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Develop an 8- to 10-slide Microsoft® PowerPoint® presentation with detailed speaker notes on the selection process of a culture-neutral assessment. Include examples of when culture-biased assessments have been problematic.

This can be in word form I will make the powerpoint I coped chapter 12 so you can find the info you need.

Fisher, C. B. (2013). Decoding the ethics code: A practical guide for psychologists. Thousand Oaks, CA: Sage.

Standards on Assessment

9. Assessment

9.01 Bases for Assessments

(a) Psychologists base the opinions contained in their recommendations, reports, and diagnostic

or evaluative statements, including forensic testimony, on information and techniques sufficient

to substantiate their findings. (See also Standard 2.04, Bases for Scientific and

Professional Judgments.)

Psychological assessment serves the public good by providing information to

guide decisions affecting the well-being of individuals, families, groups, organizations,

and institutions. Psychologists who draw their conclusions on information

and techniques based on the scientific and professional knowledge of the discipline

are uniquely qualified to interpret the results of psychological assessments in ways

that merit the public trust. However, the public and the profession are harmed

when psychologists provide opinions unsubstantiated by information obtained or

drawn from data gathered through improper assessment techniques (Principle A:

Beneficence and Nonmaleficence and Principle B: Fidelity and Responsibility).

Standard 9.01a of the APA Ethics Code (APA, 2010c) prohibits psychologists from

providing written or oral opinions that cannot be sufficiently substantiated by the

information obtained or the techniques employed.

The standard is broadly worded to apply to all written and oral professional

opinions irrespective of information recipient, setting, or type of assessment.

Information Recipient

The standard prohibits unfounded professional opinions offered to, among others,

(a) individual clients/patients or their representatives; (b) other professionals;

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268——PART II ENFORCEABLE STANDARDS

and other institutions; (e) businesses, agencies, and other organizations; (f) the

courts; (g) the military or other governing legal authorities; and (h) callers to talk

radio programs or those interacting with psychologists via the Internet or through

other media.

Setting

Standard 9.01a applies to (a) diagnostic opinions offered orally in the office of a

private practitioner; (b) written reports provided to clients/patients, other practitioners,

or third-party payors through the mail, the Internet, or other forms of

electronic transmission; (c) testimony provided in the courts; and (d) opinions

about an individual’s mental health offered over the Internet, radio, television, or

other electronic media.

Types of Assessment

The standard pertains to all unfounded opinions claiming to be based on any

form of evaluation, including but not limited to (a) standardized psychological,

educational, or neuropsychological tests; (b) diagnostic information gained

through clinical interviews; (c) collateral data obtained through discussions with

family members, teachers, employee supervisors, or other informants; (d) observational

techniques; or (e) brief discussion or correspondence with an individual via

radio, television, telephone, or the Internet.

Violations of this standard are often related to failure to comply with other standards,

including Standards 2.04, Bases for Scientific and Professional Judgments;

9.01b, Bases for Assessments; and 9.02b, Use of Assessments. The following are

examples of opinions based on insufficient information or techniques that would

be considered violations under this standard:

􀀴 Testifying on the validity of a child abuse allegation based on the results of an idiosyncratic,

improperly constructed parent checklist of child behaviors

􀀴 Diagnosing an adult with impaired decisional capacity as developmentally disabled

without taking a developmental history

􀀴 Providing preemployment recommendations on the basis of a personality test with no

proven relationship to job performance

􀀴 Submitting a diagnosis of neurological impairment to a health insurance company

based solely on information derived during therapy sessions

􀀴 Informing parents that their preschooler is autistic on the basis of a single observational

session

􀀴 Recommending a child for special education placement solely on the basis of scores

on a standardized intelligence test

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Chapter 12 Standards on Assessment——269

Psychologists who knowingly provide unsubstantiated opinions in forensic,

school, or insurance reports fail to live up to the ideals of Principle C: Integrity

and may also find themselves in violation of Standard 5.01, Avoidance of False

or Deceptive Statements (see Hot Topic “Avoiding False and Deceptive Statements

in Scientific and Clinical Expert Testimony,” Chapter 8). However, psychologists

should also be alert to personal and professional biases that may affect their

choice and interpretation of instruments. For example, in a survey of forensic

experts testifying in cases of child sexual abuse allegations, Everson and Sandoval

(2011) found that evaluator disagreements could be explained, in part, by individual

differences in three forensic decision-making attitudes: (1) emphasis on

sensitivity, (2) emphasis on specificity, and (3) skepticism toward child reports

of abuse.

(b) Except as noted in 9.01c, psychologists provide opinions of the psychological characteristics

of individuals only after they have conducted an examination of the individuals adequate

to support their statements or conclusions. When, despite reasonable efforts, such an examination

is not practical, psychologists document the efforts they made and the result of those

efforts, clarify the probable impact of their limited information on the reliability and validity

of their opinions, and appropriately limit the nature and extent of their conclusions or recommendations.

(See also Standards 2.01, Boundaries of Competence, and 9.06, Interpreting

Assessment Results.)

Standard 9.01b specifically addresses the importance of in-person evaluations

of individuals about whom psychologists will offer a professional opinion.

Under this standard, with few exceptions, psychologists must conduct individual

examinations sufficient to obtain personal verification of information on which

to base their professional opinions and refrain from providing opinions about

the psychological characteristics of an individual if they themselves have not

conducted an examination of the individual adequate to support their statements

or conclusions. As video conferencing and other electronically mediated

sources of video communication become increasingly common, appropriately

conducted assessments via these media may meet the requirements of this standard

if the psychologist has had the appropriate preparatory training and the

validity of the video methods of assessment has been scientifically and clinically

established for use with members of the population tested (Standards 2.01e,

Boundaries of Competence; 2.04, Bases for Scientific and Professional Judgment;

9.02, Use of Assessments).

􀀴 Offering a diagnosis of PTSD based on a 5-minute discussion with a listener to a radio

program hosted by the psychologist

􀀴 Offering a diagnosis of bipolar disorder based on an individual’s comments on the

psychologist’s blog

􀀴 Prescribing a psychotropic medication to an elderly patient complaining of memory

lapses without conducting a neuropsychological assessment

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270——PART II ENFORCEABLE STANDARDS

Standard 9.01b also recognizes that in some cases, a personal examination may

not be possible. For example, an individual involved in a child custody suit, a disability

claim, or performance evaluation may refuse or, because of relocation or

other reasons, be unavailable for a personal examination. The standard requires

that psychologists make “reasonable efforts” to conduct a personal examination.

Efforts that would not be considered reasonable in the prevailing professional judgment

of psychologists engaged in similar activities would be considered a violation

of this standard. Consider the following two examples of potential violations:

􀀴 A psychologist testified about a parent’s psychological fitness for visitation rights,

drawing his opinion solely from comments made by the child and divorced spouse in

the absence of an individual examination of the parent.

􀀴 A psychologist contracted by an insurance company to evaluate an individual’s mental

health as part of a current disability claim provided an opinion based solely on

job performance evaluations written by the insured’s immediate supervisors and

diagnostic information collected by another psychologist prior to the incident cited

in the claim.

􀀴 A psychologist working in a correctional facility who was asked to recommend

whether a prison guard’s mental status was a risk to prisoner protections did not

personally examine the guard but instead gave an opinion based on reports by facility

administrators, staff, and prisoners.

􀀴 A psychologist was contracted by a prison to evaluate the job potential of guards

hired for a probationary period. Without conducting an individual interview, the psychologist

wrote a report concluding that emotional instability of one job candidate

made him ineligible for full-time employment. The psychologist justified the lack of a

personal examination on the fact that several coworkers claimed the guard was too

dangerous to interview.

􀀴 A psychologist hired by the attorney of a husband engaged in a custody suit provided

court testimony on the wife’s parenting inadequacies without having interviewed her

personally. The psychologist claimed that the wife did not respond to the psychologist’s

letter requesting the interview. On cross-examination, it was revealed that the

letter written by the psychologist included the following language seemingly designed

to discourage agreement to be examined: “I have reason to believe from interviews

with your spouse and an examination of your children that you are responsible for the

children’s current mental health problems and would like to conduct an examination

to confirm or dispute these assumptions.”

When, despite reasonable efforts, a personal interview is not feasible, under

Standard 9.01b, psychologists in their written or oral opinions must document and

explain the results of their efforts, clarify the probable impact that the failure to

personally examine an individual may have on the reliability and validity of their

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Chapter 12 Standards on Assessment——271

opinions, and appropriately limit their conclusions or recommendations to information

they can personally verify. For example:

individual examination is not warranted or necessary for the opinion, psychologists explain this

and the sources of information on which they based their conclusions and recommendations.

This standard applies to those assessment-related activities for which an individual

examination is not warranted or necessary for the psychological opinion.

Such activities include record or file reviews where psychologists are called on to

review preexisting records and reports to assist or evaluate decisions made by

schools, courts, health insurance companies, organizations, or other psychologists

they supervise or with whom they consult. Record reviews can be performed to (a)

determine whether a previously conducted assessment was appropriate or sufficient;

(b) evaluate the appropriateness of treatment, placement, employment, or

the continuation of benefits based on the previously gathered information and

reports; (c) adjudicate a disability or professional liability claim based on existing

records; or (d) resolve conflicts over the applicability of records to interpretations

of federal and state laws in administrative law or due process hearings

(Hadjistavropoulos & Bieling, 2001; Krivacska & Margolis, 1995).

Reviewers provide a monitoring function for the court or a function of forensic

quality control so the court will not be misled by expert testimony of evaluators that

is based on flawed data collection and/or analysis (Austin, Kirkpatrick, & Flens,

2011). According to Standard 9.01c, psychologists who provide such services must

clarify to the appropriate parties the source of the information on which the opinion

is based and why an individual interview conducted by the psychologist is not

necessary for the opinion.

Simply complying with this standard may not be sufficient for psychologists who

are in supervisory roles that carry legal responsibility for the conduct of assessments

by unlicensed supervisees or employees. In many of those instances, psychologists may

be directly responsible for ensuring that individuals are qualified to conduct the assessments

and do so competently (see Standard 2.05, Delegation of Work to Others).

􀀵 A court-appointed psychologist attempted to contact the biological parent of a child

currently in foster care to make recommendations regarding parental visitation. The

parent was no longer at the last known residence and had not left a forwarding

address. In testimony, the psychologist described the current mental health status of

the child, the child’s statements regarding the biological parent, and the observed

relationship between the child and foster parents. In referring to the biological parent,

the psychologist informed the court of efforts to contact the parent, described how

failure to interview the parent limited any conclusions that could be drawn regarding

the parent’s psychological characteristics and parenting competence, and clarified

that recommendations regarding visitation were based on the child’s attitudes, mental

health, and foster care arrangements.

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272——PART II ENFORCEABLE STANDARDS

Review of Data From Surreptitious

Investigative Recording

There are instances when forensic psychologists may be asked to evaluate past

mental states from audio or video recordings of a defendant’s behavior at the time

of the alleged offense or surreptitious recordings of a plaintiff ’s behavior in a personal

injury, insurance disability, or divorce case (Denney & Wynkoop, 2000).

Before agreeing to review such recordings, psychologists should make sure that the

surveillance information was obtained legally at the time it was recorded, that the

party requesting the psychologist’s evaluation has the legal right to share such

information, and that inadmissibility of such information will not compromise the

psychologist’s findings. Psychologists should also take reasonable steps to ascertain

that they have been provided with all legally available recordings and other available

information relevant to the forensic opinion. The psychologist’s oral testimony or

written report should clarify the source of the information and why an individual

examination is not warranted or necessary for the type of evaluation requested.

9.02 Use of Assessments

(a) Psychologists administer, adapt, score, interpret, or use assessment techniques, interviews,

tests, or instruments in a manner and for purposes that are appropriate in light of the research

on or evidence of the usefulness and proper application of the techniques.

