The telehealth information in this document is intended to support psychologists in making informed, well-reasoned decisions around remote assessment. This information is not intended to be comprehensive regarding all considerations for assessment via telehealth. It should not be interpreted as a requirement or recommendation to conduct assessment via telehealth.
Psychologists should remain mindful to:
- Follow professional best practice recommendations and respective ethical codes
- Follow telehealth regulations and legal requirements from federal, state and local authorities, licensing boards, professional liability insurance providers, and payors
- Develop competence with assessment via telehealth through activities such as practicing, studying, consulting with other professionals, and engaging in professional development.
Psychologists should use their clinical judgment to determine if assessment via telehealth is appropriate for a particular examinee, referral question, and situation. There are circumstances where assessment via telehealth is not feasible and/or is contraindicated. Documentation of all considerations, procedures, and conclusions remains a professional responsibility.
Several professional organizations and experts have provided guidance on telehealth assessment (American Psychological Association Services [APA Services], 2020; Association of State and Provincial Psychology Boards, 2013; Grosch et al., 2011; Inter Organizational Practice Committee, 2020; Stolwyk et al., 2020) to assist psychologists in decision making and ethical and legal practice issues.
The Wechsler Memory Scale–Fourth Edition (WMS–IV; Wechsler, 2008) can be administered in a telehealth context by using digital tools from Q-global®, Pearson’s secure online-testing and scoring platform. Specifically, Q-global digital assets (e.g., stimulus books) can be shown to the examinee in another location via the screen-sharing features of teleconference platforms. Details regarding Q-global and how it is used are provided on the Q-global product page.
A spectrum of options is available for administering the WMS–IV via telehealth; however, it is important to consider the fact that the normative data were collected via face-to-face assessment. Telehealth is a deviation from the standardized administration. The methods and approaches to administering instruments via telehealth should be supported by research and practice guidelines when appropriate.
Providers engaging in telehealth assessment may train facilitators to work with them on a regular basis in order to provide greater coverage to underserved populations (e.g., only two providers within a 500-mile radius, shortage of school psychologists within a school district). If such a facilitator is well trained and in a professional role (i.e., a professional facilitator), they can present cards, grids, and response booklets as well as adjust audiovisual equipment. This approach yields the WMS–IV composite scores that are available in face-to-face assessments.
In times when social distancing is necessary (such as the COVID-19 pandemic), using a professional facilitator may not be safe or feasible. If testing must occur under these conditions, it is possible that the examinee may participate without the help of an onsite facilitator. If the examiner determines that no facilitator is required, the examinee can assist with technological and administrative tasks during testing and should be oriented to these responsibilities prior to, and again at the beginning of the session. An initial virtual meeting should occur in advance of the testing session to address numerous issues specific to testing via telehealth. This initial virtual meeting is described in the administrative and technological tasks portion of the Examiner Considerations section and referred to in various sections of this document. The examiner should consider best practice guidelines, the referral question, and the patient’s condition, as well as telehealth equivalence study conditions to determine if this is possible and appropriate. Independent examinee participation may not be possible or appropriate, for example, for examinees with low cognitive ability or with low levels of technological literacy and experience.
If the examiner determines that the examinee cannot participate independently, and testing must occur under social distancing constraints, the only facilitator available may be someone in the examinee’s home (e.g., a parent, guardian, or caretaker). If the onsite facilitator is a nonprofessional facilitator, they can assist with technological and administrative tasks during testing and should be oriented to these responsibilities in the initial virtual meeting and again at the beginning of the session.
Professional and nonprofessional facilitators typically do not remain in the room with the examinee throughout the testing session. The examiner should plan to minimize (as much as possible) the need for the facilitator to remain in the room. In rare cases when the facilitator must remain in the room, they should do so passively and unobtrusively, and merely to monitor and address the examinee’s practical needs, as well as any technological or administrative issues as necessary. The facilitator’s role should be defined clearly by the examiner. The facilitator should only perform those functions the examiner approves and deems necessary. In any case, if a facilitator is necessary it is preferred that the facilitator remain accessible.
If a professional facilitator is not available, it impacts the workflow of the session, subtest selection, and the approach to deriving composite scores. For example, if a professional facilitator is not used, Designs and Spatial Addition are not feasible for telehealth. Neither of these subtests are included in the Older Adult battery so all the relevant composite scores for that battery may be derived. The Older Adult battery (ages 65–90) only requires the response booklet; no cards or grids are required for that battery. However, for the Adult battery, the omission of Designs and Spatial Addition impacts the ability to derive all composite scores, leaving Verbal Memory Index as the only index that can be derived using the standard norms.
Several composite scores based on different sets of WMS–IV subtests are available in the WMS–IV Flexible Approach (Wechsler, 2009). The WMS–IV Flexible Approach norms, however, can be used to derive the same index scores as are available in the Older Adult battery (Immediate Memory, Delayed Memory, Auditory Memory, Visual Memory). The Visual Working Memory Index can only be obtained remotely with the use of a professional facilitator. The WMS–IV Flexible Approach Alternate Indexes Worksheet is available in the Q-global Resource Library and can be used to derive these alternate index scores.
In addition, care needs to be taken with the Visual Reproduction response booklet to ensure the examinee is not re-exposed to stimuli through the response booklet.