ASSESSMENT, TESTING, AND DIAGNOSIS Pope & Vasquez Chp.

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-Assessment, testing, and diagnosis can change peoples lives (used in decision making employment, disability, insurance, sentencing, etc.)

-general evaluation has given way to various specialized areas of assessment, each requiring its own competencies.

Awareness of Standards and Guidelines:

-APA Ethical Principles and Code of Conduct has several sections on testing, assessment, and diagnosis. -CPA Canadian Code of Ethics For Psychologists states: Psychologists provide suitable information about the results of assessments, evaluations, or research findings to the persons involved, if appropriate and if asked. This information would be communicated in understandable language. (III.5) Psychologists protect the skills, knowlefe and interpretations of psychology from being misused, used incompetently, or made useless. (IV.11) -See list of other documents useful for helping for checking if work meets highest standards (p. 190)

Staying Within Areas of Competence:

-simply having a degree or license doesnt qualify one to administer, score, etc, psychological tests. -Testing requires demonstrable competence (education, training, supervision).

Make Sure Tests and Assessment Methods Stay Within Their Areas of Competence:
-Tests should only be used to assess what they were designed to. -Consider validity and reliability of test for desired usage. Check that it has been normed and validated for relevant groups. -Cultural issues may affect validity of scores and cut-off points indicating disability. Scores from tests used in other cultures may not represent the construct intended to be measured, due to confounding cultural variables.

Technical Equivalence Means the method of data collection equally familiar to

participants across cultural groups.

Metric Equivalence Means that constructs are measurable through the same scale in
other cultures via translation.

Demonstrating Competence:
-Documenting training, clinical, and supervised hours helps establish competence when it is questioned.

Ensure that Patients Understand and Consent to Testing:

-Clients must understand BEFORE beginning, the nature, purpose, and techniques of the instrumentation, as well as who will receive or have access to the results, in order to give informed consent to assessment or treatment. -Clarify who will have access to the test report and raw data. -Therapists function in a complex framework of legal and ethical standards regarding release of test information. -Canadian 2000 Personal Information Protection and Electronic Documents Act (PIPEDA). -Unless approved by the patient, test data should only be provided by law or court order. -Released info should be limited to what is necessary. Standard Procedures for Administering Tests:

Following Standard Procedures for Administering Tests:

-accommodations for testing (for disabilities) can be made within reason, but adherence to standardized procedure is essential to protect the applicability of the norms. -Never let them take the test homeDirect knowledge of the testing conditions is important.

Recordings and Third-Party Observers:

-Audio-taping or presence of a third-party has shown to impair performance on tests. -Third-parties may facilitate validation or fairness of administration. Requests can be handled by the following: 1) allow the presence of an observer, 2) minimizing intrusion of observation, 3) use measures less affected by observation, 4) recommend the request

be withdrawn, 5) decline to administer under observation.

Be Aware of Basic Assumptions:

-Clinicians from different schools of thought can have different interpretations of test results. Be aware of own orientation and the related tendencies and effects on assessment.

Personal Factors Can Lead to Misdiagnosis:

-Being unaware about our personal dynamics and reactions can lead to faulty evaluations. -tendency to express countertransference hate, mask imprecise thinking, excuse failure, justify own misbehavior, defend against sexual material, and avoid pharmacological treatment interventions, can lead to misdiagnosis. -Must be open about ourselves and frequently consult colleagues.

Financial Factors Can Lead to Misdiagnosis:

-some diagnoses are not covered by third party coverage plans. False diagnosis is common. -Assessment is often only reimbursed for a single hour.

Low Base Rates:

-Low base rates can cause big mistakes in assessments. -Error rate is important, can lead to a large amount of false-positives.

Dual High Base Rates:

-Can make to independent variables appear linked when they are not statistically related. (see example p. 201)

Retrospective and Predictive Accuracy: Predictive Accuracy The chances that someone with a certain profile of assessment
results has a particular condition, ability, or aptitude.

Retrospective Accuracy The chances that someone with a specific condition, ability or
aptitude has particular profile of assessment results.

Affirming the Consequent Fallacy: Condition X is very likely to cause these test results.
Person Y has these test results, Person Y is very likely to have condition X.

Forensic Issues:
-Psychologists should never accept fees dependent on the outcome of a case. (contingency fee) or referrals with contingent fees. -Child custody reports should never be made on basis of assessment of only one party. -Best-interest of child is most important.

