Ethical Issues in Assessment

Ethical Issues in Assesssment

Linda K. Knauss, Ph.D., ABPPAPA/SPA Webinar

November 16,2016

Learning Objectives

• Describe the essential elements of informed consent especially as it relates to difficult situations such as evaluating clients for decisional capacity.

• Identify the clinical, ethical, and legal issues involved with the release of raw test data.

• Discuss the components of a multiculturally competent assessment.

• Recognize and resolve conflicts of interest in third party requests for service.

Introduction

• Psychological assessment serves the public by providing information to guide decisions affecting the well-being of individuals, families, groups, organizations, and institutions.

• It is important for psychologists to base their conclusions on scientific and professional knowledge of the discipline.

• Psychologists are uniquely qualified to interpret the results of psychological assessment.

Introduction

• Conducting psychological assessments can be one of the most ethically challenging areas of practice.

• Providing evaluations that are accurate, useful, and consistent with the latest advances in research and theory are only a few of these challenges.

Definitions

• Psychological assessment is the integration of a wide range of information into a comprehensive report.

• Psychological testing is a narrower term that refers to the use of standardized stimuli or procedures to gather information.

Informed ConsentStandard 9.03

• Obtain and document informed consent for assessments, evaluations or diagnostic services.

• Use language that is understandable.• Informed consent may be written or oral.

Informed Consent

– Informed consent includes:• An explanation of the nature and purpose of the

assessment• Fees• Involvement of third parties• Limits of confidentiality• Sufficient opportunity for the client to ask questions

Informed Consent

– Informed consent is needed except when:• Testing is mandated by law or governmental

regulation.• It is implied because testing is conducted as a

routine educational , institutional or organizational activity (e.g. applying for a job).• The purpose of testing is to evaluate decisional

capacity.

Informed Consent

– When providing informed consent procedures to persons of questionable capacity to consent, and for whom testing is mandated• Use language that is reasonably understandable to the

person• This often applies to assessments of children or adults

with suspected cognitive impairments

Informed Consent

• For persons who are legally incapable of giving informed consent:– Still provide appropriate explanation.– Seek the individuals assent.– Consider the person’s preferences and best interests.– Obtain permission from a legally authorized person if

required by law.– If consent from a POA not required, take reasonable steps

to protect the individual’s rights and welfare.

Informed Consent

– If an interpreter is used:• Obtain permission from client to use that interpreter.• Insure confidentiality of results and test security.• Include in reports a discussion of any limitations of the

data obtained.

Informed Consent

• Court ordered or otherwise mandated assessments– Inform clients of the nature of the services– That services were mandated and by whom– Limits of confidentiality/who will receive copies of

the report– Some examinees may not be willing to proceed

Multicultural IssuesStandard 9.02c

• The Ethics Code places an increased emphasis on cultural competency.

• The Code stresses increased sensitivity to the difficulties in providing psychological services when language fluency is not shared (by the psychologist and client).

• The assessment methods should be appropriate to the individual’s language preference and competence unless the use of an alternative language is relevant to the assessment issues.

Multicultural Issues

• There times when proficiency in English or another language is essential to the goal of the assessment.

• For example if effective job performance or school placement require the ability to communicate in that language.

• The use of nonverbal tests is not an appropriate substitute when tests in the examinee’s native language are not available.


• Interpreters and Translators– When possible, use test translations that have been

developed according to accepted methods of test construction.

– Obtain informed consent from the client to use an interpreter.

– Indicate that translation results in imprecision in test results.

– Ensure that interpreters maintain confidentiality of test results and test security.


• Use assessment instruments that are valid and reliable for the population you are testing.– In the absence of validity and reliability, describe the

limitations of the test results and interpretation.– Use measures that are appropriate given the

patient’s language preference and competence.– Linguistic and cultural differences must be

appropriately considered when interpreting assessment results.

Release of Test DataStandard 9.04

• With a release from the client, psychologists provide test data to the client or other persons identified in the release.

• Test data refers to:– The client’s actual responses to test items– Raw and scaled scores– Psychologists’ notes concerning behavior during an

examination– Anything that includes client responses is considered

test data

Release of Test Data • This is an affirmative duty to provide test data to clients.• It is consistent with the trend toward greater patient

autonomy.• Under HIPAA, clients have the right to see and receive

copies of medical records used to make decisions about them. – Access must also be given to the client’s personal

representative.• Test data can be released to anyone identified in a client

release.

