests and the abilities that you’re measuring, and then it’s the actual score. So the rationale for eliminating the results section entirely is that the scores are stuck in the back in a table for anybody who wants them or knows how to read them, and the explanation of the domains is included in the interpretation and summary if they matter. And if they don’t matter, you should not be including them anyway.
This for me, it took a lot to wrap my mind around this because I was trained in writing these comprehensive reports that included all of this information. But frankly, again, the research would say that not a lot of people need that information or find it that helpful.
So with that in mind, you’ve now got perhaps the idea of an inverted pyramid leading with the most important information, cutting out the results section, and just putting your scores in tables at the end for the people who want them. What else?
So, the main things that we’re trying to do with the report are basically: answer the referral question, make helpful recommendations, and then communicate this information effectively. And I think that adjusting the style of your report probably does these things better than a lengthy convoluted jargon-filled report.
Now, some other things that you might consider that people found helpful are graphics. So the research again would say that the audience or referral members found graphics to be helpful in interpreting scores in the report. So think about that. I know there are some programs out there that can really help with a graphical representation of scores.
As far as recommendations, this is a big area of adjustment for me. Some tips there are: use bullet points always. Do not bury your recommendations in lengthy sentences and paragraphs. So use bullets, be direct as possible, again, do not have a paragraph per recommendation. Don’t disguise or bury the actionable recommendation in the text. So make that very clear what you’re recommending and what they should do. And something that I really had to get used to was not repeating the justification for the recommendation in the recommendation. For example, I used to say, due to first name’s low processing speed and anxiety, it is recommended that first name receive 50% extra time.
So the idea is that you do not repeat the justification because you’ve already said that once in a report. So unless you’re in a situation like… I mean, I’ve seen this come up when writing reports for testing accommodations, say for college board, MCAT, SAT, ACT, that sort of thing. Sometimes they require a little bit more explicit justification for your recommendations. That might be an exception where you really have to do that. Otherwise, you really shouldn’t repeat your justifications for your recommendations.
There is some, I think, debate around how many recommendations to include. We still fall on the side of offering fairly comprehensive recommendations. I think the prevailing theory that is emerging is that you should really only recommend what people need to do now to help themselves or their kid(s). So the subtext there is that you don’t provide an overwhelming number of recommendations because people just sort of get lost and they don’t know what’s important and often just end up not acting because there are too many recommendations and they’re not sure where to go.
So a little hybrid that we have ended up adopting is, when we start the recommendation section, we have a little subheading that says “Main recommendations or Primary recommendations” and we list the top two to four ideas that they should be pursuing immediately. Like these are your next steps. And then, then we include another subheading that says “Full recommendations” and explain, these things will be helpful. They may not be as helpful immediately, but they are here for you to consider down the road. That’s sort of the happy medium that we have found to include comprehensive recommendations but still keep it nice and simple for folks to read through and act on.
I don’t know if some of y’all have gotten this feedback but I know in the past that referral sources, at least around here for me, have commented explicitly on how the comprehensive recommendations and really the comprehensive report, in general, was very helpful. Writing a nice long report does provide a contrast to certain settings, hospitals certainly, and other locations or settings. And I think people, for better for worse, maybe conflate quantity with quality.
I’m going to give an example from the workshop again, Dr. Dean Beebe’s workshop from AACN. Last year, when he… and I’m going to butcher this because I don’t have it right in front of me, but it’s something along the lines of, he showed us an email from a client. It was basically feedback about a report. And the email said, “This is the most helpful report I’ve ever seen. Thank you so much. I appreciate you taking so much time and getting to know our child as well as you did. I know exactly what to do.” On and on and on praise for this report. And then the punchline for the story is that that report was two pages long.
So, I don’t know that we have to go that extreme, especially in private practice. And of course, the asterisk with all of this is that in certain settings, forensics seems to be the one that comes up the most, certain settings require or prefer a lengthier report. Okay? So I do want to say that.
But the takeaway from all of this is that I think it’s worth looking at your reports and doing a hard investigation of what is actually useful. What does the audience want to know? And how are you communicating that information? My hope is that you might be able to save yourself some time and save yourself some mental energy from writing those parts of the report that are less useful, and you’re just burning energy doing that when no one is going to read those things. And that way you can spend your energy on the more important parts- the parts that are really what we’re getting paid for which are the interpretation, summary, and recommendations.
All right. Like last week, there will be a couple of resources in the show notes. There are some great books and articles out there on how to hone your reports. There are folks out there who can certainly help you with this process. Again, Stephanie Nelson at The Peer Consult has written a lot on streamlining your reports, readability, and so forth. Jacobus Donders has written Neuropsychological Report Writing. It’s a great book that has concrete examples of how leading clinicians in the field in different settings write their reports. So, do some research, dig in. This could be a great activity over the winter holiday if you have some time off is to really revisit your report template and figure out if it is working for you.
All right. Thanks as always for listening to this little mini-series on report writing. There is so much we could say here, but my intent with this little mini-series was just to again, get you thinking about writing your reports differently and hopefully inspiring some action in that regard to help yourself and help your referral sources.
Like I mentioned at the beginning, if you are a group practice owner and you would like to join a coaching group that will keep you accountable for reaching some of those goals in your practice, I would love to have you check out the Advanced Practice Mastermind. We have 2 or 3 spots left. You can learn more about that group at thetestingpsychologists.com/advanced.
Okay, everyone. I will be back with you on Monday with another clinical episode. Take care in the meantime.
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