Medical Causes:
-Comprehensive evaluation required to rule out medical cause of suspected diagnosis.

Prior Records and History:

-Prior records of assessment and treatment are a valuable part of a comprehensive evaluation. -Must make an effort to obtain and recognize prior history of patient. Legal precedent exists for failure to obtain prior medical history (Jablonski v. U.S.)

Indicate Reservations about Reliability and Validity:

-Must identify in formal report any suspected conditions which may have affected the results of the assessment. -Psychologists must be alert to diverse factors such as language and culture that may affect validity of assessments.

Provide Adequate Feedback:

-Feedback is a dynamic interactive process of sharing results and implications of testing and assessment with the client in question. -3 Factors can interfere with the feedback process: 1) Managed care can place unrealistic demands on clinicians time and may not adequately reimburse for feedback sessions. 2) Use of abbreviated tests may lead to a tendency to give abbreviated feedback. 3) Some results may be difficult or uncomfortable for the clinician to relay to the client. Also, translation of technical jargon or complex theories for lay people can be troublesome. Client expectations can also make clinicians reluctant to give disappointing results. ETHICS IN THE CYBER AGE Pope & Vasquez Chp. 5 Therapy in the Digital World: The Ethical Challenges of the New Technologies

-Technology allows new ways to connect with patients, overcome geographical barriers, develop new treatments. -Digital technology has benefits and risks, it takes confidential info and spreads it over electronic networks. -Health Insurance Portability and Accountability Act (HIPPA) provides rules for privacy. -Databases of private records often fail to get consent before adding patients info. Storage at distant sites and transfer over networks creates opportunity for security to be compromised. -Clinicians informal use of social media may be seen by peers or potential clients, potentially affecting their reputation and careers. -Internet Anonymity is not always absolute. -Psychological test materials are often available for viewing or purchase online without authorization or purchaser restrictions.

5 Pitfalls of Technology Use:

1) Computers and technology are not infallible. Professionals must recognize the potential weaknesses of the technologies they use and where it can fail, and prepare accordingly. 2) Agreeing to certain services on the internet without understanding the terms of use, may unknowingly allow access to confidential information or link a professionals name to unwanted to material. 3) Use of technology such as videoconferencing can create unforeseen risks of breach of privacy. 4) Our online identities can have real world consequences. We must be just as self-conscious of how are actions or words may be seen, online as we are offline. 5) Online therapy or videoconferencing may make it challenging to take precautions or be as thorough in assessments as one would with in-person clients.

Questions To Ask When Using Technology:

-Where is the computer physically located and how secure is this location against, theft, prying eyes, unauthorized access? -Is the computer protected from hackers? -Is the computer protected from malicious code that can access confidential

information? -Is your computer protected from Viruses or other Malware? -Is the computer password protected? -Is confidential information encrypted? -How are confidential files deleted? -How are computer disks discarded? -How do you guard against human error in handling information? -How do you make sure that only the intended recipient receives your confidential information? -Do your clients clearly understand the ways in which they can or cant communicate with you via e-mail, text message, or other digital media? -Is your professional web site or the web site of the clinic hospital or group practice at which you work accessible to people with disabilities? -If your web site includes a function that enables patients to communicate with you (e.g., by signing on with a user name and password) , has it been adequately secured? -If you use social networking media does this usage form a link between you and your client or clients family, and how does this affect your relationship with your client? -Are you competent to provide services through digital media? -Are you aware of the relevant laws and regulations governing the use of digital media in providing clinical services? -Are you aware of the emerging research on clinical services offered through digital media?

-Are you aware of the professional guidelines for teletherapy, internet therapy, and other clinical services provided through digital media?

PROFESSIONAL AND LEGAL STANDARDS Truscott & Crook - Chp. 2 Professional standards To be consideregyd a Profession an occupation must: 1) be an intellectual activity based on a particular knowledge base rather than a routine. 2) be practical rather than theoretical and, 3) be oriented toward service to society. -Psychologists must uphold responsibilities to serve the good of society in order to protect psychology as a profession. -The profession sets standards of entry level admission and encourages ethical practice by its members. -Duties of a professional specified in Principle III: Integrity in Relationships: III.36 Familiarize themselves with their disciplines rules and regulations, and abide by them, unless abiding by them would be seriously detrimental to the rights or welfare of others as demonstrated in the priniciples, Respect for the Dignity of Persons, or Responsible Caring. III.37 Familiarize themselves with and demonstrate a commitment to maintain the standards of their discipline. Nature of Professional Standards: Entrance Standards Different provinces have different entrance standards to the profession (Masters Degree, except for Quebec), differing coursework requirements, all require one year supervision post Masters degree. -Most jurisdictions require Examination for Professional Practice of Psychology (EPPP). -Registration is transferrable to other jurisdictions, as all require the 5 Core Competencies: 1) Interpersonal Relationships Consultation 4) Research 2) Assessment and Evaluation 5) Ethics and Standards 3) Intervention and

