Standards 9 & 10

Question 1

You receive a letter from a former client’s attorney requesting that you provide her with information from the client’s file, including the actual items from two projective tests, the client’s responses to those items, and the client’s test scores. The letter is accompanied by an authorization to release information signed by the client who is being represented by the attorney in a criminal case. As an ethical psychologist, you will send the attorney:

A. all of the requested test information.
B. the client’s responses to the test items and test scores only.
C. the client’s test scores only.
D. only a summary of the client’s performance on each test.

Answer 1

B. the client’s responses to the test items and test scores only.

This answer is most consistent with Standards 9.04 and 9.11, which distinguish between test data and test material. Standard 9.11 requires psychologists to “make reasonable efforts” to protect the integrity and security of test materials. As defined in this standard, test material includes test items, which means that providing items to the attorney would breach test security. In contrast, Standard 9.04 describes test data as including an examinee’s responses to test items and his/her test scores, which can be released with appropriate authorization.

Question 1

Assessment Techniques and Results
* when psychologists’ conclusions about the mental competence of an individual are based, to some extent, on the results of an evaluation conducted by another mental health professional, they should explain why it was necessary to use those results and how doing so may have affected their conclusions.

using tests for purposes that are supported by empirical evidence and administering and scoring tests using standardized procedures
* psychologists use tests “whose validity and reliability have been established for use with members of the population tested.”
* it also states that, “when such validity or reliability has not been established, psychologists describe the strengths and limitations of test results and interpretations.”

Allowing unqualified individuals to use psychological assessment techniques is prohibited except when doing so is for the purpose of training the individual and the individual is provided with appropriate supervision

Question 2

Adapting Assessment/Testing Procedures: Accommodations & Modifications
permits deviating from standardized procedures when doing so is supported by research or other evidence

Standards for Educational and Psychological Testing
adaptations as changes made to a test to increase its access for certain test takers that can take the form of accommodations or modifications:

Accommodations are “relatively minor changes to the presentation and/or format of the test, test administration, or response procedures that maintain the original construct and result in scores comparable to those on the original test”
* (e.g., Using a large-print or braille version of a test of content knowledge for visually impaired examinees is an example of an accommodation)

Modifications are changes to test content and/or testing conditions that alter the construct to some extent and result in scores that do not have the same meaning as scores on the original test
* when a reading test that evaluates reading comprehension and ability to decode written language is modified by providing a screen reader for examinees with dyslexia, the construct measured by the test is altered for those examinees
Accommodations and modifications should be documented in test reports along with a description of how they affect the validity of the interpretation of test scores.

Standards for Educational and Psychological Testing
modified tests be treated “like a newly developed assessment that needs to adhere to the test standards for validity, reliability/precision, fairness, and so forth”

Question 3

Guidelines for the Practice of Telepsychology: Administering tests designed to be administered in-person via telepsychology
psychologists are encouraged to consider the unique issues that may arise with test instruments and assessment approaches designed for in-person implementation when providing telepsychology services
* Wright and colleagues (2020) recommend using wider confidence intervals when interpreting test scores in this situation because the margin of error is increased whenever scores are derived from nonstandardized administration procedures
* also stress the importance of noting in test feedback and reports how assessment procedures were altered and how the alterations might affect the interpretation of test scores

Question 5

Outdated/Obsolete Test Results
An implication of these requirements is that it may be acceptable to use outdated tests results and obsolete tests when they are appropriate for the purpose of a current evaluation
* Bush and colleagues (2018) who state that the publication of a revised version of a test does not necessarily make the previous version obsolete or make its use unethical. They point out that “continued use of a prior version in some instances can be more consistent with the ethical responsibility to provide services that are beneficial”
* it’s likely to be more appropriate to use the newest version of a test when there are significant cohort changes in test scores over time, e.g., population changes in IQ scores.
* t’s likely to be more appropriate to use the previous version of a test that has norms for an examinee’s racial/ethnic group when the new version does not yet have norms for that group.

Ethics Code and Standards for Educational and Psychological Testing do not provide guidelines for determining when a test or test results become obsolete or indicate an acceptable length of time for adopting a revised version of a test.

Question 6

Use of automated and other test scoring and interpretation services
requires psychologists to choose these services on the basis of their validity and other relevant factors

psychologists “retain responsibility for the appropriate application, interpretation, and use of assessment instruments, whether they score and interpret such tests themselves or use automated or other services.

Question 7

Assessment Feedback
must take “reasonable steps” to explain assessment results to the individual or his/her representative unless the situation precludes this requirement which may occur when:
* the assessment is part of employment screening or forensic evaluation.

In these situations, the reason for preclusion should be discussed with the person prior to assessment.

Question 8

Informed Consent for Assessment
informed consent is ordinarily obtained for assessment but that there are exceptions:
* informed consent is unnecessary when the assessment is mandated by law or governmental regulations (e.g., when it is court-ordered)
* when “informed consent is implied because testing is being conducted as a routine educational, institutional, or organizational activity.”

