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[00:00:00] Dr. Sharp: Hello everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

We are back with International Assessment Series 2 with Michelle Ireland today. Michelle is going to be talking with us all about assessment in South Africa. Let me tell you a little bit about Michelle, and then we will get to our conversation.

Michelle is an early-career South African Educational Psychologist. She’s trained at the University of Cape Town, University of Stellenbosch and University of Pretoria in South Africa. She has specialized in psycho-educational evaluations in kids from kindergarten through the tertiary level education, which we’ll talk about.

She consults with schools who are geographically isolated to assist in [00:01:00] developing inclusion practices within limited resourced environments. Staff development and training and parent education programs are a big part of her work in those remote areas.

So much like last time, we’re going to be talking through the ins and outs of assessment in South Africa, what it looks like from a private practice perspective, health insurance, environmental factors, measures, all sorts of things like that. So if you enjoyed the conversation last time with Debbie Anderson, then I think you will enjoy this one as well.

If you have not rated and subscribed to the podcast, now’s a great time to do that. A very small fraction of our listeners have rated the podcast. So if you have a quick second, that would be amazing if you jump on in iTunes, give it a quick rating and help spread the word and increase the exposure for the [00:02:00] podcast.

All right, let’s get to my conversation with Michelle Ireland.

Hey everybody, welcome back to another episode of The Testing Psychologist podcast. I’m Dr. Jeremy Sharp. Today I am thrilled to be talking with Michelle Ireland who is an educational psychologist in Cape Town, South Africa.

I am excited to be talking with Michelle. This is obviously a part of our International Assessment Series. I’m excited and grateful to have her on to talk about assessment in her part of the world.

Michelle, welcome to the podcast.

Michelle: Thanks very much, Jeremy. It’s good to have a conversation with you.

Dr. Sharp: Yeah. I’ve been looking forward to this for a long time. So [00:03:00] here we are. We’ve had a two folks, now that I think about it, all of the folks on the international assessment series are going to be from the southern hemisphere; very different parts of the world, but you have that in common.

I have to ask right off the bat what the weather is like there right now, because I’m curious about that.

Michelle: It’s pretty freezing. We’ve just started our winter and so it’s pretty cold.

Dr. Sharp: Okay. Fair enough. When you say pretty cold, is that like snow? Is it icing?

Michelle: No, it’s not snow, but we’re African so we don’t handle cold very well. There’s no snow, but it’s cold enough to need two sweaters.

Dr. Sharp: Okay. Fair enough. It sounds like we have that in common right now. We’re supposed to be in summertime, but it was about 35 degrees this morning here, not cool.

[00:04:00] I like to hear about your journey to get where you’re at right now. You said before we started recording that you were born and raised here in South Africa, I’m curious what’s life been like up to this point and how’d you get to where you are?

Michelle: I’m fairly new career, and so I’ve just come off the bat of my long degree process. I’m feeling quite relieved to be out of that washing machine as I experienced it to be. I’m happy to be applying my knowledge and my skills and figuring out how the theoretical components work within my country and my environment. That’s what my day-to-day experiences has been centered around.

Dr. Sharp: Got you. Is this a second career for you or is this your [00:05:00] first career or what?

Michelle: I’m an educational psychologist, so in South Africa, to register as an educational psychologist, you essentially have to do not entirely two degrees but you have to have qualifications in both psychology and education. And so I’m some experience in both as well.

I have done some teaching and worked in a school context, which has been super useful for my current work. So I’m not entirely fresh but fresh to my expertise on this field.

Dr. Sharp: Sure. Do you have any sense what led you to go down this path in the first place? Why educational psychology?

Michelle: For me, educational psychology was just a really beautiful gap filling the gap between education [00:06:00] and psychology. And working in the South African context, you cannot separate education from psychological well-being. It’s a part of the culture.

Lack of psychological well-being is so pervasive that it seriously has very serious impacts on education. It’s been great to be the bridge between those two fields and help support on both ends. I think that’s what’s landed me in this space.