Standards of Professional Conduct: -Codes of Ethics are aspirational in nature and thus not suitable for regulatory use. Codes of Conducts are more appropriate as they set minimum standards of conduct. Characteristics of Effective Standards of Professional Conduct

1) They deal with behaviors in the professional relationship 2) They protect the public interest first, and interest of the profession second. 3) They are as non-intrusive as possible. 4) They are as unambiguous as possible about what is acceptable behavior and what is not. 5) They are self-explanatory and dont require other materials for interpetation. 6) They are non-optional, non-aspirational, and non-trivial, violation is basis for disciplinary action. -Codes of conduct differ by jurisdiction. Manitoba, Newf., Nov. Sco., PEI, NWT, have none. Psychologists are responsible for adhering to applicable codes. Professional Guidelines: -Guidelines bridge the gap between aspirations of Codes of Ethics and minimum standards of Codes of Conduct. -Are consistent with both, but provide greater detail than either for best practice. -Combine prescriptive standards, proscriptive standards, and aspirational principles. -Not definitive or enforceable. -All psychologists in Canada should be familiar with CPA guidelines, in addition to jurisdiction specific ones. Professional Accountability: -Standards of conduct usually sufficient to protect public from harm and hold violators accountable. -Legal mechanisms invoked when they prove insufficient. -Canada has two means for dealing with misconduct by professional psychologists: 1) Ethics Committees: CPA membership is beneficial but voluntary; Ethics and standards adherence required for membership. CPA ethics committee can negotiate informal resolutions of complaints; board of directors can suspend or expel members. In reality it is not much of a dissuader against unethical behavior (only expelled one member in history). 2) Provincial/Territorial Discipline Committees: Handle most complaints. Complaints initiated by regulatory college, member of public, or member of profession. Two thirds of complaints dismissed or withdrawn. Informal resolution also option for complainant. College decides whether to proceed to investigation. Named psychologist invited to respond to complaint. Investigator reviews all materials, conducts interviews if necessary. College than rules whether to dismiss, mediate negotiated settlement, or proceed to disciplinary hearing. At a hearing evidence heard

from both sides, legal counsel involved. Diverse penalties available to committee; symbolic to severe. Appeal is allowed. Complaints Against Psychologists: -Jurisdictions handle as many as 40 cases a year, many more handled informally. Disciplinary hearings are rare, 0-2 a year. Regulating Ourselves: -Each member of a self-regulating profession is both regulated and a regulator. -CPA encourages psychologists to: IV.13 uphold disciplines responsibility to society by notifying appropriate authorities of unethical and/or incompetent behavior, when informal resolution or correction is not possible. -This is a difficult role for most psychologists. Following steps recommended for handling these situations: 1) Confirm the issue objectively assess situation, own motives, competency to judge, and whether knowledge of situation is direct or rumor based. 2) Safeguard Confidentiality Clients right to confidentiality takes precedence over obligation to offset or correct harm (unless serious threat of physical harm exists). 3) Consult With Others Discuss concerns with trusted peers, protecting identity of those involved. 4) Address the Issue Confront and attempt to reach agreement with colleague on course of action. Goal is to correct the problem, not punish. Be respectful, calm, constructive and open-minded. Face to face meeting in professional surrounding is best. 5) Involve Others in an Action Plan If colleague is unwilling to address issue, or if there is risk of serious harm, authorities should be notified (regulatory body). Truscott & Cook Chp. 3 Law and legal standards -Psychologists are not lawyers, but expected to act in accordance of the law. Basic understanding of the legal system and how psychologists are perceived by the courts can inform how actions might be judged. CHARACTERISTICS OF THE LEGAL SYSTEM: -laws provide expectations for behaviors acceptable for most people. -Legal systems essential features are

