The telepractice 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 telepractice. It should not be interpreted as a requirement or recommendation to conduct assessment via telepractice.
Psychologists 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, and engaging in professional development.
Psychologists 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 Psychological Association Services [APA Services], 2020; Association of State and Provincial Psychology Boards, 2013; Grosch, et al., 2011; InterOrganizational Practice Committee, 2020; Stolwyk, et al., 2020) to assist psychologists in decision making and ethical and legal practice issues.
The Wechsler Adult Intelligence Scale–Fourth Edition (WAIS–IV; Wechsler, 2008) can be administered in a telepractice 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 WAIS–IV via telepractice; 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 when appropriate.
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 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 blocks and response booklets as well as adjust audiovisual equipment. This approach yields the WAIS–IV 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 approach to deriving composite scores.
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 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. The examiner should consider best practice guidelines, the referral question, and the examinee's condition, as well as telepractice 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 not in a professional role (i.e., 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 used, Block Design is not feasible for telepractice. Omitting Block Design impacts subtest selection and the approach to deriving composite scores. Assuming all necessary subtests apart from Block Design are administered, Figure Weights or Picture Completion can be substituted for Block Design when calculating the PRI, the FSIQ, and/or the GAI. Alternately, the PRI and the FSIQ can be prorated. This approach allows all WAIS–IV composite scores to be derived.
If Block Design is omitted and using response booklets is not feasible, subtest selection and the approach to deriving composite scores are impacted further because no Processing Speed subtest is available. Assuming all necessary subtests apart from Block Design, Symbol Search, Coding, and Cancellation are administered, the following composites can be obtained: VCI, PRI (by substitution or proration), WMI, and GAI (by substitution). In this particular situation, no FSIQ can be obtained, because 3 of the 10 core subtests are missing and all Processing Speed subtests are missing (refer to the Administration and Scoring Manual for limits on substitution and proration).