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[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.

This podcast is brought to you by PAR.

The Neuropsychological Assessment Battery offers the combined strengths of a flexible and fixed neuropsych battery. And now, you can score any of the NAB’s six modules on PARiConnect, PAR’s online assessment platform. Visit parinc.com\nab.

Hey everyone. Welcome back to the podcast and welcome to the first episode in a new series that I’m going to run for the next two months.

The series I am calling Out There Assessment is meant to shine a spotlight [00:01:00] on practitioners who work in unique environments or have unorthodox or creative specialties, folks that are practicing in ways that many of us maybe don’t, or maybe haven’t considered.

Each interview is meant to follow the same structure rule. We’ll do a short exploration of the employment environment, talk about how the individual found themselves in that environment, talk about the pros and cons, and then talk about ideas about how to pursue that particular area of practice if you are so interested.

My first guest for this series is Martha Garrett. I had a delightful conversation with Martha. Let me tell you a little bit about her.

She is the psychologist for the North Carolina Division of Services for the Blind. She has a master’s in counseling and guidance school psychology and a second master’s in mental health counseling. She’s a licensed psychological [00:02:00] associate in North Carolina and Texas. Martha has worked in a variety of settings and has been in her current position for the past 16 years. I won’t reveal too much more about Martha’s work setting.

Without further ado, let’s jump to this conversation about working in the realm of assessing visually impaired adults.

Martha. Hey, welcome to the podcast. 

Martha: Thank you so much for having me.

Dr. Sharp: Well, thank you for reaching out and answering the call for an unorthodox or unique assessment environment. I’m excited to chat with you. I would love to just dive right [00:03:00] into it and start to help people learn about this environment. So, tell me about your unique assessment setting. What do you have going on here?

Martha: I work for the North Carolina Division of Services for the Blind and my role as the psychologist is to evaluate consumers referred to us by their home counselor. So that means we serve any and all individuals who are blind and visually impaired in the entire state of North Carolina.

Dr. Sharp: That’s incredible.

Martha: Most of the time people come to the center for about 5 days, more or less and my job is to do the psychological evaluation.

Now, with this particular [00:04:00] population, traditional psychological testing for the most part was not an option, just because with the vision loss, even if someone has a certain amount of usable vision, I have to be able to decide if when they miss something, did they miss it because they didn’t know it or did they miss it because they couldn’t see it? So, I usually just give the five verbal subtests of the WAIS and then try and fill in with other stuff. It gets even trickier for academic achievement if somebody has no usable vision and is not a fluent or proficient [00:05:00] Braille user.

Fortunately, I went to the training that Dr. Jack Dial does. And he developed a whole system of evaluating people who are blind and visually impaired. And I like to use the adapted Rat that he developed that has blind and visually impaired norms. So that’s a way to get an idea of somebody’s academic achievement skills.

Dr. Sharp: I’ve heard two other practitioners talk about that system. There are a few different tests in there, right? There are some options.

Martha: Yes.

Dr. Sharp: I’ll put a link to that in the show notes. I’m sure folks will be interested just in checking it out. And I’ve seen pictures and a demo of a couple of the [00:06:00] measures available. It’s pretty remarkable actually.

Martha: It is. For some individuals, I will give the entire cognitive test for the blind. But As I tell my interns, there are a lot of moving parts to it and because of the way it’s designed, it is pretty labor intensive and can take maybe a day, day, and a half to give.

Dr. Sharp: Oh, that’s a lot. That’s a big investment. 

Martha: The information is invaluable. 

Dr. Sharp: Sure. I’m so curious about this setting that you’re working in. There are a few things that jumped out I wanted to ask about. One is, where do the referrals come from? What are [00:07:00] some typical situations where these adults might find their way to you?

Martha: Well, we’re part of the Division of Services for the Blind is under vocational rehabilitation services, but we are our own entity. So all the referrals come from the consumer’s vocational rehabilitation counselor. So they have to be in vocational rehabilitation services and then the counselor will make the referral.

A lot of times it’s just, especially with somebody who recently lost their vision, it’s like the person wants to go back to work, but they have no idea what they can do. My part of the evaluation is to get an idea of, [00:08:00] say, somebody wants to go back to school, are they going to need a lot of training or an education maybe because their academic skills were not the strongest prior to the vision loss?

Dr. Sharp: Right. That seems hard to tease out.

Martha: And that’s where all the referrals come from. It’s from the home counselor.

Dr. Sharp: Okay. And just in case folks don’t know what vocational rehab is. Could you describe real quickly what that organization is about?