The appropriate use of psychological assessments can benefit individuals, families,

organizations, and society by providing information on which educational

placements, mental health treatments, health insurance coverage, employee selection,

job placement, workers’ compensation, program development, legal decisions,

and government policies can be based. The inappropriate use of assessments can

lead to harmful diagnostic, educational, institutional, legal, and social policy decisions

based on inaccurate and misleading information.

Standard 9.02a is concerned with the proper selection, interpretation, scoring,

and administration of assessments. It refers to the full range of assessment techniques

used by psychologists, including interviews and standardized tests administered

in person, through the Internet, or through other media. According to this

standard, ethical justification for the use of assessments is determined by research on

or evidence supporting the purpose for which the test is administered, the method

of administration, and interpretation of scores. To comply with the standard, psychologists

should be familiar with the data and other information provided in test

manuals detailing (a) theoretical and empirical support for test use for specific purposes

and populations, (b) administration procedures, and (c) how test scores are to

be calculated and interpreted. Psychologists should also keep themselves apprised of

ongoing research or evidence of a test’s usefulness or obsolescence over time (see

also Standards 2.03, Maintaining Competence; 2.04, Bases for Scientific and

Professional Judgments; and 9.08b, Obsolete Tests and Outdated Test Results).

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Chapter 12 Standards on Assessment——273

Internet-Mediated Assessments

Psychologists administering assessments via the Internet need to remain up-todate

on research demonstrating their validity or lack thereof for use in this media

(Standard 2.03, Maintaining Competence). Verification of the examinee’s age, gender,

and honesty of disclosures is important to the assessment’s validity and reliability

(Alleman, 2002). Some assessments developed for in-person administration

require verbal, auditory, or kinesthetic clues for accurate diagnosis (Barak &

English, 2002). When assessments have not been validated for use of the Internet,

psychologists should make every effort to conduct an in-person evaluation. When

this is not possible, psychologists should select instruments that research or other

evidence indicates are most appropriate for this medium, implement when possible

information-gathering techniques that can best approximate in-person settings (e.g.,

video and auditory interactive technology), and acknowledge limitations of the assessment

in interpretations of the data (Standard 9.06, Interpreting Assessment Results).

Violations of Standard 9.02a occur when psychologists use assessments in a

manner or for a purpose that is not supported by evidence in the field (see also this

chapter’s Hot Topic on “The Use of Assessments in Expert Testimony: Implications

of Case Law and the Federal Rules of Evidence”).

􀀴 A psychologist contracted to conduct employment testing for an organization administered

a series of personality inventories with little or no validity evidence supporting

the link between scores on the inventories and actual job performance.

􀀴 A counseling psychologist working with an isolated rural community administered a

series of tests over the Internet without previously establishing whether the Internetmediated

scores measure the same construct as scores from the paper-and-pencil

version (Buchanan, 2002).

􀀴 A school psychologist working under pressure to meet the school system’s quotas for

weekly testing gave the same battery of tests to all students irrespective of their grade

level or presenting problem.

􀀴 A neuropsychologist conducted a forensic examination of a prisoner in a room occupied

by other prisoners, thereby compromising the validity of score interpretation

based on norms established under standardized distraction-free testing environments.

Test administration for individuals with disabilities may require modifications

and adaptations in testing administration to minimize the effect of test taker characteristics

incidental to the purpose of the assessment. Standard 9.02a permits

departure from a standard administration protocol if the method of test adaptation

can be justified by research or other evidence. For example, converting a written test

to Braille for a blind individual, physically assisting a client with cerebral palsy to

circle items on a written test, or providing breaks for an individual with a disability

associated with frequent fatigue is acceptable if the particular disability is not associated

with the construct to be measured by the test and there are professional or

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274——PART II ENFORCEABLE STANDARDS

scientific reasons to assume that such modifications will not affect the validity of

the test (American Educational Research Association [AERA], APA, & National

Council on Measurement in Education [NCME], 1999). Such accommodations are

not appropriate if the disability is directly related to the abilities or characteristics

that the test is designed to measure. Federal regulations relevant to the assessment

of individuals with disabilities include IDEA (http://idea.ed.gov/), Section 5.04 of

the Rehabilitation Act of 1973 (http://www.hhs.gov/ocr/504.html), and ADA

(www.ada.gov).

Need to Know: Assessment of Dementia

The APA Guidelines for the Evaluation of Dementia and Age-Related Cognitive Change

(APA, 2012b) stress the importance of using age-normed standardized psychological and

neurological tests, being aware of the limitations of brief mental status examinations, and

estimating premorbid abilities. The Guidelines also describe the following key elements

that should be obtained to assure accurate diagnosis of conditions associated with cognitive

decline (p. 5):

The onset and course of changes in cognitive functioning

Preexisting disabilities

Educational and cultural background that could affect testing variability

General medical and psychiatric history

Past neurological history, including prior head injuries or other central nervous

system insults (strokes, tumors, infections, etc.)

Current psychiatric symptoms and significant life stressors

Current prescription and over-the-counter medication use

Current and past use and abuse of alcohol and drugs

Family history of dementia

Presence of Third Parties to Assessments

Standard 9.02a requires that psychologists administer tests in a manner consistent

with procedures and testing contexts used in the development and validation

of the instruments. Many psychological assessment instruments and procedures are

validated under administration conditions limited to the presence of the psychologist

and testee. In rare instances, psychologists may judge it necessary to include

third parties to control the behavior of difficult examinees (e.g., parents of young

children, hospital staff for psychiatric patients with a recent history of violence). In

such situations, psychologists should select assessment instruments that are least

likely to lend themselves to distortion based on the presence of a third party and

include in their interpretations of test results the implications of such violations of

standardized testing conditions.

Psychologists providing expert forensic consultations in relation to a criminal

case, tort litigation, insurance benefits, or workers’ compensation claims may find

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Chapter 12 Standards on Assessment——275

that state law, institutional policy, or a judge’s ruling mandating the presence of a

third party during forensic assessment can compromise the assessment validity of

tests when third parties are present. For example, in neuropsychological assessments

related to workers’ compensation cases, the presence of the plaintiff ’s legal counsel,

family members, or company representatives may distort the testing process or render

test scores and interpretations invalid if the third party influences the test taker’s

motivation, behavior, or psychologist–testee rapport (American Academy of Clinical

Neuropsychology, 2001). The use of data from such assessments may be unfair to

individuals if it leads to invalid test administration or misleading interpretations of

the testee’s responses (Principle D: Justice and Standards 1.01, Misuse of Psychologists’

Work; 1.02, Conflicts Between Ethics and Law, Regulations, or Other Governing

Legal Authority; and 9.06, Interpreting Assessment Results). When there is no legal

flexibility in denying third-party presence during an assessment, psychologists

should select tests and procedures found to be least susceptible to distortion under

these conditions and ensure that their written reports highlight the unique circumstances

of the assessment and the limitations in interpretation.

Trainees and Interpreters as Third Parties

Third parties may observe evaluations for training purposes or serve as interpreters

when translation is necessary to ensure accuracy and fairness of assessments

(Standard 9.02c, Use of Assessments). In such instances, psychologists must select

procedures that, research or other evidence has demonstrated, can be applied

appropriately under these circumstances, ensure that trainees and interpreters are

trained adequately to minimize threats to the proper test administration, and

include in their reports any limitations on conclusions presented by the presence of

the third parties (Standards 2.05, Delegation of Work to Others, and 9.06,

Interpreting Assessment Results).

(b) Psychologists use assessment instruments whose validity and reliability have been established

for use with members of the population tested. When such validity or reliability has not been

established, psychologists describe the strengths and limitations of test results and interpretation.

The proper use of tests can further principles of fairness and justice by ensuring

that all persons benefit from equal quality of assessment measures, procedures, and

interpretation (Principle D: Justice and Standard 3.01, Unfair Discrimination). Fair

applicability of test results rests on assumptions that the validity and reliability of a

test are equivalent for different populations tested. Validity refers to the extent to

which empirical evidence and psychological theory support the interpretation of

test data; that is, whether the test measures the psychological construct it purports

to measure. Reliability refers to the consistency of test scores when a test is repeated

for an individual or for a given population (see AERA, APA, & NCME, 1999).

A test that is a valid and reliable measure of a psychological construct in one

population may not adequately measure the same construct in members of a different

population, especially if members of the population were represented inadequately

in the normative sample or if test validity information has not been

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276——PART II ENFORCEABLE STANDARDS

established specifically for that group. Standard 9.02b requires psychologists to

select assessment instruments whose validity and reliability have been established

for use with members of the population tested. This standard applies to psychological

assessment of any population, including clients/patients, students, job candidates,

legal defendants, and research participants.

To comply with this standard, psychologists, when selecting a test, must be

familiar with the specific populations included in the standardization sample and

the test’s validity and reliability estimates. At minimum, psychologists should determine

the applicability of a test to an individual’s age group, ethnicity/culture,

language, and gender and, where applicable, disability or other population characteristics

for which there is scientific or professional evidence to suggest that test

scores may not be psychometrically, functionally, or theoretically comparable to the

reference groups on which the test was normed (Landwher & Llorente, 2012).

Psychologists should also be familiar with relevant federal laws on the selection

and administration of nondiscriminatory assessment and evaluation procedures

(e.g., IDEA, 34 CFR 300.30[c][1][i]).

􀀴 A school psychologist was asked to evaluate a bilingual child whose family recently

moved to New York from Puerto Rico. The psychologist used the English version of

a well-known intelligence test without considering whether the standardized

Spanish version of the test was or was not most appropriate for the child’s particular

needs.

􀀴 A psychologist working in a nursing home always used the Beck Depression Inventory

(Beck, Steer, & Brown, 1996) to assess patient depression without considering the

appropriateness of other measures specifically standardized on elderly populations or

populations with chronic illnesses.

􀀴 A consulting psychologist was hired to evaluate the job performance of a factory supervisor

who had a visual disability. The psychologist limited her assessment to tests that

were validated on individuals without vision impairment and neglected to assess

unique ways in which the supervisor might successfully compensate for his disability.

The dynamic and evolving nature of this country’s cultural, political, and economic

landscape creates situations in which population-valid and reliable tests of a

psychological construct may not be available for the individual or group tested.

Psychologists asked to evaluate individuals from such groups should select tests

validated on other populations with caution because they may produce results that

do not adequately assess the qualities or competencies intended to be measured

(AERA, APA, & NCME, 1999). Recommendations based on these assessments in

turn may lead to unfair denial of educational or employment opportunities, health

coverage, legal rights, or necessary services (Principle D: Justice). According to

Standard 9.02b, psychologists who use tests without established norms for the individual

or population assessed must describe in their reports the strengths of using

the specific test results as well as the limitations the use of such tests places on

psychologists’ interpretations and recommendations.

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Chapter 12 Standards on Assessment——277

Selection of “Culture-Free” Tests

School psychologists and neuropsychologists conducting assessments of intellectual,

educational, and cognitive abilities may attempt to be culturally sensitive by

“stacking” their test batteries with nonverbal visuoperceptual and motor tests when

assessing patients who speak languages in which more traditional language-based

tests are not available. The use of such tests requires ethical caution since nonverbal

tests of cognitive ability can be just as culturally biased as verbal tests (Wong,

Strickland, Fletcher-Janzen, Ardila, & Reynolds, 2000).

􀀵 A forensic psychologist was asked to evaluate the competence to stand trial of a

prisoner who recently immigrated to the United States from Botswana. The prisoner’s

English was poor, but there were no tests for competence standardized for individuals

from the prisoner’s cultural or language group. The psychologist selected the best

culturally sensitive techniques and assessments available and in written conclusions

to the court explained the limitations of the tests used.

