How psychological assessments are being completed during the pandemic

The national lockdown in Spring 2020 has enabled our experts to develop an approach to psychological assessments in a Covid-secure and evidence-based manner where face-to-face assessments are taking place, and also remotely where this is not possible – we learnt a lot!

The approaches of individual experts varies, in general, we are now working using a combination of face-to-face (with precautions), telephone and video-conferencing approaches (if clients have access to computers). We are able to complete addendums later if necessary, but this has been less so as we have developed our approaches to minimise assessment gaps caused by remote working.

The main issues are as follows:

1) Cognitive assessments with adults especially are more limited remotely, however it is mostly still possible to determine whether someone has cognitive difficulties. It helps a lot if the client has access to a laptop/computer. Experts will try to complete this aspect face-to-face where possible.

2) Assessing attachment directly is challenging where direct observation of contact sessions can’t take place. However, contact notes, if available, are the most useful source of information. One innovation has been for experts to observe contact sessions remotely, which is much less intrusive than were they to be in the room as a relative stranger.  Attachment is also largely assessed from historic information, so this is possible. Drawing techniques are also used a lot for assessing attachment, which can be completed using videoconferencing approaches.

3) Assessing parents is more straightforward than assessing children as this can be done over the telephone in large part. 

4) Assessing children age 7 – 11 is hardest over the phone, but will be down to individual children – teleconferencing approaches have proved very effective for assessing these children if supported by an adult.

5) Assessing adolescents over the phone is easier, but again will vary across individuals.

6) Visual information can be lost when working remotely and may affect whether we can detect visual signs of mental health issues in adults and children/adolescents (e.g. depression, social anxiety) and neurodevelopmental issues (ADHD, autism). Experts are therefore doing their best to do part of the assessment face-to-face in part, for example, meeting for an hour or less and doing the rest remotely. Video-conferencing as opposed to telephone assessment makes this less of an issue.

7) A key concern for remote working is who is in the room (parent or carer/or an allegedly abusive partner) as this may affect the reliability of the information provided by the interviewee particularly for children and vulnerable adults. Even if the expert undertakes the assessment remotely, the children and/or individual in an allegedly abusive relationship, would still need to be at a neutral location, such as a school, or office. This is not an issue for parents living by themselves.

8) Another concern is about who is completing the psychometric forms. However, experts can read many tests to the individual remotely. Not all tests can be completed in this manner and can and will be posted in advance. Also, tests will be posted in an envelope within an envelope and the interviewee can open this in front of the psychologist to prove that they have not been tampered with in advance. Both points 7 and 8 are more of an issue where a child lives with a parent or where parents believed to be in abusive relationships are co-habiting.

Lots of aspects of the assessment have been unchanged by the pandemic, for example:

1) Reading the bundle.

2) Liaising with parents, foster carers, teachers and other professionals as is commonly done by telephone already.

3) We already completed a large number of psychometric tests by telephone (something that is already done).

4) Areas that can be assessed well over the phone include:

Parents: Full personal history (early life, educational/employment history, relationship history (dv), mental health history, reflective functioning (attachment), forensic history, current mental health (without visual information of meeting them), relationship with children, financial circumstances/support, statutory support received. They will also be able to provide a developmental history for the children.  

Children: Assuming they can be interviewed by phone, we can gain information about their educational, academic, emotional and social wellbeing, relationship to parents and siblings (attachment) and all psychometric tests. Often children do not talk to experts under ordinary circumstances for lots of reasons (e.g. coercion, split loyalties, social anxiety, neurodevelopmental issues etc) so some aspects of the assessment may not be too different in that regard.

This alone will produce a substantial amount of information. Overall, although reports are less straightforward under pandemic conditions, I am confident the reports will can address the Court’s needs. As we move to this way of working, more opportunities (and issues) will emerge I expect and I will keep you update this page accordingly. 

What helps?

  1. The client having access to a computer as this makes screen sharing much more viable and helps with cognitive assessments in particular. Also interpreters can just join a virtual meeting and this is working well.
  2. If children are in care already, we just liaise with their carers to help with the interview and assessments are progressing really well in these circumstances and can be completed remotely in the child’s residential setting.
  3. A reliable adult being present to assist children or vulnerable adults with the tests, the technical equipment and so on.

Safeguarding and risk procedures for remote working

  1. Psychologists do not take the email addresses or telephone numbers for children and young people, rather they will arrange teleconferencing using parent/carer telephone numbers and email addresses.
  2. As stated, we are mostly unable to assess children remotely in their home environment, they would need to be elsewhere (if face-to-face assessments can’t take place).
  3. If someone living with a family member or alone expresses suicidal ideation, psychologists will use standard practice, i.e. encourage them to speak to a GP, go to A and E or call an ambulance, and will be prepared to contact emergency services if necessary – we will ask for their address at the beginning of an assessment. They will also contact the social worker immediately as they will be best placed to co-ordinate a response. 

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