Understanding Psychoeducational Evaluations

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Understanding Psychoeducational Evaluations

• Karen Grella, Ph.D., Sarah Hahn, Ph.D., Beth
  Lesen, Ph.D.

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Questions

• What problems do you have with reports you are
  seeing?
• What are the challenges posed by documentation in
  your daily work?
• What are the most common pitfalls you find as you
  try to bridge the gap between the report and
  helping your students (accommodations)?

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Goals of Session

• What makes a report helpful and what are some of
  the common problems encountered?
• Go through key sections of most reports and
  clarify what to look for and red flags
• What do these numbers mean?
• Deciphering impressions
• Diagnosis
• Communicating with Testers

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Real vs. Ideal (or, why do all these report
stink)?

• Quality Report writing is something is not seen
  in absence of specialized training and years of
  practice
• 7 hours testing, 2-3 hrs scoring, 5-10 hrs
  writing, 6-8 years education post BA, liability
  insurance, 8G worth of tests, liability, office
  space.
• 700 reimbursement for a service valued at
• 3G.
• Quality is compromised in era of managed care

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The Report

• We will now go through the general format of most
  reports, section by section
• Psychological, PsychoEducational,
  Neuropsychological, most have same general format

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Date of Evaluation

• Most important because informs when re-eval is
  needed
• Re-eval time is informed by of actual length of
  time since testing vs. stability of disorder.
• 2 years old old not big deal for LD, big deal for
  recent TBI
• Intervening adulthood necessitates re-eval- for
  applicability if not documentation

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Tests Administered Section

• Intelligence
• Achievement
• Memory
• Attention
• Emotional Functioning
• Visuospatial functioning
• Drawing
• Self report/other report rating scales

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What is a Projective Test?
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What are projectives

• TAT
• Rorschach
• House Tree Person

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So What is the problem with Projectives?

• Lack Reliability (you will not get the same
  results every time)
• Lack Validity (dont measure what you want them
  to measure)
• As compelling as individual cases may seem, these
  methods are not supported by rigorous scientific
  study.

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Why does the use of projectives persist in the
Modern Era?
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How do we cope with Projectives Continued use?

• Yes they are still taught
• No they are not necess. sign of incompetence
• A craftsperson likes to use the tools with which
  they have experience.
• But should be used for enrichment, themes,
  suggestions, not determination of functioning in
  other areas, or diagnosis

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So what Tests are Good?

• Intelligence! (WAIS)
• Achievement! (WOODCOCK JOHNSON or WRAT, WIAT)
• Memory Tests
• Attention
• And many many others.

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What kind of tests are you looking for?

• Objective tests that are quantitatively scored,
  standardized administered, and normed.
• A disorder is only relative to what is
  considered non disordered.
• These tests compare an individual s performance
  to a group of age an education matched normal
  controls

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Intelligence

• WAIS (For adults)
• WISC (for Children)
• WASI
• WPPSI

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How is A Learning Disorder Diagnosed?

• A qualified professional collects history,
  observes behavior, interviews, gets information
  from available collateral resources, and conducts
  thorough standardized tests in areas which must
  include Intelligence and Achievement.
• The Clinician finds that an area of achievement
  is substantially below tested intelligence.
  Substantially below is usually defined as a
  discrepancy of more than 2 standard deviations
  between achievement and IQ.

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Emotional Functioning

• Composite of behavioral observations, any
  standardized tests administered, interview, and,
  when possible, collateral information obtained
  from family or teachers.
• Variability in presentation here is not a red
  flag.

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Background (History)

• May go by different headings or be couched in
  different sections
• Very helpful info, recommended read.
• Medical background, academic background, social,
  familial
• Pre or perinatal complications, high fevers,
  missed school for long periods.
• Challenges- template filler

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Body of Report

• Varies according to individual psychologist.
• Very often long winded description of test
  performance.
• Frequently it is information which was used to
  justify conclusions/summary/impressions
• There is a reason for it to be there. But it is
  not always necessary for you to engage heavily
  in the material if it is not user friendly.

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What do these numbers mean?
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Apples to Apples!

• While it does DEPEND (on tests, norms, and
  individual student) it is always helpful to look
  at all tests in same language.
• See handouts 1 and 2
• Percentile rank

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Normal Curve
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Impressions

• Also known as summary or conclusions
• If the report is long and unwieldy this is the
  section to read 3 times.
• If the psychologist is shy they may couch their
  diagnosis in there is ample evidence suggesting
• This is the place that SHOULD have a brief money
  shot of emotion, cognition, diagnosis,
  disposition.

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Diagnosis

• Could be in impressions.
• Could also be on bottom of report, after
  impressions.
• Might not be there at all

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Why are there reports with no clear diagnosis?
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Recommendations
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Communicating with Tester

• Two different windows of possible communication,
  with two different dialogues
• Pre-testing
• Post testing

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Pretesting Communication

• Tests needed
• Purpose of Eval

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Post Testing Communication

• Call, thank, establish rapport, put Ph.D. at
  ease.
• After that intro its fine to ask questions.

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Appropriate post test questions

• Do you have a diagnosis?
• Is there impairment?
• Is there a Learning Disorder?
• Can you send us a brief letter saying there is
  this diagnosis?
• Accommodations- recommendations that match
  possible accommodations

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Summary of communicating with treaters.

• Respect and Diplomacy can open doors you thought
  could not be opened.
• Give them options!
• Do not treat them like a technician!
• State preferences, dont demand.
• Be thankful . If they do fax you an addendum
  letter, remember that they are working for free.

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How do you know if retesting needed?

• Outdated
• Lack of clarity
• Scant/ too thin
• Consult other psychologist with testing
  experience and see what they say
• No diagnosis
• Results, impressions, diagnosis clearly not data
  driven
• Even with consultation and attempts to
  communicate, report is not useful

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How to find better testers?

• People or clinics who test exclusively
• People who test 2/3 of practice, or Have done so
  for years.
• Early career or restarting career (willing to
  take less to get started)
• Psych Listserves (ask psychologist who may know).
• Call up schools and see who needs subjects for
  student training
• Call up institutes and ask

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Questions?

• Beth Lesen, Ph.D. Blesen_at_ccny.cuny.edu
• Sarah Hahn , Ph.D. shahn_at_cnny.cuny.edu