􀀴 A neuropsychologist was hired by an insurance company to assess a recent Nigerian

immigrant who claimed he had suffered brain damage falling on the premises of a

store insured by the company. Because the man had such limited English skills, and no

test was available in his primary language, the neuropsychologist decided that the

most culturally sensitive approach would be to assess the man’s cognitive capacity

with an assessment battery composed entirely of visuospatial, perceptual, and motor

tasks. The psychologist’s report did not describe the limitations of test results based

on the absence of language-based assessments of reasoning and other cognitive

abilities, nor did the report acknowledge the absence of pre-injury cognitive tests

necessary to help determine whether behavioral and cognitive functioning had

declined after the fall (adapted from Wong, 2000).

and competence, unless the use of an alternative language is relevant to the assessment issues.

Language differences are part of the cultural diversity, rich immigration history,

and individual differences in hearing and other linguistically relevant disabilities

that make up the demographic mosaic of the United States. The validity and applicability

of assessment data can be severely compromised when testing is conducted

in a language the testee is relatively unfamiliar with or uncomfortable using. Under

Standard 9.02c, prior to selecting, administering, or interpreting tests, psychologists

must consider both the language preference and language competence of the testee.

Whereas the inappropriateness of English-only-based psychological testing is

obvious when testees speak little or no English, the hazards of English-only testing

for bilingual persons or oral-language-only assessment of persons with hearing

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278——PART II ENFORCEABLE STANDARDS

disabilities who can read lips and communicate in sign language are often overlooked.

The linguistic competencies of individuals who are bilingual often vary

with the mode of communication (e.g., oral vs. written language), language function

(e.g., social, educational, or job related), and topical domain (e.g., science,

mathematics, interpersonal relationships, self-evaluations). In addition, individuals’

language preferences do not always reflect their language competence.

Individuals may be embarrassed to reveal that their English, hearing, or oral language

is poor; believe non-English or nonhearing testing will negatively affect

their evaluations; or misjudge their language proficiency.

The Standards for Educational and Psychological Testing (AERA, APA, & NCME,

1999) recommends a number of steps that can help psychologists comply with

Standard 9.02c:

Psychologists can use language tests that assess multiple language domains to

determine language dominance and proficiency relevant to different modes of

assessment (e.g., written, oral) and topics (e.g., academic, interpersonal).

Whenever possible, psychologists should use test translations that have been

developed according to accepted methods of test construction (see Standard

9.05, Test Construction). For example, the Standards for Educational and

Psychological Testing recommends the use of an iterative process more akin to

test construction and validation rather than sole reliance on back translation

(translating the translation of the test back into the original language).

Additional testing or observation may be necessary to determine whether

what appears to be eccentric behavior (e.g., short phrases or reticence in

response to test questions) reflects differences in cultural communication

styles or an individual characteristic.

To the extent feasible, psychologists must ensure the language competence of

the test administrator (see also Standards 2.05, Delegation of Work to Others,

and 9.03c, Informed Consent in Assessments).

When interpreting assessment results, test norms for native speakers of

English should not be used for individuals for whom English is a second

language or should be interpreted in part as reflecting a level of English

proficiency.

When English or Other Language

Proficiency Is Essential

There are instances when proficiency in English or another language is essential

to the goal of the assessment. For example, the ability to communicate with

English-speaking employees may be a necessary qualification for a successful

applicant for a personnel position. Evaluating a student’s English proficiency may

be necessary to determine appropriate educational placement. The ability to read

and speak English may be important to certain service positions responsible for

protecting public health, safety, and welfare (AERA, APA, & NCME, 1999).

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Chapter 12 Standards on Assessment——279

Inclusion of the phrase “unless the use of an alternative language is relevant to the

assessment issues” indicates that Standard 9.02c permits psychologists to use tests

in a language in which the testee may not be proficient, if effective job performance,

school placement, or other goals of assessment require the ability to communicate

in that language.

9.03 Informed Consent in Assessments

(a) Psychologists obtain informed consent for assessments, evaluations, or diagnostic services, as

described in Standard 3.10, Informed Consent, except when (1) testing is mandated by law or

governmental regulations; (2) informed consent is implied because testing is conducted as a

routine educational, institutional, or organizational activity (e.g., when participants voluntarily

agree to assessment when applying for a job); or (3) one purpose of the testing is to evaluate

decisional capacity. Informed consent includes an explanation of the nature and purpose of the

assessment, fees, involvement of third parties, and limits of confidentiality and sufficient opportunity

for the client/patient to ask questions and receive answers.

To comply with this standard, psychologists must obtain and document, with

few exceptions, written or oral consent in the manner set forth in Standard 3.10,

Informed Consent. Psychologists must provide individuals who will be assessed

and, when appropriate, their legal representative a clear explanation of the

nature and purpose of the assessment, fees, involvement of third parties, and the

limits of confidentiality. Psychologists should also be attuned to consent vulnerabilities

related to transient disorders, such as depression (Ghormley, Basso,

Candlis, & Combs, 2011), and develop appropriate measures to ensure consent

comprehension.

Core Elements of Informed Consent in Assessment

Nature of the Assessment

The nature of an assessment refers to (a) the general category of the assessment

(e.g., personality, psychopathology, competency, parenting skills, neuropsychological

abilities and deficits, employment skills, developmental disabilities), (b) procedures

and testing format (e.g., oral interviews, written self-report checklists,

behavioral observation, skills assessment), and (c) duration of the assessment (e.g.,

hours or multiple assessments).

Purpose of the Assessment

The purpose of the assessment refers to its potential use, for example, in employment

decisions, school placement, custody decisions, disability benefits, treatment

decisions, and plans for or evaluation of rehabilitation of criminal offenders.

HMO

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Fees

Discussion of fees must include the cost of the assessment and payment schedule

and should be consistent with requirements of Standard 6.04, Fees and Financial

Arrangements. When applicable and to the extent feasible, psychologists must also

discuss with relevant parties the extent to which their services will be covered by the

individual’s health plan, school district, employer, or others (see Standard 6.04a and d,

Fees and Financial Arrangements).

Third Parties

Involvement of third parties refers to other individuals (e.g., legal guardians),

HMOs, employers, organizations, or legal or other governing authorities that have

requested the assessment and to whom the results of the assessments will be provided.

Psychologists should be familiar with ethical standards, state law, and federal

regulations relevant to the appropriate role of third parties and the release and

documentation of release of such information to others (see Standard 4.05,

Disclosures). Psychologists asked to evaluate a child by one parent should clarify

custody issues to determine if another parent must give permission.

Confidentiality

Informed consent to assessments must provide a clear explanation of the extent

and limits of confidentiality, including (a) when the psychologist must comply with

reporting requirements such as mandated child abuse reporting or duty-to-warn

laws and (b) in the case of assessments involving minors, guardian access to records

(see discussion of parental access involving HIPAA, FERPA, and other regulations

in Standards 3.10, Informed Consent; 4.01, Maintaining Confidentiality; and 4.02,

Discussing the Limits of Confidentiality). Psychologists who administer assessments

over the Internet must inform clients/patients, research participants, or others

about the procedures that will be used to protect confidentiality and the threats

to confidentiality unique to this form of electronic transmission of information

(see also Standard 4.02c, Discussing the Limits of Confidentiality).

Implications of HIPAA for

Confidentiality-Relevant Information

The HIPAA regulation most relevant to informed consent in assessments is the

Notice of Privacy Practices. At the beginning of the professional relationship, covered

entities must provide clients/patients a written document detailing routine

uses and disclosures of PHI and the individual’s rights and the covered entities’

legal duties with respect to PHI (45 CFR 164.520). Psychologists conducting

assessments should also be familiar with HIPAA-compliant authorization forms

for use and release of PHI and HIPAA requirements for Accounting of Disclosures.

These regulations are described in greater detail in the section “A Word About

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Chapter 12 Standards on Assessment——281

HIPAA” in the Preface of this book and in discussions of Standard 3.10, Informed

Consent, in Chapter 6; Standards 4.01, Maintaining Confidentiality, and 4.05,

Disclosures, in Chapter 7; Standard 6.01, Documentation of Professional and

Scientific Work and Maintenance of Records, in Chapter 9; and Standard 9.04,

Release of Test Data, in this chapter.

Dispensing With Informed Consent

Under Standard 9.03a, informed consent may be waived when consent is

implied because testing is conducted as (a) a routine educational activity, such as

end-of-term reading or math achievement testing in elementary and high schools;

(b) regular institutional activities, such as student and teaching evaluations in academic

institutions or consumer satisfaction questionnaires in hospitals or social

service agencies; or (c) organizational activity, such as when individuals voluntarily

agree to preemployment testing when applying for a job.

Standard 9.03a permits psychologists to dispense with informed consent in

assessment when testing is mandated by law or other governing legal authority or

when one purpose of testing is to determine the capacity of the individual to give

consent. Ethical steps that must be taken in these contexts are discussed next under

Standard 9.03b (Moberg & Kniele, 2006).

(b) Psychologists inform persons with questionable capacity to consent or for whom testing is

mandated by law or governmental regulations about the nature and purpose of the proposed

assessment services, using language that is reasonably understandable to the person being

assessed.

Under Standards 3.10b, Informed Consent, and 9.03a, Informed Consent in

Assessments, informed consent in assessment is not required when an individual

has been determined to be legally incapable of giving informed consent, when testing

is mandated by law or other governing legal authority, or when one purpose of

testing is to determine consent capacity. These waivers reflect the fact that the term

consent refers to a person’s legal status to make autonomous decisions based on age,

mental capacity, or the legal decision under consideration. Consistent with the

moral value of respect for the dignity and worth of all persons articulated in

Principle E: Respect for People’s Rights and Dignity, under Standard 9.03c, psychologists

must provide all individuals irrespective of their legal status appropriate

explanations of the nature and purpose of the proposed assessment. Readers may

also refer to the Hot Topic in Chapter 6, titled “Goodness-of-Fit Ethics for Informed

Consent Involving Adults With Impaired Decisional Capacity.”

Standard 9.03a often applies in situations where assessment is requested by parents

of children younger than age 18 years or family members of adults with suspected

cognitive impairments. In some contexts the affirmative agreement of the

testee is not required. In these situations, the psychologist must provide information

in a language and at a language level that is reasonably understandable to

the child or adult being assessed. When both guardian permission and child or

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282——PART II ENFORCEABLE STANDARDS

cognitively impaired adult assent are sought, psychologists working with populations

for whom English is not a first language should be alert to situations in which

prospective clients/patients and their legal guardians may have different language

preferences and proficiencies.

Mandated Assessments

Psychologists conducting forensic, military, or other assessments that have been

legally mandated should provide notification of purpose, which explains to the person

being tested the nature and purpose of the testing, who has requested the testing,

and who will receive copies of the report. If the examinee is unwilling to

proceed following a thorough explanation, according to the Specialty Guidelines

for Forensic Psychologists, “The forensic practitioner may attempt to conduct the

examination, postpone the examination, advise the examinee to contact his or her

attorney, or notify the retaining attorney about the examinee’s unwillingness to

proceed” (AP-LS Committee on the Revision of the Specialty Guidelines for

Forensic Psychologists, 2010). The APAIT provides a useful sample of a Forensic

Informed Consent Contract developed by Jeffrey Younggren, Eric Harris, and Bruce

Bennett (http://www.apait.org/apait/).

Defendants who are entering a plea of insanity may not be able to act on their

Fifth Amendment right to silence and avoidance of self-incrimination. To avoid

compromising the admissibility of a comprehensive forensic evaluation, Bush et al.

(2006) suggest that psychologists first assess competency, then sanity, and separate

the reports given to the court to provide the court the opportunity to first determine

the competence question.

