Psychological assessment of adults with learning or ...

[Pages:5]GUIDELINES

Psychological assessment of adults with learning/intellectual disabilities undertaken remotely as a consequence of Covid-19

SCOPE OF THESE GUIDELINES

These guidelines have the same scope as those developed for the profession as a whole, but relate specifically to psychological assessment of adults with learning/intellectual disabilities. As with the general guidelines:

`These guidelines apply to UK practitioner psychologists doing psychological assessments of individuals under the specific restrictions in practice which are in place during the Covid-19 pandemic. We acknowledge that remote assessment is already a recognised practice in some circumstances for particular groups; however, during the pandemic many psychologists who would not routinely consider remote assessment are being forced to do so due to the restrictions in place.

`Assessment is defined here as the collection of data based on eliciting or observing behaviour according to a structured or manualised approach requiring some control of environmental variables and, often, comparison of individual performance with standardised data. Assessment approaches will include such things as administration of cognitive tests, structured questionnaires and observations of behaviour.' (See British Psychological Society guidelines ? .uk/coronavirus-resources/ professional/psychological-assessment-undertaken-remotely)

It is important to note that these guidelines refer only to the assessment of adults with learning/intellectual disabilities. They do not refer to assessment of adults with specific learning difficulties.

BACKGROUND TO THESE GUIDELINES

The Faculty for People with Intellectual Disabilities has been made aware of requests for psychologists to undertake assessment which gives a psychological opinion on whether or not an individual has a learning disability. This is frequently to determine eligibility for services and assessments for the court (e.g. relating to capacity and best interests). These guidelines refer to factors to be considered in the use of psychometric assessments, including the use of IQ tests.

GUIDELINES

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The Society has noted that the impact of Covid-19 has meant that face-to-face assessment has been extremely limited, requires the use of personal protective equipment (PPE) and has created additional complexities in relation to the manipulation of materials. It has also affected people's daily lives in terms of significant changes to routine, and changes in how people feel and behave. The issue of whether it is appropriate to undertake assessments remotely has therefore been considered, and psychologists have been asked to consider whether it is possible to undertake assessments in this way.

PRACTICAL CONSIDERATIONS

In relation to adults with learning disabilities, there may be additional complexities. The Society's guidelines state the following:

8. Adults with intellectual disability

8.1 There will need to be additional considerations for the assessment of adults with significant cognitive impairment and reduced capacity to engage or consent.

8.2 Some patients/clients will be unable to participate in the process in a manner which is meaningful and produces valid results. Others will require adapted materials and support from a third-party carer for the assessment process, informed consent and operation of technology. It will be important to explain to the third party the parameters of their assistance to avoid interference with the testing process.

8.3 Clinical judgement should be applied by clinicians skilled with these populations as would be the case in face-to-face assessment, with considerations of the additional complexities of this mode of service delivery.

8.4 The use of commercially available test platforms to deliver third party questionnaires is recommended such as the Vineland-3 via QGlobal.

FACTORS SPECIFIC TO ADULTS WITH LEARNING DISABILITIES WHEN CONSIDERING REMOTE ASSESSMENT

The Faculty has considered the feasibility of undertaking remote assessment, and recommends that this guidance should be read in conjunction with the Society document Guidance on the Assessment and Diagnosis of Intellectual Disabilities in Adulthood (published in 2015). That document outlines the existing complexities of determining whether or not an individual has a learning disability. There are additional complexities when considering whether or not such an assessment can be undertaken remotely, and whether these additional complexities render psychometric assessment invalid. Factors to be considered are outlined below:

1 Consider whether you can assess capacity to consent to: (a) the assessment; and (b) for it to be undertaken remotely. This would need to be either by phone or video:

a. Is the person familiar with the use of either phone or video?

b. Can they use either of them independently? If not how much support will they need and who will provide it? The assessor would need to consider the extent to which the person is giving their own opinion, or is being influenced by the person supporting them.

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Assessment of adults with learning disabilities during Covid 19 restrictions | BRE33c | 29.05.2020

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Assessment by phone could make this more complex, as you would not be able to see what is happening or the extent of any support given. c. If they lack capacity, is it in their best interests for this assessment to be undertaken in this way? 2 Is the person comfortable with the use of these media? Will they be able to maintain concentration sufficiently to engage with the process? 3 Use of video media: a. Is this available for the person's use in the place where they live? b. Is the connection secure? c. What does your employer allow in terms of assessment using video? d. Does the platform meet GDPR standards? e. Is the setting one where you can see and hear the person clearly (including facial expression, other non-verbal communication and verbal communication)? f. Can you ensure that any interview will be confidential to those involved (e.g. that the setting will not be accessed by others while you are undertaking an assessment)? 4 If undertaking a psychometric assessment, for example, WAIS-IV: a. How much of the assessment can realistically be undertaken remotely? b. Does the person require support from a carer to participate in the assessment? c. Will this impact on the findings (e.g. the carer intervenes in a way that invalidates responses from the person)? d. Does administration remotely violate test validity? (Test publishers may have guidance on this issue.) e. Does administration comply with any restrictions in place regarding dissemination of test materials to others? f. Subtests requiring the physical demonstration and manipulation of materials will not be possible. 5 What other information can be gained which would allow a provisional opinion to be given? a. Can you interview an informant remotely who knows the person well in order to assess the person's social functioning via a reliable and valid questionnaire? b. Can you interview the person remotely in a way that allows you to observe, for example, communication skills and other behaviour? c. Are you able to assess whether or not the person is comfortable and not distressed by a remote interview with you? d. Are you able to access reliable background information and history (e.g. notes from other settings and contact with other services)?

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Assessment of adults with learning disabilities during Covid 19 restrictions | BRE33c | 29.05.2020

GUIDANCE

PROVIDING AN OPINION Psychologists should make it clear that they have been unable to carry out an assessment according to the usual requirements, and that any opinion is based on: (a) informant information; (b) analysis of background and history; and (c) the extent to which you have been able to observe the person remotely. They should also state that this method of assessment is only operating while the Covid-19 guidance is in place, and that a full assessment should be undertaken when it is no longer required. They should state that the opinion is provisional for the above reasons. If you feel unable to provide an opinion on the basis of the information available to you, this should be stated to the referrer. It may be helpful to explain the reasons why it was not possible, using the factors outlined above as a framework. RECOMMENDATIONS The Faculty recommends that: 1 Psychometric assessments, such as the WAIS, should not be administered remotely, due

to difficulties in administration. 2 Psychologists should not administer individual subtests. This is to reduce the impact of

practice effects on any later testing. 3 Informant questionnaires and analysis of case notes and background history could be used

to give a provisional opinion. 4 You should not give an opinion if you were unable to obtain sufficient information. 5 You include a statement outlining how the information was obtained, and why a formal

assessment (such as the WAIS) was not undertaken. REVIEW These guidelines will be reviewed in the light of any emerging evidence base relevant to this issue. AUTHORS Committee of the Faculty for People with Intellectual Disabilities

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Assessment of adults with learning disabilities during Covid 19 restrictions | BRE33c | 29.05.2020

St Andrews House, 48 Princess Road East, Leicester LE1 7DR, UK 0116 254 9568 .uk info@.uk

? British Psychological Society | Incorporated by Royal Charter Registered Charity No 229642 | BRE33c/29.05.2020

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