Conducting The Evaluation

The requirements for and components of informed consent— including contracting details (i.e., who is the client, who is paying for the psychologist's services, and who will have access to the data)—were discussed earlier in this chapter. We proceed with a discussion of the conduct of the evaluation on the assumption that adequate informed consent has been obtained.

Conduct of the Assessment

A conducive climate is critical to collection of valid test data. In conducting their assessments, psychologists strive to create appropriate rapport with clients by helping them to feel physically comfortable and emotionally at ease, as appropriate to the context. The psychologist should be well-prepared and work to create a suitable testing environment. Most psychological tests are developed with the assumption that the test takers' attitudes and motivations are generally positive. For example, attempting to collect test data in a noisy, distracting environment or asking a client to attempt a lengthy test (e.g., an MMPI-2) while the client is seated uncomfortably with a clipboard balanced on one knee and the answer form on another would be inappropriate.

The psychologist should also consider and appreciate the attitudes of the client and address any issues raised in this regard. Some test takers may be depressed or apathetic in a manner that retards their performance, whereas others may engage in dissimulation, hoping to fake bad (i.e., falsely appear to be more pathological) or to fake good (i.e., conceal psychopathology). If there are questions about a test taker's motivation, ability to sustain adequate concentration, or problems with the test-taking environment, the psychologist should attempt to resolve these issues and is expected to discuss how these circumstances ultimately affect test data interpretations in any reports that result from the evaluation. Similarly, in circumstances in which subtle or obvious steps by clients to fake results appear to be underway, it is important for psychologists to note these steps and consider additional instruments or techniques useful in detecting dissimulation.

Another factor that can affect the test-taking environment is the presence of third-party observers during the interview and testing procedures. In forensic evaluations, psychologists are occasionally faced by a demand from attorneys to be present as observers. Having a third-party observer present can compromise the ability of the psychologist to follow standardized procedures and can affect the validity and reliability of the data collection (McCaffrey, Fisher, Gold, & Lynch, 1996; McSweeney et al., 1998). The National Academy of Neuropsychology has taken a position that third-party observers should be excluded from evaluations (NAN, 2000b). A reasonable alternative that has evolved in sexual abuse assessment interviewing, in which overly suggestive interviewing by unskilled clinicians or the police is a well-known problem, can include video recording or remote monitoring of the process when appropriate consent is granted. Such recording can have a mixed effect. It can be very useful in demonstrating that a competent evaluation was conducted, but it can also provide a strong record for discrediting poor-quality work.

Data Collection and Report Preparation

Psychologists are expected to conduct assessments with explicit knowledge of the procedures required and to adhere to the standardized test administration prescribed in the relevant test manuals. In some contexts—particularly in neuropsychological assessment, in which a significant number and wide range of instruments may be used—technicians are sometimes employed to administer and score tests as well as to record behaviors during the assessment. In this situation, it is the neuropsychologist who is responsible for assuring adequacy of the training of the technician, selecting test instruments, and interpreting findings (see National Academy of Neuropsychology [NAN], 2000a). Even in the case of less sophisticated evaluations (e.g., administration of common IQ or achievement testing in public school settings), psychologists charged with signing official reports are responsible for assuring the accuracy and adequacy of data collection, including the training and competence of other personnel engaged in test administration. This responsibility is especially relevant in circumstances in which classroom teachers or other nonpsy-chologists are used to proctor group-administered tests.

Preparation of a report is a critical part of a psychological assessment, and the job is not complete until the report is finished; this sometimes leads to disputes when payment for assessment is refused or delayed. Although it is not ethically appropriate to withhold a completed report needed for critical decision making in the welfare of a client, psychologists are not ethically required to prepare a report if payment is refused. Many practitioners require advance payment or a retainer as a prerequisite for undertaking a lengthy evaluation. In some instances, practitioners who have received partial payment that covers the time involved in record review and data collection will pause prior to preparing the actual report and await additional payment before writing the report. Such strategies are not unethical per se but should be carefully spelled out and agreed to as part of the consent process before the evaluation is begun. Ideally, such agreements should be made clear in written form to avoid subsequent misunderstandings.

Automated Test Scoring and Interpretation

The psychologist who signs the report is responsible for the contents of the report, including the accuracy of the data scoring and validity of the interpretation. When interpreting assessment results—including automated interpretations— psychologists must take into account the purpose of the assessment, the various test factors, the client's test-taking abilities, and the other characteristics of the person being assessed (e.g., situational, personal, linguistic, and cultural differences) thatmightaffectpsychologists'judgments or reduce the accuracy of their interpretations. If specific accommodations for the client (e.g., extra time, use of a reader, or availability of special appliances) are employed in the assessment, these accommodations must be described; automated testing services cannot do this. Although mechanical scoring of objective test data is often more accurate than hand scoring, machines can and do make errors. The psychologist who makes use of an automated scoring system should check the mechanically generated results carefully.

Psychologists are ethically responsible for indicating any significant reservations they have about the accuracy or limitations of their interpretations in the body of their reports, including any limitations on automated interpretative reports that may be a part of the case file. For example, psychologists who obtain computer-generated interpretive reports of MMPI-2 protocols may choose to use some or all of the information so obtained in their personally prepared reports. The individually prepared report of the psychologist should indicate whether a computer-assisted or interpretive report was used and explain any modified interpretations made or confirm the validity of the computerized findings, as appropriate. A summary of criteria helpful in evaluating psychological assessment reports (Koocher, 1998) is presented in Table 8.1.

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