Dr. Sharp: I think that can be said around the world, of course, but to hear you put it that way, it’s very poignant that they’re intertwined so closely.

Michelle: Yeah.

Dr. Sharp: Did you, I’m jumping into personal questions right away so [00:07:00] feel free to ignore this or tell me to a different direction but did you have any experiences growing up with the educational environment that led you to think we need to work more closely with the psychologists or bridge the gap here a little more?

Michelle: I don’t think there were any huge moments for me. It’s definitely a cumulative process. South Africa was just declared the most unequal society in South Africa. I’ve been fortunate enough to not be on the lower end of that discrepancy.

Many of my close friends and my colleagues as I was growing up and working through school were on the opposite end of that trajectory. It was quite enlightening to see that, and that definitely shaped my perceptions of the world which [00:08:00] inevitably shaped my career choices.

Dr. Sharp: Of course, that makes sense. Let’s jump into the educational part. Talk to me about the educational system there. I found at least so far with talking to folks internationally, that the trajectory is very different than the U.S., even going back to elementary, middle or high school. So how do you go down this path to become an educational psychologist in South Africa?

Michelle: South African education system is very different to the American education system. It’s based off of a British curriculum. South Africa is an ex British colony, the same with Australia. So we’ve got a lot in common with Australian and British systems.

[00:09:00] From the very ground up, we don’t even have what you call kindergarten. We have what we call Grade R, which is reception year, and then elementary school. We don’t have middle school. They’re just divided into two. So we call them primary schools, which is your elementary school. And then high school, which is from 8th grade until 12th grade.

When you’re done with elementary and high school, then you move on to tertiary education. For me specifically, that looked like 3 years of undergraduate training which is already specialized, mine was into education and psychology. So it’s a 3-year undergraduate program. You take two majors and [00:10:00] you whittle them down by the time you get to the end of your 3rd year.

For me, I kept the education and the psychology. After that, for me, I decided to go the teacher training route. And so I did what they call postgraduate certificate in education which allowed me to be a teacher. And so I worked in teaching for a little while.

And then in order to go into the psychology field, you do a 1-year honors degree and then a 2-year master’s degree with an additional year of internship and clinical training. And then depending on which specialization you go into, you may have to also do community service before you can register.

Dr. Sharp: Got you. I was trying to track all of that and maybe did not do a good job. What does that end up being [00:11:00] after undergraduate, four years, five years?

Michelle: I had them all up. For me, it was probably about 8 years total.

Dr. Sharp: Okay. Including undergraduate.

Michelle: Including undergraduate.

Dr. Sharp: Got you. Okay. My gosh. I might ask a lot of dumb questions here. Just trying to …

Michelle: Not dumb questions, useful.

Dr. Sharp: Thank you. It sounds like a similar amount of time, my doctoral program was 5 years after undergraduate, but it just is broken up in different ways, it sounds like.

When you say that you went that direction even in undergraduate, is there anything that happened in high school where you had to even choose your [00:12:00] track at that point or do you wait till you get to university to figure that out or how does that work?

Michelle: There are two options for studying psychology in South Africa. And so you can begin your undergraduate degree in what they used to call a BPsych program. It’s mostly been discontinued at the moment, but that would have been an option for me.

There’s two parts to your question. The first one is, can you start off your undergraduate in a very specialized way? The answer is yes, you can. I didn’t. At the high school level, yes, you do need to select subjects that you take but for the most part, that wasn’t really relevant for the psychology degree.

There are certain entrance requirements. You needed to have a baseline of your home language, and you also needed to have a baseline in [00:13:00] mathematics because you’re required to do certain statistical courses within psychology as well.

Dr. Sharp: Of course. I got you. So then once you started to progress through undergraduate, could you have done anything with those degrees in education and psychology if you didn’t do any post-undergraduate training or do you have to go to graduate school or get that postgraduate certificate?

Michelle: Yeah, you can’t do much with a 3-year degree. You probably could get a higher paying job or a higher placement in a company and based on it but not necessarily in your field. You could possibly do like research assistantship and that kind of thing but that would be the closest you would get to psychology or education.

