Psychometry being done less often by clinicians

[bcliff]

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As I understand, it's relatively common for clinicians to utilize psychometrists and clinical assistants to aid in the administration of certain testing, but where should the line be drawn? It seems like some clinicians are more comfortable allowing psychometrists holding only a bachelors degree to administer increasingly complicated assessments and in certain cases to write up these assessments. Does the APA have an official opinion on the use of psychometrists? Do clinicians owe it to their clients to be an active part of every step of the evaluation process, or to at least forewarn their clients that their practice uses psychometrists to administer testing?

 

[G Costanza]

I think the future of psychometrists will require licensure at the state level.

 

[bcliff]

I think the future of psychometrists will require licensure at the state level.

http://psychometristcertification.org

I agree, but I wonder if in the meantime clinicians should start requiring clinical assistants take this certification exam? The test doesn't seem very comprehensive (120 multiple choice questions), and is difficult to take since it's only proctored once every few months in different regions of the US, but I do feel like it's a step in the right direction of standardizing what it means to be a psychometrist and what standard a clinician should hold his or her staff to.

 

[Pragma]

Here is a relevant position paper on the topic:

http://www.nanonline.org/docs/PAIC/PDFs/NAN_Test_Tech.pdf

I am not entirely opposed to technicians, but personally I think the extensive use of them conflicts with many of the challenges facing neuropsychologists. When you start having BA level folks do most of the work involved with the testing, you make it harder to argue against mid-level encroachment (e.g., OT/Speech).

I'll note that I was trained without ever having access to a tech. I see how the business model works for some (i.e., can see multiple patients simultaneously and avoid the "grunt work"), but so much of what I learned in cases and information that assisted with my conclusions was a function of the time I spent with the patients. You'd really have to have a high-caliber tech that you trusted to catch a lot of important details - which once again, seems to argue against our value, which to me goes just beyond interpretation. I don't really agree with the 5 minute interview, have the tech do the rest, and then write the report model. But sadly, that is what seems to be most profitable for some folks. I think it is imperative that the NP is in the room, testing hypotheses/limits, and building more of a rapport with the patient in order to have a better qualitative sense of the case. have a tech do some of it? Maybe - but not all of it, IMO.

 

[MBellows]

As I understand, it's relatively common for clinicians to utilize psychometrists and clinical assistants to aid in the administration of certain testing, but where should the line be drawn? It seems like some clinicians are more comfortable allowing psychometrists holding only a bachelors degree to administer increasingly complicated assessments and in certain cases to write up these assessments. Does the APA have an official opinion on the use of psychometrists? Do clinicians owe it to their clients to be an active part of every step of the evaluation process, or to at least forewarn their clients that their practice uses psychometrists to administer testing?

In my area I've only ever seen people with master's in counseling, psychology, or social work be allowed to do this and only under the supervision of a psychologist. Then again, in my area Psychological Associates are rather strong. In the practice that I work pre-doctoral interns usually do the testing.

 

[Pragma]

In my area I've only ever seen people with master's in counseling, psychology, or social work be allowed to do this and only under the supervision of a psychologist. Then again, in my area Psychological Associates are rather strong. In the practice that I work pre-doctoral interns usually do the testing.

I see either doctoral students filling the tech role (but also learning to do write-ups so it is in the name of training). But it is not uncommon at all in my area for people to hire and train BA/BS level folks to be full time techs. In fact, it's a common model at the AMCs in my city. Usually it is seen as a stepping stone to grad school, as sometimes there are opportunities for research involvement as well.

 

[cara susanna]

My last placement had two "campuses." I conducted testing at one campus, but they had a psychometrist conduct testing at the other. The psychometrist would score the data and then send it to me and my supervisor to write up in reports.

 

[bcliff]

I see either doctoral students filling the tech role (but also learning to do write-ups so it is in the name of training). But it is not uncommon at all in my area for people to hire and train BA/BS level folks to be full time techs. In fact, it's a common model at the AMCs in my city. Usually it is seen as a stepping stone to grad school, as sometimes there are opportunities for research involvement as well.

For these BA/BS folks, what are they allowed to do? Simply administering, or writing up reports and doing intake interviews too?

 

[Pragma]

For these BA/BS folks, what are they allowed to do? Simply administering, or writing up reports and doing intake interviews too?