Martha: Vocational rehabilitation is the agency. Our function is to help people return to competitive employment. We are specifically for people who are blind and visually impaired. There’s [00:09:00] what we call general VR, which is the vocational rehabilitation for every other disability, but we are specifically focused on blind and visually impaired. 

Dr. Sharp: Got you! Yeah, I just finished up an eval for our vocational rehab here in Colorado just the other day.

Martha:  Awesome.

Dr. Sharp: Yeah. It’s a great service. The other thing I wanted to ask about, you said that folks will come and spend several days with you for this evaluation process. Help me understand what’s happening over the course of those few days.

Martha: Well, the cool thing is that the facility where they come is part of our career and training center. The evaluation unit is part of the career and training center. And so our individuals will stay. We have a dorm setting for our [00:10:00] students who come to classes. So they’ll come and stay overnight.

which is one of the things that we’ve discovered and I’ve discovered of the 16 and a half years I’ve been here is that just being with a group of folks who were blind and visually impaired is incredibly empowering for people because they may be the only person in their area that has a vision loss because VI is a very low-incident disability. So they get to be around other people who’ve lost their vision and are moving forward with their lives.

So they come in, [00:11:00] depending on the person, if they have a certain amount of usable vision, then they will be seen by the low-vision specialist and our low-vision optometrist. And I have to say, I feel like we have the best low-vision optometrist because she will spend whatever amount of time that person needs and will answer any question they have. She’s probably the kindest, gentlest person I have ever met who is incredibly knowledgeable.

Dr. Sharp: That’s wonderful.

Martha: Usually on Mondays, they get to spend the day with me. And that’s where I like to start with an initial interview and then I have some other surveys that I like to give before we [00:12:00] start into what I call the more conventional psychological testing.

So, I’ll do an interview. I have a personality inventory. I use the quality of life inventory because it’s a good way to get out where people are. And depending, if somebody says they’ve been depressed, they have some anxiety or some other stuff, I may give some other surveys like that, and then I’ll do the conventional psychological, the WAIS, some form of academic achievement, depending.

I am very fortunate that here we have two instructors who can help me give the braille versions of the Woodcock-Johnson and the Rat 5 because [00:13:00] I do not read braille or those two instruments are also available in large braille, so it’s just based on the individual. That’s on Monday.

Then one of those days, if they do need to see the low vision optometrist and specialist, they’ll see them. Then they do a vocational evaluation with our vocational evaluator to get an idea of what their interests are, what transferable skills they may have in their previous job, and what can they bring to a new environment.

And then I have my standard joke of, in terms of work values, if somebody doesn’t like being around people, customer service may not be the [00:14:00] job for them.

Dr. Sharp: Yeah, I think I’ve said that myself before. Sure.

Martha: And then we go over all the results with them, and then the report goes to the counselor.

When I first started, I wasn’t very good at making recommendations, but I got a lot better now, which is taking different things and just from my interactions with the person. And then for most people, let’s face it, the big thing, almost all of our folks are going to need is assistive technology, right? How to use your device. How do you access the screen reader?

Dr. Sharp: Right. And are you helping them with that there in the moment, while they’re there? 

[00:15:00] Martha: Recommendations. And as I like to tell people, I know just enough to make me dangerous. I can show them, okay, so if you have a computer, did you know that you do have a screen reader built-in? Here’s how you can access it.

Dr. Sharp: Yeah, I imagine that especially these days, our phones, our computers, there’s a lot of assistive technology built in, but the majority of us never have a reason to look at it or use it. It’s just a matter of accessing and figuring out how to turn it on and make it work.

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

The Neuropsychological Assessment Battery, or NAB, is a comprehensive instrument offering the combined strengths of a flexible and fixed neuropsych battery. It lets you administer the full battery, any of its six modules, or individual tests. And now the NAB modules are available for scoring on [00:16:00] PARiConnect, PAR’s online assessment platform. Learn more at parinc.com\nab.

Let’s get back to the podcast.

Martha: Right. That’s pretty much my role in terms of the evaluation process.

Dr. Sharp: Yeah. How did you find your way to this work setting? Was it an accident? Was it on purpose? You said you’ve been there 16 years. 

Martha: I got here. It was a point in my life where I was just ready for a change. I had reached the top of what to call the food chain at my previous job before I moved here, and [00:17:00] my dad passed. I felt like if I was going to make a change and now is the time. I actually had some friends who were living here, so I just had some money saved up, just packed up and said, okay, let’s do this.

I saw, whenever the job advertised, and I thought that’d be kind of cool. That’s one population I have not worked with and I applied. I got hired and I’ve been here since.