Informed Consent for the Assessment of Malingering

Malingering refers to the intentional production of false symptoms to attain an

identifiable external benefit (Iverson, 2006; National Academy of Neuropsychology

Policy and Planning Committee, 2000). Assessment of malingering is one of the

most challenging tasks facing forensic psychologists (Kocsis, 2011). Some have

argued that assessment of malingering is the number one priority of forensic

assessment, preceding any professional conclusions in forensic evaluations (Brodsky

& Galloway, 2003). Malingering can be manifested through intentional under- or

overperformance during psychological assessment. Accurate assessment of malingering

is ethically important because errors in diagnosis can impede justice when

undetected in forensic procedures or obscure adequate treatment for psychopathology

(Principle A: Beneficence and Nonmaleficence; Kocsis, 2011).

Some have questioned whether describing the purposes of tests for malingering

during informed consent compromises the validity of the assessment or whether

failing to include such information during informed consent violates testees’

autonomy rights (Principle E: Respect for People’s Rights and Dignity and Standard

9.03, Informed Consent in Assessments). Current standards of practice support

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Chapter 12 Standards on Assessment——283

communicating to testees during informed consent or notification of purpose that

measures will be used to assess the examinee’s honesty and efforts to do well (Bush

et al., 2006). Psychologists conducting assessments for Social Security Disability

benefits should take extra steps to craft language and procedures that ensure testees

understand that honesty and effort are required (Chafetz, 2010).

Research on Coached Malingering

A practical concern in the forensic assessment of defendants or plaintiffs is

whether existing tests of malingering can detect over- or underexaggeration of

symptoms when the examinee has been coached by individuals familiar with the

tests (Jelicic, Cuenen, Peters, & Merckelbach, 2011). When researchers attempt to

study the extent to which commonly used tests are vulnerable to coached faking,

there is a risk that the information provided to research participants or disseminated

through publication will be used to improve the success of coached malingers

(Berry, Lamb, Wetter, Baier, & Widiger, 1994). Ben-Porath (1994) suggests that to

protect against these risks, investigators can (a) coach research participants on

items similar but not identical to those on the test under investigation, (b) provide

only a brief synopsis of coaching instructions in published articles, and (c) release

information on verbatim instructions only to those bound by the APA Ethics Code

to protect the integrity of tests (see also Standard 9.11, Maintaining Test Security).

patient to use that interpreter, ensure that confidentiality of test results and test security are maintained,

and include in their recommendations, reports, and diagnostic or evaluative statements,

including forensic testimony, discussion of any limitations on the data obtained. (See also Standards

2.05, Delegation of Work to Others; 4.01, Maintaining Confidentiality; 9.01, Bases for Assessments;

9.06, Interpreting Assessment Results; and 9.07, Assessment by Unqualified Persons.)

Compliance with the consent requirements outlined in Standard 3.10 obligates

psychologists to provide information in a language and at a language level that is

reasonably understandable to the client/patient and, where applicable, his or her

legally authorized representative. Psychologists may use the services of an interpreter

when they do not possess the skills to obtain consent in the language in

which the client/patient is proficient.

When delegating informed consent responsibilities to an interpreter, psychologists

must ensure not only that the interpreter is competent in the consent-relevant

language (see Standard 2.05, Delegation of Work to Others) but that the interpreter

also understands and complies with procedures necessary to protect the confidentiality

of test results and test security. An interpreter who revealed the identity of a

client/patient or the nature of specific test items used during the assessment would

place the psychologist who hired the interpreter in potential violation of this standard.

Because test validity and reliability may be vulnerable to errors in interpretation,

Standard 9.03c also requires that the involvement of the interpreter and any

related limitations on the data obtained be clearly indicated and discussed in any

assessment-based report, recommendation, diagnostic or evaluative statement, or

forensic testimony.

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284——PART II ENFORCEABLE STANDARDS

9.04 Release of Test Data

(a) The term test data refers to raw and scaled scores, client/patient responses to test questions

or stimuli, and psychologists’ notes and recordings concerning client/patient statements and

behavior during an examination. Those portions of test materials that include client/patient

responses are included in the definition of test data. Pursuant to a client/patient release, psychologists

provide test data to the client/patient or other persons identified in the release.

Psychologists may refrain from releasing test data to protect a client/patient or others from substantial

harm or misuse or misrepresentation of the data or the test, recognizing that in many

instances release of confidential information under these circumstances is regulated by law. (See

also Standard 9.11, Maintaining Test Security.)

Definition of Test Data

In Standard 9.04a, the term test data refers to the client’s/patient’s actual

responses to test items, the raw or scaled scores such responses receive, and a psychologist’s

written notes or recordings of the client’s/patient’s specific responses or

behaviors during the testing. The term notes in this standard is limited to the assessment

context and does not include psychotherapy (or process) notes documenting

or analyzing the contents of conversation during a private counseling session.

Test Data and Test Materials

Recognizing that availability of test questions and scoring criteria may compromise

the validity of a test for future use with a client/patient or other individuals

exposed to the information, Standard 9.04a distinguishes test data, which under

most circumstances must be provided upon a client/patient release, from test materials,

which under most circumstances should not (see Standard 9.11, Maintaining

Test Security). The definition of test data does not include test manuals, protocols

for administering or scoring responses, or test items unless these materials include

the client’s/patient’s responses or scores or the psychologist’s contemporaneous

notes on the client’s/patient’s testing responses or behaviors. If testing protocols

allow, it is good practice for psychologists to record client/patient responses on a

form separated from the test items themselves to ensure that upon client/patient

request, only the test data and not the test material itself need be released.

The Affirmative Duty to Provide Test Data

to Clients/Patients and Others Identified

in a Client’s/Patient’s Release

Release to Clients/Patients

Under Standard 9.04a, psychologists have an affirmative duty to provide test data

as defined above to the client/patient or other persons identified in a client/patient

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Chapter 12 Standards on Assessment——285

release. The obligation set forth by Standard 9.04a to respect clients’/patients’ right

to their test data is consistent with legal trends toward greater patient autonomy and

the self-determination rights of clients/patients as set forth in Principle E: Respect

for People’s Rights and Dignity. Although not explicitly stated in the standard, it is

always good practice for psychologists to have a signed release or authorization from

the client/patient even if the data are to be given directly to the client/patient. This

standard does not preclude psychologists from discussing with a client/patient the

potential for misuse of the information by individuals unqualified to interpret it.

Release to Others

A fundamental tension exists between the desire of psychologists to respect

clients’/patients’ right to determine who will have access to their assessment results

and the desire to ensure that the data are not reviewed by unqualified individuals

who might misinterpret or misuse the data or violate contractual agreements

designed to protect a test publisher’s proprietary interests (Principle A: Beneficence

and Nonmaleficence, Principle D: Justice, and Principle E: Respect for People’s

Rights and Dignity). The language of Standard 9.04 reflects this tension by providing

exceptions to the release of test data under conditions in which the release

might lead to substantial harm or misuse of the test.

There are several reasons why the standard supports release of test data to

clients/patients and those whom they authorize to receive the data. First, whether a

person designated by the client/patient is qualified to use test data is determined by

the context of the proposed use. For example, restricting release of test data to

individuals with advanced degrees or licensure in professional psychology would

preclude other qualified health care professionals from using the information.

Broadening but limiting the definition of qualified person to health professionals

might jeopardize appropriate judicial scrutiny of psychological tests and a client’s/

patient’s right to the discovery process to challenge their use in court. Second, even

if a consensus of “qualified” person could be achieved, requiring a psychologist to

confirm the education, training, degrees, or certifications of other professionals

would pose burdens that might not be possible or feasible to meet. Third, as

described below, with few exceptions, HIPAA regulations require that covered entities

provide clients/patients and their personal representatives access to PHI.

Withholding Test Data

Standard 9.04a permits psychologists to withhold test data to protect the client/

patient or another individual from substantial harm. The standard also permits

withholding test data to protect misuse or misrepresentation of the data or the test.

Before refusing to release test data under this clause, psychologists should carefully

consider the proviso in the standard “that such decisions may be regulated by law.”

For example, when refusing a client’s/patient’s request to release test data based on

the psychologist’s judgment that the data will be misused, psychologists should

document in each specific case their rationale for assuming that the data will be

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286——PART II ENFORCEABLE STANDARDS

misused and refrain from behaviors that may be in violation of other standards

(e.g., Standard 6.03, Withholding Records for Nonpayment).

Implications of HIPAA

Requiring psychologists to release test data to the client/patient or others pursuant

to a client/patient release reflects a sea change in the legal landscape from paternalistic

to autonomy-based rules governing access to health records. In particular,

HIPAA establishes the right of access of individuals to inspect and receive copies of

medical and billing records maintained and used by the provider for decisions

about the client/patient (45 CFR 524). This requirement does not include psychotherapy

notes or information compiled in reasonable anticipation of or use in civil,

criminal, or administrative actions or proceedings. In addition, psychologists who

are covered entities under HIPAA must also provide such access to a client’s/

patient’s personal representative (45 CFR 164.502[g][1]).

HIPAA severely limits the ability of covered entities to use professional judgment

to determine the appropriateness of releasing test data to clients/patients and

their personal representatives. For example, the right of clients/patients to obtain

their own test data under HIPAA regulations means in practice that they can pass

it on to other individuals of their choice.

Harm

Under HIPAA, psychologists who are covered entities can deny client/patient

access to test data if it is reasonably likely to endanger the life or physical safety of

the individual or another person or, in some cases, likely to cause equally substantial

harm (Principle A: Beneficence and Nonmaleficence). In addition, psychologists

must allow clients/patients the right to have the denial reviewed by a

designated licensed health care professional. HIPAA regulations thus severely limit

psychologists’ ability to exercise their professional judgment as to what constitutes

substantial harm to clients/patients.

Misuse or Misrepresentation of the Test

Release of “test data” that include client/patient responses recorded on the test

protocol itself can raise issues of copyright protection and fair use by test development

companies (Principle B: Fidelity and Responsibility). If testing protocols

allow, psychologists may wish to record client/patient responses on a form separated

from the test items themselves to comply with contractual agreements with

test developers and to maintain test security (Standard 9.11, Maintaining Test

Security). When test data cannot be separated from test materials that are protected

by copyright law, psychologists’ decision to withhold release of test data

would be consistent with HIPAA regulations and Standard 9.04a. According to

Richard Campanelli, director of the Office for Civil Rights at the U.S. DHHS,

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Chapter 12 Standards on Assessment——287

under Section 1172 (e), withholding PHI would not be in violation of HIPAA if to do

so would violate trade secret laws (http://aspe.hhs.gov/admnsimp/pl104191.htm).

􀀴 To protect against the misuse of test data in possible instances when they would be

released to clients/patients or another identified person, a psychologist used an idiosyncratic

code to record testees’ responses. When a client/patient requested the test

data be released to another licensed practitioner, it was clear that the test data were

undecipherable to others, and the psychologist refused to provide the code. The psychologist

was in violation of Standard 9.04a and HIPAA regulations, because in this

particular case there was no reason to assume misuse of test data. The psychologist’s

failure to appropriately create and store records also violated Standard 6.01,

Documentation of Professional and Scientific Work and Maintenance of Records.

Withholding Data in Anticipation of Its

Use for Legal Purposes

There are instances, however, when HIPAA constraints are not at issue. For example,

HIPAA does not require release of PHI to clients in situations in which information

is compiled in reasonable anticipation of, or for use in, civil, criminal, or

administrative actions or proceedings. In other instances, such as certain educational

evaluations, test data may not come under the PHI classification, and thus the HIPAA

Privacy Rule would not apply (see Standard 4.01, Maintaining Confidentiality).