Just testing/scoring. But trust me - I have heard of places allowing the BA/BS person to input data into a report template (for the purpose of saying they helped with report writing when they are applying for grad school)) and I thought it was bogus when I heard about it.

Usually the techs are given a lot of structure - such as a behavioral observations form and places to write notes that might be helpful going into the report.

I think the key, to me, is how you use the tech. IMO, many places will use the tech to do almost everything and will spend minimal time with the actual patient (long enough for a quick interview). I don't think that is appropriate practice - but like I said before, I am biased because I have always done all of my own testing.

 

[bcliff]

Just testing/scoring. But trust me - I have heard of places allowing the BA/BS person to input data into a report template (for the purpose of saying they helped with report writing when they are applying for grad school)) and I thought it was bogus when I heard about it.

Usually the techs are given a lot of structure - such as a behavioral observations form and places to write notes that might be helpful going into the report.

I think the key, to me, is how you use the tech. IMO, many places will use the tech to do almost everything and will spend minimal time with the actual patient (long enough for a quick interview). I don't think that is appropriate practice - but like I said before, I am biased because I have always done all of my own testing.

I would think that Clinical PhD programs may have a problem with this practice? I mean wouldn't it be considered unethical and hurt a potential applicant's chance in a program if the admissions committee gets the sense that ethics aren't important to the applicant?

Also, does anyone have any stats on psychometrist compensation?

 

[Pragma]

No one without extensive training (i.e., only doctoral students under supervision and Ph.D. level) should be interpreting data and writing reports. I also think intake interviews require a higher level of skill than a BA level person has.

I'd agree with all of this. In fact, I'd put interviewing at the same level of skill required as report-writing and test interpretation. I view the interview as a critical part of the assessment process, and not something that can just be summed up in some structured form that a tech or inexperienced doctoral student could complete.

 

[Pragma]

I would think that Clinical PhD programs may have a problem with this practice? I mean wouldn't it be considered unethical and hurt a potential applicant's chance in a program if the admissions committee gets the sense that ethics aren't important to the applicant

I suppose it depends. There are lots of ways that people market themselves for graduate school, and some people do come in with some clinical experience. For example, some BA-level RAs get trained on things like the SCID or other structured interviews for research protocols. Some are neuropsych techs and do tons of administrations. I'd imagine that some people, if they heard "assisted with report writing," would raise an eyebrow. But some people might think (wow, they must be really advances) and not really give it a second thought.

I certainly wouldn't recommend that a student market themself this way. But then there is also the practical issue here: Some psychologists use pretty much fixed batteries and have a fairly standard report template. That isn't how I was trained, but it wouldn't be very hard to train your tech to plug in the numbers into your report if that is how you do your write-ups. Like I said - not anything I advocate - but you know it happens. It is the psychologists like that which are making the argument for us to get replaced by computer testing instruments (or heck, eventually just these psychometricians).

 

[Pragma]

If I were evaluating a student who marketed themselves to grad school that way and really played up that they basically practiced outside their competence at the behest of a psychologist, I might be inclined to steer clear. I would be wary of having to retrain someone who has been taught bad and/or unethical practices.

I'd agree. But sometimes the people making these decisions also don't really care about clinical experience (look mostly at research productivity).

 

[bmedclinic]

I know my comment here is slightly off topic.. but hear me out.
The future isnt someone with a BA, or even in most cases a person with an MA/MS.

My wife (SLP) got back from their big conference (ASHA) two weeks ago, and all their assessments are rapidly moving to be computerized. I know a sizable portion of the psychology world (the old guard, if you will) is literally afraid of computers.. but imo that's the direction it's headed.

Before you say "psychology wont go that way" let me ask you why you think that? What is it that we do (assessment wise) that is all that different from an SLP? Sure, clinical interviews are always going to need to be done by a skilled practioner (PhD), but I have a feeling that the majority of the major assessments will sooner rather than later be administered by a computer.

 

[MBellows]

I see either doctoral students filling the tech role (but also learning to do write-ups so it is in the name of training). But it is not uncommon at all in my area for people to hire and train BA/BS level folks to be full time techs. In fact, it's a common model at the AMCs in my city. Usually it is seen as a stepping stone to grad school, as sometimes there are opportunities for research involvement as well.

As far as some of the administration goes, I'd prefer a trained actor over someone with a BA/BS in psych. At least then there are transferable skills.

