LCSW--Psych Testing

[doctorpsych]

Prior to beginning my doctoral education, I worked at a prestigious medical school's psychiatry department as an MSW administering and scoring neuropsychological tests. A trained monkey could administer most psychological tests.

Did I have the competency to interpret most of those tests? Certainly not, although it certainly isn't rocket science. I was trained to do so, although I was supervised by a psychologist. Most LCSWs are not interested in administering and interpreting psych tests anyway, so you guys have nothing to worry about.

which tests did you administer and interpret?

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[edieb]

Actually, inside the test administration and/or technical manuals there is a specification that the interepretation should be left to those with doctoral psychology degrees.

If you go to the Indiana Psychological Association's web site, they do have a law (google "restricted test list") prohibiting LPCs and MSWs/LCSWs from testing.

 

[berkshiredoc]

STANDARDS FOR QUALIFICATIONS OF TEST USERS
American Counseling Association


(Approved by the American Counseling Association Governing Council at its March 22-24, 2003 Meeting)


The professional qualifications essential to the use of tests in counseling arise from a synthesis of knowledge, skills, and ethics. While some professional groups are seeking to control and restrict the use of psychological tests*, the American Counseling Association believes firmly that one’s right to use tests in counseling practice is directly related to competence. This competence is achieved through education, training, and experience in the field of testing. Thus, professional counselors with a master’s degree or higher and appropriate coursework in appraisal/assessment, supervision, and experience are qualified to use objective tests. With additional training and experience, professional counselors are also able to administer projective tests, individual intelligence tests, and clinical diagnostic tests. This training may occur in graduate school, in post-graduate professional development instruction, or in supervised training in use of the test. Professional counselors are qualified to use tests and assessments in counseling practice to the degree that they possess the appropriate knowledge and skills, including the following areas:

1. Skill in practice and knowledge of theory relevant to the testing context and type of counseling specialty.

Assessment and testing must be integrated into the context of the theory and knowledge of a specialty area, not as a separate act, role, or entity. In addition, professional counselors should be skilled in treatment practice with the population being served.

2. A thorough understanding of testing theory, techniques of test construction, and test reliability and validity.

Included in this knowledge base are methods of item selection, theories of human nature that underlie a given test, reliability, and validity. Knowledge of reliability includes, at a minimum: methods by which it is determined, such as domain sampling, test-retest, parallel forms, split-half, and inter-item consistency, the strengths and limitations of each of these methods; the standard error of measurement, which indicates how accurately a person’s test score reflects their true score of the trait being measured; and true score


*For the purpose of this document, terms such as inventory, instrument, measure and scale are encompassed by the terms test or assessment.



theory, which defines a test score as an estimate of what is true. Knowledge of validity includes, at a minimum: types of validity, including content, criterion-related (both predictive and concurrent), and construct methods of assessing each type of validity, including the use of correlation; and the meaning and significance of standard error of estimate.

3. A working knowledge of sampling techniques, norms, and descriptive, correlational and predictive statistics.

Important topics in sampling include sample size, sampling techniques, and the relationship between sampling and test accuracy. A working knowledge of descriptive statistics includes, at a minimum: probability theory, measures of central tendency; multi-modal and skewed distributions, measures of variability, including variance and standard deviation; and standard scores, including deviation IQ’s, z-scores, T-scores, percentile ranks, stanines/stens, normal curve equivalents, grade- and age-equivalents. Knowledge of correlation and prediction includes, at a minimum: the principle of least squares; the direction and magnitude of relationship between two sets of scores; deriving a regression equation; the relationship between regression and correlation; and the most common procedures and formulas used to calculate correlations.

4. Ability to review, select, and administer tests appropriate for clients or students and the context of the counseling practice.

Professional counselors using tests should be able to describe the purpose and use of different types of tests, including the most widely used tests for their setting and purposes. Professional counselors use their understanding of sampling, norms, test construction, validity and reliability to accurately assess the strengths, limitations, and appropriate applications of a test for the clients being served. Professional counselors using tests also should be aware of the potential for error when relying on computer printouts of test interpretation. For accuracy of interpretation, technological resources must be augmented by a counselor’s firsthand knowledge of the client and the test-taking context.

5. Skill in administration of tests and interpretation of test scores.

Competent test users implement appropriate and standardized administration procedures. This requirement enables professional counselors to provide consultation and training to others who assist with test administration and scoring. In addition to standardized procedures, test users provide testing environments that are comfortable and free of distraction. Skilled interpretation requires a strong working knowledge of the theory underlying the test, test’s purpose, statistical meaning of test scores, and norms used in test construction. Skilled interpretation also requires an understanding of the similarities and differences between the client or student and the norm samples used in test construction. Finally, it is essential that clear and accurate communication of test score meaning in oral or written form to clients, students or appropriate others be provided.



6. Knowledge of the impact of diversity on testing accuracy, including age, gender, ethnicity, race, disability, and linguistic differences.

Professional counselors using tests should be committed to fairness in every aspect of testing. Information gained and decisions made about the client or student are valid only to the degree that the test accurately and fairly assesses the client’s or student’s characteristics. Test selection and interpretation are done with an awareness of the degree to which items may be culturally biased or the norming sample not reflective or inclusive of the client’s or student’s diversity. Test users understand that age and physical disability differences may impact the client’s ability to perceive and respond to test items. Test scores are interpreted in light of the cultural, ethnic, disability, or linguistic factors that may impact an individual’s score. These include visual, auditory, and mobility disabilities that may require appropriate accommodation in test administration and scoring. Test users understand that certain types of norms and test score interpretation may be inappropriate, depending on the nature and purpose of the testing.

7. Knowledge and skill in the professionally responsible use of assessment and evaluation practice.

Professional counselors who use tests act in accordance with ACA’s Code of Ethics and Standards of Practice (1997), Responsibilities of Users of Standardized Tests (RUST) (AAC, 2003), Code of Fair Testing Practices in Education (JCTP, 2002), Rights and Responsibilities of Test Takers: Guidelines and Expectations (JCTP, 2000), and Standards for Educational and Psychological Testing (AERA/APA/NCME, 1999). In addition, professional school counselors act in accordance with the American School Counselor Association’s (ASCA’s) Ethical Standards for School Counselors (ASCA, 1992). Test users should understand the legal and ethical principles and practices regarding test security, using copyrighted materials, and unsupervised use of assessment instruments that are not intended for self-administration. When using and supervising the use of tests, qualified test users demonstrate an acute understanding of the paramount importance of the well being of clients and the confidentiality of test scores. Test users seek on-going educational and training opportunities to maintain competence and acquire new skills in assessment and evaluation.


References:

American Counseling Association. (1997). Code of ethics and standards of practice. Alexandria, VA: Author.

American Educational Research Association, American Psychological Association, National Council on Measurement in Education. (1999). Standards for educational and psychological testing. Washington, DC: American Educational Research Association.

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By the way, many graduate programs in education include testing, and I believe these courses of study would be recognized as conferring competence
if used to supplement the knowledge base of MSW's.

 

[Therapist4Chnge]

Actually, inside the test administration and/or technical manuals there is a specification that the interepretation should be left to those with doctoral psychology degrees.

If you go to the Indiana Psychological Association's web site, they do have a law (google "restricted test list") prohibiting LPCs and MSWs/LCSWs from testing.

I know most/all testing companies have restrictions on who can buy their assessments....of course, some places are more strict than others.

 

[littleplate]

hi all.

i'm new in this forums and am a final year undergrad studying under the uni of Lancaster. kinda feels like im butting in but just to give a new perspective, where im studying.. training in psych testing can come from either internships under licensed clin. psychs or during industrial training. ive been trained *officially* under supervision with numerous clin. psychs and am able to administer, score and interpret psych. assessments but my scope however is limited to the 3 wechsler scales, the VABS, 16pf and mmpi. how is it different from the US? are students not trained to administer these tests?

*ah, i hope i don't ignite any hostile replies >.<*

 

[Therapist4Chnge]

Students are trained to interpret a variety of assessments (under the supervision of a licensed clinician), but this is for training purposes. To charge independently for your work, you must be licensed, trained, etc. Only doctoral level clinicians are suppose to administer, score, interpret assessments.....but this isn't always the case. I'm sure others give stuff like the BAI, BDI, etc....which are simple self-report measures, but allowing someone without proper training to administer and interpret something like a Woodcock Johnson would be irresponsible.

 

[BSWdavid]

Interesting, I know that in Indiana it is considered within the scope of practice for an LCSW to administer, score, and interpret psychological tests. However, the statute goes on to state that the LCSW must be "trained in how to use the test." - So legally, at least in Indiana, it is possible, as long as the clinician has proper training. The problem being, what is proper training? The statute doesn't define what proper training entails.