Dr. Sharp: What was that? I know many people we’ve had those flashpoint moments in our lives, it’s time to time to make a change of some sort. And it sounds like you took the lead, so not deliberate [00:18:00] necessarily. It was, Hey, I’m going to move to this place and figure out what to do. And the job appeared for you.

Martha: Yeah. I have another part of my job which is providing individual counseling services for the consumers here. And my clinical supervisor looked at my transcripts and stuff. I wasn’t, let me back up just a little bit. In Texas which is where I came from, I didn’t have to be supervised. They have what they call the exempt agency rule. I work for state of Texas. It’s an exempt agency. I didn’t have to be supervised because I’m a master’s level.

I moved to North Carolina and their board requirements are way different. So I had to be [00:19:00] supervised, and so my clinical supervisor felt uncomfortable because I didn’t meet the boundaries of competence, so the first four and a half years I was employed here, I was also in graduate school working on a master’s in mental health counseling.

Dr. Sharp: Wow. Did the job support you in that? 

Martha: Oh, yeah. 

Dr. Sharp: That’s great. It sounds like you not only had to be supervised, but you said you hadn’t worked with the population. So I imagine you were doing a lot of on-the-fly learning as well.

Martha: Exactly. I had had some experience with people who were blind but it was in a residential setting with people with severe, profound developmental disabilities, which is way [00:20:00] different. 

Dr. Sharp: Sure. What a journey. If you had to identify, what do you enjoy most about this work environment?

Martha: The consumers, there’s just such a broad group of people and they are to come here to the training center. They are the most courageous people I have ever met. And the reason I say that is because they are willing to confront everything that vision loss entails. And there’s a huge adjustment to the blindness process.

[00:21:00] Dr. Sharp: I’m sure that y’all just see people at their most vulnerable and their most empowered and brave catching them in such a meaningful time.

Martha: Well, I know I was really fortunate. There was a consumer who was here a number of years ago and when he finished the program, he looked at me and said, when it’s time for me to do my internship, can I do it with you? And of, course, I said, you bet.

Well, 8 years later, he shows up and says, I’m ready and I said, okay, do. And because he was visually impaired, he wanted to formalize an adjustment to blindness class [00:22:00] where we talk about the process of adjustment to blindness. It’s not group therapy. It’s a class where we talk about it. We did it. We did a pilot and the consumers enjoyed it. The teachers felt like it made an impact. So it’s now part of the curriculum.

Now, it is voluntary and it’s open because we have what we call rolling enrollment, and that’s probably been the other exciting part is offering an adjustment to blindness class, and we are one of the few places that addresses adjustment blindness.

Dr. Sharp: Sure. I could see that [00:23:00] being powerful. It’s something that those folks need, especially if they’re newly visually impaired. That’s remarkable. Are there any parts of the position that are more challenging for you or things that you could do with less?

Martha: Yeah. Well, my background is in institutions. I tell people, professionally, that I grew up in an institute. I started right out of college at a state-operated facility for people with severe, profound developmental disabilities which was a state psychiatric facility. So I’ve worked in a bunch of different places and there’s just that bureaucracy piece that’s just like, really? Okay.

[00:24:00] Dr. Sharp: Any government agency, right?

Martha: Yeah, it just comes with the territory and it doesn’t bother me nearly as much as it did when I was much younger. I think some of it, I’m just like, okay, this is part of the process and this is what I have to do.

Dr. Sharp: Yeah. You don’t have to say anything that’s going to get you in trouble, but how does that get in your way in this position? How does the bureaucracy …

Martha: There’s a lot of tedium and a bunch of tedious pieces. I’m trying to think of it. The other piece is [00:25:00] being forward-thinking and then trying to drag other people with you, meaning when I first came here, we rarely did what we call community-based evaluations. People had to come here. There were some exceptions because we are located on the grounds of the Governor Morehead School for the Blind, which is kids, so certain populations can’t sit foot on campus, so we would go out to see them.

I started advocating that there were some people we should go out and see, people who were more medically fragile, people who may not be able to, like Asheville is a 4.5-hour drive from here. I [00:26:00] can go. So, that took a lot of advocacy on my part.

Dr. Sharp: Sure, I bet. That seems to be the common complaint with folks in universities or government agency. It takes time to make any kind of decision or change things. I could see that. If you’re ready, you’re like, we need to do this. It’s hard to wait and let it move through the red tape.

Martha: Yeah. And then, especially during COVID, I learned how to operate three virtual platforms.

Dr. Sharp: Oh my gosh.

Martha: And for some folks, I found that the test results were mostly [00:27:00] valid, but there were other situations where it was like, really? Okay, please do not answer the phone, just other stuff going on in the background. So, unless it’s absolutely necessary, I don’t do virtual evaluations anymore. I had to during COVID. Not so much now.