 

[Pragma]

I know my comment here is slightly off topic.. but hear me out.
The future isnt someone with a BA, or even in most cases a person with an MA/MS.

My wife (SLP) got back from their big conference (ASHA) two weeks ago, and all their assessments are rapidly moving to be computerized. I know a sizable portion of the psychology world (the old guard, if you will) is literally afraid of computers.. but imo that's the direction it's headed.

Before you say "psychology wont go that way" let me ask you why you think that? What is it that we do (assessment wise) that is all that different from an SLP? Sure, clinical interviews are always going to need to be done by a skilled practioner (PhD), but I have a feeling that the majority of the major assessments will sooner rather than later be administered by a computer.

I think some of the assessments will be given that way sooner rather than later, but I wouldn't say the majority. I agree with the sentiment that it is going in that direction, but I'd imagine that there are more battles to be fought.

 

[Pragma]

As far as some of the administration goes, I'd prefer a trained actor over someone with a BA/BS in psych. At least then there are transferable skills.

I'd prefer at least a doctoral student over a BA/BS person myself, but I am just saying the norm that I have witnessed at the AMCs in my area. Considering the use of techs is fairly normative (at least within neuropsychology), you might imagine how the decision-making process goes from a financial standpoint.

 

[bmedclinic]

I think some of the assessments will be given that way sooner rather than later, but I wouldn't say the majority. I agree with the sentiment that it is going in that direction, but I'd imagine that there are more battles to be fought.

not to derail this thread, but let me ask you a question: what is preventing the majority (not some) of these assessments from going the computerized route?

Cost. No.
Scoring complexity? Computers have that adv. hands down.
Precedent? WJ-III, MMPI-2-RF, etc.

Why wouldnt it happen? From a business standpoint (which I admit, is not my greatest talent, there's a lot of money to be made/saved) by eliminating a human in lieu of a computer.

You pay the full time BA person, what 30k per year? (that's what a psychometrist I was working with while in my MA program got) For 30k a year, how many computerized assessments can 1 neuropsychologist administer? A whole heck of a lot, as far as I can tell.

 

[bcliff]

not to derail this thread, but let me ask you a question: what is preventing the majority (not some) of these assessments from going the computerized route?

Cost. No.
Scoring complexity? Computers have that adv. hands down.
Precedent? WJ-III, MMPI-2-RF, etc.

Why wouldnt it happen? From a business standpoint (which I admit, is not my greatest talent, there's a lot of money to be made/saved) by eliminating a human in lieu of a computer.

You pay the full time BA person, what 30k per year? (that's what a psychometrist I was working with while in my MA program got) For 30k a year, how many computerized assessments can 1 neuropsychologist administer? A whole heck of a lot, as far as I can tell.

In my experience one of the BS psychometrists I knew was making roughly 19k per year to administer assessments (WAIS/WISC; WJ-III; MMPI; Psychosexual/Psychoed; clinical interviews; etc.), score the assessments, write the assessments up into a report (using a template), and then send the results to the doc to be 'reviewed'. His experience is what preempted this thread in the first place, I feel that the work he was doing exceeded his own level of education and his reimbursement was markedly lower than what it ought to be. The number of assessments that the doc was able to administer for hundreds of dollars per client was exceptionally higher because of the work that the BS psychometrist was putting forth, and the psychometrists salary was not representative of that.

 

[Pragma]

not to derail this thread, but let me ask you a question: what is preventing the majority (not some) of these assessments from going the computerized route?

Cost. No.
Scoring complexity? Computers have that adv. hands down.
Precedent? WJ-III, MMPI-2-RF, etc.

Why wouldnt it happen? From a business standpoint (which I admit, is not my greatest talent, there's a lot of money to be made/saved) by eliminating a human in lieu of a computer.

You pay the full time BA person, what 30k per year? (that's what a psychometrist I was working with while in my MA program got) For 30k a year, how many computerized assessments can 1 neuropsychologist administer? A whole heck of a lot, as far as I can tell.

Not all common tests will be easily computerized. For example, how are you going to do that on block design, grooved pegboard, etc? I am sure there are ways, but they will take time to achieve the level of standardization/respect that many of our existing measures have.

The other piece is implementation/market share. I've already agreed that things are moving in the computerized direction - if not in administration we already have it for scoring for many measures. So as cool as an ipad version of Trails might be, would you expect every practice to invest in this technology immediately? Even if I do, do I want to use that with my delirium consult inpatients?

