Following completion of their evaluations and reports, psychologists often receive requests for additional clarification, feedback, release of data, or other information and materials related to the evaluation. Release of confidential client
TABLE 8.1 Assessing the Quality of a Psychological Testing Report
Item to be Included
Comments in Report Should Address
Referral information Informed consent
Current status observations
Deviations from standard practice
Listing of instruments used
Reliability and validity
Who referred the person? What questions are to be addressed? Was the person (or parent or guardian) advised about the nature and purpose of the evaluation, as well as who is to pay, what charges are anticipated, who will have access to the data, and what feedback will be provided?
What is the relevant psychosocial ecology (e.g., school failure, recent divorce, criminal charges, etc.)? Is a statement about any third party obligations or entitlements (e.g., responsibility for payment or access to findings) noted?
What behaviors were observed during the interview (e.g., mood, rapport, concentration, language barriers, physical handicaps, etc.)?
Were any deviations from standard practice in test administration needed to accommodate the client? Is a complete list of the tests administered provided? Does the list specify the full names of the instruments and version or form used? Does the report provide descriptive information or references for any unusual instruments or techniques used? If more than one set of norms exist, are the norms used in evaluating the particular client reported on specified? Are the test results obtained deemed reliable and valid, or should they be considered in light of any mediating factors?
Are scores for each instrument administered presented and explained? Are the meanings of the data discussed in the context of the referral questions? Are homogeneity, variability, or scatter in patterns of scores discussed? Are technical terms and jargon avoided?
If a summary is provided, does it err by mentioning material not addressed in the body of the report? If recommendations are made, is it evident how these flow from the data? Do recommendations relate cogently to the referral questions? If a diagnosis is requested or if differential diagnosis was a referral question, does the report address this issue? Is the report signed by the person who conducted the evaluation? Are the degree(s) and title of the person signing provided? If the signer is unlicensed or a trainee, has a licensed supervisor countersigned the report?
Source: Koocher (1998).
information is addressed in the ethics code and highly regulated under many state and federal laws, but many other issues arise when psychological testing is involved.
Psychologists are expected to provide explanatory feedback to the people they assess unless the nature of the client relationship precludes provision of an explanation of results. Examples of relationships in which feedback might not be owed to the person tested would include some organizational consulting, preemployment or security screening, and some forensic evaluations. In every case the nature of feedback to be provided and any limitations must be clearly explained to the person being assessed in advance of the evaluation. Ideally, any such limitations are provided in both written and oral form at the outset of the professional relationship. In normal circumstances, people who are tested can reasonably expect an interpretation of the test results and answers to questions they may have in a timely manner. Copies of actual test reports may also be provided as permitted under applicable law.
On some occasions, people who have been evaluated or their legal guardians may request modification of a psychologist's assessment report. One valid reason for altering or revising a report would be to allow for the correction of factual errors. Another appropriate reason might involve release of information on a need-to-know basis for the protection of the client. For example, suppose that in the course of conducting a psychological evaluation of a child who has experienced sexual abuse, a significant verbal learning disability is uncovered. This disability is fully described in the psychologist's report. In an effort to secure special education services for the learning problem, the parents of the child ask the psychologist to tailor a report for the school focusing only on matters relevant to the child's educational needs—that is to say, the parents would prefer that information on the child's sexual abuse is not included in the report sent to the school's learning disability assessment team. Such requests to tailor or omit certain information gleaned during an evaluation may be appropriately honored as long as doing so does not tend to mislead or misrepresent the relevant findings.
Psychologists must also be mindful of their professional integrity and obligation to fairly and accurately represent relevant findings. A psychologist may be approached by a case management firm with a request to perform an independent examination and to send a draft of the report so that editorial changes can be made. This request presents serious ethical considerations, particularly in forensic settings. Psychologists are ethically responsible for the content of all reports issued over their signature. One can always listen to requests or suggestions, but professional integrity and oversight of one's work cannot be delegated to another. Reports should not be altered to conceal crucial information, mislead recipients, commit fraud, or otherwise falsely represent findings of a psychological evaluation. The psychologist has no obligation to modify a valid report at the insistence of a client if the ultimate result would misinform the intended recipient.