Dr. Sharp: Okay. Got you. Oh, it’s [00:14:00] similar to here, we can’t do much with an undergraduate in psychology.

Michelle: Yeah.

Dr. Sharp: I got you. Did you know from the beginning when you started undergraduate that you wanted to go for more postgraduate training and be a practicing psychologist.

Michelle: No, I didn’t. I figured it out as I went along. For me, I did a specialization. We could pick various modules for psychology. One of my 3rd year specializations was developmental psychology. It was only at that point where it clicked for me that this is something that I really want to do.

It’s quite daunting, especially when you’re at that young age coming fresh off the back of high school that you realize the implications of wanting to go down the route of being a psychologist and how long it takes.

[00:15:00] In South Africa, I’m sure it’s the same in the USA, and in most parts of the world, it’s extremely competitive to get into the postgraduate programs. And so there’s really no guarantee of you getting in even at the honors level.

And so your results have to be extremely high and you have to be very conscious of that’s where you’re heading towards by the end of your degree. Luckily, I realized that before quite the end of my degree but it’s pretty tough to get into the training courses.

Dr. Sharp: I got you

Michelle: To be able to use your expertise and knowledge.

Dr. Sharp: I see. I know here in the U.S. we have what are called professional schools, which tend to admit bigger [00:16:00] incoming classes, and they’re generally more for profit than some other universities. Do you have professional schools in psychology there or are the programs all pretty small and fairly limited?

Michelle: In South Africa, the majority of education is done through state institutions so the universities are all state owned. Majority are funded through their own research initiatives, but they are state owned.

There are some private organizations, which I guess, in some ways would be similar to your professional training programs. We have one college that’s called the South African College of Applied Psychology. They do a lot more practical components.

In South Africa, like I said, to be a [00:17:00] psychologist, you need to have done at least master’s level training, but there is one category which they call a registered psychological counselor, which is an honors degree level. For example, that South African College of Applied Psychology focuses very strongly on that type of category whereas the professional training for psychologists happens more at the government owned training universities.

Dr. Sharp: Got you. Am I remembering right that honors level is that 1-year postgraduate training after undergraduate?

Michelle: Yeah. It’s a flimsy category. The professional opinions on it differ, but in my experience, it’s been a flimsy category that was developed for good reasons [00:18:00] to tackle the huge need that my country has.

It was developed at the time where HIV was ravaging the country and there was a need for both pre and post HIV counseling and pre and post HIV testing counseling as well as adherence counseling. So medication adherence counseling. And so they created this category, which is not very well-defined.

Dr. Sharp: I see. Oh, that’s wild. So it was in response to a national crisis in a way just to certify more counselors. Okay.

Michelle: Yeah.

Dr. Sharp: Got you. You had to go through that year to get to your master’s program. Is that right?

Michelle: Yeah. There are different options for that honors year program. I call myself an educational psychologist [00:19:00] in South Africa. There’s five categories and educational psychologist is one of them.

Some of the categories have specialist honors training. So an educational psychology is one of those. And my honors training was already specialized towards educational psychology before I went into my master’s training.

Dr. Sharp: Got you. Do some of the other categories not require that honors designation?

Michelle: They all require it, but some of them, you can do a general honors in psychology and then your master’s training would be more specialized.

Dr. Sharp: Got you. Okay. So you did your honors year. Then you did your master’s program. Then community something.

Michelle: I didn’t have to do community service because of my registration category. Yeah, [00:20:00] it’s very complicated. I had to do an internship training; professional onsite training at different organizations and institutions like supervised practice and then you write an ethical board exam and then you can register.

Dr. Sharp: Got you. And then that’s it.

Michelle: And that’s it. Then you’re in the big bad world.

Dr. Sharp: Right. Do it. It’s terrifying.

Michelle: Yeah.

Dr. Sharp: Let me ask a few more questions with the education part. You also said that you did this teacher training after undergraduate, right?

Michelle: Yeah.

