Ethical Issues in Assesssment

Linda K. Knauss, Ph.D., ABPP

APA/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 Consent
Standard 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 Issues
Standard 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.
 Multicultural Issues
• 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.
 Multicultural Issues
• 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 Data
Standard 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.
 Release of Test Data
• 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.
 Release of Test Data
• 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.
 Release of Test Data
• Without a release from the client,
psychologists are to provide others with test
data only as required by law or court order.
 Release of Test Data
• 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.
 Release of Test Data
• 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 Security
Standard 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 Service
Standard 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.)
 Obsolete Tests and Outdated Test
Results
• 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.
 Obsolete Tests and Outdated Test
Results
• 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
 Obsolete Tests and Outdated Test
Results
• 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.
 Obsolete Tests and Outdated Test
Results
• 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 Services
Standard 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 Feedback
Standard 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.