Complete full test administration in one day?

[Childdoconeday]

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Does anyone belong to a system where you complete testing - intake and evaluation in one day? I am advocating to split a testing session into two days as I feel like it can be jarring to go from the clinical interview straight into testing, but just wanted to first survey around to see if perhaps that is standard for some systems. Thanks!

 

[erg923]

Does anyone belong to a system where you complete testing - intake and evaluation in one day? I am advocating to split a testing session into two days as I feel like it can be jarring to go from the clinical interview straight into testing, but just wanted to first survey around to see if perhaps that is standard for some systems. Thanks!

jarring?

 

[WisNeuro]

Yes, I do interview, testing, and report writing same day. If it's straightforward, they get feedback same day as well. The vast majority of my colleagues in town do interview and testing same day.

 

[Childdoconeday]

A clinical interview could be anxiety provoking for some or even draining. Going from that straight into testing sounds like it could be quite difficult for some. Some people need more of a rapport building or even time between sessions to feel
comfortable for testing.

jarring?

 

[Childdoconeday]

That’s fascinating! Do you have them complete intake paperwork before hand so you have some information beforehand , or do you do the full interview before testing?

If you do cognitive testing that may be more demanding, do you do that first or are you always starting off with the clinical interview?

QUOTE="WisNeuro, post: 21322842, member: 248083"]
Yes, I do interview, testing, and report writing same day. If it's straightforward, they get feedback same day as well. The vast majority of my colleagues in town do interview and testing same day.
[/QUOTE]

 

[WisNeuro]

I'd say that the interview being anxiety provoking enough to derail testing happens <5% of the time. If you educate people about the evaluation process up front when you schedule them, you'll find that interview and testing on the same day is not a problem.

 

[WisNeuro]

That’s fascinating! Do you have them complete intake paperwork before hand so you have some information beforehand , or do you do the full interview before testing?

If you do cognitive testing that may be more demanding, do you do that first or are you always starting off with the clinical interview?

they get intake paperwork mailed to them when we schedule them. Always start off with the interview. The interview should lead your hypothesis testing during the cognitive testing.

 

[WisNeuro]

There are some circumstances that make sense for splitting interview and testing into separate visits. Best one being if you have a decent rate of no shows. This will cut down on your dead time. Second being if you are working with insurance companies that have onerous prior auth policies. Most of my referrals are from Neurology and the referring Neurology note qualifies for prior auth >90% of the time for my patients.

 

[psych.meout]

Does anyone belong to a system where you complete testing - intake and evaluation in one day? I am advocating to split a testing session into two days as I feel like it can be jarring to go from the clinical interview straight into testing, but just wanted to first survey around to see if perhaps that is standard for some systems. Thanks!

In the work I did before grad school and in my practica, we almost always did the entire process (interview, testing, scoring, integration, report writing, and feedback) in a single day.

A clinical interview could be anxiety provoking for some or even draining. Going from that straight into testing sounds like it could be quite difficult for some. Some people need more of a rapport building or even time between sessions to feel
comfortable for testing.

We often don't give patients full credit for how resilient they are. We project onto them our anxieties about how they will handle things and if they will be able to make it through testing. It can be a bit exhausting for some , but the vast majority of patients are capable of making it through the entire process in a day without much distress.

 

[Therapist4Chnge]

I’ve seen this work well with dementia evals, most likely for those with mild to moderate impairment already. I don’t typically do these evals, but they are commonly done in one day.

My typical referral (mTBI/TBI/CVA/etc) is seen over multiple days. One day for the intake (90min, though sometimes longer for IMEs, cases w interpreters, etc), and then they come back for testing. I rarely if ever split up the testing over two days, but in legit cases I will sometimes offer this, but mostly my batteries are short enough that if they need two days, that’s a red flag. Then a feedback session ~1wk later, or so.

There are outside factors influencing the timeframes of my cases bc I only see worker’s compensation and legal cases, which are almost always longer than commercial insurance. Sometimes I need to do a phone conference after the intake, sometimes after the testing, etc. Turn around time is generally 2-3 weeks, depending on document review.

I’m sure commercial cases are quicker to turn around, but I defer to others who are more familiar with the current standards.

 

[PsyDr]

I found that some of the dementia eval patients would get scared and not return.