I can't help but laugh that psychologists gripe because social workers want to provide psychological testing (with psychologists claiming that LCSW training is not up to par with clinical psych training), but many of these same psychologists are encroaching on psychiatry by wanting the right to prescribe medications (which, psychiatrists might claim that a psychologist's training in pharmacology is no where near that of a psychiatrist). I find this quite ironic - the same argument turned around.

 

[Student4Life0]

I am actually looking at a job posting right now for "Assessment Clinician" at a hospital. "Seeking clinician to provide mental health assessments and counseling to youth in detention centers." Job posting going out to LCSW, PhD, or MSN with psychiatric clinical specialty.

Wow...I just threw up a little.

 

[edieb]

Your post reflects your superficial thinking, BSWDavid. In addition to 7+ years of traning, Psychologists who prescribe obtain a Master's degree in psychopharmacology. Social workers who want to do testing do not obrain near that much training. Psychologists who prescribe must pass a nationally standardized exam. Social workers who want to do testing do not pass any sort of exam.

 

[Student4Life0]

People will typically cut corners where ever they can.

 

[cplreyes]

Interesting, as far as I know Psychologists do not have to pass a nationally standardized exam to administer and interpret psych tests, why should other disciplines for that manner.

As far as scope of work, master level clinicians are not formally taught sex therapy (example), but can practice in this field only after engaging in the appropriate study, training, consultation, and supervision from people who are competent in those interventions or techniques. Otherwise, it would be unethical and malpractice. A court of law would look into all this areas to establish credibility. Simply having a doctorate degree would not be enough.

Your post reflects your superficial thinking, BSWDavid. In addition to 7+ years of traning, Psychologists who prescribe obtain a Master's degree in psychopharmacology. Social workers who want to do testing do not obrain near that much training. Psychologists who prescribe must pass a nationally standardized exam. Social workers who want to do testing do not pass any sort of exam.

 

[erg923]

Interesting, as far as I know Psychologists do not have to pass a nationally standardized exam to administer and interpret psych tests, why should other disciplines for that manner.

Well, you know wrong, son. While it's not focused exclusively on assessment, psychometric issues are represented within the items on the national Examination for Professional Practice of Psychology (EPPP), which is required of all psychologists who practice. Comprehseive/qualifying exams, which are standard in doctoral programs, also require demontrated knowledge of psychomteic assessment.

However, to even better answer your question: Because, unlike doctoral programs in clinical and couseling psychology, its NOT a part of their curriculum or clinical practicum training. This is something that ALL doctoral students in psychology are REQUIRED to learn and practice, both in their doctoral training (its a core feature in ALL doctoral curriculums) and during their predoctoral internship year.

 

[BSWdavid]

From the Indiana code: (3) using appraisal instruments as an aid in treatment planning that the clinical social worker is qualified to employ by virtue of the counselor's education, training, and experience; and

However, I would agree that most, if not all, clinical social work programs Do not provide adequate training in psych testing. Just because something isn't prohibited be law doesn't mean it is okay to practice either. Similarly, virtually no third-party payer will reimburse a clinical social worker to provide psychological testing.

Sort of like a dentist performing a tonsillectomy - scary! They might work in the mouth, but that doesn't mean they are entitled to full reign.

 

[erg923]

From the Indiana code: (3) using appraisal instruments as an aid in treatment planning that the clinical social worker is qualified to employ by virtue of the counselor's education, training, and experience; and

However, I would agree that most, if not all, clinical social work programs Do not provide adequate training in psych testing. Just because something isn't prohibited be law doesn't mean it is okay to practice either. Similarly, virtually no third-party payer will reimburse a clinical social worker to provide psychological testing.

Sort of like a dentist performing a tonsillectomy - scary! They might work in the mouth, but that doesn't mean they are entitled to full reign.

Right. It should be reiterated that what we are talking about here is psychological assessment, not "testing." Testing is simply asigning a label to a number that a test generates. "Assessment" is comparing that number in the context of dozens of other variables and then being able to determine what the whole picture means or represents. That is, the integration of multiple data sources (psychometric and nonpsychometric) in order to make judgments about behavior and diagnosis. Nobody is going to have a problem with an LCSW giving a BDI and STAI at their intake sessions. When they give and then start making diagnoses and suggestions based on a WAIS and trail making...thats when they are out of their area. Fortunately, most LCSWs know this and dont venture into that realm. Although I have heard horror stories of an LCSW providing TBI npsych evals to returning vets. Interesting, I didn't know LCSW training explored the mechanism and physics of blast injuries, much less provide training in functional neuroanatomy and neurology.

 

[O Gurl]

.Interesting, as far as I know Psychologists do not have to pass a nationally standardized exam to administer and interpret psych tests, why should other disciplines for that manner. .

Really? You cannot be serious. Licensing boards? EPPP? 6+ years of training that includes testing and diagnosis?

.As far as scope of work, master level clinicians are not formally taught sex therapy (example), but can practice in this field only after engaging in the appropriate study, training, consultation, and supervision from people who are competent in those interventions or techniques. Otherwise, it would be unethical and malpractice. A court of law would look into all this areas to establish credibility. Simply having a doctorate degree would not be enough. .

Well there you have it. One cannot look to laws or boards to spell out each and every possible infraction. The answer to the question posed in the OP is simple; LCSWs should not conduct testing because it is not a part of their training. And I mean training as defined in the bolded portion above--the course work, the supporting knowledge (developmental psych, learning and cognition, cognitive neuroscience, statistics and test construction, etc.),the supervision, and the practice (practicum and internship experience). Even within psychology, there is a general respect for specialties. Thus, neuropsych assessments, forensic evaluations, learning disability/developmental delay assessments, pre-surgical evaluations, etc. are handled by those who focused their training in that area. So even though we have the same letters behind our names, a child psychologist whose training has been in Autism would get legally crucified if they performed a bariatric surgery evaluation and the patient later died following non-adherence to medical advice. Attempts to capitalize on vague wording in statutes and laws are just pathetic. It is called professional responsibility and ethics--and at the end of the day, this is what should guide decisions regarding scope of practice.

The crux of this discussion falls back to scope of practice. Degrees and disciplines are distinct for a reason. I think that a lot of the "turf wars" that erupt within mental health are the result of people who either did not understand what they were getting into when they pursued a certain degree (thus, disillusioned) or are purposefully trying to circumvent the traditional route to do the job they want. To a certain extent, nearly every profession in mental health can be accused of this. Social workers are NOT trained to diagnose or administer/interpret/integrate test findings. Period. Psychologists are NOT trained sufficiently in medicine to prescribe. Sure, we could pursue psychopharm training and take the standardized test, at the end of the day though, that is not the equivalent of pre-med undergraduate courses, medical school, and residency. Also, psychopharm alone may give you a foundation of applying psychotropics to certain presentations, but does it teach you about interactions with other medical treatments? No. Psychiatrists are NOT trained sufficiently to administer/interpret/integrate psychological tests and in some cases (barring advanced training and additional supervised practice) NOT trained to provide advance psychotherapy. If you want to look within psychology at the PsyD vs. PhD debate, the PsyD does NOT receive the same breadth and depth of academic/research training. Sure there are some exceptions to this rule who seek substantial additional training and experiences, but it is just that--an exception.

So how about determining what you'd like to do, seeking appropriate training to do it, and being happy?

 

[Therapist4Chnge]

Interesting, as far as I know Psychologists do not have to pass a nationally standardized exam to administer and interpret psych tests, why should other disciplines for that manner.

In addition to be on the EPPP (national exam), psychological assessment is a core area of study in every APA-acred. program. Unfortunately, many people outside of the field believe that they can take a class or observe someone a few times and be sufficiently informed about psychological assessment. In reality, some of the most important aspects of learning psychological assessment have nothing to do with learning how to ADMINISTER the assessment, but instead involve learning the supporting research, statistics, rationale for the test construction, etc.

As far as scope of work, master level clinicians are not formally taught sex therapy (example), but can practice in this field only after engaging in the appropriate study, training, consultation, and supervision from people who are competent in those interventions or techniques. Otherwise, it would be unethical and malpractice. A court of law would look into all this areas to establish credibility. Simply having a doctorate degree would not be enough.