Dr. Sharp: Does everyone have to do something like that to go to a master’s program in psychology or was that just your choice?

Michelle: No, it’s [00:21:00] specifically for the educational psychology category. I guess, in the U.S. context, the closest category to what I have experienced as majority of U.S. psychologists practice in would be the equivalent of our clinical psychology.

The differentiation is educational psychologists work predominantly with children and learning based factors, whereas clinical psychologists work more with psychopathology but the trajectory is probably closest to the U.S. training system where you do a more broad undergraduate which has psychology in it, then you specialize a little further when you do your honors training.

And then you do your master’s training, which is very specific in clinical psychology and psychopathology. Those are the students who also need to [00:22:00] do community service which is done in our government hospitals.

Dr. Sharp: I see. And with education part with the master’s program or at any point post-undergraduate, are all psychologists trained in assessment or is that something that you have to pick and specialize in or what?

Michelle: All psychologists are trained in assessment measures of some type. Not all of them are trained in everything. For example, only clinical and educational psychologists, sometimes counseling psychologists, are trained in, for example, IQ measures. Educational psychologists are the only ones who are trained in any kind of academic or academic performance-based assessments.

[00:23:00] And then there’s one other category, which is called industrial psychologists. Do you guys also have them?

Dr. Sharp: We have industrial organizational psychologists.

Michelle: Yeah. So that’s what we’ve got. And then they will do training in psychometrics that are purely in the industrial psychology range.

Dr. Sharp: Oh, interesting. Okay. Got you. So if you wanted to, could you have come out and opened a therapy practice where you are just doing counseling or do you have to pick an assessment versus counseling track or what?

Michelle: My program, you’re more funneled towards the population group and not so much towards therapy versus assessment. So for me, my training was in therapy and assessment of children within the educational band whereas a clinical psychologist would be funneled towards a population group that is [00:24:00] exhibiting some kind of psychopathology and so their therapy would be psychopathology oriented as well as their assessment.

Dr. Sharp: I see. Okay. This is great. Thank you for bearing with all these questions. I’m just trying to see how this looks differently. And so what do you do day-to-day now? First of all, when did you finish and get into the real world?

Michelle: I finished 2 years ago. I registered and got done with my ethics exam. I’ve been practicing officially for 2 years.

My day-to-day work initially was predominantly in schools, so I split my time between two schools. The need dictated the majority of my work. At the one school it was 50/50 counseling and family-based practice [00:25:00] with assessment and at the other schools it was purely counseling. And then I’ve slowly moved into private practice where I do psychoeducational assessments.

Dr. Sharp: Okay. So you are in private practice now.

Michelle: I am, yes.

Dr. Sharp: Great. Congratulations on that.

Michelle: Thank you.

Dr. Sharp: Sure. What’s your private practice look like a day-to-day? I know you said you also do some consulting with schools too.

Michelle: Yeah. It was difficult to schedule this interview because my private practice is so unpredictable and my work is so unpredictable. In a good week, I am home-based and I have office space available for 3 days a week where I do face-to-face [00:26:00] interventions and assessments with children and their families.

And then the rest of the time is my favorite report writing and then international consultations with schools and international families.

Dr. Sharp: Tell me what that looks like; the international consultation with schools and families.

Michelle: I work with schools and organizations that are really restricted in terms of their location. They don’t have access to any kinds of services. South Africa is often a hub for many African countries, and so people will come to South Africa to consult with South African therapists.

Our training is really good in South Africa and it’s easy to travel to South Africa from the majority of other countries. I’m an available resource. [00:27:00] I’m available to provide expertise to environments that just don’t have any access to it.

Dr. Sharp: So this could be from all over the continent of Africa.

Michelle: Yeah.

Dr. Sharp: Folks coming from all over. Okay, I got u. Are you consulting on clinical cases or educational policy or what?

Michelle: A bit of everything. Those type of environments, they really don’t have access to any kind of support services. So whatever the school’s need is predominantly where I will put my focus.