 

[ClinicalABA]

We do a separate intake session (caregiver interview and unstructured observation of child, often with early intervention staff present as well), with a testing session scheduled 2-4 weeks afterwards. Info from intake is submitted for prior authorization. I deal almost exclusively with Medicaid, and they typically turn around the auth in 2-15 days, but have up to 15 business days, i think. I'll maybe get 1-2 clients a year where no prior-auth is needed, and we still do the intake session.

With my population (toddlers) the unstructured intake- in addition to being necessary for the prior-auth- gives the kiddo a chance to get used to the setting, see that I'm not one of the doctors who gives them shots, etc. It can often take ~15-30 minutes for the initial stranger anxiety and shyness to go away, and that would run too far into the developmentally appropriate attention span for testing. I start the next session with the formal cognitive and language testing. it would be tough to direct the kiddo to transition to the formal tasks after the unstructured free play of the intake interview, so starting with the "boring" stuff first during a different testing session is often the best way to go. As is it, I try to do testing, preliminary scoring, feedback, and written recommendations during the testing session, and that often pushes the kiddos limits! I also can't do much testing after 12, as kiddos are hungry and then we get into nap time (for the clients, not me!). Best case scenario, I write the report same day as the testing.

 

[WisNeuro]

^brings up a good caveat to my points. I only see adults for clinical neuropsych evals. Of which, interview and testing should only take up 3-4 hours of time for most things. Child and forensic evals are a different ballgame.

 

[AcronymAllergy]

I used to do it all on the same day. Now, primarily to increase access and determine the actual necessity of a full neuropsych eval (have had some questionable and/or very impaired referrals come through), I do the interview first and then schedule a follow-up appt for testing. I have access to EMR which minimizes the need for them completing paperwork ahead of time. But if I were out in the community, I'd definitely have a few pre-appointment info forms.

If I had full control over things, I'm undecided how I'd structure things. But I can say that I hardly ever ran into actual problems from a patient perspective when I interviewed and tested on the same day.

 

[ClinicalABA]

...Best one being if you have a decent rate of no shows. This will cut down on your dead time...

Yep- with it taking 8-10 months between initial call and appointment, no shows can be an issue, Though our rates are relatively low, it's still better to lose an hour and be able to reschdule 3-6 than it is to lose 4-7 hours.

 

[deleted343839]

Does anyone belong to a system where you complete testing - intake and evaluation in one day? I am advocating to split a testing session into two days as I feel like it can be jarring to go from the clinical interview straight into testing, but just wanted to first survey around to see if perhaps that is standard for some systems. Thanks!

It depends on the type of assessment you're doing and what other information you're incorporating (eg, direct behavioral observations, collateral interviews, etc.). But yes, in many clinical settings with adults, doing the whole evaluation in one day is the norm and is more efficient for everyone involved. Many patients prefer to get it all done in one day, especially if they have rearranged their usual routines to complete the appointment.

I don't think it's all that "jarring" for the vast majority of our patients, and if someone becomes upset during the process it usually happens during the interview, regardless of whether testing is added on or not. True adverse reactions to testing per se are uncommon. Psych testing is pretty tolerable compared to many medical tests and diagnostic procedures. A more typical response is just to complain about how long it all takes.

 

[psych.meout]

It depends on the type of assessment you're doing and what other information you're incorporating (eg, direct behavioral observations, collateral interviews, etc.). But yes, in many clinical settings with adults, doing the whole evaluation in one day is the norm and is more efficient for everyone involved. Many patients prefer to get it all done in one day, especially if they have rearranged their usual routines to complete the appointment.

I don't think it's all that "jarring" for the vast majority of our patients, and if someone becomes upset during the process it usually happens during the interview, regardless of whether testing is added on or not. True adverse reactions to testing per se are uncommon. Psych testing is pretty tolerable compared to many medical tests and diagnostic procedures. A more typical response is just to complain about how long it all takes.

Another consideration is logistics. For some of the neuropsych assessment I've done, the patients are driving in by a couple hours from rural communities. They much prefer to get everything done in one day rather than take a half day just traveling to the clinic, especially for older adults who rely on others for transportation needs.

