Attitudes, Beliefs and Behaviors of Practicing Psychologists Regarding Psychological Assessment

Recent research has documented the effectiveness, benefits, and value of psychological assessment, yet the use of psychological assessment is declining. To better understand why an effective treatment intervention is being underutilized, this project sought to understand the attitudes, beliefs, and behaviors of practicing psychologists regarding psychological assessment. The investigators of this study surveyed 26 psychologists who are members of a statewide association of psychologists in the western United States. Results revealed that 96% of participants enjoyed their graduate training in psychological assessment and 93% of participants view psychological assessment as valuable, yet 78% believed that psychological assessment was underutilized. Participants were most likely to refer for neuropsychological testing followed by cognitive testing, personality testing, Therapeutic Assessment, and vocational testing. The price of psychological testing was by far the strongest deterrent to a professional from making a referral. Other deterrents with some influence included the time involved and not knowing good assessors to refer to for an assessment. Most participants surveyed had little or no knowledge of Therapeutic Assessment. Recommendations for increasing the use of this valuable resource for health care providers are provided. Perspectives of Psychological Assessment 4 Introduction Unlike psychotherapy, psychological assessment is a unique aspect of psychological care provided by doctoral level clinical psychologists, and assessment can provide a wide range of information. According to Meyer et. al., 2001, psychological assessment can be utilized to describe current functioning, including cognitive abilities, severity of disturbance, and capacity for independent living; to confirm, refute, or modify the impressions formed by clinicians through their less structured interactions with patients; to identify therapeutic needs, highlight issues likely to emerge in treatment, recommend forms of intervention, and offer guidance about likely outcomes; to aid in the differential diagnosis of emotional, behavioral, and cognitive disorders; to monitor treatment over time and evaluate the success of interventions or identify new issues that may require attention as original concerns are resolved; to manage risk, including minimizing legal liabilities and identifying untoward treatment reactions; and to provide skilled, empathic assessment feedback as a therapeutic intervention in itself. However, the use of psychological assessment is declining (Piotrowski et. al., 1998; Eisman et al., 2000). The most common reasons cited for the decline include the increase of managed care, use of psychotropic medications to determine diagnosis, and a lack of studies measuring the value and cost-effectiveness of psychological assessment (Eisman et al., 2000). Inter-professional tension between psychologists and other groups has also been noted as a factor, and the reasons for this include misunderstandings about the contribution of psychological assessment to treatment planning and patient care, poor quality of reports, lack of constructive dialogue regarding assessment findings, and competition for limited mental health benefits (Eisman et al., 2000). In addition to the traditional value of assessment, research conducted over the past 25 years has demonstrated that psychological assessment procedures when combined with personalized, collaborative, and highly involved test feedback, have positive, clinically meaningful effects on treatment (Poston & Hanson, 2010). When psychological assessment has Perspectives of Psychological Assessment 5 been conducted from a collaborative therapeutic model of assessment, there is a strong therapeutic effect in itself (Finn & Tonsager, 1992; Newman & Greenway, Aschieri & Smith, 2012, Smith, Handler & Nash, 2010). Additionally, the positive working alliance developed during psychological assessment has been shown to carry over into formal psychotherapy (Hilsenroth, et al., 2004). Little and Smith (2009) also documented better alliance, cooperation, and satisfaction with treatment in psychiatric inpatients who completed a Therapeutic Assessment. To better understand why an effective treatment intervention is being underutilized, this project will sought to understand the attitudes, beliefs, and behaviors of practicing psychologists regarding psychological assessment. This understanding will inform new ideas to increase the use of a valuable resource for health care providers. The project also explored beliefs and knowledge about Therapeutic Assessment, which is the leading collaborative technique. Therapeutic Assessment is a semi-structured collaborative assessment approach developed by Steven Finn and his colleagues at the Center for Therapeutic Assessment (Finn, 2007; Finn & Tonsager, 1997). Therapeutic Assessment works to maximize the therapeutic benefit of assessment (Finn, 2007). The specific aim of the study was to determine the barriers that cause psychologists to underuse psychological assessment. Several predictions for the results were made based on the pervious literature as well as the anecdotal experience of the investigators. The predictions for the study included that psychologists will report that they are less likely to refer for psychological assessment because: They lack knowledge about psychological assessment They believe it is not cost effective and time efficient They feel vulnerable referring their own clients to another mental health provider who might expose deficiencies in their knowledge or work They are concerned about losing their clients to other professionals. Perspectives of Psychological Assessment 6 Method Participants The study sample included 27 psychologists who are members of a statewide association of psychologists in the western United States; 16 graduated from a Ph.D. program (59%) and 11 graduated from a Psy.D. program (41%). Procedures After contacting the association and explaining the purpose of the study, an association administrator sent an email to all members of the association through their list serve on behalf of the investigator. In this institutional review board (IRB)-approved introductory email, individuals were asked to complete a brief survey about their attitudes and perspectives toward psychological assessment. The email described the purpose of the survey and included a link to the online survey. There was no time limit for completing the survey. Twenty-eight surveys were returned, but one survey was discarded because the psychologist noted that the respondent did not understand how to rank order the items at the beginning of the survey. The association that was surveyed was unaware of how many of its members subscribe to its list serve, but they estimated that there were approximately 500 members of the organization at the time the survey was distributed. This reflects a low return rate of between 5 to 10 percent. Measures As there were no available measures previously used to examine this topic, the author developed the survey based on clinical experience, relevant literature, and input from practicing clinicians. The survey included a consent form, a question about the participant's highest earned degree, and several questions about their personal beliefs and knowledge about psychological assessment. The survey included 18 quantitative questions, though an optional comment area was provided at the end of the survey to allow the participants additional space for qualitative comments. Perspectives of Psychological Assessment 7 Participants were asked to rank order the types of psychological assessment to which they would be most likely to refer, the methods for finding a referral source for psychological assessment, and the factors that would deter them from referring for psychological assessment. Some questions were framed in yes/no format (e.g., “I am trained on the following psychological assessment measures”) while others were presented in a 5-point Likert scale (1= strongly disagree, 5=strongly agree) (e.g., “When I have referred clients for psychological assessment it has felt like a collaborative process with the evaluator”). Refer to Appendix A and B to see all the items included on the survey. Although the number of comments at the end of the survey was insufficient to conduct a formal qualitative analysis, relevant comments will be highlighted below. Data Analysis As this paper was exploratory in nature, descriptive statistics were used to analyze the results. Means, standard deviations, frequencies, and ranges were calculated for each survey item. Also, responses to open ended questions were studied to explore additional information, including other factors that may influence the referral process. Results Appendix A and B display the survey findings; Appendix A presents attitudes, beliefs, and behaviors about psychological assessment while Appendix B presents knowledge of psychological assessment. The overall results of the survey are summarized below. Types of Assessment Most Likely to Refer to All 27 participants ranked in order the types of psychological assessment to which they would be most likely to refer. Means and standard deviations were calculated for each type of assessment. The responses are listed below in order from most likely to refer to least likely to refer: Perspectives of Psychological Assessment 8 Table 1: Assessments Most Likely to Refer to Mean Ranking Standard Deviation Neuropsychological Testing 2.07 1.07 Cognitive Testing (Learning Disability, ADHD, Giftedness, etc.) 2.15 1.13 Personality Testing 3.22 1.42 Therapeutic Assessment 3.41 1.28 Vocational Testing 4.15 1.03 Participants were most likely to refer for neuropsychological testing, and least likely to refer for vocational testing. Methods for Finding a Referral Source A total of 26 participants ranked in order the likelihood that they would use cert