Often, it will start off as like, hey, can you give us some advice on this case or could you have some support resources that you can refer us to? And then it will whittle down to policies that are [00:28:00] in place to support the child in their context, and those types of factors. So it really bridges the gap in all areas.

Dr. Sharp: I see. And then in terms of the cases that you see in your private practice from day-to-day, what do those look like? What kind of referral questions do you get? Where do they come from? And so forth.

Michelle: The majority of my cases come from schools and children are identified as having learning difficulties or underperformance at school for the gauntlet of reasons. And so the majority of my assessments are exploratory and making recommendations for intervention and support based on the child’s needs.

Dr. Sharp: I see. You said that a lot of your referrals [00:29:00] come from schools.

Michelle: Yeah.

Dr. Sharp: Is that right? Do the schools do much testing themselves?

Michelle: We’re really under-resourced. I have the freedom to practice as a private practitioner. There’s no restrictions on services that government must provide and services that I may provide. Officially, government services are supposed to cover assessment practices but they very often don’t, or if they do, there’s 2 to 3 year waiting list. If parents have access to it and they can obtain it privately, then they do.

Dr. Sharp: I see. Just making sure I understand, are you saying [00:30:00] that the government funds assessment through the school district? Like school districts should be providing assessment or are there other state-funded assessment practitioners available too, outside the school?

Michelle: No, it’s mostly through the district, so through your own school district.

Dr. Sharp: I got you. So this gets into the health insurance question a little bit. What does that look like in South Africa?

Michelle: I would say that probably I’m overestimating that about 10% of the population has health insurance. Of that 10%, probably about 5% of those health insurance companies will allow psychological testing to be [00:31:00] funded. So there’s very few people that can have access to services based on health insurance.

Very often, the parents that I work with choose not to do their billing for me through their, we call it medical aid here, through their health insurance because it completely depletes any access to other medical services. So they have a medical savings amount which gets dried up completely by one assessment. So the majority of parents pay privately for my assessments.

Dr. Sharp: Got you. You said that only 10% of the population has medical aid. How is the healthcare paid for the other 90%?

[00:32:00] Michelle: It’s state provided.

Dr. Sharp: Just state provided. Okay. This is getting away from assessment just a little bit, but it’s important for the context, does that include everything? Is that preventative visits, checkups, specialists, surgeries? That’s all of it.

Michelle: Yeah.

Dr. Sharp: Got you. This is a complicated question; does it seem to work well?

Michelle: For the 10%, yeah.

Dr. Sharp: For the 10%? Interesting.

Michelle: Generally, if you’re a part of the 10% who has medical aid, you can also afford not to have medical aid. So it’s more of an actual insurance policy of if you need to be hospitalized.

Government access to emergency services and long hospitalizations [00:33:00] is really poor. Morbidity rates are really high. It’s more of an insurance policy to make sure that if something really bad happens to you, you can go into a private hospital.

Access to everyday services; dentists, psychologists, gynecologists, it’s all in one bag. Psychologists, as I’m sure happens in the world around, are very much on the bottom of that pack.

Dr. Sharp: You may have mentioned this earlier, but are there psychologists that work in state-funded settings where someone could go that route, but just with a long wait list?

Michelle: Yes. Depending on the category and depending on the referral reason, yes. We do have psychiatric hospitals [00:34:00] and there are states employed clinical psychologists who work there; clinical psychologists and psychiatrists who are employed there.

There’s a triage system of being able to access those services. So even if you deserve those services, you may not necessarily get them even if you wait for them. It’s the worst cases get access to the services because of a need prioritization.

Dr. Sharp: I see what you mean. Gosh, I’m working through this, do the parents who come see you, do they really have any other option for getting an assessment for their kid? What are the other options for a comprehensive assessment that you might offer?

Michelle: Comprehensive, nothing. The state based assessments are very basic [00:35:00] and like I said, will take between 2 to 3 years, and will be allocated on a needs based. So if you’re on the highest level of need, you will get access to it possibly after 2 to 3 years.