*I'll come back to this*

 

[cplreyes]

Case in point. Pulled this from a psych program. My buddy graduated from here and will be taking the psych exam through the CA Psych Board. Big deal, he took one psych testing and assessment class and one physiology class that does not primarily focus on neurology. If this is the standard, then any master level clinician could add these classes to their curriculum or take them post graduation. Btw, their classes are 6 weeks long . Look for yourself:

GRADUATES IN CLINICAL PSYCHOLOGY, UPON COMPLETION OF THE INTERNSHIP
REQUIRED BY THE BOARD OF PSYCHOLOGY OF THE STATE
OF CALIFORNIA, ARE ELIGIBLE TO SIT FOR THE CALIFORNIA LICENSING
EXAMINATIONS FOR PSYCHOLOGIST.​

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OCTOR OF PSYCHOLOGY​

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COURSE DESCRIPTIONS
CONTEMPORARY SYSTEMS OF PSYCHOLOGY 1 unit
An exploration of past and contemporary systems of psychology and current philosophical
thought concerning methodologies. An examination of contemporary psychological
techniques in terms of their historical context.
PHYSIOLOGICAL PSYCHOLOGY 2 units
A study of the physiological and neurological correlates of behavior. Emphasis on central
nervous system determinants of human behavior and organic bases of psychopathology.
BIOLOGICAL AND DEVELOPMENTAL PSYCHOLOGY 3 units
A life cycle study. The biological, psychological and social development of individuals
and families through the life span. The impact of the experiences of childbirth, early
childhood, adolescence, adult life, aging and death.
PSYCHOTHERAPEUTIC DIAGNOSTICS 8 units
A review of the major categories of psychopathology as described in the DSM 1V with
emphasis on the issues of symptomatology, etiology, prognosis, psychosocial and psychopharmacological
treatment. Diagnosis of problem formulation and crisis intervention.
An examination of the interface between pathology and the therapeutic strategies.
PSYCHOLOGICAL TESTING AND ASSESSMENT 8 units
A focus on issues in measuring psychological processes. A study of measurement theory
and the construction and validation of tests including the administration, scoring and
interpretation of the most commonly used clinical instruments for psychological evaluation
of cognitive functioning. WAIS, WISC, MMPI-2, BENDER, TAT and other instruments.
HUMAN SEXUALITY (SEX THERAPY) 1 unit
An examination of the physiological, psychological and socio-cultural aspects of human
sexuality with a focus on therapeutic interventions for sexual disorders and dysfunctions.
Clinical case presentations.
PROFESSIONAL ETHICS AND LAW 2 units
A study of ethical principles for psychologists. Includes a review of current law, APA
standards and policies of California's Board of Psychology.
CHILD ABUSE 1 unit
Prevention, intervention, reporting and treatment.
SUBSTANCE ABUSE 1 unit
Assessing and treating alcoholism, drug addiction and other forms of chemical
substance dependency.
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BEREAVEMENT COUNSELING 2 units
An exploration of how to cope with grief. Loss, grief and stress as related to the family
unit. The effects of family dynamics on the grieving process.
GROUP PROCESS 3 units
A group experience in the basic counseling skills of empathetic listening, confrontation
and immediacy. A study of the nature of the therapeutic relationship. Methods of group
interventions from a variety of theoretical perspectives. Students actively participate in
the process as client/patient, psychologist, or group facilitator.
PSYCHOANALYTICAL THERAPY 8 units
An overview of psychoanalytic theories. Understanding the concepts of transference
and counter-transference and dream work. An indepth study of the development of personality
and psychopathology, including an exploration of contributions in the areas of
object relations, ego psychology, and self-psychology from the perspectives of Freud,
Melanie Klein, Bion, Winnicut and others. An examination of developmental diagnosis
with a focus on differentiating borderline, narcissistic and neurotic conditions.
RESEARCH METHODS 3 units
An indepth study of research methodology and statistics. The study of the construction,
measurement, statistical analysis and application of these methods in problem solving
and clinical case study research.
CONTEMPORARY INTERVENTIONS 3 units
Contemporary Interventions addresses the need for students to be exposed to what is
new in the profession, improvements in clinical application/techniques and updates and
growth of existing modalities. An intensive case conference study focusing on the process
of bringing theory and clinical practice together in preparation for the Clinical Case
Study. An opportunity for the student to hone diagnostic skills with the formulation of a
treatment plan and rationale based upon his/her clinical-theoretical perspective. The
module will also explore Group Process so that group theory, process and application
will be integrated in a relevant manner.
PSYCHOPHARMACOLOGY 3 units
A study of psychotropics and their impact upon psychological disorders, the categories
of psychotropics and their utilization in treatment. An introduction to clinical psychopharmacology
and the ethical and legal considerations.
DOMESTIC VIOLENCE 2 units
Assessment, detection and intervention strategies for spousal and/or partner abuse.
AGING AND LONG TERM CARE 1 units
The study of the psychological problems in aging including disorders of old age, infirmities,
and involvement with long term care.
TREATMENT PLANS 1 unit
Clinical management of psychopathology.
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CLINICAL TECHNIQUES 15 units
Introduction to diagnosis and psychotherapeutic handling of clinical cases. Evaluation
of different theoretical orientations and interventions. Clinical presentations by students
and faculty. Faculty will facilitate student involvement with case vignettes.
CLINICAL CASE STUDY/DISSERTATION 10 units
The Clinical Case Study is equivalent to the doctoral dissertation in a Ph.D. program. It
demonstrates recognizable skills and abilities to present a clinical case for review and to
formulate a diagnosis and treatment plan.
SUPERVISED PROFESSIONAL EXPERIENCE 3 units
Pre-Doctoral Board of Psychology Hours
For those students who elect to apply at least 120 hours or more to earning an additional
three unit maximum credit in Supervised Profession Experience, a fee of $350.00 will
be assessed for evaluation and documentation.
ELECTIVES
ACADEMIC WRITING SKILLS 1 unit
During the doctoral program, students earn course credit in most classes based on written
assignments culminating in the Clinical Case Study Dissertation. This one unit
course teaches proper format, grammar, sentence structure, outline design, and reference
citations.
MARKETING YOUR SELF AND YOUR PRACTICE 1 unit
Course will cover advertising, marketing, resumes and cvs, creating a business plan and
building your skills. Selling yourself is a necessary fact of doing business, and you are
the product! You are selling yourself more so than in most types of business because
your expertise, personality and looks make up what others buy. Altruistic goals won’t
“cut” it by themselves, good intentions to make the world a better place and a willingness
to help other won’t allow you the type of living you need to reward your efforts
UNLESS people pay you for them. Therapy is a “word of mouth” referral business; the
secret is how to generate your name in lots of mouths consistently over a long period of
time by understanding that your practice is a business; you must sell yourself; you must
define your niche, your consistency of effort is rewarded, and these create opportunities.
MEDIA RESOURCES AND RESEARCH .5 unit
Course introduces students to a variety of resources necessary for critical research, including
internet libraries, scholarly resources, and online and/or campus academic support​

systems.​

 

[erg923]

While classwork is necessary for setting a foundation for which to build upon, the learning in a doctoral program (especially in something as complex as psychological and personality assessment) comes primarily from closely supervised clinical practicum experiences over the course of 3-5 years. Of course no one is competent is assessment after one course, and no one has claimed such a thing. Where did you get that from? My suspicion is that you just have a poor understanding of the both the extent and nature of clinical training/learning within a doctoral program.

Moreover, as mentioned before, other areas of clinical competence are necessary and assist one in clincial assessment. Thus, a well rounded training that promotes the evolution of apt clinical judegment, clinical interviewing and history taking skills adds to one's ability to perfom appropriate/competent psychometric assessment. So its not like alll those other classes are not relevant to assessment. Its all aggregate.

 

[cplreyes]

While classwork is necessary for setting a foundation for which to build upon, the learning in a doctoral program comes primarily from closely supervised clinical practicum experiences over the course of 3-5 years. Of course no one is competent is assessment after one course, and no one has claimed such a thing. Where did you get that from? My suspicion is that you just have a poor understanding of the both the extent and nature of clinical training/learning within a doctoral program.

Moreover, as mentioned before, other areas of clinical competence are necessary and assist one in clincial assessment. Thus, a well rounded training that promotes the evolution of apt clinical judegment, clinical interviewing and history taking skills adds to one's ability to perfom appropriate/competent psychometric assessment. So its not like alll those other classes are not relevant to assessment. Its all aggregate.

That goes without saying ....the practicum and those same additional classes are, for the most part, a standard in other professional master level programs. We're simply discussing administering and interpreting some psychometric tests. FYI to everyone, the Surgeon General reported that Master level clinicians can administer and interpret psychometric tests, but only to clients who are already participating in therapy with that clinician. That is, the test would simply assist with their biopsychosocial assessment. The service cannot be delivered as a stand-alone service (this is where the professions differ). I've know about this for sometime now but I can't for the life of me find the link. I emailed a test prep company who considers it common knowledge. So when I get their response, I'll post the link here.

 

[Therapist4Chnge]

That goes without saying iebanana:....the practicum and those same additional classes are, for the most part, a standard in other professional master level programs. We're simply discussing administering and interpreting some psychometric tests.

As someone who has lectured at the Masters, Specialist, and Doctoral level...this is completely false. The breadth and depth of the classroom training is much different, as are the practica experiences. At what point in the MS level training will the students learn about the impact of ceiling effects, truncation, various reliability coefficients, statistical significance, etc on the results of a given psychological assessment? This isn't just an issue with psychologists who develop assessments, it also impacts the clinician. I regularly have to consult alternative norms for different assessments because the support data is not as strong for some of the populations I assess. Last week (?) I had an issue of truncation, which anyone going "by the book" would have interpreted incorrectly. For the record...this wasn't a complex neuropsychological exam, it was a screener.