Organizations, Courts, and

Government Agencies

The use of the term client/patient in this standard refers to the individual

testee and not to an organizational client. This standard does not require industrial–

organizational or consulting psychologists to release test data to either an organizational

client or an employee when testing is conducted to evaluate job candidacy or

employee or organization effectiveness and does not assess factors directly related

to medical or mental health conditions or services. Psychologists working in these

contexts would not be required to provide the test data to the employees themselves

under this standard because the organization, not the employee, is the client (see

also Standards 3.07, Third-Party Requests for Services; 3.11, Psychological

Services Delivered To or Through Organizations; and 9.03, Informed Consent in

Assessments). Similarly, forensic psychologists, military psychologists, and others

working under governing legal authority are permitted by the Ethics Code to withhold

release of test data from a testee when the client is an attorney, the court, or

other governing legal authority. Finally, all psychologists are permitted by the Ethics

Code to withhold release of test data when required by law (Standard 1.02, Conflicts

Between Ethics and Law, Regulations, or Other Governing Legal Authority).

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(b) In the absence of a client/patient release, psychologists provide test data only as required by

law or court order.

Standard 9.04b recognizes the clients’/patients’ right to expect that in the

absence of their release or authorization, psychologists will protect the confidentiality

of test data. The standard does permit psychologists to disclose test data without

the consent of the client/patient in response to a court order (including

subpoenas that are court ordered) or in other situations required by law (e.g., an

order from an administrative tribunal). In such instances, psychologists are wise to

seek legal counsel to determine their legal responsibility to respond to the request

(see also Standard 4.05b, Disclosures). Psychologists may also ask the court or other

legal authority for a protective order to prevent the inappropriate disclosure of

confidential information or suggest that the information be submitted to another

psychologist for qualified review (see also Standard 1.02, Conflicts Between Ethics

and Law, Regulations, and Other Governing Legal Authority).

Implications of HIPAA

Standard 9.04b provides stricter protection of confidential test data than HIPAA.

Under the HIPAA Privacy Rule, PHI may be disclosed in response to a subpoena,

discovery request, or other lawful process that is not accompanied by an order of a

court or administrative tribunal, if the covered entity receives satisfactory assurance

from the party seeking the information either that reasonable efforts have been

made to ensure that the client/patient has been notified of the request or reasonable

efforts have been made to secure a qualified protective order (45 CFR 164.512[e][1]).

Psychologists who disclosed information in such an instance would be in violation

of 9.04b. The greater protection provided by 9.04b is consistent with most states’

more stringent psychotherapist–patient privilege communication statutes.

9.05 Test Construction

Psychologists who develop tests and other assessment techniques use appropriate psychometric

procedures and current scientific or professional knowledge for test design, standardization, validation,

reduction or elimination of bias, and recommendations for use.

Test development is the foundation of good psychological assessment.

Psychologists who construct assessment techniques must be familiar with and

apply psychometric methods for establishing the validity and reliability of tests,

developing standardized administration instructions, selecting items that reduce or

eliminate bias, and drawing on current scientific or professional knowledge for

recommendations about the use of test results (see also Standard 2.01, Boundaries

of Competence; Turchik, Karpenko, Hammers, & McNamara, 2007).

Standard 9.05 applies to all test development activities, not just those implemented

in professional testing services or research settings. Psychologists who

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Chapter 12 Standards on Assessment——289

develop tests or other assessment techniques to serve private practice clients/

patients, organizational clients, or the courts can violate this standard if they fail to

use proper psychometric methods for test construction.

Psychometric Procedures

To be in compliance with Standard 9.05, psychologists must be familiar with and

competent to implement appropriate psychometric procedures to establish the

usefulness of the test (Standard 2.01, Boundaries of Competence). A good resource

for complying with this standard in the Ethics Code is the Standards for Educational

and Psychological Testing (AERA, APA, & NCME, 1999). The following are brief

definitions of psychometric procedures presented in greater detail by the AERA,

APA, and NCME (1999).

Validity, Reliability, and Standardization

Validity is the degree to which theory and empirical evidence support specific

interpretations of test scores. Methods for establishing test validity include content,

concurrent, construct, and predictive validity as well as evidence-based

response processes, internal structure of a test, and consequences of testing.

Reliability is the degree to which test scores for a group of test takers are consistent

over repeated administrations of a test or for items within a test. Methods for

establishing test reliability include internal consistency coefficients, analysis of the

standard error of measure, test–retest, split-half, or alternative form comparisons.

Standardization refers to the establishment of scoring norms based on the test

performance of a representative sample of individuals from populations for which

the test is intended.

Validity and reliability must be assessed appropriately for each total score, subscore,

or combination of scores that will be interpreted. Where relevant, descriptions

of the test to users, school personnel, organizational clients, and the courts

should include a description of the psychometric procedures used during test

development.

􀀴 An industrial–organizational psychologist was hired by a firm to develop a selection

system for promotion of line workers to supervisors. The psychologists used appropriate

sampling and validation procedures to construct a 20-item measure. When he

presented the final measure to the firm’s board of trustees, the board president

expressed concern that items on attitudes toward the firm were not included. The

psychologist agreed to add a few of these to the test without further validation (see

Lowman, 2006, Case 3).

􀀴 Over the years, a school psychologist had observed that students who had been

removed from their homes because of child abuse or neglect frequently gave a set of

common and unique narrative responses to items on the Wechsler Intelligence Scale

for Children Comprehension subtest (WISC; Wechsler, 1991). Cognizant of school

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Recommendations for Use

In their recommendations for use, test developers must provide adequate guidance

to allow users to administer tests in a standardized fashion and score and interpret

responses according to established criteria. Psychologists who develop tests or

assessment techniques must provide explanations of the meaning and intended

interpretation of reported scores by users, school personnel, organizational clients,

the courts, and others as appropriate. For example, a test manual might explain how

score interpretation can be facilitated through norm- or criterion-referenced scoring,

scaling, or cut scores.

Reduction or Elimination of Test Bias

Test bias may refer to systematic errors in test scoring. The term is associated

more frequently with test fairness and refers to assessment norms applied to persons

from different populations that fail to establish measurement equivalence: The

degree to which reliability and validity coefficients associated with a measure are

similar across populations. Depending on the purpose and nature of testing, failure

to determine item, functional, scalar, or predictive measurement equivalence when

developing a test can lead to over- or underdiagnosis, faulty personnel recommendations,

inappropriate educational placements, and misinformation to the courts

(AERA, APA, & NCME, 1999; Knight & Hill, 1998).

􀀴 An industrial–organizational psychologist developed a prescreening employment test

for a large personnel department. After demonstrating high levels of interitem and

test–retest reliability, the scale was touted as a culture-free measure of employment

preparedness. However, the psychologist did not examine whether the factor structure,

predictive validity of the test for job performance, or other psychometric factors

were equivalent across the members of major ethnic/cultural groups in the city who

applied for positions in the company.

psychologists’ legal duty to report suspected child abuse, she constructed a test

composed of 10 narrative statements that she believed were typical of abused and

neglected children. She developed a scoring system where 0 to 1 indicated that the

child was probably not abused or neglected, 2 to 3 suggested that the child should

be further observed, and 4 to 10 supported a suspicion of child abuse or neglect that

should be reported to child protective services. She began to use the scale to decide

whether to make a report of child abuse. When she became district supervisor of

psychological and social services, she required all school psychologists and social

workers to administer the scale to children with whom they worked despite the lack

of evidence of its reliability or validity.

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Chapter 12 Standards on Assessment——291

􀀴 A psychologist working for a test company was responsible for developing a test for

premorbid speech and language predictors of childhood-onset schizophrenia. Child

inpatients who had already been diagnosed with schizophrenia were the only population

available for test development. The test yielded good test–retest reliability and

was validated on correlations with practitioner diagnoses of childhood schizophrenia.

In writing the test manual, the psychologist described the test as useful for identifying

children at risk for the disorder. The manual did not indicate that test norms were

applicable only to inpatients who had already manifested the disorder.

Psychologists’ validity reports should accurately reflect the soundness of the test

validation research supporting the use of an assessment procedure. Psychologists

should include in their reports limitations of methodological or statistical weaknesses

that would limit the usefulness of the test.

􀀴 A psychologist was hired by a company to develop a work climate questionnaire to

help in their restructuring plans. In her lengthy validity report to the company, the

psychologist buried information that indicated problems with sample representativeness

and low validity coefficients and failed to include this information in the executive

summary (see Lowman, 2006, Case 8; Principle C: Integrity).

Test Revisions

Once tests have been developed, test developers are responsible for monitoring

conditions that might warrant test revision, modifications in recommendations for

test interpretation, or limitations or withdrawal of test use. According to the

Standards for Educational and Psychological Testing, tests “should be amended or

revised when new research data, significant changes in the domain represented, or

newly recommended conditions of test use may lower the validity of test score

interpretations” (AERA, APA, & NCME, 1999, Standard 3.25, p. 48). The scope of

test revision will depend on the conditions warranting change and may include

revisions in test stimuli, administration procedures, scales or units of measure,

norms or psychometric features, or applications (Butcher, 2000). Bersoff, DeMatteo,

and Foster (2012) emphasize psychologists’ responsibility to keep up-to-date on

society-wide improvements or shifts in test performance known as the Flynn effect

(Flynn, 1984).

􀀴 A test company sold a popular test to help determine cognitive decline in newly

admitted nursing home patients. The test had been used for more than 15 years.

During the past 5 years, the psychologist directing the geropsychological test

department of the company had been getting complaints that patients were being

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292——PART II ENFORCEABLE STANDARDS

9.06 Interpreting Assessment Results

When interpreting assessment results, including automated interpretations, psychologists take

into account the purpose of the assessment as well as the various test factors, test-taking abilities,

and other characteristics of the person being assessed, such as situational, personal, linguistic,

and cultural differences, that might affect psychologists’ judgments or reduce the accuracy of

their interpretations. They indicate any significant limitations of their interpretations. (See also

Standards 2.01b and c, Boundaries of Competence, and 3.01, Unfair Discrimination.)

Accurate interpretations of assessment results are critical to ensure that appropriate

decisions are made regarding an individual’s diagnosis, treatment plan, legal

status, educational placement, or employment and promotion opportunities. It is

ethically imperative that when providing interpretations, psychologists take into

account the purpose of the test and testee characteristics and indicate any significant

limitations of their interpretations.

The Purpose of the Test

As required by Standard 9.06, the purpose of the assessment must be considered

carefully in the interpretation of test scores. At the same time, psychologists must

also resist allowing test interpretations to be biased by pressures from school personnel,

parents, employers, attorneys, managed care companies, or others with a

vested interest in a particular interpretation (AERA, APA, & NCME, 1999).

When offering recommendations, drawing conclusions, or making predictions

from test scores, psychologists should refer to test manuals prepared by the test developer

as well as relevant research to understand the extent to which tests, in isolation

or within the context of other tests, are directly related to the purpose of testing.

underdiagnosed. The psychologist reasoned that the test norms established 15 years

ago might not be applicable to a better-educated cohort of elderly persons.

However, the company’s current 5-year plan focused on the development of new

depression inventories and had no budget for revisions of current tests. The psychologists

decided not to rock the boat and to wait for the next 5-year plan to

recommend a revision of the test (see also Standard 1.03, Conflicts Between Ethics

and Organizational Demands).

􀀴 A neuropsychologist was hired by an insurance claims company to evaluate whether

an individual insured by the company had sustained neurological damage following a

car accident or whether the individual was feigning symptoms. Following administration

of a battery of tests, the psychologist determined that the individual’s test scores

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Chapter 12 Standards on Assessment——293

Test Factors and Examinee Characteristics

With the exception of perhaps some employment-related screenings, interpretations

should never be based solely on test scores. Standard 9.06 requires psychologists

to consider factors associated with the testing context, the examinee’s test-taking abilities,

and other characteristics that may affect or inappropriately bias interpretations.