Obviously, this might not be the case for all patients and splitting up the testing (which I've done) might be indicated for the individual patient and some clinicians (e.g., those who have commented here) do it as a matter of course for other logistical reasons (e.g., no-shows).

 

[deleted343839]

Another consideration is logistics. For some of the neuropsych assessment I've done, the patients are driving in by a couple hours from rural communities. They much prefer to get everything done in one day rather than take a half day just traveling to the clinic, especially for older adults who rely on others for transportation needs.

^^^ This. I work in an academic medical center that serves a large geographic area, and it's not unusual for patients drive an hour or more to reach my clinic. The most common negative experience is when the patient is scheduled incorrectly (eg, as a returning or established patient) and there is not enough time to do the full evaluation in one day. I became hypervigilant about my template (and who gets to schedule my patients) after this happened a few times.

 

[Childdoconeday]

Wow!

In the work I did before grad school and in my practica, we almost always did the entire process (interview, testing, scoring, integration, report writing, and feedback) in a single day.


We often don't give patients full credit for how resilient they are. We project onto them our anxieties about how they will handle things and if they will be able to make it through testing. It can be a bit exhausting for some , but the vast majority of patients are capable of making it through the entire process in a day without much distress.

^^^ This. I work in an academic medical center that serves a large geographic area, and it's not unusual for patients drive an hour or more to reach my clinic. The most common negative experience is when the patient is scheduled incorrectly (eg, as a returning or established patient) and there is not enough time to do the full evaluation in one day. I became hypervigilant about my template (and who gets to schedule my patients) after this happened a few times.

For you and for others who complete it all in one day, is the interview always first or do you try to knock the cognitive testing out in the beginning?

 

[erg923]

Wow!


For you and for others who complete it all in one day, is the interview always first or do you try to knock the cognitive testing out in the beginning?

How do you know what testing you need/would be helpful to do if you don't interview them first?

 

[Childdoconeday]

How do you know what testing you need/would be helpful to do if you don't interview them first?

I receive a pretty detailed referral question so I have a fairly good idea of what to expect . I just am wondering if the intake may tire out the client but from what it sounds like, it may not be an issue

 

[psych.meout]

I receive a pretty detailed referral question so I have a fairly good idea of what to expect . I just am wondering if the intake may tire out the client but from what it sounds like, it may not be an issue

As Erg noted, interview is always first so that you know what testing is needed. Even with a very detailed referral, it's unlikely that the referring provider covered every area of interest, especially if they were only asking the patient questions they felt were relevant to the initial complaint . Doing the interview also gives you an idea of their understanding of their problems and consistency with the referral, which then may alter your testing battery .

And again, we tend to overestimate how taxing tasks are for patients. Sure, some people might not be able to do both in one day due to fatigue, but the vast majority of patients are able to. This is also why you do the interview first, you get an idea of who they are and what their endurance might be, while also building rapport that you can use during testing.

 

[PsyDr]

Why in the hell is the interview supposed to be so taxing?

 

[psych.meout]

Why in the hell is the interview supposed to be so taxing?

I don't know, maybe for some highly neurotic or emotionally dysregulated people talking about difficult topics might make them too emotional to be tested?

I'm just speculating, as I've never experienced this despite evaluating patients with whole hosts of comorbidities, trauma histories, personality disorders, etc.

 

[deleted343839]

For you and for others who complete it all in one day, is the interview always first or do you try to knock the cognitive testing out in the beginning?

How do you know what testing you need/would be helpful to do if you don't interview them first?

Again, depends on the referral question. For example, when doing presurgical evaluations it is common to do the testing up front.

 

[psych.meout]

Again, depends on the referral question. For example, when doing presurgical evaluations it is common to do the testing up front.

I've done chronic pain evals (pumps, stimulators, and back surgery) more than any other presurgical, and we always did the interview up front as well. Most of the data is coming from that and the MMPI-2/RF anyways.

 

[deleted343839]

I've done chronic pain evals (pumps, stimulators, and back surgery) more than any other presurgical, and we always did the interview up front as well. Most of the data is coming from that and the MMPI-2/RF anyways.

Sure, there's a lot of practice variation and I've personally seen it done both ways. Testing first is not universal, but it is common for pre-surgical evaluations. Some larger centers sequence things this way for logistical reasons, though there is a clinical rationale for it as well.