Dr. Sharp: Yeah, I’m with you. I know there are folks out there who are all in on virtual assessment and are doing it really well. It was a challenge for our practice as well. We couldn’t ever dial it in to feel like we’re getting the data that we need it to, or as good a data, I suppose.

Well, maybe we start to close. I would love to talk with you about how to get into this. If there are folks out there who are listening and are like, maybe I want to work in this environment. Do you have any suggestions, resources, or recommendations for folks who might want to move in this [00:28:00] direction in their own states?

Martha: Recommendation would be to, first of all, if you haven’t spent any time with this population, spend some time with them. Learn as much as you can about visual impairment. There’s so many misconceptions and stereotypes. And that’s probably one of the biggest complaints I get from people about people don’t understand, especially our folks.

Then if you’re interested in it, start saying who does, like, for me, the vocational evaluations.[00:29:00] Okay? Can you tap in that way? because that’s how I wound up here. I did find out, I think it was through your podcast that there is a program out of Utah that is training psychologists to work with VI, but for the most part, you have to learn it on your own.

Dr. Sharp: Yes. I think it takes some work to actually try to specialize in this, but if…

Martha: That would be, or if you’re a school psychologist, then ask if you can work with the VI population and be willing to do the VI evaluations, but also be willing to learn. It’s the same thing. Learn everything you [00:30:00] can about visual impairment because I feel like it’s incredibly rewarding. The folks I work with are just wonderful. Also, I feel like I’m incredibly lucky with the instructors that I get to work with. I feel like we have some of the best teachers around that go out of their way to make accommodations and adaptations per individual.

Dr. Sharp: I hear you. I’ve interacted with a few folks who work in this area and to a person, everyone is super passionate about their work and all in on helping this population.

[00:31:00] Martha: Yeah. Although it’s considered a low-incident disability, if you think about gun violence and other things, the rate of survival is much higher for people, but the vision loss piece is going up too. 

Dr. Sharp: That’s a great point. Well, it just makes me think about, you’re not just dealing with vision loss. There’s some trauma and processing pretty difficult experiences that may often go along with it as well.

Martha: Yeah, and also think about the rates of diabetes; diabetic retinopathy is [00:32:00] a leading cause of vision loss, as well as glaucoma. I feel as there are medical advances in treatment, there also may be increases in visual loss.

Dr. Sharp: That makes sense. Well, just knowing a little bit, I grew up in South Carolina and spent a lot of time in the Carolinas. I don’t want to make too big of a leap, but I know that some of the lifestyle and health concerns of that area can be more significant than other parts of the country. We could do a whole series of podcasts probably on just comorbid health conditions that you probably have to work with and know about.

Martha: Oh, yeah, that’s the whole other piece.

Dr. Sharp: Right. Well, this is good for anybody who might be interested in thinking about getting into this area of practice [00:33:00] that it’s not just the assessment. There’s many other aspects of folks health that you’ll need to be aware of. It’s a complex area.

Martha: It is.

Dr. Sharp: It is wonderful that you’re doing this work. I imagine you’re in pretty high demand. There aren’t many folks out there who can do it.

Martha: Yeah, and my goal is I want to share my knowledge with as many people as I can. I’ve been very fortunate. I have interns from the North Carolina Central University from their psychology department and also from the University of Chapel Hill in their vocational rehabilitation counselor/mental health counseling program. So I’m trying to train as many people as I can.

[00:34:00] Dr. Sharp: That’s great. I know that it’s so needed. It’s good work. 

Martha: Thank you so much.

Dr. Sharp: Well, this has been a pleasure to talk with you. Thanks for jumping on and sharing a little about your work environment. I think folks will probably get a kick out of this. It’s always nice to hear about people doing different things out there in the assessment world. So I really appreciate your time, Martha.

Martha: Well, thank you so much. I really appreciate the opportunity to talk about this because this is one of the things I’m very passionate about just because like I said, it’s a low-incident disability, but why they are just as important as everybody else and honest evaluation is so important.

Dr. Sharp: [00:35:00] Well said. Yeah, 100%. Just because something is low incidents, it doesn’t mean that I shouldn’t have as high quality of an evaluation as anybody else might be able to get. Well, lucky to have you and it was very nice to chat. Thank you.

Martha: I enjoyed it. Hopefully, we will chat more.

Dr. Sharp: Sounds good.

All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes, so make sure to check those out.

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And if you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist Mastermind Groups. I [00:36:00] have mastermind groups at every stage of practice development, beginner, intermediate, and advanced.

We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.

The information contained in this podcast and on The Testing Psychologist 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. 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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