It is frustrating to hear this sentiment over and over ("we are taking the same classes, you just do research"), as the training is quite different. As mentioned earlier, there are large differences between self-report screeners and psychological assessment. If you really want an apples and oranges comparison, throw in some neuropsych measures. Should MA/MS level people be able to administer, interpret, and write reports including neuropsych assessments? No offense, but all psychological assessment should be left to doctorally-trained professionals. This is a point of irritation for me personally because I've come across too many providers (mid-level & doctoral) who have no business writing an integrated report using various psychological and neuropsychological assessments.

 

[erg923]

the practicum and those same additional classes are, for the most part, a standard in other professional master level programs. We're simply discussing administering and interpreting some psychometric tests.

As t4c said, that is just NOT true. 1.) A masters program has less time for these training experiences, should they even be offered. 2.) Unless its a masters program specifically in clinical psych (as oppsed to MSW, MFT, etc), training in the administration and intepretation of psychometrics doesnt go beyond the use of screening measures such as the Beck and alike. And again, no one has a problem with masters level clincians (or physicians) using these. Thats what they are for! They are supposed to be screening measures that anyone with some basic training in mental health service delivery can use!

Again, not being in the field, you are vastly underestimating the complexity of interpreting and drawing sound diagnostic conclusions from multi-method psychological and neuropsychological test batteries. And NO, its not just about giving a test and interpreting a score via looking at the test manual. Again, thats "testing," not assessment. One has to be cognizant (and formally trained) in a whole host of other issues when putting together a battery, even a screener battery. Knowing what tests to choose (eg., the good ones from the not so good ones), what norms to use (if the norms of said test are appropriate for this particular patient), how the norms were derived (regression modeling vs actual population sampling), what kinds of norms are available (clinical groups vs only normals), sample sizes, floor and ceiling effects, statistical sensitivity and specificity issues, assessment of effort and response bias, etc, and most of all, what it all means if all the tests results contradict each other. Thats where the blend of solid clinical judgement, clinical experience, and data interpretation comes in. And this takes years to get a solid hold on, trust me.

 

[O Gurl]

Case in point. Pulled this from a psych program. My buddy graduated from here and will be taking the psych exam through the CA Psych Board. Big deal, he took one psych testing and assessment class and one physiology class that does not primarily focus on neurology. If this is the standard, then any master level clinician could add these classes to their curriculum or take them post graduation.

Cplreyes, I'm actually in awe of your flagrant disregard of one (major) fact: psychological assessments have huge implications for the patient.

No one just administers comprehensive batteries and writes integrated reports for fun. There is usually a really serious issue at hand, whether it is a criminal trial and the defendant requires a psych evaluation for competency; or a child in need of an evaluation for autism/spectrum disorder; or a patient in neurology who requires an evaluation for dementia; or a transplant team that needs a candidate screened for a new organ; or a child custody dispute... there is a serious question in need of answering. I'm not sure what sort of assessments you'd like to think you will provide at the master's level, but I can assure you NO ONE (no defense attorney, no school system, no neurology or transplant team, nor any family court judge) is going to pay you to do so with without a doctorate nor will they accept your diagnosis/recommendation. So really we are arguing a moot point, aren't we?

 

[cplreyes]

Cplreyes, I'm actually in awe of your flagrant disregard of one (major) fact: psychological assessments have huge implications for the patient.

No one just administers comprehensive batteries and writes integrated reports for fun. There is usually a really serious issue at hand, whether it is a criminal trial and the defendant requires a psych evaluation for competency; or a child in need of an evaluation for autism/spectrum disorder; or a patient in neurology who requires an evaluation for dementia; or a transplant team that needs a candidate screened for a new organ; or a child custody dispute... there is a serious question in need of answering. I'm not sure what sort of assessments you'd like to think you will provide at the master's level, but I can assure you NO ONE (no defense attorney, no school system, no neurology or transplant team, nor any family court judge) is going to pay you to do so with without a doctorate nor will they accept your diagnosis/recommendation. So really we are arguing a moot point, aren't we?

I don't know what state you live in, but this is happening already. Master level clinicians currently diagnose clients and make recommendations in all these settings. And btw, you actually have to be certified as an expert in a particular niche by your corresponding board in order to get paid by the courts, and many master level clinicians are certified by the BBS in CA. You obviously are not in the field practicing or at least not in this CA, because if you were you would have already experience the difficulty of getting a job in all these settings as they are filled by master level clinicians. As I said before, tests can be administered and interpreted by master level clinicians as longs as they are being provided to their ongoing patients. They are not able to provide it as a stand alone service.

 

[cplreyes]

As someone who has lectured at the Masters, Specialist, and Doctoral level...this is completely false. The breadth and depth of the classroom training is much different, as are the practica experiences. At what point in the MS level training will the students learn about the impact of ceiling effects, truncation, various reliability coefficients, statistical significance, etc on the results of a given psychological assessment? This isn't just an issue with psychologists who develop assessments, it also impacts the clinician. I regularly have to consult alternative norms for different assessments because the support data is not as strong for some of the populations I assess. Last week (?) I had an issue of truncation, which anyone going "by the book" would have interpreted incorrectly. For the record...this wasn't a complex neuropsychological exam, it was a screener.

It is frustrating to hear this sentiment over and over ("we are taking the same classes, you just do research"), as the training is quite different. As mentioned earlier, there are large differences between self-report screeners and psychological assessment. If you really want an apples and oranges comparison, throw in some neuropsych measures. Should MA/MS level people be able to administer, interpret, and write reports including neuropsych assessments? No offense, but all psychological assessment should be left to doctorally-trained professionals. This is a point of irritation for me personally because I've come across too many providers (mid-level & doctoral) who have no business writing an integrated report using various psychological and neuropsychological assessments.

Fyi, the curriculum I posted earlier is for a two-year PsyD program, classes are 6 weeks long. I think they meet once a week per class. And a great number of these grads are licensed in CA and in private practice as well as other settings. Really!

Clearly, master level clinicians are already performing psych tests on their clients and CA allows it. Sooooo.....it all sounds like turf war to me.

 

[O Gurl]

I don't know what state you live in, but this is happening already. Master level clinicians currently diagnose clients and make recommendations in all these settings.

Yes. And Satan is giving out sleigh rides all next week.

You obviously are not in the field practicing or at least not in this CA, because if you were you would have already experience the difficulty of getting a job in all these settings as they are filled by master level clinicians.

No. Last I checked, the VA (where I currently work) nor any other hospital is hiring master's level neuropsychologists. Perhaps you could post links to these ads? I also have yet to catch the court cases where the defense attorney's star mental health professional is not a "Dr. ______."

As I said before, tests can be administered and interpreted by master level clinicians as longs as they are being provided to their ongoing patients. They are not able to provide it as a stand alone service.

Well, wait... you just discredited your prior assertion. So now you are aware of master's level neuropsychologists, child psychologists, forensic psychologists, etc. who are hired by third parties (schools, courts, treatment teams) to do evaluations on their current therapy patients???

 

[erg923]

For what its worth, a 2 year Psy.D. program sounds like a joke and probably provides low quality training in comparison with your standard, university based Ph.d program (of which your opposition on here is largely a product of). You probably picked a very poor example program to base your impressions from. Its unfortunate that these places are allowed to exist. The average time for competion of the Ph.D. in this country is 6 years. Thus, a Psy.D program that is 2 years is improbable at best (you couldnt accumulate enough hours for your APPI to be compettive for predoc internship in that amount of time) and if they actually aretrying to sending their peeps out for internship in the 3rd year, then they are woefully undertrained in comparison to other program grads applying. Again, not a good example. Anyway, back to the bigger issue...

You addressed none of the points t4c and I raised regarding psych assessment and the skills this requires- you have only repeated the mantra that "this is already happening in some settings." If you base your judgement on appropriate practice by what some uninformed clinicians do, then you're not really thinking critically about the issue.

For the sake of argument, let's just say no one did this. What would your argument be for them doing them (as opposed to a licensed psychologist)? T4c and I have made our arguments for why they do not have the qualifications or training to do anything beyond using psychometric screening measures (such as the Beck and what-have-you) during intakes and therapy sessions with patients. You disagree apparently and think they should be able to do much more...as much as the doctoral trained folks. So, let's here your argument for why they are indeed appropriately trained (and how their training is on par with doctoral-level practitioners), preferably addressing issues we have raised in the previous arguments (knowledge of various tests and multivariate statistics, norms, item response theory. etc). Where exactly do you think these people would get their training for these higher level issues? You don't just pick these things up on your own without appropriate training AND heavy supervision. We already established that is not in their curriculums and generally not a focus in masters level practicums. So lets hear it...