When relevant, psychologists should take into account observations of test-taking

styles, fatigue, perceptual and motor impairments, illness, limited fluency in the language

of the test, or lack of cultural familiarity with test items that would introduce

construct-irrelevant variability into a test score (AERA, APA, & NCME, 1999).

In addition to familiarity with the test itself, psychologists should have the specialized

knowledge necessary to formulate professional judgments about the meaning

of test scores as they relate to the individual examinee (see Standard 2.01b and c,

Boundaries of Competence).

Test takers’ scores should not be interpreted in isolation of other information

about the characteristics of the person being assessed. Such information may be

gained from interviews, additional testing, or collateral information from teachers,

employers, supervisors, parents, or school or employment records. Such information

may lead to alternative explanations for examinees’ test performance.

were at the lower boundaries of normal functioning. Although the psychologist made

no effort to obtain information regarding the patient’s neurological functioning before

the accident, he concluded in his report that there was no evidence to support an

injury claim.

􀀴 A psychologist conducting employment assessment for law enforcement personnel

interpreted candidates’ scores using norms from a broad range of reference groups

rather than police normative data (Gallo & Haglin, 2011).

􀀴 An inpatient at a psychiatric hospital had a Monday appointment with a psychologist

to help determine whether he was well enough to go home for the weekend. When

he arrived for the appointment, he was obviously distressed and told the psychologist

that the patient he shared his room with had threatened to kill him. The psychologist

confirmed this story with one of the orderlies. Rather than reschedule the appointment,

the psychologist decided to conduct the required standardized assessment and

clinical interview. In his report, the psychologist noted that the patient had high scores

on the Minnesota Multiphasic Personality Inventory (MMPI; Butcher, Dahlstrom,

Graham, Tellegen, & Kaemmer, 2002) indicating paranoid tendencies and high levels

of stress that might be interpreted as a lack of readiness to go home. The psychologist’s

report did not address how the events surrounding the roommate’s threats

might have influenced MMPI scores and responses to interview questions.

􀀵 An industrial–organizational psychologist was responsible for administering and

interpreting standardized group tests for employee promotion. During one testing

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294——PART II ENFORCEABLE STANDARDS

Limitations

Under Standard 9.06, psychologists must indicate any significant limitations of

their interpretations. In general, interpretive remarks that are not supported by

validity and reliability information should be presented as hypotheses. When test

batteries are used, interpretations of patterns of relationships among different test

scores should be based on identifiable evidence. If none are available, this must be

stated in the report. Interpretations of test results often include recommendations

for placement, treatment, employment, or legal status based on validity evidence

and professional experience. Psychologists should refrain from implying that

empirical relationships exist between test results and recommendations when they

do not, as well as distinguish between recommendations based on empirical evidence

and those based on professional judgment.

Automated Interpretations

Computer-generated interpretations are based on accumulated empirical data

and expert judgment but cannot take into account the special characteristics of the

examinee (AERA, APA, & NCME, 1999). Psychologists should use interpretations

provided by automated and other types of services with caution and indicate their

relevant limitations.

9.07 Assessment by Unqualified Persons

Psychologists do not promote the use of psychological assessment techniques by unqualified

persons, except when such use is conducted for training purposes with appropriate supervision.

(See also Standard 2.05, Delegation of Work to Others.)

Psychologists’ professional and scientific responsibilities to society and those with

whom they work (Principle B: Fidelity and Responsibility) include helping ensure that

the administration, scoring, interpretation, and use of psychological tests are conducted

only by those who are competent to do so by virtue of their education, training, or experience.

Standard 9.07 prohibits psychologists from promoting the use of psychological

assessment techniques by unqualified persons. For example, psychologists should not

employ persons who have not received formal graduate-level training in psychological

assessments to administer, score, or interpret psychological tests that will be used to

determine an individual’s educational placement, psychological characteristics for

session, two employees got into a shouting match that threatened but did not become

a physical fight. In his reporting of the test results to managers, the psychologist

mentioned there was a disturbance that could have had a significant detrimental

effect on testees’ performance and recommended that those who requested should

be permitted to retake the tests.

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Chapter 12 Standards on Assessment——295

employment or promotion, competence to stand trial, parenting skills relevant to child

custody, mental health status or diagnosis, or treatment plan.

Psychological Assessments Conducted by Trainees

Standard 9.07 does not prohibit psychologists from supervising trainees in the

administration, scoring, and interpretation of tests. However, (a) the trainees must

be qualified on the basis of their enrollment in a graduate or postdoctoral psychology

program or externship or internship and (b) supervision must be appropriate

to their level of training. For example, psychologists teaching a first-year graduatelevel

personality assessment course that requires students to submit scored protocols

of individuals they have independently assessed must ensure that (a) the course

adequately prepares students for initial testing situations and (b) students inform

persons tested or their legal guardians that the testing is for training purposes only

and not for individual assessment.

When students registered in advanced practica, externships, or internships have

had a sequence of courses in an assessment program, faculty and site supervisors

must nonetheless provide a level of supervision appropriate to the trainees’ previous

education and experience and see that trainees administer, score, and interpret

tests competently (see also Standard 2.05, Delegation of Work to Others).

􀀴 A group practice of consulting psychologists was hired to conduct psychological assessments

of applicants for promotion to management positions in a large national company.

After a month, the managing psychologists realized they had not negotiated a

contractual fee large enough to employ the number of advanced-degree psychologists

required to conduct all of the assessments. To stay within budget, they set up an internship

program for business school seniors and trained them to administer the tests.

􀀵 A psychologist served as an on-site supervisor for externships of third-year school

psychology graduate students in a large school district. All students had taken a series

of advanced courses in educational assessment. In addition to reviewing their transcripts,

during the first weeks of the externship, the psychologist observed each student

administer tests and carefully reviewed and provided feedback on their scoring

and interpretation of the standard battery of tests they were expected to use. She held

weekly supervision meetings with the students and continued to review their reports

throughout the year.

􀀴 Members of a group practice composed of educational, school, and clinical psychologists

specializing in learning disabilities and school-related disorders were finding it

difficult to keep up with the hours required to provide individualized treatment, family

therapy, and psychological assessment. To meet their needs and keep costs down, they

decided to hire and train recent college graduates who had majored in psychology or

education to independently administer some of the assessments.

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296——PART II ENFORCEABLE STANDARDS

9.08 Obsolete Tests and Outdated Test Results

(a) Psychologists do not base their assessment or intervention decisions or recommendations on

data or test results that are outdated for the current purpose.

Standard 9.08a prohibits psychologists from making evaluative, intervention, or

treatment decisions or recommendations based on outdated data or test results,

unless such information is specifically relevant to the diagnostic or placement decision.

The standard applies to psychologists who administer, score, and interpret the

test as well as to psychologists who use test results for intervention decisions or

recommendations. Whether test data or results are outdated for the current purpose

may be determined by whether the test from which scores were derived is itself

obsolete (see Standard 9.08b, below).

Standard 9.08a is addressed to the use of test scores that may have been

derived from currently used tests but are obsolete for the purposes of the evaluation.

Previous scores derived from an up-to-date version of a test may be obsolete

if individuals might be expected to score differently or require a different

test based on (a) the amount of time between the previous administration and

the current need for assessment, (b) maturational and other developmental

changes, (c) educational advancement, (d) job training or employment experiences,

(e) change in health status, (f) new symptomatology, (g) change in work

or family status, or (h) an accident or traumatic experience.

In some instances, it may be appropriate to use outdated test scores as a basis of

comparison with new test results to evaluate the long-term effectiveness of an educational

program or intervention or to help identify cognitive decline or a sudden

change in mental health or adaptive functioning relevant to treatment, placement

in an appropriate educational or health care environment, disability claims, competency

hearings, or custody suits. When outdated data or results are used, psychologists’

reports and recommendations should include explanations for their use

and their limitations (see Standard 9.06, Interpreting Assessment Results).

􀀵 A neuropsychologist was asked to evaluate cognitive and personality factors that might

be responsible for a sudden change in adaptive functioning of an 80-year-old nursing

home resident. The resident had been given a battery of intelligence and personality

tests 5 years previously upon admission to the nursing home. Advances in geropsychology

in the past 5 years had resulted in more developmentally appropriate and sensitive

assessment instruments for this age group. The psychologist conducted a new evaluation

using the more valid instruments. In her summary, she compared the results of the

assessment with the results of the earlier evaluation, accompanied by a discussion of

the limitations of comparing current performance with the older test results.

Psychologists should resist pressures to use obsolete test results from schools,

health care delivery systems, or other agencies or organizations that seek to cut

HMO

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Chapter 12 Standards on Assessment——297

expenses by using outdated test results for employment, promotion, educational

placement, or services (see Standard 1.03, Conflicts Between Ethics and

Organizational Demands).

(b) Psychologists do not base such decisions or recommendations on tests and measures that are

obsolete and not useful for the current purpose.

Test developers often construct new versions of a test to reflect significant

(a) advances in the theoretical constructs underlying the psychological characteristic

assessed; (b) transformations in cultural, educational, linguistic, or societal influences

that challenge the extent to which current test items validly reflect content

domains; or (c) changes in the demographic characteristics of the population to

be tested affecting interpretations that can be drawn from standardized scores.

Standard 9.08b prohibits psychologists from using outdated versions of tests for

assessment or intervention decisions when interpretations drawn from the test are

of questionable validity or otherwise not useful for the purpose of testing.

The expense of purchasing the most up-to-date version of a test is not an ethical

justification for using obsolete tests when the validity of interpretations drawn

from such tests is compromised. Psychologists working with schools, businesses,

government agencies, courts, HMOs, and health care delivery systems that resist

purchasing updated tests because of costs or ease of record keeping should clarify

the nature of the problem, urge organizational reconsideration, and, if such recommendations

are not heeded, strive to the extent feasible to limit harms that will arise

from misapplication of the test results, ensuring that their actions do not justify or

defend violating testees’ human rights (see Standards 1.02, Conflicts Between Ethics

and Law, Regulations, or Other Governing Legal Authority; and 1.03, Conflicts

Between Ethics and Organizational Demands).

The standard does permit psychologists to use obsolete versions of a test when

there is a valid purpose for doing so. In most cases, the purpose will be to compare

past and current test performance. When use of an obsolete test is appropriate to

the purpose of assessment, psychologists should clarify to schools, courts, or others

that will use the test results which version of the test was used, why that version

was selected, and the test norms used to interpret the results.

􀀵 A psychologist asked to evaluate an employee’s claim that an industrial accident was

responsible for a current disabling psychological disorder learned that the employee

had been administered a battery of cognitive and personality tests several years earlier

during preemployment screening. The psychologist decided it would be useful and

appropriate to compare the complainant’s current performance with his performance

on test scores obtained prior to the accident. One of the previous scores was derived

from an older version of a test that had been updated and revised recently. The psychologist

decided to administer the older version of the test to better determine

whether functioning had been affected by the accident. The psychologist’s report

included a rationale for the use of the older version of the test.

HMO

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298——PART II ENFORCEABLE STANDARDS

9.09 Test Scoring and Interpretation Services

(a) Psychologists who offer assessment or scoring services to other professionals accurately

describe the purpose, norms, validity, reliability, and applications of the procedures and any special

qualifications applicable to their use.

Standard 9.09 applies to psychologists who develop or sell computerized,

automated, web-linked, or other test scoring and interpretation services to

other professionals. Psychologists offering these services must provide in

manuals, instructions, brochures, and advertisements accurate statements

about the purpose, basis and method of scoring, validity and reliability of

scores derived from the service, the professional contexts in which the scores

can be applied, and any special user qualifications necessary to competently

use the service.