What is Pearson comes out with one expensive piece of hardware and another company has a different piece of hardware? Not everyone is going to buy it right away Heck, it has taken many folks awhile just to get around to buying the WAIS-IV. So when you say sooner rather than later, I don't agree that it is imminent (like in the next 3-4 years), but I would see a good chunk transitioning within 10 years (just my guess).

The other piece is the role of the psychologist/neuropsychologist when these things transition over. We've already got neurologists using computerized tests to make ADHD diagnoses (you seem to assume that neuropsychologists will be the ones using them). Some folks are worried that computerizing all of our assessments will just cut us out of the loop (not just the techs).

 

[bmedclinic]

fair points

 

[ResearchGirlie]

We began to move part of our research assessment battery to computer versions but found that at least 30% of our participants felt really uncomfortable around a computer. We could have taught them how to use it for purposes of the assessment but felt that it would be better to avoid that issue given that it was a fair number of people that would feel less confident on the computer. Also, we found that it didn't really save time because a person had to be there to answer any additional questions. This is in a population with severe cognitive and emotional deficits so it likely wouldn't be that way in every lab or clinic but it's definitely something to think about when envisioning the switch to computer testing.

 

[MBellows]

Not all common tests will be easily computerized. For example, how are you going to do that on block design, grooved pegboard, etc? I am sure there are ways, but they will take time to achieve the level of standardization/respect that many of our existing measures have.

The other piece is implementation/market share. I've already agreed that things are moving in the computerized direction - if not in administration we already have it for scoring for many measures. So as cool as an ipad version of Trails might be, would you expect every practice to invest in this technology immediately? Even if I do, do I want to use that with my delirium consult inpatients?

What is Pearson comes out with one expensive piece of hardware and another company has a different piece of hardware? Not everyone is going to buy it right away Heck, it has taken many folks awhile just to get around to buying the WAIS-IV. So when you say sooner rather than later, I don't agree that it is imminent (like in the next 3-4 years), but I would see a good chunk transitioning within 10 years (just my guess).

The other piece is the role of the psychologist/neuropsychologist when these things transition over. We've already got neurologists using computerized tests to make ADHD diagnoses (you seem to assume that neuropsychologists will be the ones using them). Some folks are worried that computerizing all of our assessments will just cut us out of the loop (not just the techs).

While it's certainly not in the comprehension of anyone at the BA/BS level, how would a computer cope with the occasional (or often in geriatric neuropsychology) need to modify the testing procedures in order to get any viable information?

 

[Pragma]

While it's certainly not in the comprehension of anyone at the BA/BS level, how would a computer cope with the occasional (or often in geriatric neuropsychology) need to modify the testing procedures in order to get any viable information?

Of course it wouldn't be capable of that. I am a neuropsychologist and I don't agree with the idea that our testing can just be picked up and completed by anyone (or a computer). I think a substantial proportion of our tests will be migrated to electronic formats, but never entirely.

I think there is a way to embrace technological advances while preserving the integrity of the testing process (e.g., makes sense for some tests and not for others). But to the original point of the thread - I think the over-use of "automated administration" (whether that is via a tech or a computer) does not really advance our cause as a field. But as I mentioned - I'm biased towards doing your own testing and was trained that way.

 

[MBellows]

Of course it wouldn't be capable of that. I am a neuropsychologist and I don't agree with the idea that our testing can just be picked up and completed by anyone (or a computer). I think a substantial proportion of our tests will be migrated to electronic formats, but never entirely.

I think there is a way to embrace technological advances while preserving the integrity of the testing process (e.g., makes sense for some tests and not for others). But to the original point of the thread - I think the over-use of "automated administration" (whether that is via a tech or a computer) does not really advance our cause as a field. But as I mentioned - I'm biased towards doing your own testing and was trained that way.

👍👍👍👍

 

[Therapist4Chnge]

I use FT psychometricians for all of my neuro assessments, as it isn't feasible for me to do all of my own testing (between billing and total time spent). I believe a person can be trained to handle the administration of most neuropsych instruments, though interpretation is a far far different matter. I liken it to the difference between a mech tech and a mechanic. A technician can be trained to work on aspects of the car, but the mechanic needs to understand the entire picture. Changing the oil, tweaking the alignment, or swapping out brake pads are pretty straight-forward tasks. I can train someone to do certain tasks, but the overall evaluation is my responsibility.