Let's Get Digital: Flexible Assessment Options and Benefits

This week's blog was contributed by Maegan Sady, PhD, ABPP-CN. Maegan is a project director in PAR's research and development department in addition to being a licensed psychologist and board-certified neuropsychologist. She worked as a pediatric neuropsychologist for nearly a decade before joining PAR.

As we emerge from the pandemic, the need for flexibility in assessment is here to stay. The only way to begin to combat socioeconomic and technological disparities is to offer more options, but how do we do it? Several themes on flexible assessment have emerged from what we learned during the pandemic, and PAR is ready to help.

Shifting formats

Many psychologists have adopted a hybrid, in-person/telehealth assessment model, necessitating careful deliberation over personal and professional implications. Which tests can be given remotely, and what evidence is needed to make that decision? Which clients are a good fit for teleassessment? Which tests can be given while wearing personal protective equipment (PPE)? If we sit six feet away from our client, how do we indicate where to start on the response page? How do we assess patients who cannot travel and do not have high-speed internet? In essence, how can we answer every referral question without compromising our ethical obligations to our tests, our patients, and each other?

Thankfully, timely guidelines emerged from the American Psychological Association; the Inter Organizational Practice Committee, which focuses on neuropsychology; and a new book, Essentials of Psychological Tele-Assessment. More recently, journal articles are beginning to present viable models for teleassessment and hybrid practice, both generally and for special populations (e.g., older adults, pediatric medical patients, historically underserved populations). Evidence is building that testing remotely or with PPE can be valid for many tests and within many populations. A few articles even address the impact of teleassessment on trainees, with recommendations for supervisors.

Digital tools are more flexible

Whether you're testing someone face-to-face, from the next room, or fully remotely, electronic materials make life easier. Digital versions of more than 150 test manuals allow you to access administration and normative information from your home office and clinic any day of the week. Digital stimulus books, available for some of PAR's most popular tests, allow you to cut back on the number of items you're transporting and cleaning. They also make it easier to switch to a new test in the moment. To provide full remote administration options, we modified or specially designed eight performance-based tests for remote administration, and indirect evidence supports the remote utility of multiple others.

To use these tools most effectively, you can find white papers and video demonstrations for digital and remote administration on our website. Our digital materials do not confine you to a single device type, and our E-stimulus books do not require Wi-Fi or Bluetooth.

Screening as a model of care

With longer waitlists, pressure to assess more patients in less time, and more complex presenting problems, screening approaches are becoming more valuable. Screening can assist with triage, and doing so within a telehealth format has been shown to reduce wait times, increase satisfaction, and lead to more timely intervention and referral. Questionnaire-only assessment can be an efficient way to make treatment recommendations for patients with primarily emotional or behavioral concerns. More than 60 rating scales are available on PARiConnect as well as in print, meaning this evaluation approach can save time whether it's executed remotely or in-person.

Screening in the context of a full evaluation allows you to cover more domains in less time. With 15 screeners/short forms of rating scales available on PARiConnect and several more in print, you can quickly add a measure of suicide risk, substance abuse, trauma, or depression to your battery. You can also use one of our performance-based screening tests to efficiently determine whether mental status, intellectual ability, or academic performance requires a closer look.

New presenting problems

In addition to new formats, testing is also changing in terms of content. Psychologists know all too well that the past two years have magnified or introduced multiple forms of stress and trauma, including anxiety, grief, effects of systemic racism, and food and housing insecurity. As a result, experiences of PTSD, depression, substance abuse, and parenting stress have increased. Adding a few extra measures to your test library is a good way to ensure you're able to assess for a wide range of presenting issues.

Validity

With new procedures come new potential threats to validity. Practitioners must consider the integrity of testing remotely, in PPE, and under the general stress of a pandemic, in addition to more traditional considerations around effort and applicability of tests. There are creative ways to mitigate these threats, and we must document our efforts in our reports, citing limitations in interpretation where necessary.

Poised for success

In spite of challenges, psychologists have persisted. Testing settings are fluid, clinical conclusions have more caveats, and the list of areas for future research is longer than ever but patients continue to depend on you. We have our work cut out for us, but together we can make psychological assessment more accessible, meaningful, and innovative.