[Edited to clarify that my comments refer to pre-surgical evaluations, which often rely on fixed test batteries. Not to be confused with evaluations for cognitive disorders, developmental disorders, etc.]

 

[Childdoconeday]

Why in the hell is the interview supposed to be so taxing?

I guess I just feel like for kids sitting through an interview prior to a day full of testing can be boring or tiresome

 

[AbnormalPsych]

I've always tested same day (adults). Record review and interview first, talk to any in person collaterals, break, testing w/ breaks, scoring while testing and on testing breaks (e.g., lunch), interp + report writing same day or next day or so. Feedback can be same day if diagnosis and recs are clear. I will schedule it a week or so out if it is not yet clear and I want more time to work through everything. There has only been a handul of times in my career I have had to have someone back for testing on another day. Usually that is because they are late to start on Day 1.

With the referrals I have I can generally start the day with patient at 9 or so and get them out between 1-3, depending on the complexity of the case and amount of testing.

 

[AcronymAllergy]

I forgot to mention above that as with many other posters, I work exclusively with adults. I can't recall ever having observed or heard that the interview was taxing for them. I'm sure it's happened, but not often enough for me to remember it. Although I also typically get through my interview in about 45 mins, sometimes an hour if there's a bunch going on.

If the interview is that intense and takes longer than the above, sometimes I'll break it up. Or I'll talk to the collateral on a different day (or while the patient is testing if I have an intern or tech).

 

[WisNeuro]

As or the "taxing" interview issue, In like a decade, I'd say the interview has led to pushing off the testing less than a handful of times. In every single one of those instances, the issue was purely psychiatric. Even the moderately demented can get through an interview and a DRS-2+ just fine.

As for testing first. Only way I would ever do that would be is I was administering a fixed battery (e.g., pre-DBS eval, pre-post NPH tx, pre-surg). Relying on the referral question alone is problematic. A not insignificant amount of the time, the referring provider has not conceptualized things well, or has missed key elements. In non-fixed situations, testing before interview is simply bad clinical care IMO.

 

[Childdoconeday]

As always, very helpful and informative. Thank you all I appreciate your responses!

 

[PsyDr]

I guess I just feel like for kids sitting through an interview prior to a day full of testing can be boring or tiresome

That is important information for you. Is the kid not socialized to let adults talk in an age and situation appropriate manner? Are there severe hyperactivity issues? Are the class and/or SES issues? Are the parents appropriately modulating their child's affective tone? In what style are they parenting?

Most kids, even young kids, can sit through an hour or adults talking. They might be bored. But most parents are capable of mostly making their kids behave.

@psych.meout hopefully most interviewers can handle people being upset, and redirect things so as to make the interview tenable. Witnessing severely upset people is a significant part of the job. We should all be able to handle this.

 

[singasongofjoy]

We do a separate intake session (caregiver interview and unstructured observation of child, often with early intervention staff present as well), with a testing session scheduled 2-4 weeks afterwards. Info from intake is submitted for prior authorization. I deal almost exclusively with Medicaid, and they typically turn around the auth in 2-15 days, but have up to 15 business days, i think. I'll maybe get 1-2 clients a year where no prior-auth is needed, and we still do the intake session.

With my population (toddlers) the unstructured intake- in addition to being necessary for the prior-auth- gives the kiddo a chance to get used to the setting, see that I'm not one of the doctors who gives them shots, etc. It can often take ~15-30 minutes for the initial stranger anxiety and shyness to go away, and that would run too far into the developmentally appropriate attention span for testing. I start the next session with the formal cognitive and language testing. it would be tough to direct the kiddo to transition to the formal tasks after the unstructured free play of the intake interview, so starting with the "boring" stuff first during a different testing session is often the best way to go. As is it, I try to do testing, preliminary scoring, feedback, and written recommendations during the testing session, and that often pushes the kiddos limits! I also can't do much testing after 12, as kiddos are hungry and then we get into nap time (for the clients, not me!). Best case scenario, I write the report same day as the testing.

This is what it typically looks like for me too, except usually I have them leave for a lunch break and then come back for the feedback and written recommendations. HOpefully the kid takes a nap in the car during lunch. We do mostly Medicaid and insurance authorization is a big reason for us to split it up even when I am doing adolescent and adults.