 

[Therapist4Chnge]

I don't know what state you live in, but this is happening already. Master level clinicians currently diagnose clients and make recommendations in all these settings. And btw, you actually have to be certified as an expert in a particular niche by your corresponding board in order to get paid by the courts, and many master level clinicians are certified by the BBS in CA. You obviously are not in the field practicing or at least not in this CA, because1. if you were you would have already experience the difficulty of getting a job in all these settings as they are filled by master level clinicians. As I said before, 2. tests can be administered and interpreted by master level clinicians as longs as they are being provided to their ongoing patients. They are not able to provide it as a stand alone service.

1. I must have missed that long line of non-doctorally trained clinicians who are testifying in court about matters of assessment and diagnosis. The people I see most testifying are typically boarded forensic psychologists, boarded neuropsychologists, and senior clinical psychologists with a specialization in the needed area. No offense to MA/MS training, but they'd get slaughtered on the stand in regard to assessment and diagnostic questions. I'd love to see someone defend the MA/MS training when the opposing council will have a board-certified psychologist/neuropsychologist with a stack of objective assessment data and the training to back it up.

2. This is a backdoor, unethical, and frankly dangerous precedent if a non-doctorally trained practitioner is conducting assessments. As previously mentioned, assessments aren't given willy-nilly, but instead are used to settle serious matters.

Fyi, the curriculum I posted earlier is for a two-year PsyD program, classes are 6 weeks long. I think they meet once a week per class. And a great number of these grads are licensed in CA and in private practice as well as other settings. Really!

Clearly, master level clinicians are already performing psych tests on their clients and CA allows it. Sooooo.....it all sounds like turf war to me.

That kind of program is a cancer and should be shut down, as it is not representative of even the worst APA-acred. doctoral program out there. There are plenty of 4-box top and $100 degree programs out there for every subject, that doesn't mean every other degree in a particular subject is illegitimate.

No. Last I checked, the VA (where I currently work) nor any other hospital is hiring master's level neuropsychologists. Perhaps you could post links to these ads? I also have yet to catch the court cases where the defense attorney's star mental health professional is not a "Dr. ______."

I've never heard of a "masters level neuropsychologist", though I'd LOVE to see what they have to say on pretty much any matter. I'm 7 years in, and I'm still learning.

You addressed none of the points t4c and I raised regarding psych assessment and the skills this requires- you have only repeated the mantra that "this already happening in some settings." If you base your judgement on appropriate practice by what some uniformed clinicians do, then you're not really thinking critically about the issue.

Stop bringing logic and reason into the discussion, as it obviously has no place in his position, thus it will fall on deaf ears.

 

[cplreyes]

Because I realize that this is forum for doctors or doctors to be, I'm going to post one last time for master level clinicians looking for this information on the web. Unfortunately, the BBS does not have information readily available on their website to answer this question, unless you email them directly, as one forum user posted earlier. Please search this thread for the Board's direct answer regarding this topic. They stated that "yes" clinicians licensed by them (CA) are able to administer and interpret tests. The only thing that I would add is that master level clinicians should provide this service as an adjunct service to their current patients. That is, you (master level clinicians) can not provide this as a "stand-alone" service.

There are a few other things that I'm going say. For one, I've been in the field since 2003 in a major metropolitan area of the U.S., with one of the biggest public mental health departments in the nation. I can honestly say that there is not a significant need for testing in community mental health. Psych testing is provided in this field as an adjunct service and typically to help clarify a diagnosis. In my eight years seeing patients, I have referred a hand-full of clients for psych testing. I and most clinicians, doctorate and master level, have successfully treated clients by conducting thorough biopsychosocial evaluations, developing treatment plans, and systematically providing interventions that are consistent with their assessment results and treatment plan objectives.

Let's get one thing clear, the RECENT development and expansion of PsyD programs is mainly attributed to people wanting to differentiate themselves from master level clinicians in a very tough market which is saturated with clinicians. This has resulted with more PsyDs than the market can absorb. Public agencies are not hiring PsyDs or PhDs in any greater number than before, because the need for them has not increase. Now, if you're looking to go into private practice and want to exclusively provide psych testing, than get a PsyD or PhD, because (as I mentioned before in an earlier post) the Surgeon General does not support master level clinicians practicing psych testing as a "stand along service." Also, if you want to go into a niche, like neuro-pysch, than you would need a doctorate degree.

This new group of PsyDs has only fueled the "turf war" because now, more than ever, there are more PsyDs and master level clinicians fighting for the same jobs in public agencies, schools, courts, jails/detention centers/camps, hospitals etc., and really, we get paid the same or have very similar salaries. This is because any third party payer is not going to reimburse a provider for a psych test unless then can show that it is needed, and only after a regular assessment has been conducted.

So, if you're searching the web looking for the answer to "can master level clinicians administer psych tests," than the answer is "yes," but know that PsyDs here will try to convince you otherwise. Keep in mind that with any service that you provide, you have to meet industry standards and conduct your services in an ethical manner. This can be met by education (not necessarily through your grad program), training, consultation, or supervision, and show competence when conducting any assessment or delivering interventions.


LCSWs, Nurses (MSNs), and now MFTs work in most settings (if not all) and they assess, diagnose and make recommendations for their clients. And their practices are respected.

Hopefully this answers your questions, and good luck with your master-level program if that is what you decide. I work with many doctorate level clinicians and we do the same work and get make the same salaries. Plus, I have way less school loans!

 

[erg923]

Congrats on evading the training issues we raised. You have done nothing to defend your argument and are simply following a trend that you have observed (N=1) without questioning its underlying validity or thinking critically about the training issues involved.

I think a big difference in our perception of the issues is the environments in which we work. I think the majority of us practice (or train) in academic medical centers/hospitals, VAs, and clinics where the expertise of neuropsychologists and other doctorally-trained psychologists are well utilized and perform much more extensive evaluations than in CMH settings.

 

[KayJay85]

I can honestly say that there is not a significant need for testing in community mental health. Psych testing is provided in this field as an adjunct service and typically to help clarify a diagnosis. In my eight years seeing patients, I have referred a hand-full of clients for psych testing. I and most clinicians, doctorate and master level, have successfully treated clients by conducting thorough biopsychosocial evaluations, developing treatment plans, and systematically providing interventions that are consistent with their assessment results and treatment plan objectives.

Maybe I am missing something, but what you just described is what everyone seems to agree is appropriate use of basic testing by mid-level mental health professionals.

No one is contesting LCSWs using depression, anxiety, or cognitive screeners as part of their intake assessments or to aid treatment planning as long as they make appropriate referrals when specialized testing is needed. Which it sounds like you have done with some cases. You then go on to say, that if a person wants to pursue a niche, then the doctorate is needed. This, too, seems to be on the same page with others. Most integrated assessments in psychology are to address specialty populations, like the ones mentioned previously: criminal populations and forensics, neuropsychology, child development issues, medical populations, and so on. So no one is "trying to convince" master's level clinicians of something that isn't true. Yes, they can utilize basic tests (like self report measures and checklists) to inform their own work with the patient, but they are also expected (ethically) to refer to doctoral level providers for in-depth assessments.

As a side note, though, I find it odd that in 8 years of CMH, you've only found it necessary to refer "a handful" or clients for full battery assessments. In my 6-month CMH practicum, learning disabilities, personality disorders, cognitive decline were not infrequent issues. This may speak to what others have pointed out: assessment is more than just administering and scoring tests. Anyone with a manual can do that. However it takes some skill to recognize when assessment is warranted.

 

[BSWdavid]

This thread has sparked my interest so I decided to do a little digging on the matter. A few years ago, in Indiana, psychologists attempted to get certain psychological assessments legally restricted, barring anyone other than a psychologist from providing said assessments. Ultimately, the state ruled against the psychologists' appeal, thus, masters level clinicians, in Indiana, are legally permitted to provide psychological testing/assessment. I asked one of my professors about psychological testing and his opinion was that social workers should not provide psych testing as we aren't trained to do so. Additionally, I have never heard of a clinical social worker that provided testing services, nor have I encountered a third-party payer that would reimburse an LCSW or LMHC for providing psych testing.

 

[Therapist4Chnge]

As a side note, though, I find it odd that in 8 years of CMH, you've only found it necessary to refer "a handful" or clients for full battery assessments. In my 6-month CMH practicum, learning disabilities, personality disorders, cognitive decline were not infrequent issues. This may speak to what others have pointed out: assessment is more than just administering and scoring tests. Anyone with a manual can do that. However it takes some skill to recognize when assessment is warranted.

