How to do psychological testing via telehealth

While some psychologists may pause their psychological assessment services during the COVID-19 crisis, others have time-sensitive, high-needs or high-stakes testing that needs to continue. A new guidance on tele-assessment from APA’s Div. 12 (Society of Clinical Psychology) provides some advice on practicing in this time.

Some standardized testing administration methods will need to be altered. Altering these administration procedures should be done carefully, thoughtfully and deliberately, with special attention paid to how the alterations themselves may modify the data. These six principles will help psychologists continue providing tele-assessments within the current physical distancing constraints.

Note: This article is a brief summary of the full guidance on tele-assessment during the COVID-19 crisis from the Boards of the Society for Personality Assessment and Section IX (Assessment) of APA’s Div. 12.

While some test materials and procedures will need to be modified to allow for physical distancing, psychologists should be sure they do not jeopardize test security. For example, sending stimulus materials (copies of psychomotor task stimuli or record forms) may not be approved by test publishers.

It is important for the psychologist to know the limits of tele-testing and to consider whether this approach is appropriate given the referral question, evidence, client characteristics/ preferences and clinician expertise. Do your best to keep the administration procedures as close as possible to the traditional, in-person procedures. Remote audio-visual monitoring of the test administration, even with self-administered instruments, is essential.

To date, there is limited research and evidence for equivalence of testing in a remote, online format compared to a traditional, face-to-face format. Psychologists should think through every single task administered and decide just how much the quality of the data are likely affected by the alternate administration format.

There will certainly be some tests or subtests that are not possible to replicate via telehealth. However, psychologists can consider tasks that tap similar constructs. Remember that the most robust and meaningful scales in multi-faceted tests are typically the overall “full scale” indices, rather than their subscales. That means that slight data problems may not be as important, meaningful or disruptive because they are only partially contributing to the larger, overall score.

Psychological assessment requires psychologists to use their clinical judgment to interpret test scores, including their margin for error, within the context of individual and contextual factors, including presenting problems, diversity considerations and other factors. Integrating test data derived from non-standardized administration procedures broadens the margin of error. It is important for psychologists to be deliberate and explicit about the broader confidence intervals and potential for errors in the administration process, interpretation and in the write-up of results.

The ethical principles that underlie the APA’s Ethics Code are built on the foundation of doing good, avoiding harm and being faithful and just in our work. These principles remain intact during this crisis period. This includes ensuring that the process of informed consent is thorough, clear and ongoing. It is important to be transparent in reports about the novel circumstances under which the assessment was conducted, as well as the considerations that went into how data are interpreted, with consideration to alterations, and integrated with other information.