Question 9

Informed Consent w/ persons of “questionable capacity (forensic)
person should be provided with information about the general nature and purpose of the assessment in “reasonably understandable” language
* Fisher (2017) notes that describing the purpose of a test of malingering to an examinee might compromise the test’s validity but that deceiving the examinee about the purpose might violate the examinee’s autonomy rights
* She states that, as a resolution of this dilemma, “current standards of practice support communicating to … [examinees] that measures will be used to assess the examinee’s honesty and efforts to do well, without describing the particularities of the tests that will be used to measure exaggeration or other elements of malingering

Question 10

Using an Interpreter for an Assessment
when using the services of an interpreter to assist with the assessment of a client, psychologists:
* obtain informed consent from the client for use of the interpreter
* make sure that confidentiality of test results and test security are maintained
* include in their feedback and reports a description of any limitations of the obtained data resulting from use of an interpreter

Question 11

Test Data and Test Materials
“test data” includes:
* “raw and scaled scores
* client/patient responses to test questions or stimuli
* psychologists’ notes and recordings concerning client/patient statements and behavior during an examination

may refrain from releasing test data to the client or the person identified in the client’s authorization so to protect the client or others from harm or misuse of the data as long as this is permitted by law
* the Health Insurance Portability and Accountability Act (HIPAA) allows covered entities to withhold test data when its release is reasonably likely to endanger the life or physical safety of the client or other person

“test materials” includes:
* “manuals
* instruments
* protocols
* test questions or stimuli
requires psychologists to “make reasonable efforts” to protect the integrity and security of test materials in ways that are consistent with legal requirements and contractual obligations
* As noted by Fisher (2017), this requirement does not prohibit psychologists from discussing an individual test item with a client when doing so will help the client understand his/her test results

Question 12

Informed Consent for Therapy
clients should be informed about:
* “the nature and anticipated course of therapy
* fees
* involvement of third parties
* limits of confidentiality”
AND
* given an opportunity to ask and receive answers to their questions

experts emphasize that it should be viewed as a continuous process rather than a one-time event
* Barnett and Behnke (2013), the informed consent process “should continue throughout the [therapeutic] relationship with additional information being shared and discussed whenever substantive changes to the existing agreement and services provided are anticipated”

Question 13

Use of treatments “for which generally recognized techniques and procedures have not been established.”
* psychologists must inform clients of “the developing nature of the treatment, the potential risks involved, alternative treatments that may be available, and the voluntary nature of their participation
* “when the therapist is a trainee and the legal responsibility for the treatment provided resides with the supervisor, the client … [must be] informed that the therapist is in training and is being supervised and … given the name of the supervisor.”

Question 14

Telepsychology
unique concerns related to the telepsychology services include the potential limitations of telepsychology:
* the possibility of disruptions due to technology failure
* the increased risk for breaches of confidentiality
the limited ability to respond to emergencies

***must be aware of laws and regulations relevant to informed consent in the jurisdiction where they are located and, when a client is located in another jurisdiction, the relevant laws and regulations in that jurisdiction
*

Question 15

Providing Therapy to Clients Served by Others
proceed with caution and sensitivity to the therapeutic issues when asked to provide services to a person who is receiving services from another mental health professional & the appropriate action in this situation depends on the nature of the services being provided by the other professional
* e.g., if a client tells you during her first session that she’s seeing another therapist for the same problem because she thinks doing so will help her resolve the problem more quickly, you would probably not want to continue seeing the client
* e.g.., when a client is seeking therapy from you to deal with the recent death of his father and tells you he’s also in group therapy for his long-standing gambling problem, it would be acceptable for you to accept him as a client (in this situation, you’d want to obtain the client’s authorization to consult with the other therapist to coordinate the two treatments)

Question 16

Sexual Intimacies
prohibits sexual intimacies with current clients under any circumstances
prohibits sexual intimacies with former clients for at least two years following termination of therapy and then only in the “most unusual circumstances” Standard 10.08 also states that therapists “bear the burden of demonstrating” that a sexual relationship with a former client is not exploitative, which requires considering the following factors:
* (1) the amount of time that has passed since therapy terminated
* (2) the nature, duration, and intensity of the therapy
* (3) the circumstances of termination
* (4) the client’s/patient’s personal history
* (5) the client’s/patient’s current mental status
* (6) the likelihood of adverse impact on the client/patient
* (7) any statements or actions made by the therapist during the course of therapy suggesting or inviting the possibility of a post-termination sexual or romantic relationship with the client/patient

prohibits psychologists from engaging in sexual intimacies with “individuals they know to be” relatives and significant others of current therapy clients

prohibits psychologists from providing therapy to individuals they have been sexually involved with in the past

Question 17

Termination of Therapy
requires psychologists to terminate therapy when it becomes clear that a client no longer needs or is benefiting from it
* this does not mean that a therapist and client cannot reevaluate the client’s progress and determine if there’s a valid reason to continue therapy (e.g., if there are additional treatment goals to address)

provide pretermination counseling and suggest alternative service providers as appropriate
* an exception to this requirement (may terminate therapy without pretermination counseling and referrals) “when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship.”

Guidelines for referral decisions are not provided in the standards of the APA Ethics Code but are provided in its aspirational guidelines
* Principle B states that “psychologists consult with, refer to, or cooperate with other professionals and institutions to the extent needed to serve the best interests of those with whom they work.” (aka the client’s welfare is the top priority when making referrals to alternative services)

[Note: a specific number of referrals is not specified in the APA Ethics Code but that some experts recommend giving clients a minimum of three referrals]