The CMH setting has a great need for full battery psychological and/or neuropsychological assessment, but it is too costly to support because they do not carry a sufficient # of psychologists in house (if any), as most psychologists are in administration/supervision positions. In other settings, psychological and/or neuropsychological assessment is utilized with much more frequency. VA Hospitals, prisons, public hospitals, academic medicine, private rehabilitation facilities, school systems, private practice, child custody cases, bariatric evals, etc.

 

[KayJay85]

The CMH setting has a great need for full battery psychological and/or neuropsychological assessment, but it is too costly to support because they do not carry a sufficient # of psychologists in house (if any), as most psychologists are in administration/supervision positions. In other settings, psychological and/or neuropsychological assessment is utilized with much more frequency. VA Hospitals, prisons, public hospitals, academic medicine, private rehabilitation facilities, school systems, private practice, child custody cases, bariatric evals, etc.

Well, I have to admit that my CMH experience was through a grad school practicum placement and the CMH center is affiliated with our university. Therefore there was a small team of psychologists on-site. I freely admit that this is likely not the case in more rural/under-served areas. Thanks for pointing that out as I did not mean to disregard this issue.

However, Cplreyes has indicated that he/she has worked in a CMH in a large metropolitan area of CA (correct me if I am wrong). So I'm just guessing that psychologists in the general community are not scarce and that referring out is possible. What bugs me about his/her response is the suggestion that it simply has not been important. That makes me terribly concerned for the patients he/she sees. Lower SES/uninsured people are not immune to dementias, learning disabilities, and developmental disorders. For a clinician to seemingly dismiss the need for these issues to be identified is beyond troubling...

 

[O Gurl]

This thread has sparked my interest so I decided to do a little digging on the matter. A few years ago, in Indiana, psychologists attempted to get certain psychological assessments legally restricted, barring anyone other than a psychologist from providing said assessments. Ultimately, the state ruled against the psychologists' appeal, thus, masters level clinicians, in Indiana, are legally permitted to provide psychological testing/assessment. I asked one of my professors about psychological testing and his opinion was that social workers should not provide psych testing as we aren't trained to do so. Additionally, I have never heard of a clinical social worker that provided testing services, nor have I encountered a third-party payer that would reimburse an LCSW or LMHC for providing psych testing.

I really appreciate this comment as it demonstrates that most professionals, regardless of degree or discipline, do not require policing to do the right thing by their patients. Even if in Indiana or California, it is not spelled out that practicing beyond your training is illegal, I'd wager that the randomly selected LCSW in either state would take a similar position to BSWDavid's professor.

I think the exchange right above between kayjay85 and t4c is really honing in on the problem with cplreyes, the OP, and other like-minded MH professionals: a disregard for ethics in patient care. The comment regarding the "handful" of full battery referrals cplreyes has made in 8 years of practice is very telling. Yes, there is likely a shortage of in-house psychologists in his place of practice. So naturally, the response of people like him/her is not to address the issue of access to services from trained individuals (psychologists), but to add a course or two to their discipline's training curriculum and do it themselves.

Who cares about competency, eh?

 

[Therapist4Chnge]

Well, I have to admit that my CMH experience was through a grad school practicum placement and the CMH center is affiliated with our university. Therefore there was a small team of psychologists on-site. I freely admit that this is likely not the case in more rural/under-served areas. Thanks for pointing that out as I did not mean to disregard this issue.

However, Cplreyes has indicated that he/she has worked in a CMH in a large metropolitan area of CA (correct me if I am wrong). So I'm just guessing that psychologists in the general community are not scarce and that referring out is possible. What bugs me about his/her response is the suggestion that it simply has not been important. That makes me terribly concerned for the patients he/she sees. Lower SES/uninsured people are not immune to dementias, learning disabilities, and developmental disorders. For a clinician to seemingly dismiss the need for these issues to be identified is beyond troubling...

The problem is two fold:

1. Assessment is often cost prohibitive for people without insurance.
2. Providers often don't make the right referral, mostly because the diagnosis is wrong.

 

[berlin81]

This thread has brought forward a lot of issues that are happening in certain areas, so if I am being repetitive, my apologies.

In terms of testing, there is an obvious standard where ideally a PhD/PsyD should administer, interpret, and evaluate any structured assessment. As a current MA psychologist, I actually agree that this standard should be more fully implemented amongst state licensing boards. If a MA psychologist such as myself administers the testing, that's fine as long as a PhD/PsyD is available to help interpret the results. This can be typically done in a supervision/consultation type interaction, which I think is good to have no matter what level of training and education one has achieved.

On the opposite side, there is a clear issue that some geographic areas (especially rural) have difficulty with supplying supervision/consultation. This is a big issue in my home-state where the state licensing board has allegedly looked a implementing additional supervision requirements for all MA psychologists. Again, I am a pro-supervision guy since I think it helps with all aspects of clinical work. However, the accessibility of supervision/consultation with a PhD/PsyD is of great concern due to the geographic challenges that some are faced with.

I know that the first topic in this thread discussed whether or not a LCSW is capable of doing psychological testing. As many previous posters have stated, it is completely unethical, and I agree with them. However if a MA psychologist that has been trained appropriately and some sort of state-licensing standard requires supervision/consultation, then that's fine. What I think is important to acknowledge is that access to various forms of mental health treatment are not equal across a region, and as a result some consideration has to be made towards what can be done to increase comprehensive services in disadvantaged areas.

 

[Therapist4Chnge]

I think most master's level providers would be hard pressed to acquire all the training of a doctoral level clinical neuropsychologist. Is access to care a problem? Absolutely. But I don't agree that letting individuals with less training attempt to do what doctoral level people do bridges that gap - it would simply provide people with less competent services that still wouldn't adequately address the assessment questions.

MA/MS curriculums are not setup to address psychological assessment at the level needed to competently administer, score, and interpret the assessments. There are no shortcuts to the training, and it isn't something that can be picked up in a couple of classes and a practica. Neuropsychological assessment is an entirely different animal, and unless a doctorally-trained clinician (the vast majority being clinical/counseling folks) is formally trained in it, it would be unethical for them to attempt neuropsychological assessment.

I think one of the biggest areas of misunderstanding is the difference between administration/scoring and interpretation. Manuals may be able to explain how their assessment works, and suggest how it should be interpreted, but their explanations are quite limited because no assessment is done in a bubble. How do you select which assessments are appropriate? How do you explain conflicting data? What comorbid diagnoses may impact a patient's performance on a given assessment? How do the patient's meds impact their performance?

I saw a case the other day that was a great example of what I'm talking about.

The pt's history included relapsing/remitting MS, an anxiety disorder, HTN, and a host of other medical issues. The presenting problem was a recent TBI. They were emotionally labile, impulsive, reported all sorts of somatic issues, showed signs of depression, and I was consulted to evaluate the pt's psychological and cognitive functioning post-TBI.

So what training does an MA/MS level therapist receive to adequately and ethically conduct this evaluation?

As an aside, this is actually one of the more straight forward cases I've handled in the past few weeks, so it isn't like I'm cherry picking.

 

[Therapist4Chnge]

Exactly. When do physicians refer out? When the case is messy.

Though, in Jon Snow world, every psychiatric/MH patient would see a doctoral level psychologist for assessment as part of routing standard of care (in addition to a primary care physician and psychiatrist). I am a fan of treatment teams. I do understand this approach is too expensive. And, I've had many physicians argue that it is unnecessary. As a simple exam, I know neurologists who refer very rarely for neuropsychological testing. They see what they consider to be straight forward cases (stroke, alzheimer's disease) and see no reason to refer out for an assessment when it doesn't change their diagnosis. I disagree with this thinking. I think there is no such thing as a straight forward case with regards to MH/Cognition. In these circumstances, we get the referrals too late, when things are very declined, when we can be of much more use early on. Even in cases where the diagnosis is clear, e.g., Huntington's disease, documenting baseline cognitive/emotional status is critical for assessing functional decline.

Cost is definitely a consideration, though there really is no substitute for proper assessment.

 

[berlin81]

MA/MS curriculums are not setup to address psychological assessment at the level needed to competently administer, score, and interpret the assessments. There are no shortcuts to the training, and it isn't something that can be picked up in a couple of classes and a practica. Neuropsychological assessment is an entirely different animal, and unless a doctorally-trained clinician (the vast majority being clinical/counseling folks) is formally trained in it, it would be unethical for them to attempt neuropsychological assessment.

I think one of the biggest areas of misunderstanding is the difference between administration/scoring and interpretation. Manuals may be able to explain how their assessment works, and suggest how it should be interpreted, but their explanations are quite limited because no assessment is done in a bubble. How do you select which assessments are appropriate? How do you explain conflicting data? What comorbid diagnoses may impact a patient's performance on a given assessment? How do the patient's meds impact their performance?

I saw a case the other day that was a great example of what I'm talking about.

The pt's history included relapsing/remitting MS, an anxiety disorder, HTN, and a host of other medical issues. The presenting problem was a recent TBI. They were emotionally labile, impulsive, reported all sorts of somatic issues, showed signs of depression, and I was consulted to evaluate the pt's psychological and cognitive functioning post-TBI.

