Stephanie Taylor, Ed.S, NCSP &
A. Jordan Wright PhD, ABAP
A nationwide shortage of school and other psychologists currently impacts student success across the nation.The National Association of School Psychologists (NASP) recommends one school psychologist for every 500–700 students while the actual ratio is closer to one school psychologist for every 1,653 students, with some areas exceeding the recommended ratio by up to 10 times.
For more information on PL’s Remote Psychoeducational Assessments, click here
The American Psychological Association’s (APA) Center for Workforce Studies confirms that distribution of psychologists does not align with the distribution of those with mental health needs across the country, and these charts on “Data Tool: Distribution of Licensed Psychologists and Mental Health Indicators” further highlight the need to redistribute existing resources to the places they are needed.
Given this situation, many educational organizations struggle to provide timely evaluations for students referred for possible eligibility for special education, 504 plans, and interventions. Schools can be challenged by a variety of issues—regional staffing shortages, increased volume of requests, seasonal spikes in student referrals—to name a few. No matter the issue, the result is the same: despite best efforts, many students are not being assessed in a timely manner; educators are not receiving the data they need to support educational planning; and related service providers are unable to perform essential duties beyond evaluating students.
Tele-assessment is changing this situation for school districts and students across the country. Remote assessments help schools and parents complete assessments by connecting students with fully credentialed professionals. Using tele-assessment, schools can take advantage of a distributed workforce across districts to better manage efficiency. This further frees schools to focus existing resources on counseling, crisis management, bullying prevention, and other important programs for students who need to receive services in person.
For example, NASP states in “Guidance for Delivery of School Psychological Telehealth Services” that while directly addressing remote assessments delivered via telehealth, “telehealth allows for assessments to be conducted in multiple locations in a single day. This provides school psychologists with scheduling flexibility and also the opportunity to provide assessment services to students who may not have access to a licensed school psychologist.”
Assessments conducted by clinical and school psychologists are often the most sensitive of all related services. Determining cognitive ability and academic achievement level can have enormous impact on the student, parents, and teachers, making many psychologists apprehensive about engaging in tele-assessment. This guide will focus primarily on psychoeducational assessment research and best practices. While it will primarily refer to students, the principles also apply to those in non-school settings.
Staying educated about changes in one’s professional field is a necessary and time-intensive endeavor. Most professionals turn to best practice guidance to ensure they are conducting their services to the highest standard. But, what do they do when best practices have yet to be universally adopted? They must turn to those who have the most experience in the field, the research available, and practical guidance that embraces their professional judgement. While the research base for tele-assessment is still young, there is some solid evidence of its mode equivalence (ability to collect comparable scores to traditional, in-person assessment) within the bounds of specific administration parameters.
According to research on tele-assessment by Dr. A. Jordan Wright, when done thoughtfully and deliberately, tele-assessment appears to be equivalent to traditional, in-person assessment. Equivalence does not necessarily mean that the same child will get the exact same scores on a test given in two different modes (e.g., tele-assessment vs. traditional, in-person assessment). It means there is no significant and systematic alteration in the data that emerge between the modes. That is, for example, kids do not consistently do significantly better or worse in one mode. Because of this equivalence research, scores that emerge from a tele-assessment can be calculated and compared using the traditional norms for a test developed in a non-tele-assessment context.
It’s important to understand that some tests have direct evidence of equivalence in tele-assessment and traditional assessment formats. In these cases, the tests themselves have been studied. It’s understood that the method of administration does not introduce significant alteration in the data elicited, and, as such, the norms and validity data from the original in-person measure can be generalized to tele-assessment for that assessment instrument. However, more research is needed.
Other tests have indirect evidence of equivalence, such as academic achievement tests that are extremely similar to the Woodcock-Johnson IV Tests of Achievement (Schrank, McGrew, & Mather, 2014), which do have direct evidence (Wright, 2018). Regardless of whether a test has direct or indirect empirical support of equivalence, the ultimate goal is to try to replicate, as closely as possible, the conditions of traditional, in-person test administration but in the remote, tele-assessment environment. The intention of this guide is to help you do just that by knowing what to consider and what to account for.