Who should have access to the data on which psychologists predicate their assessments? This issue comes into focus most dramatically when the conclusions or recommendations resulting from an assessment are challenged. In such disputes, the opposing parties often seek review of the raw data by experts not involved in the original collection and analyses. The purpose of the review might include actual rescoring raw data or reviewing interpretations of scored data. In this context, test data may refer to any test protocols, transcripts of responses, record forms, scores, and notes regarding an individual's responses to test items in any medium (ECTF, 2001). Under long-standing accepted ethical practices, psychologists may release test data to a psychologist or another qualified professional after being authorized by a valid release or court order. Psychologists are exhorted to generally refrain from releasing test data to persons who are not qualified to use such information, except (a) as required by law or court order, (b) to an attorney or court based on a client's valid release, or (c) to the client as appropriate (ECTF, 2001). Psychologists may also refrain from releasing test data to protect a client from harm or to protect test security (ECTF, 2001).
In recent years, psychologists have worried about exactly how far their responsibility goes in upholding such standards. It is one thing to express reservations about a release, but it is quite another matter to contend within the legal system. For example, if a psychologist receives a valid release from the client to provide the data to another professional, is the sending psychologist obligated to determine the specific competence of the intended recipient? Is it reasonable to assume that any other psychologist is qualified to evaluate all psychological test data? If psychologists asked to release data are worried about possible harm or test security, must they retain legal counsel at their own expense to vigorously resist releasing the data?
The intent of the APA ethical standards is to minimize harm and misuse of test data. The standards were never intended to require psychologists to screen the credentials of intended recipients, become litigants, or incur significant legal expenses in defense of the ethics code. In addition, many attorneys do not want the names of their potential experts released to the other side until required to do so under discovery rules. Some attorneys may wish to show test data to a number of potential experts and choose to use only the expert(s) most supportive of their case. In such situations, the attorney seeing the file may prefer not to provide the transmitting psychologist with the name of the intended recipient. Although such strategies are alien to the training of many psychologists trained to think as scientific investigators, they are quite common and ethical in the practice of law. It is ethically sufficient for transmitting psychologists to express their concerns and rely on the assurance of receiving clinicians or attorneys that the recipients are competent to interpret those data. Ethical responsibility in such circumstances shifts to receiving experts insofar as justifying their own competence and the foundation of their own expert opinions is concerned, if a question is subsequently raised in that regard. The bottom line is that although psychologists should seek appropriate confidentiality and competence assurances, they cannot use the ethics code as a shield to bar the release of their complete testing file.
The current APA ethics code requires that psychologists make reasonable efforts to maintain the integrity and security of copyright-protected tests and other assessment techniques consistent with law and with their contractual obligations (ECTF, 2001). Most test publishers also elicit such a pledge from those seeking to purchase test materials. Production of well-standardized test instruments represents a significant financial investment to the publisher. Breaches of such security can compromise the publisher's proprietary rights and vitiate the utility of the test to the clinician by enabling coaching or otherwise inappropriate preparation by test takers.
What is a reasonable effort as envisioned by the authors of the ethics code? Close reading of both the current and proposed revision of the code indicate that psychologists may rely on other elements of the code in maintaining test security. In that context, psychologists have no intrinsic professional obligation to contest valid court orders or to resist appropriate requests for disclosure of test materials—that is to say, the psychologist is not obligated to litigate in the support of a test publisher or to protect the security of an instrument at significant personal cost. When in doubt, a psychologist always has the option of contacting the test publisher. If publishers, who sold the tests to the psychologist eliciting a promise that the test materials be treated confidentially, wish to object to requested or court-ordered disclosure, they should be expected to use their own financial and legal resources to defend their own copyright-protected property.
Psychologists must also pay attention to the laws that apply in their own practice jurisdiction(s). For example, Minnesota has a specific statute that prohibits a psychologist from releasing psychological test materials to individuals who are unqualified or if the psychologist has reason to believe that releasing such material would compromise the integrity of the testing process. Such laws can provide additional protective leverage but are rare exceptions.
An editorial in the American Psychologist (APA, 1999) discussed test security both in the context of scholarly publishing and litigation, suggesting that potential disclosure must be evaluated in light of both ethical obligations of psychologists and copyright law. The editorial also recognized that the psychometric integrity of psychological tests depends upon the test taker's not having prior access to study or be coached on the test materials. The National Academy of Neuropsychology (NAN) has also published a position paper on test security (NAN, 2000c). There has been significant concern among neuropsychologists about implications for the validity of tests intended to assess malingering if such materials are freely circulated among attorneys and clients. Both the American Psychologist editorial and the NAN position paper ignore the implications of this issue with respect to preparation for high-stakes testing and the testing industry, as discussed in detail later in this chapter. Authors who plan to publish information about tests should always seek permission from the copyright holder of the instrument and not presume that the fair use doctrine will protect them from subsequent infringement claims. When sensitive test documents are subpoenaed, psychologists should also ask courts to seal or otherwise protect the information from unreasonable public scrutiny.
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