When test interpretations, in addition to scores, will be provided to users

of the services, psychologists providing the services must document the sources,

theoretical rationale, and psychometric evidence for the validity and reliability

of the particular interpretation method employed. The Standards for Educational

and Psychological Testing recommends that scoring services provide a summary of

the evidence supporting the interpretations that includes the nature, rationale,

and formulas for cutoff scores or configural scoring rules (rules for scoring test

items or subtests that depend on a pattern of responses; AERA, APA, & NCME,

1999). If algorithms or other rules for scoring jeopardize proprietary interests,

copyrights, or other intellectual property rights issues, owners of the intellectual

property are nevertheless responsible for documenting in some way evidence in

support of the validity of score interpretations (AERA, APA, & NCME, 1999;

Bersoff & Hofer, 1991).

Need to Know:

When to Use Obsolete Tests

The Ethics Code does not prescribe a specific time period in which psychologists should

adopt a new version of a test. Such decisions depend on which version is best suited for

an examinee within the context of the specific purpose of testing. Psychologists should

be cautious about adopting a test publisher’s recommendations for when they should

purchase and transition to a revision, since such recommendations do not have legal

standing and test developers have a financial stake in encouraging the purchase of new

versions (Bush, 2010). Bush (2010) recommends that psychologists should be guided by

whether independent research on the new or revised measure supports its use for a

particular purpose or patient population; use of the prior version of the test may be

preferable and may include the rationale for selecting a specific edition in the written

assessment report.

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Chapter 12 Standards on Assessment——299

Descriptions of the application of test scoring and interpretation procedures

must include a discussion of their limitations. For example, computer-generated or

automated systems may not be able to take into account specific features of the

examinee that are relevant to test interpretation such as medical history, gender,

age, ethnicity, employment history, education, or competence in the language of the

test; motor problems that might interfere with test taking; current life stressors; or

special conditions of the testing environment.

(b) Psychologists select scoring and interpretation services (including automated services) on the

basis of evidence of the validity of the program and procedures as well as on other appropriate

considerations. (See also Standard 2.01b and c, Boundaries of Competence.)

Standard 9.09b applies to psychologists who use computerized, automated, weblinked,

or other test scoring and interpretation services developed by other professionals

or test vendors. Psychologists should select only test scoring and

interpretation services that provide evidence of the validity of the program and

procedures for the types of evaluation or treatment decisions that are to be

informed by the assessment and that are appropriate for the individual case under

consideration. Psychologists should not use scoring and interpretation services if

the psychometric information provided by the test scoring or interpretation services

is inadequate or fails to support the applicability of the scoring and interpretation

methods to the goals of the particular assessment.

Implications of HIPAA

When the test data to be scored and interpreted by the service come under the

HIPAA definition of PHI, the Notice of Privacy Practices must list the name of the

service or the psychologist must obtain a valid authorization from the client/patient

to transmit the information to the service (see more detailed discussion on core

requirements for valid HIPAA authorizations under Standard 4.05a, Disclosures).

Psychologists must also ensure that the service receives, stores, transmits, and discloses

client/patient information in a manner that is HIPAA compliant. In most

instances, psychologists will enter into a business associate agreement with the testing

service (45 CFR 160.103 and 164.504[e]). As part of the business associate

contract, the service must provide assurances to the psychologist that information

will be safeguarded appropriately. If a psychologist discovers that the service has

violated HIPAA regulations in some way, the psychologist must correct the error or

terminate the business associate contract.

assessment instruments, whether they score and interpret such tests themselves or use automated

or other services.

Irrespective of whether psychologists use a service or score and interpret test

data themselves, the psychologist is ultimately responsible for the appropriate

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300——PART II ENFORCEABLE STANDARDS

selection, administration, scoring, interpretation, and use of the test. Under

Standard 9.09c, psychologists must acknowledge this responsibility and take

appropriate steps to ensure that tests were properly scored and interpreted.

To be in compliance with Standard 9.09c, psychologists must avoid simplified

interpretations of test scores that can lead to misdiagnosis, inadequate or

iatrogenic treatment plans, or unfair or invalid personnel decisions or that

can mislead the trier of fact in judicial and government hearings (AERA, APA,

& NCME, 1999) and possess the following competencies (Standard 2.01,

Boundaries of Competence):

Sufficient familiarity with scoring and interpretation techniques to adequately

perform these tasks themselves, detect errors in test scores provided

by a service, and critically evaluate canned interpretations.

Training and experience necessary to identify the limitations of test service

interpretations and know when collateral test scores and other relevant information

are necessary to adequately interpret and apply test results. Such

information might include an examinee’s health status, culture, gender, age,

employment history, educational experiences, language competencies, physical

disabilities, symptoms of or empirical evidence to assume comorbid disorders,

current life stressors, and special conditions of the testing environment.

Need to Know: Security and

Interpretation of Online Testing

The use of online preemployment testing is becoming increasingly popular because of the

convenience, lower cost, and expansion of the pool of national and international applicants

that can be screened. Organizational and consulting psychologists utilizing these

systems need to be aware of the serious security risks associated with this new technology.

As detailed by Foster (2010), these tests are often offered without security to enable easy

administration and worldwide reach. This poses a threat to test interpretation since there

is usually no way to authenticate who actually took the test, and test theft and cheating

are easily accomplished.

9.10 Explaining Assessment Results

Regardless of whether the scoring and interpretation are done by psychologists, by employees or

assistants, or by automated or other outside services, psychologists take reasonable steps to

ensure that explanations of results are given to the individual or designated representative unless

the nature of the relationship precludes provision of an explanation of results (such as in some

organizational consulting, preemployment or security screenings, and forensic evaluations), and

this fact has been clearly explained to the person being assessed in advance.

Psychologists who administer, supervise, or otherwise are responsible for test

administration are also responsible for ensuring that the individuals tested, their

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Chapter 12 Standards on Assessment——301

guardians, or personal representative receive an explanation of the assessment results.

The purpose of an explanation is to enable a client/patient to understand the meaning

of a test score or test score interpretation as it relates to its purpose, implications,

and potential consequences. According to the Standards for Educational and

Psychological Testing, an appropriate explanation “should describe in simple language

what the test covers, what scores mean, the precision of the scores, common misinterpretations

of the test scores, and how scores will be used” (AERA, APA, & NCME, 1999,

Standard 5.10, p. 65). Whenever possible and clinically appropriate, psychologists

assessing children and adolescents should provide feedback to the child as well as his

or her guardian; the feedback should be appropriate to the child’s developmental level.

Employees and Trainees

According to Standard 9.10, the responsibility for appropriate test explanation

lies with the psychologist. It takes into account whether he or she personally scored

or interpreted the test, assigned the scoring or interpretation to an employee or

assistant, or used an outside service (Standard 2.05, Delegation of Work to Others).

The standard does not require that psychologists provide the explanation but that

they take reasonable steps to ensure that one is given. The term reasonable steps is

used to acknowledge situations in which the examinee may not wish to or is unable

to meet for an explanation of results or an employee has misinformed the psychologist

about an explanation taking place. If, however, a psychologist is aware that

appropriate staff is unavailable or unable to provide the explanation, the psychologist

should do so personally.

􀀴 A psychologist supervised several interns at an outpatient unit of a veterans hospital.

The interns were responsible for administering a battery of psychological tests to new

patients. Weekly supervision meetings with the interns included discussion of test

selection, administration, scoring, and interpretation. The psychologist paid only cursory

attention to instructing the supervisees on how to explain test results to patients.

The clinic director received several complaints that interns’ explanations of test results

were confusing and distressing to patients (see also Standard 2.05, Delegation of

Work to Others).

Use of Automated Scoring Services

A psychologist who asks a scoring service to send a computerized interpretation

to a client/patient should take reasonable steps to ensure that the computerized

interpretation provides an explanation adequate for conveying test performance

information to examinees. As discussed under Standard 9.09b, psychologists who

are covered entities under HIPAA who use scoring services must include this information

in the Notice of Privacy Practices or obtain a specific client/patient authorization

to use such services and ensure that the service transmits information and

protects client/patient privacy in a HIPAA-compliant manner.

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302——PART II ENFORCEABLE STANDARDS

􀀵 A psychologist decided to use a popular scoring service for some frequently administered

tests after examination of the company’s materials indicated that the scoring

system was reliable and valid. An added benefit of the service was that it would send

test interpretations directly to the client. For the first set of test data the psychologist

sent to the service, she asked the service to send her the test interpretation that is

usually mailed directly to the client. The psychologist reviewed the interpretive materials

and believed that the information was too sparse to adequately inform clients and

might create confusion. She therefore decided to continue using the service for scoring

but did not permit the service to send explanations directly to the client.

Exceptions

Standard 9.10 permits exceptions to this requirement when an explanation of

the results is precluded by the psychologist–examinee relationship, such as instances

when an organization or legal counsel has retained the psychologist’s services or

assessment has been ordered by a judicial referral. For example, it is usually inappropriate

for psychologists to provide an explanation of test results directly to the

examinee when testing is court ordered, when it involves employment testing, or

when it involves eligibility for security clearances for government work. Rather,

reports are released to the court or retaining party and cannot be released to examinees

and their family members, doctors, lawyers, or other representatives without

the permission of the retaining party or the court (Bush et al., 2006; National

Academy of Neuropsychology Policy and Planning Committee, 2003). In such situations,

prior to administering assessments, psychologists are required to inform

examinees that the psychologist will not be providing them with an explanation of

the test results. If legally permissible, the psychologist should provide the reason

why an explanation will not be given (see Standards 3.10c, Informed Consent; 3.11,

Psychological Services Delivered To or Through Organizations; and 9.03, Informed

Consent in Assessments).

9.11 Maintaining Test Security

The term test materials refers to manuals, instruments, protocols, and test questions or stimuli and

does not include test data as defined in Standard 9.04, Release of Test Data. Psychologists make

reasonable efforts to maintain the integrity and security of test materials and other assessment

techniques consistent with law and contractual obligations, and in a manner that permits adherence

to this Ethics Code.

An assumption of test validity is that individuals take the test under prescribed

standardized conditions. For many tests, a critical aspect of standardization is that

testees are equally unfamiliar with the test items. When some testees have access to

test items prior to the administration of the test, the test norms and thus interpretations

based on scaled scores may not be psychometrically defensible. Duplicating

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test materials or making video or audio recordings of an assessment session that

subsequently enters the public domain also threatens the ongoing validity of tests.

Individuals who have had uncontrolled access to test content can manipulate or

coach others to manipulate test results that harm the public by enabling individuals

to malinger or to obtain positions for which they are unqualified. Many tests consist

of a static number of items that are costly to develop, take years to construct, and

are not easily replaced. Thus, release of test materials can compromise the validity

and usefulness of a test and jeopardize the intellectual property rights of test

authors and publishers.

Definition of Test Materials and Test Security

Under Standard 9.11, test materials are manuals, instruments, protocols, and test

questions or stimuli that do not come under the definition of test data, as defined

in Standard 9.04a, Release of Test Data. Under Standard 9.11, psychologists have a

duty to make reasonable efforts to protect the integrity and security of test materials

and other assessment techniques. With few exceptions, test materials that do not

include client/patient responses should never be released to clients/patients or others

unqualified to use the instruments. Unless specifically recommended by the test

developer, self-administered tests should not be given to clients/patients to take

home. Additional security precautions need to be taken for tests administered

through the Internet. Psychologists should consult test developers and, if necessary,

seek legal consultation before distributing copyrighted tests over the Internet

(Bersoff et al., 2012).

This standard does not prohibit psychologists from discussing individual test

items with clients/patients if it assists in explaining test results (Standard 9.10,

Explaining Assessment Results). Psychologists may also send test materials to other

qualified health professionals bound by their ethical guidelines to protect the security

of the instruments, taking appropriate steps not to violate copyright laws.

􀀴 A patient of a psychologist in independent practice was discussing her anxiety about

an upcoming psychological evaluation for a job promotion that required security clearance.