How do we identify best practice? Best practices are typically based on association guidelines, current studies on methodology, anecdotal information from examiners and schools, case studies, and publisher requirements. PresenceLearning brings 5 years of experience administering remote assessments to students in both traditional, brick-and-mortar schools as well as at home. In addition to research, Dr. Wright and Ms. Taylor have drawn from PresenceLearning’s clinical experts, clinical and school psychologists in the PresenceLearning Care Network, and their own experience delivering tele-assessment to provide the following best practices to make sure you get off to a solid start with tele-assessment.
Test selection is a good place to start your planning. Many of the topics you will need to consider—for example, the student environment, equipment needed, and test security—may change based on the assessment you plan to use, so you’ll begin by selecting the assessment.
When determining what tests you are going to give, make sure you know and understand the literature base to support them, the constructs the tests intend to measure, and how they measure them. Understanding how the constructs in individual tests are measured and how those individual tests come together to form indices will help you determine the likely effects of any administration alterations. Test publisher websites have become a valuable source of information on these topics and their application to remote administration, as well. Reviewing available research on any direct equivalency will also help you know what equipment is necessary to adhere to the conditions of the study.
You may decide to abandon some tests or subtests entirely. It could be for practical reasons. For example, subtests using a significant number of manipulatives based primarily on interaction between the examiner and the student might not be appropriate. Or, you may have empirical concerns that the altered administration may not accurately reflect the student’s level of functioning. For example, tests that measure reaction times may be affected by internet speed. In these cases, if the data from these tests are necessary, be thoughtful about test and subtest substitutions, whenever feasible.
Ultimately, the goal is to try to approximate as closely as possible standardized administration procedures. This goal will guide each step of your decision-making process for preparation and the actual administration of the assessment.
When considering students, there are three main items to assess: is the student appropriate for tele-assessment, is the student environment conducive to tele-assessment, and has a proctor been prepared for the assessment?
Understandably, there is a lot of apprehension around which students are “right” for tele-assessment. It may be easier to ask which students are not appropriate. With experience and onsite support, many students can be validly assessed remotely even when initially, they may have seemed unlikely candidates. When considering student selection, it is helpful to start with the following questions:
Tele-assessment utilizes an adult on the student end to help set up the environment, called a proctor. It is unlikely that the student/parent/guardian/caregiver or proctor will know how to set up the workspace. Provide them with explicit directions in advance, including making sure the student has the necessary equipment to complete the assessment you have selected. Remember that equipment may vary widely based on the assessment you’ve selected and whether you intend to complete a full administration or are planning to substitute subtests.
Standard equipment includes:
The student should have a quiet, confidential environment, free of distractions or disruptions, with a comfortable chair and desktop that are the appropriate height for the student. In essence, you want to replicate the traditional testing environment as closely as possible. The appropriate desktop space, historically, has been one of the biggest pain points in tele-assessment. The student has not had enough space for the document camera and the student response books. Don’t be afraid to ask the proctor to give you a 360º view of the room where the student will be assessed so that you can assess potential distractions, look at the deskspace, and look out for other potential issues. If the assessment is taking place in a home setting, also find out who else will be in the home during the session to consider possible distractions.
As with all assessment, it is important to mitigate any interruptions or possible deviations from standardization; however, tele-assessment should not be held to a higher standard than in-person assessment. Assessment in the school setting often takes place in less than ideal conditions with interruptions, distracting noises, small desktop spaces, and unmotivated students. Experienced examiners are used to making concessions and feel comfortable determining when it crosses the line from merely less than ideal to actually affecting the validity of the assessment. With experience and ability to assess the remote environment to their satisfaction, you will soon develop that same sense of the “fine line” with tele-assessment.
You’ll need to prepare students in advance for the actual assessment. Discuss with them what they should expect throughout the assessment process, just as you would do in-person. Additionally, make sure to let them know they need to alert you immediately if they cannot see or hear you. Check to ensure they understand how the process will go.
Proctors may be any adult who can follow directions and be guided by a trained examiner. Ideally, a proctor is simply “the hands” of the examiner/clinician. Because they are not trained professionals, it is important to speak to them ahead of time to both set up the student testing site and also to help them know what to expect. In the home setting, assuring that the parents/guardians/caregivers understand what the process will look like is part of informed consent.