So what training does an MA/MS level therapist receive to adequately and ethically conduct this evaluation?

As an aside, this is actually one of the more straight forward cases I've handled in the past few weeks, so it isn't like I'm cherry picking.

I have to disagree on a few of the points you made. In your example you mentioned such considerations as medical diagnoses, medications, selection of assessments. I cannot speak for all MA psychologists or training programs but in the training that I have had it is absolutely essential and the above factors are examined. If there are master's programs that do not explore these issues, they should close-up shop. For example, I had to do an intellectual assessment on a patient who was MMR. Just before he came for testing, he had some sort of medical procedure which led to him taking Vicodin for a few days. Obviously testing could not be done but I had to explain my reasons to the patient's incompetent psychiatrist (who at first did not think that the patient was MMR).

Again, I think for the sake of accuracy and responsibility, PsyD/PhD's should be available to supervise and consult on comprehensive assessments. Moreover, if the MA psychologist is the patient's therapist, this could possibly relieve him or her having excessive test anxiety since a therapeutic relationship might of already been established. And as far as compensation for the PsyD/PhD, they would obviously get a supervision/session fee for their time. As far as neuropsych testing goes, I am not aware of any master's programs that have comprehensive training in that area. Therefore that should be reserved for the PsyD/PhD.

Bottom line, I don't think that there is any serious risk with having master's psychologists conducting comprehensive assessments. I do think some supervision/consultation requirements should be put in place, but it also opens the door for PsyD/PhD's to still get compensated and possibly the chance of mentoring the master's psychologist.

 

[Therapist4Chnge]

Bottom line, I don't think that there is any serious risk with having master's psychologists conducting comprehensive assessments. I do think some supervision/consultation requirements should be put in place, but it also opens the door for PsyD/PhD's to still get compensated and possibly the chance of mentoring the master's psychologist.

You don't know what you don't know. I'm not aware of any master's program that has comprehensive training in ANY area, not just neuropsych. I have yet to see a curriculum that remotely prepares a non-doctorally trained clinician to administer, score, and interpret psychological assessments. This thread started because SOCIAL WORK wanted to expand their scope of practice with no addition training or mentorship, and they have even less if any crossover in training.

So with no classroom training, no mentorship, and no data....I can't see how someone can argue that psychological assessment is anything but the sole domain of doctorally-trained psychologists.

 

[Therapist4Chnge]

yeah, except speech pathologists do it and neurologists use mindstreams and cut and paste from the pregenerated reports and bill for it. it's ugly out there

I know. SLPs doing "cognitive testing" is ridiculous and Neurologists "interpreting" neuropsych assessment data is equally as bad.

 

[Savagebee]

Im entering into an LPC oriented program in the Fall, and was reviewing my schedule recently.
It has numerous assessment courses, along with one titled "intellectual assessment"
What would this be covering? It sounds as though this is for IQ testing, but my understanding was what had been covered here by the majority, only PhDs and PsyDs did this.
I just recently set up an appt for one of my residents to go see the only psychologist in town for an IQ test, and had to wait 4 weeks due to a backlog, so it kind of made me wonder what the point was of an intellectual assessment course, as there are several private practice/HMO LPCs I can get her into sooner, but none of them offer this.

Now the program Im going into is 61 hours, with the majority being in class, so perhaps that makes some difference in my state, but if it does its the first Ive heard of it

 

[Savagebee]

I know. SLPs doing "cognitive testing" is ridiculous.

What are they doing? All of the SLPs Ive known have never mentioned this, and I work PT as a case manager at an inpt geri psych and FT as the SSD at a nursing homw with SLP's on staff.

If its just simple MMSEs and MOCAs is that so unusual? They have RNs do those routinely at the hospital, but have a couple of LPCs and LCSWs that are available

 

[slinger]

This is an interesting thread. Since the idea of treatment teams is in the best interest of the clients, I think this is what should be pursued for all places. LOL, will that happen, no. Too costly, as mentioned above.

As a social worker with experience in CMH and currently VA hospitals, I appreciate the wide array of opinions of psych nurses, psychologists, and social workers. Yesss, even the psychiatrists too. There is always going to be turf, period. I do think it is not an impossible task for LCSW's to become proficiently trained in psych testing and assessments. This would of course add a lot of curriculum and time to the MSW programs. I would prefer that this be done after the 2-3 years of clinical supervision required to obtain an LCSW. It isn't that far fetched.

I think there are some over-zealous MSW potentials out there that would like to blur the line more than it should be, for the sake of providing more and more services to the clients, with less education. So they can walk around and say, "I can do assessments, diagnosis, therapy, etc. with my MSW", basically to compare to PhD graduates and what they can do. I honestly feel that for the majority, this is being done out of a marketing technique. I have no interest in providing group testing batteries.

I will say my undergrad was in Psych and Social Work. The psych program had extensive psychology lab classes where we did rigorous tests and learned a great deal about statistical significance.

On another note, I have worked with many PhD Psych candidates at the VA. I hope people aren't thinking that it is some sort of rocket science rigorous training that makes the training that MSW's go through pale in comparison, it really isn't. I found myself during practica sitting next to the Psych interns doing the same things all day long.

I do get tired of the Psych interns asking me, "so you guys do case management?". I went into clinical social work for one reason, to do psychotherapy with Soldiers/Veterans. There is a small case management piece, but even good Psychologists are willing to make a phone call or two. I get tired of the elitism that comes from some, it should come from none. I get tired of the turf war stuff.

I say, do what you are trained to do, advocate for more training if you want to do more. Do what you are trained to do the best you can, and for now; refer med evals to psychiatrists and psych nursing staff, refer neuro psych evals to neuro psychologists, and refer psychotherapy consults to whomever you think the client would best fit with.

 

[Savagebee]

I've seen what amounts to an attempt at a a full neuropsych complete with report.

Im hoping that went over like a turd in the punch bowl.

 

[O Gurl]

There is always going to be turf, period. I do think it is not an impossible task for LCSW's to become proficiently trained in psych testing and assessments. This would of course add a lot of curriculum and time to the MSW programs. I would prefer that this be done after the 2-3 years of clinical supervision required to obtain an LCSW. It isn't that far fetched.

But where does it end? I do not think that adding on to every degree to expand every profession's scope of practice is good for anyone, except the ones who are able to charge a bit more by infringing on another domain. I'm not as bothered by turf wars as there are reasons degrees and disciplines vary. All of this muddling only creates a more confusing and less consistent standard of care for those in need of services. In the particular case of psych testing, adding courses to the MSW curriculum will not cut it. What about practicum and internship experiences completing these assessments and writing dozens of reports? Also, at least for the case of neuropsych, there is a 2-yr postdoc required that is often followed by national boarding. In other areas like learning disability, forensics, school psychology, and medical evaluations (transplant, bariatric, and hep. C), one can see the need for similar criteria to indicate that a professional is uniquely trained in these specialties. The findings of evaluations change lives. Taking a degree built on a difference training model and adding courses does not begin to scratch the surface of necessary training. Nor should it. Nor is there a need to.

On another note, I have worked with many PhD Psych candidates at the VA. I hope people aren't thinking that it is some sort of rocket science rigorous training that makes the training that MSW's go through pale in comparison, it really isn't. I found myself during practica sitting next to the Psych interns doing the same things all day long.

Then that is quite a disservice to those psych interns. No testing/assessment? No case conceptualization competencies? No research component? Yikes. They are going to be in for a world of hurt in the job market I am interning at a VA now and outside of psychosocial assessments or psychoed groups (depending on the clinic) there has been no overlap between my training activities and the work of my SW colleagues. But that is another thread.

I do get tired of the Psych interns asking me, "so you guys do case management?". I went into clinical social work for one reason, to do psychotherapy with Soldiers/Veterans. There is a small case management piece, but even good Psychologists are willing to make a phone call or two. I get tired of the elitism that comes from some, it should come from none. I get tired of the turf war stuff.

I get what you are saying, but am also confused that you find it elitist to think that someone with a degree in social work would do case management. I am not sure how or why social work ever transitioned into psychotherapy and at one point in my graduate training (admittedly well before internship) I would have made the same assumption. This is an artifact of the blurring of lines that has created the current hazy mental health environment. I still have to clarify that I am not a "shrink" and do not prescribe meds.

I say, do what you are trained to do, advocate for more training if you want to do more. Do what you are trained to do the best you can, and for now; refer med evals to psychiatrists and psych nursing staff, refer neuro psych evals to neuro psychologists, and refer psychotherapy consults to whomever you think the client would best fit with.

I agree with you on everything except the bolded part. Instead of advocating to do something outside one's scope of practice I'd encourage pursuing the degree and career path to do what one really wants.

