185 Transcript

Dr. Jeremy Sharp Uncategorized Leave a Comment

[00:00:00] Dr. Sharp: 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, licensed psychologist, group practice owner, and private practice coach.

PAR offers the RIAS-2 and RIST™-2 Remote to remotely assess or screen clients for intelligence, and in-person e-Stimulus Books for these two tests for in-person administration. Learn more at parinc.com.

Welcome back, everybody. It is so good to have you here. I hope you are all doing well. Let’s see. What are we talking about today?

So today I am doing a summary of the article from the IOPC, the Inter Organizational Practice Committee, all about guidelines for assessment during the pandemic.

So this is the most [00:01:00] recent article that came out from the IOPC, co-authored by Karen Postal, Bob Bilder, let’s see who else was on that co-author list? It was a real rockstar co-author list. So, check that out. It’ll be linked in the show notes, but I’m going to summarize the article for any of you who may be running low on time to read articles. I know that is often the case for me.

Just to provide a brief summary. I think this is a great piece of work to pull together the existing research. I don’t know that there’s a ton of new information in the article compared to what I’ve seen over the last several months, but I also acknowledge I’ve been paying pretty close attention to this because I’ve been doing a number of presentations on remote assessment for different entities. So I’ve kind of stayed tuned into it. For those of you who may not have been [00:02:00] reading everything that’s out there, this is a nice, like I said, summary, and it really, really pulls together the state of the literature right now. It’s small literature granted, but it pulls it together quite nicely.

Before I get to the actual episode, I want to invite any of you beginner practice owners to check out the beginner practice mastermind group. This is a group coaching experience just for testing psychologists who are launching a practice in 2021. So I think we have one or two spots left at this point.

The group starts on March 11th. So. Let’s see, two weeks before that gets going. And yeah, if you are thinking about launching a practice or maybe just launched and trying to get some traction and need some support and guidance, this could be for you. You can go to thetestingpsychologist.com/beginner and get more information. You can also apply for a pre-group… sorry, [00:03:00] I always say that. You’re not applying for a pre-group call, you are scheduling a pre-group call and then we’ll figure out if the group is a good fit for you. You’re not really applying for anything, so don’t get scared. But you can get more information and schedule that call at thetestingpsychologist.com/beginner.

All right. Let’s jump to the summary of the latest IOPC guidance on assessment during the pandemic.

Okay. Let’s dig into this latest article from the IOPC. So the article starts with an outline of why neuro-psych assessment is important. It cites a little bit of literature explaining the utility of neuro-psych testing and how [00:04:00] it does add something to treatment and conceptualization above and beyond what can typically be found through more traditional means like interviewing therapy, and other modes of client contact. So that may be interesting for some of you. I know that this is a side note, but I have run into one particular insurance panel that will not approve any hours for neuro-psych assessment because they have claimed that the literature says that it does not provide any benefit above and beyond therapy as usual. So that might be valuable if any of you have run into a similar situation.

After, they spend just a bit of time discussing why a neuropsych assessment is important. Then it goes into a section where it talks about the dangers of delaying a neuro-psych assessment during the pandemic. And they cite a number of examples of how [00:05:00] this might be the case. As you might guess, one of the examples is medical conditions getting worse. For example, someone with epilepsy, uh, waiting for a neuropsych eval before getting surgery, and then they have to endure further seizures while they’re waiting.

They talk about increased risk of accidents, for example, in older adults or individuals who are experiencing cognitive decline. So any amount of time that they go without a neuro-psych assessment to guide them and guide their families on treatment could result in increased risk of accidents and them hurting themselves or someone else.

They also give an example of academic performance declining in kids if we put off the assessment of learning disorders. And they also cite an example, just a random example of psychiatric concerns getting worse, and of course, [00:06:00] suicide is one of the things that we think of right off the bat with a situation like that. So, so they talk through again, a number of risks or dangers of delaying neuro-psych assessment during the pandemic. So, kind of building the case that we do need to find a way to do this or continue to do this.

Now on the flip side, the article then talks about the risks of performing an assessment during the pandemic.

The first thing that they talk about is contracting COVID-19, of course. So this would apply to the clinician or the client. Related to that, they discussed the risk of transmission to the community. So, even if you or the client presented as asymptomatic, the transmission to the community could be quite problematic. They discussed the idea that the validity of the assessment could be undermined by [00:07:00] anxiety, either anxiety about the illness or anxiety about a divergent process, modifying the test administration format, and so forth or PPE, so assessment being undermined by poor validity, secondary to anxiety.