Setting boundaries with the proctor is important. Before the assessment, discuss your expectations. Let them know that you will guide them through what to do, and they shouldn’t take any action without your direction—including speaking to the student. Let them know it’s possible you may ask them to leave during the assessment, depending on the age of the student and if the proctor is distracting to the student. You may also ask them to sit behind and to the side of the student (as far back as possible), so that they are themselves not distractions and can be easily seen on camera by you throughout the process. This may not always be possible, given physical room constraints, but try to figure out a way to replicate this even if you have to get creative (e.g., if they are far off to the side, off camera, you may have them join the session on their phone so that you can monitor them visually and give them direction, but make sure the student cannot see them on their view of the tele-assessment platform.
Just before the session, communicate clearly to the proctor what will happen if technology fails during a session. Your contingency plans should include clear direction for what will happen in the rare case that audio or video are lost. This may include exchanging phone numbers in advance and planning who will call whom. Depending on the interruption, length of interruption, where in the test you were when it occurred, you will determine whether to regroup or reschedule. Whatever the plan is, make it clear to the proctor so that no session is ever abandoned. It is important that they understand that a disconnection is not an end to the session.
Depending on the test selection and what materials are at the student site, there may be actions for the proctor after a session, as well. Considering these actions will be part of selecting your assessment and understanding how you will adhere to test security, as detailed later in this guide.
Once a proctor is identified (if being used), it is imperative to meet with them or the student themselves about technology and materials in addition to the student environment. Readiness should be verified a minimum of 24 hours before the test session.
A readiness check consists of a tech check, materials check, and environment check and typically consists of verifying computer and internet readiness as well as making sure all items needed for the assessment are ready. If these items are not deemed ready 24 hours before the scheduled testing session, it may be a good idea to reschedule while solutions are being sought. If a proctor/adult is being used, the student should not be involved until you can be reasonably assured of a smooth session.
See the checklist below to guide your Readiness Check.
Depending on the test used, the materials may differ. Make sure the proctor or student knows what to expect and how to handle materials they receive, including:
Discuss with the proctor and/or student exactly what to expect on the day of testing. Help them to set up the environment, including the following:
You also must think about your workspace, including, having the right equipment to display sample items and what your setting looks like to the student.
Your workspace should be professional, with minimal audio and visual distractions. Think about what the student can see in your immediately surrounding environment. You’ll need to prepare your workspace for testing differently than you might prepare it for a typical therapy session. Consider removing any distracting personal items, artwork, or other things that could pull students’ attention during the assessment. Be extremely careful about using virtual backgrounds—while they may seem to make your environment more neutral, they can actually be distracting, as the sides of your head may intermittently disappear and look glitchy.
If you are utilizing a document camera, make sure you are modeling how much desk space is needed for display items. You’ll also want to elevate your computer or webcam to a level that is closest to a straight-on view of your face. A camera angle below or above your face can be distracting and won’t meet the benchmark of trying to approximate an in-person session.
Make sure that you are very well lit from the front. While a room may be bright, if the majority of light is coming from behind your head, it will cast you in a severe shadow online. One option is to use a specific monitor light for video conferencing that clips onto a monitor or a laptop and shines directly into your face to ensure you are well lit.
Rehearse and practice with the test materials in advance to master the sequence and flow. If you are using a platform that has an examiner and a student view, it is helpful to have two computers side by side while practicing so you can see both views. Do this for each test you plan to administer. When you can be confident and fluid with the assessment materials and technology, the student will feel more at ease with the process.
The necessary equipment may include:
In addition, as discussed in the proctor section, make a contingency plan for if and when the technology falters or fails. Write any phone numbers down, rather than store them on your computer in case you cannot access them.
Technology contingency plans might include:
When preparing for sessions, make sure you know how to contact tech support for whatever web platform you are using. You will want to have their phone number or chat function handy, so that if there are technology problems that can be handled quickly, you can contact them and get them taken care of (this can save you from having to abort and waste a whole session!). Most platforms have extremely responsive tech support professionals who can handle platform problems relatively quickly and easily.
You’ll also need to develop a safety plan. While you may be in the same state, city, or even office as a student, the logistics around safety are different in a tele-assessment context than they are in traditional, in-person work. Ideally, during the tele-assessment, the student will be located in a testing room or clinic office with a paraprofessional or caregiver (e.g., teacher, counselor, psychometrist) nearby who is knowledgeable about local resources and accessible by cell phone; however, that may not always be the case. Ensure that the proctor is fully oriented to the possibility that they may need to be involved in this aspect of the session in the event that a safety need arises, and make sure they are informed of your Safety Plan as well as specifically what the plan is. Most importantly, make sure both you and the proctor have a hard copy of the details of the Safety Plan; it does no one any good to have it stored digitally if the technology fails.
