The telepractice information in this document is intended to support practitioners in making informed, well-reasoned decisions around remote assessment. This information is not intended to be comprehensive regarding all considerations for assessment via telepractice. It should not be interpreted as a requirement or recommendation to conduct assessment via telepractice.
Practitioners should remain mindful to:
- Follow professional best practice recommendations and respective ethical codes.
- Follow telepractice regulations and legal requirements from federal, state and local authorities, licensing boards, professional liability insurance providers, and payors.
- Develop competence with assessment via telepractice through activities such as practicing, studying, consulting with other professionals, reviewing the available evidence, and engaging in professional development.
Practitioners should use their clinical judgment to determine if assessment via telepractice is appropriate for a particular examinee, referral question, and situation. There are circumstances where assessment via telepractice 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 telepractice assessment (American Occupational Therapy Association [AOTA], 2020; American Psychological Association Services [APA Services], 2020; Association of State and Provincial Psychology Boards, 2013; Cason, et al., 2018; Grosch, et al., 2011; InterOrganizational Practice Committee, 2020; Stolwyk, et al., 2020) to assist practitioners in decision making and ethical and legal practice issues.
The Bruininks-Oseretsky Test of Motor Proficiency (2nd ed., BOT–2) must be administered by a qualified professional through observation and direct interaction with the examinee to follow standardized procedures.
Various options are available for administering the BOT–2 via telepractice based on the role of an on-site facilitator. However, it is important to consider the fact that the normative data were collected via face-to-face assessment. Telepractice is a deviation from the standardized administration, and the methods and approaches to administering it via telepractice should be supported by research and practice guidelines.
Without a facilitator and the standardized manipulatives in the BOT–2 kit at the location of the examinee, BOT–2 cannot be administered in a standardized format via telepractice. However, the clinician can interact with and observe the examinee via telepractice to obtain qualitative information on fine and gross motor skills (e.g., ability to manipulate small items, hopping on one foot). The clinician can review the BOT–2 items to identify relevant skills for structuring clinical observations. Even though items involving specific, standardized manipulatives cannot be administered remotely, the performance observations can still provide useful information using alternate materials. This approach, however, does not allow for the calculation of scores.
Providers engaging in telepractice 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 evaluating practitioners within a school district). If such a facilitator is well trained and in a professional role (i.e., a professional facilitator, certified assistants), they can present test items and supervise for safety as well as adjust audiovisual equipment during a telepractice assessment. Given the use of numerous manipulatives during BOT–2 administration, the professional facilitator must have the BOT–2 kit and paper components readily available to use for standardized administration. This approach yields the BOT–2 subtest and composite scores that are available in face-to-face assessment mode. If a professional facilitator is not used, it impacts the workflow of the session, subtest selection, and the ability to reliably derive composite scores. Refer to The Use of Facilitators in Remote Test Administration for further information.
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 may be possible that the examinee participates with the help of a nonprofessional on-site facilitator in the examinee’s home or other location (e.g., a parent, guardian, caretaker). These on-site facilitators can assist with technological and administrative tasks during testing (e.g., providing pages of the examinee booklet) but will require orientation to these responsibilities before the session. If using an on-site facilitator who is not in a professional role, the examiner should use their professional judgment about the capacity of the facilitator to perform the required functions correctly, safely, and without interfering in the testing session.
An initial virtual meeting with the designated on-site facilitator should occur in advance of the testing session to address numerous issues specific to testing via telepractice. 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. After this initial meeting, the examiner should consider if remote administration is possible and appropriate before proceeding.
For BOT–2, facilitators should remain in the room with the examinee throughout the testing session 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 in advance of the testing session. The facilitator should only perform those functions the examiner deems necessary and instructs the facilitator to complete.
With a well-trained facilitator in a professional role (i.e., professional facilitator, certified assistant), subtests from the BOT–2 could successfully be administered with a remote examiner and all subtest and composite scores could be derived. When using a nonprofessional facilitator (e.g., parent), the examiner will have to determine in any of the subtests that do not require standardized manipulatives (i.e., Fine Motor Precision, Fine Motor Integration, and Bilateral Coordination) are possible and appropriate given the evaluation conditions. If any subtests are deemed to be inappropriate for remote administration even with use of a facilitator, then you will not be able to obtain some composite scores.