Much of the health service psychology and broader mental healthcare world has rallied in recent weeks to adapt clinical practice to the necessary physical distancing constraints of the COVID-19 crisis. The bulk of clinical services, largely based on verbal interaction between the client and service provider, has moved to a distributed and distance service delivery model, largely relying on online teleconferencing technology to continue face-to-face contact with consumers (clients, parents, schools, etc.).
However, the situation is more challenging with assessment services that have standardized administration procedures that require in-person contact. In considering these challenges, some psychologists may choose to pause their psychological assessment services during this time; however, there are others who do time-sensitive, high-need and/or high-stakes assessments that really need to continue. Most current and emerging telehealth guidelines largely focus on psychotherapy and, as such, tele-assessment guidance is necessary.
In response to the need for physical distancing and isolation requirements, test publishers have started to modify their service delivery options, such as the ability to use remote testing options (for example, emailing a link to the testing interface to the respondent or presenting stimuli over their remote testing platforms).
However, multiple types of assessment, including cognitive, neuropsychological and autism assessment, are disproportionately burdened by the current physical distancing, limited contact, and stay-at-home constraints. These assessment methods have historically relied on tasks and interpersonal procedures that require in-person interaction, such as the manipulation of physical materials, standardized interactions between assessor and client, and clinical observation of the person in a physical environment.
These principles are an effort to offer help to those providing psychological assessment service under physical distancing constraints. They are not meant to supplant typical practices and guidelines under normal circumstances. That is, when it becomes safe and feasible to resume in-person services, these recommendations should not override typical and standardized practice. However, they are meant to allow for at least some continuity of the care and needed services provided during this unprecedented time.
The overarching context within which these principles are being developed is an understanding that the research and evidence base for equivalence of cognitive, neuropsychological, and other interactional measures in a remote, online format compared to a traditional, face-to-face format is extremely nascent. Some early evidence, under very controlled circumstances, of possible equivalence exists (e.g., Brearly, 2017; Cullum et al., 2006; Galusha-Glasscock et al., 2016; Harrell et al., 2014; Parmanto et al., 2013; Smith et al., 2017; Wadsworth et al., 2018; Wright, 2018).
Replications of studies are needed, and evidence needs to be amassed. Therefore, the following principles are aimed at continuing care while understanding that equivalence between in-person testing and tele-testing is not guaranteed. That means that validity of the data should be overtly addressed in the report.
This guidance represents the best, current, available knowledge and opinions of the Boards of the Society for Personality Assessment and Section IX (Assessment) of APA Div. 12 (Society of Clinical Psychology). The principles here are not necessarily shared by all organizations. For example, the Interorganizational Practice Committee, a coalition of national neuropsychology organizations including APA Div. 40 (Society for Clinical Neuropsychology), is producing tele-neuropsychological specific assessment guidance. Further, no recommendation provided here should be followed if it contradicts federal, state, or local laws overseeing the practice of psychologists providing assessment services.
Finally, these principles should be considered all together. That is, no one principle is meant to allow psychologists the ability to alter test administration, if the other principles are not considered as well.
The purpose of these principles is to allow for the best possible practice within the current physical distancing constraints; as such, some standardized 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 alter the data. Psychologists, fully trained in the standardized administration procedures of all tests they are planning to give, also need to practice the altered procedures with individuals other than their clients before attempting actual assessments.