Your Safety Plan might include:
Monitor the student’s environment
Throughout the assessment session, it is extremely important to continuously monitor the student’s physical environment. You should be mindful of all potential distractions that you identified during the session preparation, as well as be on the look-out for any you didn’t. These can include other people interacting with the student, noises and movements happening that are visible to the student from their testing station, or many other things outside your control. Get in the habit of noting on your protocol times when the student may seem distracted (and when there are actual environmental distractors that pop up). That will allow you to cross-reference them with any responses that may have been affected or seem to be out of sync with other answers. Recording sessions may offer you the ability to re-watch them with a specific eye toward possible distractions. However, recording also comes with an additional set of HIPAA and FERPA considerations for how to securely store those videos, when and how to destroy them, and obtaining permission for minors.
Be mindful of the proctor
During testing, work to reinforce the boundaries and expectations you set with the proctor. If an onsite professional, parent, guardian, or caregiver is in the room, continue to be mindful of their interactions and potential distractions during the process. Make sure you can either see them at all times (either on the primary camera, behind and to the side of the student, or on a separate video feed somehow) or be certain that they have left the space entirely to ensure they are not interfering with the assessment in inappropriate ways.
Be mindful of the physical materials
Throughout sessions that require the use of physical materials on the student’s side, be explicit and specific about how students should use materials. For example, if response booklets have been sent to the student’s location for a specific test, and the proctor or student has been instructed not to open the envelope until told, during the session it will be important to instruct them and then watch them open the envelope and take out the response booklets. Once the testing is complete for that session, again, both instruct them and watch them put the response booklets into the addressed, stamped envelope and seal it to return to you. This is even important if the student is located in a testing room, because materials could be misplaced or altered. If you are utilizing a document camera, it is also good practice to take a screenshot of each page in student books as they are completed. Those pictures can then be used to cross reference items once they are returned to you. This practice also protects test security by minimizing opportunities to copy the actual items from the response booklets in some way. It does not make it impossible, but it is a reasonable step toward maintaining test security (APA, 2017).
Monitor for fatigue
It is important to monitor tele-assessment fatigue and eye strain throughout sessions. The length of tele-assessment testing sessions may need to be adjusted differently than in-person sessions. In addition to considering the age and functioning level of the student, you should consider any potential impact of not having the in-person interaction, not having as much ability to observe body language (below the shoulders), and what is known about eye strain and fatigue in videoconferencing (Mouzourakis, 1996). After considering all factors, it may be safer to err on the side of shorter sessions rather than marathon sessions. Of course, consistent with standardized practice, you do not want to stop sessions in the middle of tests (or worse, subtests), but you should consider administering fewer measures in any given session in order to mitigate fatigue.
You’ll need to watch for tele-assessment fatigue which can be triggered by having to pay attention at length to a screen. Signs of tele-assessment fatigue can include more frequent glances away from the monitor, neck stretches, sighs, and expressions of tiredness. Additionally, keep track of students asking repeatedly how much longer a given task will take. While this is generally pretty common, even in traditional, in-person assessments, on tasks like continuous performance tests (which are quite long and boring, on purpose), more frequent questions about time remaining in a session can be a sign of actual fatigue. You should always be ready to abort sessions, if needed. Fatigue is one reason psychologists might choose to abort a session.
Be ready to access tech support if necessary
Another reason psychologists might choose to abort a session is when there is significant and justified frustration with the technology being used. That is, if there are constant interruptions to the connection on the platform, or audio keeps cutting in and out, all participants can get frustrated, justifiably. When this is the case, it is often best to cut your losses, abort the session, and enact your contingency plan. While sessions are cut short in traditional assessments from time to time for a variety of reasons, the introduction of technology can require us to be prepared for this strategy.