And then they also talked through, what I thought was a helpful section. This is information I’ve seen before, but it’s nice to see it recapped where they talk about legal risks as well which would fall into a couple of camps. The idea that practitioners might be questioned on the validity of results from an evaluation conducted via alternative means or an unstandardized format. And they also talk about the idea of your liability insurance, maybe not covering the transmission of illness within your office. So if those are things that are [00:08:00] concerning for you, you could certainly check that out to make sure that your liability insurance would cover you. And if not, that may inform your decision.

So after that, the authors of the article transition into the typical models for doing assessment during the pandemic. And throughout the article, they have a couple of nice tables or infographics, I suppose, where they talk about sort of the balance of validity of the assessment with safety and how those really are two sides, polar opposite, you know, like when one goes up, the other goes down. There’s an inverse relationship. That’s what I was looking for. So there’s an inverse relationship between validity of the assessment and safety of the assessment. And we have to balance those things.

But the models map onto that idea I[00:09:00] think pretty clearly where at one end of the spectrum, we have in-person assessment like we did pre-COVID. This is what they call it, the gold standard. After that though, things get more interesting. So many of you have maybe heard some of these methods being discussed on listservs or podcasts and whatnot, but one of those is an in-person assessment with PPE.

This is the model that we have been using in our practice, which is an outpatient mental health practice over the last, I’d say six months, since probably June or July. Now we have had relatively low case rates for most of that time compared to many parts of the country. So that’s certainly a factor to keep in mind and something that I’ll circle back to when we talk about decision-making for which model you might pick. But in-person with PPE is one model to choose from. It’s sort of one step removed from totally in-person, no PPE.

[00:10:00] Now they make sure to point out that we still don’t have great research or really any good research on the impact of using PPE during the administration. We don’t know how that affects the validity or the performance that we might get from someone. And that really runs the gamut. So you could be masked, could be face shields, could be the plastic barriers. We just don’t have good research on the impact of using PPE, at least as far as they specified.

So the next step up with a little bit more protection or distance or buffer with regard to COVID is in-clinic tele-neuropsychology.

Let’s take a quick break to hear from our featured partner.

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All right, let’s get back to the podcast.

I have been calling this the hybrid model. It looks like that terminology is not exactly right. But this is the model where both the client and the practitioner or clinician are in the same office suite but they are in different individual [00:12:00] offices and the assessment is taking place really over telehealth entirely.

Now, it may be proctored, it may not be proctored, but that’s the setup here. The interesting thing about this setup is that this is where most of the research has been conducted as far as tele-neuropsychology. It is a nice setup, but the authors point out that it is not ideal because many people still say that when you have to modify the administration of a measure that is doing it over telehealth and introducing a proctor and whatnot, that it is changing the test that you’re in effect giving a different test at that point. And so we can’t even really call it then the same thing.

Okay. So the next model that they speak about is in the home tele-neuropsychology or direct to [00:13:00] home. They’re not super supportive of this. I don’t think many people are. It is maybe a better than nothing approach, but when you are testing into someone’s home, you really are introducing a range of risks just due to the lack of control of the environment. So you don’t know if people are in a private space, are they able to access fast internet, are they going to be protected from interruptions? And it also introduces a barrier in terms of keeping track of the individual and their health and their performance. And it’s just one more step removed.

They also point out rightfully so that lack of access can become a really big issue, particularly, lower SES clients and certain racial or ethnic groups that [00:14:00] certain folks don’t have internet access at the same rate or at the same speed and are less technologically literate than others. So if that’s something that… these are just variables that come into play when you test directly to home.

And then lastly, they mentioned the idea of a hybrid. Now, a true hybrid, or at least the way that they define is actually the mode that we are using, which is doing feedbacks and intakes over telehealth but doing the testing in person with PPE. And there are any number of combinations that you could use to do a hybrid model.

Now, perhaps, more importantly, the authors then walk through a rubric for how to make the decision on what to do and which of these models to choose. So there are a number of factors to consider.

The first is urgency. So we touched on that at the beginning of the podcast, but [00:15:00] urgency of the case and whether it is going to be more or less risky to conduct the assessment now. And there are so many factors that could go into that, but that’s the first component that you want to consider. What is the urgency here?

The second one that they talk about is symptom acuity. So, it can go both ways. Is the symptom so acute that it’s going to, going to color the assessment in the wrong direction? But on the other side, are these acute symptoms that actually need to be assessed as quickly as possible in order to help the patient as quickly as possible? So symptom acuity is something to take into account.

