Assessment practices of professional …...0 10 20 30 40 50 Percentage of time spent conducting asst...
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Transcript of Assessment practices of professional …...0 10 20 30 40 50 Percentage of time spent conducting asst...
Assessment practices of professional psychologists: Results of a national survey
C. Vaile Wright, Ph.D.Director, Research & Special Projects
Practice Directorate
Assessment practices of professional psychologists: Results of a national survey
• Acknowledge my co-authors:– Shannon G. Beattie (APA)
– Daniel I. Galper, Ph.D. (APA)
– Abere Sawaqdeh Church (Washington State U)
– Lynn F. Bufka (APA)
– Virginia Brabender (SPA)
– Bruce L. Smith (SPA)
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Present results from a manuscript currently under review titled… Survey was developed collaboratively between staff members in practice research and policy at APA and two psychologists representing the society for personality assessment
Assessment represents a smaller part of the practices of professional psychologists than before managed care
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1959 1969 1982 mid 1990's mid 2000's
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Cited from: Lubin & Lubin, 1972; Lubin, Larsen, Matarazzo, & Seever, 1986; Camara, Nathan, & Puente, 2000; Rupert & Morgan, 2005; Rupert, Stevanovic, & Hunley, 2009
MCO’s (1970’s)
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The ability to proficiently administer, score, and interpret psychological assessments, as well as select measures suitable for the clinical issue, has traditionally been viewed as a competency that distinguishes psychologists from other mental health providers. Yet national surveys of psychological assessment show that for decades, there has been a reduced emphasis on assessment in clinical practice, with the frequency of time reportedly spent conducting assessments dropping from 44% in 1959 to 28% in 1969 to 22% in 1982. More recent surveys conducted in the 2000’s suggest the decline has increased, in that, on average, psychologists devote only about 10-15% of their practice time to assessment. In the mid-1990s, the American Psychological Association (APA) conducted two studies specifically targeted at investigating this apparent decline in assessment practice by psychologists, and assessing the threats and/or barriers to assessment services. CLICK The first study found that only 12% of psychologists reported spending more than 10 hours per week conducting assessments Around the same time, the APA’s Board of Professional Affairs charged the Psychological Assessment Work Group to assess possible threats and barriers professional psychologists encounter in their attempts to conduct psychological assessments. Qualitative responses from more than 400 psychologists highlighted numerous barriers encountered by practicing psychologists, namely difficulties associated with managed care organizations (MCOs) such as resistance to the use of psychological assessment, difficulties in the (pre)authorization process, and problems with reimbursement
• 297 APAPO members returned 28-item email survey (16.7% response rate)– 58 years old– 90% identified as White/Caucasian– 52% male– Setting:
• 61% outpatient mental health• 15% inpatient hospital• 13% forensic setting
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So what, if anything, has changed in the last 15-20 years? To answer this question, we conducted a follow-up study combining the efforts of these two previous APA-supported surveys, and asked professional psychologists about their use of assessment in their practices, and the potential barriers and facilitators to conducting these assessments given our current health care system While the current study is designed to be primarily descriptive in nature in order to identify current trends among evaluators, we are also interested in examining the influence of MCOs on specialization in psychology.
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MCO’s (1970’s)Most common in forensic and inpatient settings
BDI, MMPI, and WAIS most common instruments
Referral question: assist in dx; assist in making recommendations; screen for neuro and cog deficits
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Across all settings, 17% of psychologists reported spending more than 10 hours per week conducting assessments compared to the 12% found in the previous APA study Participants who reported working in a forensic setting spent a significantly greater percentage of their time conducting psychological assessment (49.5%) compared to participants in a nonforensic setting (26.1%; t = -3.98, p < .001). A similar relationship was found for inpatient settings, with psychologists working in an inpatient setting reporting they spend nearly 47% of their time conducting assessments compared to psychologists in a non-inpatient setting (26.1%; t = -4.05, p < .001). The most commonly used assessment instruments as reported by our sample were: (a) Symptom specific measures/inventories, such as the Beck Depression Inventory (78.2%, n = 165), (b) the MMPI (any version; 77.7%; n = 164), and (c) the WAIS (any version; 75.8%; n =160). Compared to the total sample, participants reported using the MMPI more frequently in forensic settings (t = -3.119, p < .003). Moreover, participants in inpatient settings were more likely to use the WAIS (t = -3.7, p < .001), the Mini Mental Status Exam (t = -3.1, p < .003) and the Halstead-Reitan (t = -3.49, p < .001) compared to psychologists in non-inpatient settings. The most commonly cited reasons endorsed by psychologists for conducting assessment was to assist in diagnosis (84.8%), to assist in making treatment, academic, or vocational recommendations (79.2%), and to screen for (or document) cognitive or neuropsychological deficits (70.6%). The least commonly cited uses for assessment in practice related to the use of outcome assessment/quality improvement efforts.
Nearly 68% of surveyed psychologists reported that reimbursement issues were the most common barrier to conducting psychological assessment, mirroring the qualitative results from the previous APA survey (Eisman et al., 2000)
– High cost of assessment materials also a significant barrier– Those who identified as working in a forensic setting appeared
to be less influenced by reimbursement rates
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READ SLIDE. Over half of the sample also cited the high cost of assessment materials to be a significant barrier to conducting assessment. When examining difference in reimbursement concerns by setting, those who identified as working in a forensic setting appeared to be less influenced by reimbursement rates, in that they were less likely to state that higher reimbursement rates would increase their use of assessment (M = 2.35 vs. 2.56 respectively) and less likely to identify reimbursement as a barrier compared to non-forensic setting psychologists (M = 1.74 vs. 2.17 respectively). Lack of awareness of the value of assessment by referral sources Negative articles about psychological assessment in professional publications Lack of access to suitable assessment instruments Lack of adequate training to perform assessment testing when needed Lack of expert accessors to refer clients/patients for assessment testing Negative comments about psychological assessment in the press
So what has changed in 20 years….• In general, assessment represents a smaller part of the practices of
professional psychologists than before managed care • However, for psychologists in some specialty areas and settings, namely
forensic psychology and inpatient settings, assessment represents a significant portion of their work
• Large majority of psychologists believe assessment is a valuable aid in making diagnostic decisions and treatment recommendations
• Many psychologists identify that greater coverage by third-party payers, as well as having access to less costly assessment instruments, would enable greater use of assessment with patients.
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Let us return to our original question of interest, which was – what, if anything, has changed in the last 15-20 years in the area of assessment use by professional psychologists? And the answer appears to be that very little has changed. READ BULLET POINTS The goal of practice surveys, such as this one, is to identify current trends in professional practice in order to inform standards of practice and care, and highlight any areas of concern. One potential concern relates to the small percentage of treatment outcome assessments being conducted by practicing psychologists, which scholars have argued represents best practice, is an ethical responsibility, and is a significant measure of accountability and quality improvement efforts among psychologists. Following the implementation of the Patient Protection and Affordable Care Act (PPACA, 2010), there is a greater demand for accountability in the health care field with Federal agencies and third-party payers seeking confirmation that treatments provided are effective for the patient, as well as cost-efficient. Psychologists may need to find ways to incorporate outcome measurement into their standard practice of care in order to demonstrate they are providing effective care, thereby remaining competitive within the evolving health care market. We acknowledge several limitations to the current study that I do not have the time to go into now but I would be happy to talk about after the session
Contact information:
C. Vaile Wright, PhDAPA Practice – Practice Research and Policy [email protected]