Release of Test Data

• Psychologists may refrain from releasing such data in order to protect the client or others from substantial harm. – However, this is rare.

• Psychologists may also withhold test data to protect against misuse or misinterpretation of the data (violate test security).

• However, psychologists must document their rationale for assuming the data will be misused.


• Before refusing to release test data:– Be sure there is a real threat of harm.– Recognize such decisions may be regulated by law.– Under HIPAA, if test data is withheld, clients have

a right to have the denial reviewed by a licensed health care professional.


• If clients have the right to obtain their own test data

• That they can pass on to any individual of their choice

• Requiring psychologists to deny a request from a client to release information to other persons is ineffective and illogical.


• Without a release from the client, psychologists are to provide others with test data only as required by law or court order.


• Concerns– Attorneys may misinterpret or misuse information

in court cases.

– Attorneys may use test stimuli or manuals to coach future clients in other cases.• Anecdotal reports exist about attorneys who coach

their clients on how to give favorable responses to the tests.


• Response to concerns– If an attorney attempted to interpret the data, the

opposing party would have experts available to correct any misinterpretation.

– The 2002 Ethics Code distinguishes between test materials and test data.

– Psychologists can withhold test data if they believe it violates test security.• Goes from must resist sending out test data to may

resist

Maintaining Test SecurityStandard 9.11

– Test data is different from test materials– Test materials are defined as manuals,

instruments, blank protocols and test questions.– In contrast to test data– Psychologists are required to a make reasonable

efforts to maintain the integrity and security of test materials.

– Those portions of test materials that include client responses are considered test data.

Third Party Requests for ServiceStandard 3.07

• This standard states: – When psychologists agree to provide services to a

person or entity at the request of a third party, psychologists attempt to clarify at the outset of the service the nature of the relationship with all individuals or organizations involved. This clarification includes the role of the psychologist (e.g., therapist, consultant, diagnostician, or expert witness), an identification of who is the client, the probable uses of the services provided or the information obtained and the fact that there may be limits to confidentiality (p. 1065).

Third Party Requests for Service

• The key element in this standard is clarifying the relationship with all of the parties involved. Psychologists are often asked by third parties to do evaluations. This is common in organizational, forensic and neuropsychological contexts. In these situations, it is crucial for psychologists to clarify their roles before beginning the evaluation, including the probable use of the information from the evaluation.

Third Party Requests for Service • The person being evaluated also has a right to know in advance whether

he or she will have access to the report, test data, or feedback. Individuals who are assessed have the right to full informed consent regarding the planned evaluation before deciding whether to participate, and psychologists need to provide enough information for this decision making process.

• It is a mistake to assume that people receiving services automatically give up their rights when services are requested by a third party. It is up to the client to accept the conditions of the third party, unless the services are court ordered.

• It is also important that clients understand the implications of not agreeing to arrangements requested by a third party. It may mean an inmate is not considered for parole, an employee is not eligible for promotion, or a physician can not return to work.

Third Party Requests for Service• Thus the question of who is the client may not be the most

useful way to conceptualize this dilemma. It may be more helpful to begin with the premise that the person receiving the services is always the client.

• This is because nothing other than a court order takes away a persons right to informed consent, confidentiality, and access to records. The fact that informed consent is a process that takes place with the person receiving the services, not with a third party implies that the receiver of services is always a client.

Third Party Requests for Service• However, the service provider may have additional obligations to a

third party such as prison authorities, the Human Relations manager in an organization, and so on.

• It is through the informed consent process that the client who is to receive the assessment or therapeutic services learns of the obligations to the third party and agrees to whatever arrangements are necessary such as sending a test report directly to an organizational representative, or giving up access to test data or records.

• It is best to have this agreement in writing either as part of the informed consent document or a separate release of information form.

Obsolete Tests and Outdated Test Results Standard 9.08

• Many professionals begin using new versions of a test within one year of the publication date.

• However, the APA Ethics Code (APA, 2010) and other guidelines are not this clear.

• What does the APA Ethics Code say?• Standard 9.08(b) states: “Psychologists do not base such

decisions or recommendations on tests and measures that are obsolete and not useful for current purposes” (APA, 2010). – Thus the Ethics Code does not prescribe a specific time period in

which psychologists should begin using a new version of a test.

Obsolete Tests and Outdated Test Results

• The decision about when to use a new version of a test is closely related to the reason tests are revised.