If necessary, be ready to access tech support in the middle of sessions. Make sure you have the contact information for the tech support of the tele-assessment platform you have chosen, as well as the best way to contact them (some respond faster using the chat option on their website; some respond faster with a phone call, etc.). Hitches in technology are often unavoidable, and most people know and understand this. Be transparent throughout the process, letting the student and proctor know that because of whatever is happening, you need to “pause” the session and contact the platform’s tech support for help. This may be a moment to suggest that the student take a break, get some water, go to the bathroom, or otherwise just take a break from staring at a computer screen (assuming you do not need them present to fix whatever is happening on the platform). Hopefully, in most cases, tech support will be rapid and effective, and within a few minutes, sessions can continue. As always, it is important to document all the events of a testing session. The more you write down things that occurred, when they occurred, and how long a resolution took, the more you will be able to evaluate any potential impact those events had on testing outcomes.
Transitioning a practice from in-person to remote is not always intuitive. Seeking out training and professional development that incorporates both active learning and coaching is essential. When transitioning current skills to new settings, having the opportunity to speak to experts for ongoing coaching while also being able to embed learning into job-based activities creates an environment for skills to be generalized more quickly. According to education researcher Linda Darling-Hammond and colleagues at the Learning Policy Institute, an effective training program should:
When considering tele-assessment specifically, it is necessary to divide training into both empirical information and “nuts-and-bolts” of administration. To get a full picture of tele-assessment, receiving training on each of these aspects is considered a minimum threshold. Training that only focuses on administration techniques may not prepare you to consider how deviations from standardization may affect outcomes of each subtest, and training that only focuses on empirical information may not prepare you to manage the very real situations that arise in the course of a testing session. Wright and Raiford’s (2021) Essentials of Psychological Tele-Assessment is an excellent start to your training, though it does not include any experiential (active learning) components as a static book. The length of formal, live training will likely depend on your experience level and may vary from 2 to 4 hours in length. When seeking out training, vet the quality using the Learning Policy Institute information above. A comprehensive approach to quality training should provide ongoing support and not be a one-shot thing (even if components of the training are stand-alone workshops or webinars).
In addition to formal training, practicing the entire workflow is essential and holds great practical value. Practicing with a colleague is an opportunity for highly qualified feedback. Make sure that you give tests and subtests from beginning to end. You should be able to do this fluidly/fluently at least three times in practice before working with a student. Ideally, you would also do one practice run-through with someone who is proficient in tele-assessment (before working with a student), followed by a case consultation on at least the first tele-assessment case you have, to ensure you are administering and interpreting tele-assessment measures accurately (in alignment with the empirical literature).
As such, here is a recommended workflow for preparation to conduct psychological tele-assessments:
It’s important to consider HIPAA- and/or FERPA-compliance for a tele-assessment platform. Protection of student data and information should always be a top priority. Especially in the case of psychological assessments, information communicated is private and sensitive (and much of it constitutes protected health information). Not only must you ensure that the platform you are using is HIPAA-compliant during sessions, you need to think about HIPAA- and FERPA-compliance in the storage and retention of materials. When working with schools, they may have specific policies about who retains the original test records and student booklets. If a video has been created, it constitutes an educational record which has specific rules around how/if it can be retained and destroyed. To protect yourself, familiarize yourself with federal, state, and school policies.
In addition to making sure you are using a secure platform, it is important to think about getting materials to and from the student. As mentioned in The Clinician section above, you must consider not only how you will ensure the student/proctor doesn’t view items prior to assessment or alter them afterward, but also the security of the test itself must be considered.
All clinicians have a professional obligation to protect the security of assessments in their possession. That responsibility extends to tele-assessment as well. The ability to ensure security may also impact your test and subtest selection. If you decide to move forward with assessments that require materials to be sent to the student site, those logistics must be managed with test security in mind.
There are many methods that clinicians, schools, and teletherapy companies have used to protect security. Some of these methods include:
Evaluations should always be built on multiple data sources. Tests are one piece of those data. You should always be diligent about observing the student’s environment during each and every task to contextualize any findings from tests that seem like they may not accurately represent a student’s actual functioning or abilities. Nothing can replace triangulation of data and professional judgment to support the validity of any assessment, in-person or remote.
Assessment settings are always in a state of evaluation by the psychologist. Even at brick-and-mortar schools, it can be difficult to find a quiet room free from distractions. Monitoring as to whether the environment will yield valid results takes place as a matter of course. Tele-assessment is no different. Each environment must be looked at carefully to consider any potential effect on results.
By adhering to the recommendations above and continuing to engage in professional development surrounding this emerging field, you will gain your own confidence and become comfortable with tele-assessment. Research will also continue to grow and sculpt best practices that will shape all future guidance.
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