Technician use in research

[megamaramon]

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I am a clinical attending pediatric neuropsychologist for an academic medical center. For my hospital-based work, I use neuropsychology technicians. This is in line with my state’s regulations, where only psychologists who are approved to practice neuropsychology can train and use technicians for work.

Recently, part of my time was moved to a research center on campus. For some reason, this research center uses a technician in their data collection. The technician is administering WASI-II, CELF-5, WRAT-5, D-KEFS, etc. The research participants are not getting any feedback/interview/diagnosis as part of the research study; the tests are purely data collection.

I have asked this research center why they use a technician and not a trained research assistant. They apparently had gotten direction from a previous neuropsych that these measures had to be administered by a technician. I’m trying to make sense of it: if that was the case, then no research lab would be able to psych measures as part of their study without hiring a neuropsych and their technician.

We had a technician hired at this research center, but they moved away. We are currently trying to find another technician. The problem is, in my state, there are some academic restrictions on registering as a technician, making it difficult to find a suitable candidate.

Something’s weird here, and here are my questions: has anyone run into this? How do you explain that the measures could be administered by a research assistant as long as they are supervised and fidelity checks are made? Or, am I completely wrong here?

I have emailed by state board for clarification, but they have not responded. They are also not posting their meeting minutes for the past 6 months, but that’s a whole other story.

 

[PsyDr]

1) Consult your state law. Some states have distinction between the title of "research assistant" and "technician", some states do not have a distinction. Sounds like yours does.

2) NAN has standards for neuropsych technicians. They have to have a bachelors degree, and you must be physically on site.

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

3) OPM also has a guide for supervision, which may apply if you are doing human subjects research with federal funding. I don't remember.

4) IIRC, you might have some obligations to tell participants about the rare "incidental findings" under federal regulations for human subject whatever. So "never feedback" isn't really a thing. You're probably never going to see a neuropsych profile consistent with a brain tumor, but try telling that to the federal requirements.

5) You sound like you know the right answer, and are looking for a workaround. That's usually not a great move.

 

[megamaramon]

1) Consult your state law. Some states have distinction between the title of "research assistant" and "technician", some states do not have a distinction. Sounds like yours does.

2) NAN has standards for neuropsych technicians. They have to have a bachelors degree, and you must be physically on site.

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

3) OPM also has a guide for supervision, which may apply if you are doing human subjects research with federal funding. I don't remember.

4) IIRC, you might have some obligations to tell participants about the rare "incidental findings" under federal regulations for human subject whatever. So "never feedback" isn't really a thing. You're probably never going to see a neuropsych profile consistent with a brain tumor, but try telling that to the federal requirements.

5) You sound like you know the right answer, and are looking for a workaround. That's usually not a great move.

Right now, the only time I’m hearing of reaching out to the participants after the testing is if there are concerns about depression or suicide. They have a procedure in place where an on site psychologist meets with the participant.

The technician requirements is where this research center is running into trouble. In my state, they have to have a bachelor’s plus 4 specific classes. None of the applicants have those 4 classes even with their bachelors, which means they could not register as a technician until they find some sort of online program and take a course or two they are missing.

I’m new to this center, and my FTE for it is pretty small (.10). I’m still trying to figure out their procedures and why things are done in certain ways. I used to meet with the previous technician for weekly supervision and did fidelity checks on their protocols.

I don’t know any other neuropsychs locally who are providing research support, and would definitely like to hear more about how others are doing this.

 

[bcliff]

Something’s weird here, and here are my questions: has anyone run into this? How do you explain that the measures could be administered by a research assistant as long as they are supervised and fidelity checks are made? Or, am I completely wrong here?

I initially misread your post and deleted my first reply... I was confused by the word technician, because I usually use the word psychometrist. That's neither here nor there though.

I've never run into this before. My initial reaction is that you do not need a psychometrist (with the same level of training, etc., as would be expected in clinic) because these data are not being collected as part of a clinical evaluation. There is no referral question; you're not clinical hypothesis testing; etc. - A neuropsychological evaluation is an evaluation performed by a neuropsychologist, not some magic combination of specific cognitive tests. Without 96132/33 level data review, synthesis, and integration of results, it could be perceived as unethical to share incidental findings with participants, as it's unclear what's "noise" and what's a meaningful finding.

A caveat to this, which I've seen in at least one (healthy aging) study I was a part of (years ago as an undergraduate) was that participants could request that their raw data be shared with one of their existing providers, with the limitations described above. Another caveat would be to have a blanket policy for all participants (e.g., "an investigator will contact you within X days of your study visit if any of your scores on the following indices fall at or below two standard deviations below the mean, as scores at or below this threshold may be clinically meaningful. In such a case, we will encourage you to follow-up with your primary care provider for guidance on next steps or other referrals that may be useful.") - In neither case, though, would I think it unallowable to have a clinical research coordinator (CRC) or research assistant (RA) administer the tests; the results would just be couched with the caveat that they were not administered in a manner consistent with a clinical neuropsychological evaluation. That point should be made clear in the informed consent document.

In most IRBs I write nowadays, I say something along the lines of "these data are not clinical in nature, as they are not collected or reviewed in a manner consistent with a clinical neuropsychological evaluation." My use of CRCs (rather than psychometrists) actually strengthens this point (e.g., these data were not collected by a psychometrist, which I've deemed fine for the purposes of my research, but is not the standard I apply in my clinic).

Try posting to some of the neuropsych LISTSERVs if you haven't already; I'm usually impressed by the shared wisdom on those email lists.