1) Adversarial one party versus another party. Justice emerges when both sides have equal chance to present case and challenge evidence. 2) Visible Courts are open to the public. Justice must be seen so that public can trust the legal judicial institution. 3) Remedial Legal systems function is to right wrongs, provide remedies, or settle conflicts. Sentencing is motivated by a desire to denounce unlawful behavior, deter the offender, protect society, rehabilitation, provide reparations, and/or promote responsibility. Civil suits determine fault. Areas of Law: Substantive Law laws that define rights, duties, and obligations of citizens. Procedural Law procedures by which substantive law is applied. Three Areas of Substantive Law: criminal, mental health, and civil. 1) Criminal Offences described in criminal code. Can result in fine or jail time. State prosecutes. Elaborate procedures ensure fair treatment of accused. -Citizens rights detailed in Charter of Rights and Freedoms (1982). Youth crimes (12 to 18) covered by Youth Criminal Justice Act (2002). Youth can be ordered to have psychological assessment with or without consent, and can be placed in custody for up to 30 days in order to complete ordered testing. Extensive legislation for confidentiality of testing exists. 2) Mental Health Three types of legislation concerning mental health law. Mental Health Act (provincial), Criminal Code of Canada (federal), and Consent to Treatment, Adult Guardianship, and Adult Protection legislations (provincial). All legislation must be in-line with Charter of Rights and Freedoms or can be challenged in court and amended. 3) Civil Most applicable to psychologists. Regulates relationships and resolves disputes between parties. Based on common law. Leading cases set precedents. Few leading cases specifically concerning psychologists in Canada. Mostly medicine and other health profession precedents applied. Can compensate the wronged, can limits to behaviors, can educate public, provide a controlled setting for disputes. Wrongs are intentional or unintentional. If intentionality of battery or assault is proven, loss or damage does not need to be demonstrated in order to be awarded damages. For emotional damages, it must be demonstrated. Psychologists usually accused of unintentional harm due to negligence.

Negligence: Negligence in legal terms is conduct that fails to meet the standard required by society.

Must establish 5 elements for negligence claim to be valid. 1)Duty of care owed by defendant to plaintiff, 2) failure to provide reasonable care 3) degree of causation 4) damage or injury 5) plaintiff s conduct must not preclude recovery. Duty of Care traced to the Hippocratic oath. Practitioner has duty to act in best interest of client, duty of confidentiality, and duty to maintain high standards of profession. No contract required for psychologists. Duty is represented by existence of professional relationship. Reasonable Care court decides what it is, not the profession. Inexperience not a defense for failure to meet standards of care. Higher risks to patient means higher standards, more experienced professional can mean higher standards. Failure to keep abreast of new research, emergency situations, and honest mistakes are all taken into account by court. Causation Most difficult issue to be resolved. Two types: Factual actions caused injury or probably caused injury; Proximate damage must be foreseeable in light of the action. Plaintiff s Conduct conduct at the time of the negligence, if illegal may affect the ruling in their favor. Example. If client lied about history and thus psychologists actions were misinformed and resulted in harm.

Relationships and Consequences Relevant to Legal Expectations:

-Claims are increasing against psychologists. Grounds for Claims Include: Suicide Haines vs. Bellissimo If defendant can demonstrate that reasonable care was provided, precedents favor the psychologist. Psychotherapy Types of therapy that cause recall of painful memories resulting in present day disability have brought charges against the therapist. Precedent finds psychologist not liable as long as patient demonstrated adequate support and emotional stability required for such treatments, and problem behavior cannot be directly linked to the therapy. Assessment Psychologists have been sued for failing to accurately assess needs for special education. Although in most precedents the psychologist has not been found liable, there is the potential for breach of contract liability in some situations.

Third Parties Tarasoff vs Regents of the U. of California. (1976). Duty exists to provide reasonable care to protect intended victim when intent to harm is stated by a client. Including a duty to warn if circumstances require. Precedents dictate that intended victim must be identifiable either as an individual or class of victims (eg. Girls under 5) for duty to exist. Intent to harm is not limited to verbalization but can be demonstrated by either means, which still require action by the professional. -If therapy itself is cause of harm to a third party, duty for extended reasonable care to the third party may exist. Whether this is grounds for liability if 3rd party is harmed depends on the societal benefit. If the use of the therapy does more good than bad, psychologist will likely not be ruled liable.