 

[slinger]

But where does it end? I do not think that adding on to every degree to expand every profession's scope of practice is good for anyone, except the ones who are able to charge a bit more by infringing on another domain. I'm not as bothered by turf wars as there are reasons degrees and disciplines vary. All of this muddling only creates a more confusing and less consistent standard of care for those in need of services. In the particular case of psych testing, adding courses to the MSW curriculum will not cut it. What about practicum and internship experiences completing these assessments and writing dozens of reports? Also, at least for the case of neuropsych, there is a 2-yr postdoc required that is often followed by national boarding. In other areas like learning disability, forensics, school psychology, and medical evaluations (transplant, bariatric, and hep. C), one can see the need for similar criteria to indicate that a professional is uniquely trained in these specialties. The findings of evaluations change lives. Taking a degree built on a difference training model and adding courses does not begin to scratch the surface of necessary training. Nor should it. Nor is there a need to.

I think in your mind, you are belittling the training that clinical social workers receive. We do two, one year internships, where our 2nd internship is a clinical practicum comprised of case conceptualizations, heavy reserach - case presentations, and dozens of reports like you mention. I hope you have a more optimistic attitude about the future social workers you might work with, and what they are capable of.

Then that is quite a disservice to those psych interns. No testing/assessment? No case conceptualization competencies? No research component? Yikes. They are going to be in for a world of hurt in the job market I am interning at a VA now and outside of psychosocial assessments or psychoed groups (depending on the clinic) there has been no overlap between my training activities and the work of my SW colleagues. But that is another thread.

How is it a disservice? I mentioned above that the very items you mentioned the interns are doing, we are as well.

I get what you are saying, but am also confused that you find it elitist to think that someone with a degree in social work would do case management. I am not sure how or why social work ever transitioned into psychotherapy and at one point in my graduate training (admittedly well before internship) I would have made the same assumption. This is an artifact of the blurring of lines that has created the current hazy mental health environment. I still have to clarify that I am not a "shrink" and do not prescribe meds.

It is not elitist of me to think this, no more than it wouldn't be elitist for you to get tired of people thinking that all psychologists do is "psych testing". I am not a case manager, and don't like to be referred to as one. Case managers are at the undergraduate level, and I never really worked in that arena. Social Work started out as community outreach/change, social change for the benefit of everyone. It is completely not that anymore. Just because you aren't sure why social workers transitioned into psychotherapy, doesn't make the lines "blurred" and the mental health field going in a "hazy" direction what so ever. Menninger's had psychoanalysts and clinical social workers as well as psychologists. Their chief of psychotherapy was a clinical social worker. The realization for modern psychology is that not only psychologists and psychiatrists provide therapeutic changes in the realm of behavior, cognition, and neurochemistry.

I agree with you on everything except the bolded part. Instead of advocating to do something outside one's scope of practice I'd encourage
pursuing the degree and career path to do what one really wants.

I hear and respect your opinion on this but wholeheartedly disagree. Here is some of my background

Bachelor's of Psychology and Social Work
M.A. Intelligence Studies
M.A. Forensic Psychology
Master of Clinical Social Work

I am perfectly happy being well versed, and would encourage everyone to get as much education as possible to be the best practitioner that one can be. Myself and one other guy are the 2 leading providers of Combat related PTSD psychotherapy within groups and individuals. I think we should welcome different professions in this, under a watchful eye of course. As the insurance companies tend to create narrow-focused care that creates roadblocks, we need to diversify our delivery of treatment.


Back to one of the initial discussions, I am one of those that is an advocate for psychologists (with the required training) to prescribe medications, such as they can do in states like New Mexico. With my experience with Psychiatrists, they spend 15-20 minutes with a patient, and either titrated medication, or start something completely new. I have had a Psychopharmacology grad class, in most cases the psychiatrists I have worked with have valued my opinion with relation to increased rate in negative behaviors within med adjustment, and have taken my counsel, of course they were confused how I was knowledgeable in medication. Times are changing people. As you graduate from your programs, another program is changing and adding to it.

I am not a big fan of psychiatry. I feel that there should be psychologists/social workers and physicians in general. Psychologists/social workers are the ones who work with the individuals on a weekly basis for long period of interaction. I think that physicians should always be consulted when mixing medications so that proper dosage can always be considered. I can see a problem with a psychologist giving a 73 year old man a heavy hitting dose of neuroleptic, which is why physician counsel is needed to find out why you wouldn't.

This whole mess of prescribing psych meds should be outlawed unless within a team environment, or appropriate consultations were used. I have gotten off of my soapbox now.

I was very inspired by my psychologist professor who taught me psychopharm. Very intense class. He trains the whole FBI victim assistance program and was director of a neurological institute, where he was in charge of psychiatrists.

 

[Therapist4Chnge]

I think in your mind, you are belittling the training that clinical social workers receive. We do two, one year internships, where our 2nd internship is a clinical practicum comprised of case conceptualizations, heavy reserach - case presentations, and dozens of reports like you mention. I hope you have a more optimistic attitude about the future social workers you might work with, and what they are capable of.

Most/All doctoral level students complete that by their 3rd year of doctoral training. They then go on to do another year or two of training, internship, post-doc...and (if you want to do neuropsych) an additional 2 years of training.

The research is most likely quite different, same with the reports, assessment, conceptualization (integrating in assessment data), etc.

It is not elitist of me to think this, no more than it wouldn't be elitist for you to get tired of people thinking that all psychologists do is "psych testing". I am not a case manager, and don't like to be referred to as one. Case managers are at the undergraduate level, and I never really worked in that arena. Social Work started out as community outreach/change, social change for the benefit of everyone. It is completely not that anymore. Just because you aren't sure why social workers transitioned into psychotherapy, doesn't make the lines "blurred" and the mental health field going in a "hazy" direction what so ever. Menninger's had psychoanalysts and clinical social workers as well as psychologists. Their chief of psychotherapy was a clinical social worker. The realization for modern psychology is that not only psychologists and psychiatrists provide therapeutic changes in the realm of behavior, cognition, and neurochemistry.

What makes it blurred is when social workers say, "You do therapy, we do therapy...", "you do assessments, we do assessments...", etc. The Devil is in the details, but that doesn't stop it from happening.

 

[O Gurl]

I think in your mind, you are belittling the training that clinical social workers receive. We do two, one year internships, where our 2nd internship is a clinical practicum comprised of case conceptualizations, heavy reserach - case presentations, and dozens of reports like you mention. I hope you have a more optimistic attitude about the future social workers you might work with, and what they are capable of.

How is it a disservice? I mentioned above that the very items you mentioned the interns are doing, we are as well.

I am sorry that you feel I am belittling. That is not my intent. However, LCSWs do 2 years of supervised practice after fewer years of coursework. Psychologists complete 5 years at their grad school taking courses, doing research (thesis and dissertation), completing clinical practicum from years 2-5. Formal training in assessment (intelligence, personality, neuropsych) is part of our course work and practicum. We then complete a year long internship followed by either a 1 or 2 year postdoc. Are you suggesting 2 years of supervised practice after 2 years of coursework (4 years total) is the same? Really? I am not trying to be a jerk or elitist, but a doctorate is a doctorate for a reason. It requires many years of intense coursework. My original point was that adding some assessment courses to the MSW is not the same as going in and integrating all the same core curriculum (psychopathology, physiology of behavior, learning, developmental psych, social psych, 3-part statistics course, etc) and having them complete 6-7 years of supervised practice that psychologists undergo. If that is the case, then why not just become a psychologist? That's the part I don't get.

And I say it is a disservice to those interns b/c your facility (by your description) is preparing them for the same jobs as their colleagues who have trained for approximately half the time. Which, strangely enough, you bristle at when it comes to bachelor's level case managers. You are offended by being compared to people who spent less time in training, yet want psychologists and clinical social workers to practically be interchangeable:

I am not a big fan of psychiatry. I feel that there should be psychologists/social workers and physicians in general. Psychologists/social workers are the ones who work with the individuals on a weekly basis for long period of interaction. I think that physicians should always be consulted when mixing medications so that proper dosage can always be considered.

So if I have it right, you would see physicians handling/supervising all medicine (fair enough) and bachelor's level social workers providing case management and linking patients with services. What would be the distinction between clinical social workers and psychologists?

 

[BSWdavid]

The thing to remember is that clinical social workers have been around for awhile and have been providing psychotherapy for over forty years (some even more). In fact, clinical social workers provide more mental health services than psychologists, psychiatrists, and counselors combined. So stating that social workers are blurring professional boundaries is incorrect as they have been providing mental health services for a long time, and currently are the majority of psychotherapists in the nation. The line being referred to was crossed many years ago.

Line crossing and professional expansion is common in all professions. At one time psychiatrists provided the majority of psychotherapy services and fought psychology's inflation of it's professional boundaries. We also see this with RxP and also with nurses providing primary care services, etc.