To reduce the patient’s anxiety, the psychologist took out from his files several

of the standardized tests that are usually administered for such purposes and went

over them with the patient.

Laws Governing Release of Records

Implications of HIPAA

As a matter of practice, psychologists should keep test materials separated from

a client’s/patient’s mental health records so the materials do not come under the

HIPAA-defined “designated record set,” which may not be withheld pursuant to

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304——PART II ENFORCEABLE STANDARDS

client/patient release under federal law. Test materials do not have to be included in

the patient’s record if test data, as defined by Standard 9.04, Release of Test Data, are

not recorded on the test material itself. Separated does not necessarily mean that the

test data and test material must be kept in a separate file cabinet, but it does require

that they are separated by a folder or binding unit so they are not confused or commingled

with the test data records. Psychologists should seek legal advice before

making such a determination and be mindful that removing clients’/patients’

responses from the test protocol after they have been recorded on the material can

constitute unlawful alteration of the patient’s record.

Implications of FERPA

School psychologists may also find that laws governing the release of school

records supersede the requirements of Standard 9.11. FERPA establishes the right

of parents to obtain copies of their children’s school records where failure to provide

the copies would effectively prevent a parent or eligible student from exercising

his or her right to inspect and review the education records (20 U.S.C. § 1232G[a]

[1][A]; 34 CFR § 99.11b; www.ed.gov/offices/OM/fpco/ferpa/index.html). Schools

are not required to provide copies of the records unless, because of distance or

other considerations, it is impossible for the parent or student to review the records.

Psychologists working in schools may also release test materials to attorneys or

other nonprofessionals in response to a court order. In these situations, psychologists

can request that the court issue a protective order requiring that test items not

be duplicated or made available to the public as part of the court record and

returned to the psychologist at the end of the proceedings.

Copyright Protection Laws

Release of “test data” that include client/patient responses recorded on the test

protocol itself can raise issues of copyright protection and fair use by test development

companies. If testing protocols allow, psychologists may wish to record client/

patient responses on a form separated from the test items themselves to comply

with contractual agreements with test developers and to maintain test security

(Standard 9.11, Maintaining Test Security).

When test data consisting of PHI cannot be separated from test materials that are

protected by copyright law, psychologists’ decision to withhold the release of test

data would be consistent with HIPAA regulations and Standard 9.04a. According to

Richard Campanelli, director of the Office for Civil Rights at the U.S. DHHS, under

Section 1172 (e), withholding PHI would not be in violation of HIPAA if to do so

would violate trade secret laws (http://aspe.hhs.gov/admnsimp/pl104191.htm).

In school contexts, reproduction of a test without permission may also be a

violation of copyright law, although providing a single copy of a used protocol to

parents under FERPA regulations may fall under the “fair use doctrine” provisions

District v. State of California Department of Education, 2005).

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The increase in use of listservs, social media, and websites authored by psychologists

has also given rise to an increase in threats to test security. Psychologists

need to monitor their online communications to ensure that they do not divulge

sensitive information about the content or interpretation of frequently used psychological

tests (Schultz & Loving, 2012).

HOT TOPIC

The Use of Assessments in Expert Testimony:

Implications of Case Law and the

Federal Rules of Evidence

In 1988, testimony by mental health professionals accepted as experts by the court played a key role in the conviction

of Kelly Michaels on 115 counts of sexual offenses involving 20 nursery school children. The “experts”

claimed that the responses of children to assessment questions fit the profiles of abuse “documented” by Roland

Summit (1983) and Suzanne Sgroi (1982). However, these profiles, drawn from clinical work with sexually abused

children, were largely theoretical and had never been subjected to tests of validity or reliability in or out of a

forensic context (Fisher, 1995). Five years after Ms. Michael’s conviction, the Appellate Division ruled that the data

on which the experts’ testimonies were based were unreliable, invalid, and not probative of sexual abuse and

therefore could not be used as evidence of guilt (State of New Jersey v. Margaret Kelly Michaels, 1993).

The Kelly Michaels case served as a wake-up call for psychologists on the ethical and legal consequences

of providing expert testimony based on assessment instruments and procedures that have not gained general

acceptance within the field and do not have established relevance to the legal question at hand (Faller &

Everson, 2012; Everson & Faller, 2012; Klee & Friedman, 2001; Olafson, 2012; Standards 2.04, Bases for

Scientific and Professional Judgments, and 9.01, Bases for Assessments). This Hot Topic highlights ethical and

legal challenges in selecting forensically valid assessment instruments for expert testimony.

Relevant Case and Federal Law

Mental health professionals are not alone in receiving increased scrutiny of expert opinion in criminal and civil

cases. In recent years, there has been an increase in federal and case law requiring judges to determine evidentiary

admissibility of expert testimony based on the general acceptance of methods and procedures within

the expert’s field (Klee & Friedman, 2001; Sales & Shuman, 2007).

The “General Acceptance” Standard. The “general acceptance” standard for admissibility of expert testimony

was first established by the Supreme Court in Frye v. United States (1923). In Daubert v. Merrell Dow

Pharmaceuticals, Inc. (1993), the standard was expanded to require specific relevance to the legal question at

hand and demonstrated scientific reliability and validity. In General Electric Co. v. Joiner (1997), the Court held

that judges should exclude from evidence expert testimony when the gap between the data (and the methodology

used to substantiate the data) is too great (Grove & Barden, 1999). The “general acceptance” standard

was explicitly extended to practitioners in Kumho Tire Co., Ltd. v. Carmichael (1999).

As of 2004, the Federal Rules of Evidence (70 FED. R. EVID. 702) require judges to permit expert testimony

only if it is derived from reliable principles and methods in the expert’s field and these principles and methods

have been applied reliably to the facts of the case.

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306——PART II ENFORCEABLE STANDARDS

In light of case and federal law, appropriate selection of psychological assessment methods for forensic use

should be determined by the legal question at hand, the psychometric properties of the instruments and procedures,

and admissibility standards established by the court (Bush et al., 2006; Standards 2.01f, Boundaries

of Competence; 9.01a, Bases for Assessments; and 9.02, Use of Assessments).

Challenges of the “General Acceptance” Standard to Selection

and Use of Assessments in Forensic Contexts

The integration of Daubert, Kumho, and Joiner into the courts’ standard for admissibility of expert testimony

has led to ethical and legal debate regarding whether assessments used in clinical settings should be included

in forensic opinions if they have not been validated for application to issues before the court. For example,

Grove and Barden (1999) argue that diagnostic categories derived from the text revision of the DSM, fourth

edition, text revision (DSM-IV-TR; American Psychiatric Association, 2000), while useful in increasing the reliability

of practitioners’ agreement on a patient’s diagnosis, may not be acceptable under the Daubert–Kumho–

Joiner evidentiary criteria because they are derived from a process of consensus among a small group of

professionals that sometimes draws upon available research but does not require scientific data to validate

the existence or etiology of the disorder.

Similar arguments have been made against the use of tests such as the Rorschach Comprehensive System

as data for expert testimony regarding psychopathology, based on the fact, among others, that its validity and

reliability in and outside of forensic settings continue to be the subject of intense scientific debate (Grove,

Barden, Garb, & Lilienfeld, 2002; Ritzler, Erard, & Pettigrew, 2002). Others have challenged whether assessments

for neurological injury claims meet the Daubert–Kumho–Joiner standard for evidentiary admissibility in

the absence of premorbid baselines or empirically established ecological validity of the tests to predict functioning

in everyday life (Stern, 2001).

Kaufman (2011) has identified four recurring challenges to the admissibility of neuropsychological evidence

that include (1) battery selection (fixed vs. flexible), (2) symptom validity measures, (3) causation opinions, and

(4) nonpsychologists exerting neuropsychological opinions.

The Limits of Psychological Assessments for Child Custody Disputes. In recent years, courts have begun

using the ambiguous standard “best interests of the child” as a means of resolving custody decisions (APA,

2010d; Elrod & Spector, 2004). Currently, there are no reliable legal criteria or any validated mental health or

behavioral criteria on which a psychologist can provide an expert opinion on “best interest” (Krauss & Sales,

2000). Forensic psychologists hired to evaluate the mental health of one or more family members can provide

expert opinion on the interpretation of data based on assessment instruments found to be reliable and valid

indicators of children’s or parents’ emotional and cognitive status and their interpersonal interactions with one

another. However, unless there is established scientific evidence that these instruments can reliably determine

whether joint custody or the number of visitations permitted for a noncustodial parent would be in the best

interests of the child, expert opinion that implies a direct empirical link between the data collected to specific

recommendations regarding custody decisions before the court may be inadmissible under the Daubert–

Kumho–Joiner standard and in violation of Standard 9.01a, Bases for Assessments (Ellis, 2012; Otto &

Martindale, 2007).

Forensic Assessment Relevant to Violent or Abusive Crimes. In criminal cases, forensic psychologists are

often called upon to provide expert testimony based on a defendant’s response to assessment instruments

designed to measure inclinations toward violence or psychopathologies associated with abusive or other

criminal behaviors (Nedopil, 2002; Tolman & Rotzien, 2007). Psychometric techniques for evaluating the validity

of such assessment instruments most often depend on probability evidence and comparisons of within- and

between-group responses to determine a test’s reliability and validity. By contrast, the ultimate decision before

the court in such cases is categorical: A defendant is either guilty or innocent. The opinions of psychologists

testifying as expert witnesses must therefore reflect the limitations of the methods in which data were

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Chapter 12 Standards on Assessment——307

obtained (Vitacco, Gonsalvas, Tomony, Smith, & Lishner, 2012). The clinical forensic evaluator can testify as to

the degree to which a defendant’s test scores reach criteria for psychological characteristics associated with

different criminal behaviors but cannot form an opinion as to whether those scores indicate the defendant’s

behavioral guilt or innocence in the legal case at hand (Fisher, 1995; Krauss & Lieberman, 2007).

Ethical and Legal Considerations in the Selection and Use

of Assessment Instruments for Expert Testimony

Psychologists providing expert testimony based on psychological assessments with established relevance to the

legal question at hand assist the courts in making fair determinations by illuminating data on the legal issue.

However, neither justice nor the legal rights of plaintiffs or defendants are well served when psychologists

declaring “expert” status present forensic opinions based on assessment instruments and techniques insufficient

to substantiate their findings (Principle B: Fidelity and Responsibility; Principle D: Justice; Standards 2.04,

Bases for Scientific and Professional Judgments, and 9.01, Bases for Assessments). The following are points that

psychologists should consider when expert testimony will be based on psychological assessment:

Select assessment instruments and procedures with established psychometric validity and reliability for

the legal question at hand (Standards 9.01a, Bases for Assessments, and 9.02a, Use of Assessments).

Ensure that established principles of test interpretation have been applied reliably to the facts of the

case (Standard 9.06, Interpreting Assessment Results).

Prepare testimony that reflects awareness of and meets legal criteria for the admissibility of expert

testimony based on the reliability of the scientific foundation on which an opinion is based and the

established validity and reliability in providing data relevant to the legal question for which their opinion

is sought (Bush et al., 2006; Daubert–Kumho–Joiner; Standards 2.01f, Boundaries of Competence,

and 2.04, Bases for Scientific and Professional Judgments).

Take full responsibility for ensuring testimony is not flawed by the use of unorthodox assessment procedures

and provide the court with reasoning that led from the data to the expert opinion (Grisso, 2003;

Heilbrun, 2001).

Acknowledge limitations in the applicability of the test data to the legal issue (Standard 9.06, Interpreting

Assessment Results).

Avoid omission of relevant data or overemphasis on minor facts to support an opinion (Bush et al., 2006).

Avoid offering testimony beyond the data collected. Remember, “An expert opinion that answers the

ultimate legal question is not an ‘expert’ opinion, but a personal value judgment” (Grisso, 2003, p. 477).

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