• There are many considerations that go into the decision by test developers to revise a test. – Current research– Patient population– Purpose of the test– Demographics of the population– Cultural influences (pictures of cars, telephones, etc.)


• Personality tests are also revised to address changes in diagnostic criteria, and to address new or additional problem areas that tests are intended to assess.

• There are appropriate justifications for using earlier versions of

revised tests. – To compare past and current test performance, such as before and after a

head injury. – For research purposes such as a longitudinal study. – An earlier version of a test may have more research about its current use. – An older version of a test may be better suited to use with certain

populations.


• A related issue has to do with test results that are outdated for the current purpose.

• Standard 9.08(a) of the APA Ethics Code (APA, 2010) states: “Psychologists do not base their assessment or intervention decisions or recommendations on data or test results that are outdated for the current purpose”.

• Previous test scores even from a current version of a test may be obsolete and misleading if the individual has changed over time due to:– maturational changes– educational advancement– job training or employment experience– changes in health, work, or family status – an accident or traumatic experience


• Personality test results are also likely to change. – A short term emotional crisis may cause an MMPI-2 profile

to look pathological, while a short time later when the crisis has passed, the test results could be within normal limits.

– A Beck Depression Inventory from yesterday could be inaccurate today.

– Interpretations from test results need to be valid and useful for the purpose of testing.


• In some situations it may be helpful to keep outdated test scores similarly to outdated test materials.

• They may be useful as a comparison with new test results: – To evaluate the effectiveness of an educational program – Or intervention– They may be used to identify cognitive decline – Or the sudden change in emotional or adaptive functioning

• They can also be useful to document a developmental disability.

Assessment in the Digital Age

• By computer• Cannot observe behavior• Cannot verify ethnicity• Cannot see motor problems• Video is better than voice or email• Computer generated reports

Test Scoring and Interpretation ServicesStandard 9.09

• This is about psychologists who develop or sell computerized, automated, web-linked, or other test scoring and interpretation services.

• Must document sources of interpretation• Note that scores can not account for history,

education, competence with language, life stressors, etc.

Test Scoring and Interpretation Services

Select scoring and interpretation services carefully.

Use only services that provide evidence of reliability and validity.

When test data is sent to a scoring service, the HIPAA privacy notice must list the name of the service, or the psychologist must get an authorization from the client to send their data to the service.

Test Scoring and Interpretation Services

Psychologists retain responsibility for the appropriate use of assessment instruments whether they score and interpret the tests themselves, or use automated services.

Psychologists must avoid simplified interpretations of test scores.

Must be familiar with scoring and interpreting techniques of the test.

Must know when collateral test scores and other information is necessary to interpret test results.

Assessment FeedbackStandard 9.10

According to Kenneth Pope (1992), “Feedback may be the most neglected aspect of assessment.”

Psychologists are usually required to give feedback to clients on testing results, and clients have access to their test reports (HIPAA).◦ Word reports knowing clients will read them

However, there is an exception to this requirement in some forensic and employment circumstances.◦ In these situations, the client should be informed in advance that they

will not receive an explanation of test results.

Assessment Feedback

• The feedback session should enable the client to understand what the tests covered, what the scores mean, the accuracy of the scores, and how the information will be used.

• Can give client a summary of the report with major findings, themes and recommendations.

• It is recommended to provide feedback to children and adolescents that is developmentally appropriate whenever possible.

Assessment Feedback

• Giving feedback is not always easy.• Providing effective feedback requires the skill of an

effective therapist.• The goal of most psychological assessments is to

make recommendations that will affect the life of the examinee.

• The effectiveness of the feedback session can determine whether or not the recommendations will be followed.

Assessment Feedback

• It is important to assess the client’s reaction to the feedback process.– Especially when their reaction may be negative.

• It may be necessary to follow-up with the client to make sure the recommendations are understood .

• A good feedback session includes providing an atmosphere where clients feel comfortable asking questions.

Conclusion• Conducting psychological assessments can be one of the

most ethically challenging areas of practice. • Providing evaluations that are accurate, useful, and

consistent with the latest advances in research and theory are only a few of the challenges.

• To recognize and resolve ethical dilemmas in the areas of:– Release of test data; Multicultural issues; Assessment feedback;

Third party requests for service; Assessment in the digital age; and Obsolete tests and test results

• Will improve ethical decision making skills related to assessment.

Education

Ethical Issues in Assessment