The next point to consider is incremental validity. So this is really getting at the question of, will testing add much to the referral question or is it necessary to test right now such that it would [00:16:00] add useful clinical information above and beyond what is already known? And they give the example of course, of a kid who has a previous diagnosis of dyslexia and wants an updated assessment, well, you probably don’t need to go through and give a full neuropsych battery at that time, you can just do the reading specific measures and other pointed narrow-band measures to get at the referral question rather than a more comprehensive battery, at least right now.

Another factor that they discuss is the health risks for the client and the clinician. So thinking for yourself, are you in a high-risk population? And there are a number of qualities or characteristics that might place you in a high-risk category. You can find those on the internet, at CDC, et cetera. [00:17:00]But also for the client, is the client in a high-risk population? And is it going to behoove them to go through this assessment?

Another factor, the last one that they talk about are the community factors. So being aware of the broader context of COVID-19 in your community, the number of cases, the transmission rate, the positive test rate, all of those factors. These are sort of the epidemiological factors, I suppose, that help drive decisions about what to do around the community and whether people are able to open their businesses or kids go to school and whatnot. So just being mindful of your community factors and how that might impact your community if there was some spread within your office.

Now the one thing I was really kind of hoping for a more definition [00:18:00] or a concrete discussion of how to weigh these factors, of course, I think that’s really, really hard. But they basically just say, here are the things you need to consider and then choose for yourself what makes the most sense when you weigh out all these options?

The article then goes into a section on preparing to reopen your practice. I think this stuff has been pretty well discussed in previous articles and other resources that are out there.

I’m not going to go into great detail about preparing to reopen, but it is nice. They actually go through and they kind of compile all the information that I’ve seen out there over the past year on what to do throughout the testing process. So things that you need to do before the patient arrives, things to do upon arrival- that’s like temp checks and things like that, what to do during the appointment, minimizing [00:19:00] contact, et cetera, and then afterward and wrapping up. So that was a nice section of the article. Even though it’s not brand new information, it is nice to have all in one place where you can just see the bulleted list.

They do emphasize moving to electronic forms if you haven’t already. So using something like IntakeQ for example. There’s a link to that in the show notes, but some means of sending electronic form so you’re not having to pass paper back and forth.

And then, to start to wrap up, the article talks about informed consent and how to account for non-standard administration in your report.

So they give a few examples of places where we need additional informed consent where we might not have otherwise had them. So there are examples of providing informed consent [00:20:00] for in-office assessment when someone is coming in and running the risk of contracting the virus. There is an informed consent for tele-neuropsychology and there is a separate informed consent for the hybrid model.

So the moral of the story here is that your patients just need to know what they’re getting into and it’s up to you to provide these informed consents to make sure that they know what to expect.

And then the last part, like I said, is they give a nice sample paragraph for how to explain the non-standard administration in your report text. And that was really cool too. I’ve um, gotten a lot of questions over the past year or so about how do you explain how the administration changed and account for that in the report? And so this is a nice paragraph. We use it in our practice and have been [00:21:00] for several months.

All of these tips and tricks and everything from the article will be linked in the show notes. So I do have the article linked and you should be able to access it relatively easily.

Like I said, it’s not a lot of brand new information. I think I was maybe hoping for more of that, more conclusions around what we should “be doing.” But it’s a nice compilation of all the information that’s out there and a nice summary of the research as far as we know so far on tele-neuropsychology over the last year or so.

So I highly recommend that you check it out. It’s a quick read. I went through it in I don’t know, maybe 15 or 20 minutes, maybe less than that. And it’s relatively short. So definitely worth checking out to see if there’s anything there that you have not been putting in place or might need to brush up on.

[00:22:00] So thank you as always for checking this out. A little bit of a shorter clinical episode today. We’ve got some great interviews coming up over the next month or so. We have another masterclass coming up. We have, let’s see, interview with a two psychologists around validity and performance factors in ADHD assessment. I’m going to be interviewing the co-developers of the Spectra personality measure.

Let’s see. What else? There are a two other great ones. They’re just slipping my mind right now.

So yeah, stay tuned. If you’re not subscribed to the podcast, now is a great time to do that. If you have any friends who you think might want to listen and they aren’t aware of the podcast, spread the word, that’s always great. And it’s been a pleasure to continue to do the podcast and bring some of this info to you. So I will [00:23:00] be back on Thursday with a more businessy episode and I hope to see you there. All right. Take care.

The information contained in this podcast and on The Testing Psychologists website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment. Please note that no doctor-patient relationship is formed here. And similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. [00:24:00] If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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