If you have a really good school district and very efficient psychologist in that district, you may be lucky to get an assessment done after a year. So there aren’t options for parents who can’t afford to have their children tested.

Dr. Sharp: I see. Do any psychologists in private practice like yourself “take insurance” or is it all private pay if you’re in private practice for the most part?

Michelle: It depends. There’s probably about 50/50 who will take insurance. How I work is that parents can be reimbursed by their insurance after they have paid my [00:36:00] account.

There are some practitioners who will claim through the medical aid or health insurance so that the client does not have to do any kind of monetary exchange with the professional. I would say probably about 50% of people in private practice would do that.

Dr. Sharp: I see. Okay. Gosh. This health care situation is, it’s always an interesting topic to sort through. I’m curious how people access services, right?

Michelle: Yeah.

Dr. Sharp: Before we totally leave that, being in private practice and being a psychologist, is that a financially viable career for someone there? With [00:37:00] the hierarchy of healthcare professionals, can you charge a rate that affords a decent standard of living?

Michelle: Yeah, I would say so. I would say for the most part. I think it’s like the world over where you need to build up your client base and you need to make sure that you have a fairly reasonable influx of patients.

South Africa is densely populated in some areas and very rural in other areas. And so if you were a psychologist in a rural area, I think it would be exceptionally difficult to make a living wage. I live in a major city and so I am able to access a large client pool and so I feel like I can make decent living.

Dr. Sharp: Yeah. Okay. I’m curious about that. Let’s talk about your actual assessments. You said that a lot of referrals come from schools and it’s a lot of learning issues, [00:38:00] things like that. What kind of measures are you using? Let’s start there.

Michelle: Even in South Africa, that is not a simple question. I personally use predominantly U.S. normed tests like the WISC, the WIAT, BASC, BRIEF, those kinds of tools.

Our local cognitive assessment for children was last normed in 1989 and it was normed on a population of children who were living under apartheid. So I don’t find it especially psychometrically valid and so I don’t like to use it, but it then also comes with a huge complication of using tests that were not normed on the South African population.

Dr. Sharp: How do you work with [00:39:00] that?

Michelle: It’s very difficult. There’s a lot of qualitative interpretation and so statistics are informative rather than used as a decision making tool.

Dr. Sharp: Sorry to interrupt you, I’m really interested in this whole. What does that look like when you administer a WISC, let’s say, when you say there’s a lot of qualitative interpretation? What do you write in the report about that or how do you explain it to parents?

Michelle: That’s an interesting question. For example, the majority of the time I’ll question the validity of the VCI, the Verbal Comprehension Index, because firstly, the majority of children who I work with are not English first language speakers. We have 11 official national [00:40:00] languages and so doing an assessment in a child’s non-native tongue comes with the full gamut of difficulties.

Everywhere around the world that is true. So immediately you’re starting on the back foot with validity questions about mode of instruction and all of those various factors. If your VCI is already compromised before you even begin with anything else, you have to just take the information that you can get.

I do the formal administration and I do a lot of dynamic assessment. For example, in Block Designs, a lot of children become quite overwhelmed by that type of task because they’ve never really experienced something similar to having to [00:41:00] build a model, especially in the resource deprived areas.

I do the full administration of the assessment battery. And then afterwards, I will present the tasks to the child again, and then do some scaffolding techniques of providing two suggestions on how to do and on how to approach problem solving on those tasks, and then evaluate the child’s learning potential in a very qualitative way.

If you’re getting a really low Block Design score but the child is, with very brief suggestions, able to complete all of the designs, then you can see that a child has fair amounts of learning potential rather than a statistical cutoff where a child might fall in a very low range.

Dr. Sharp: Yeah. The VCI makes sense to me that that would [00:42:00] be compromised given the questions, I didn’t even think about visual spatial stuff, but that makes sense.

Michelle: Yeah. When giving instructions and even the word design to a second language learner is really quite a tough vocabulary word so that brings up additional complications.

Dr. Sharp: Sure. So then how does that work with the educational assessment, like with the WIAT and the norms? I’m thinking so much that it’s based on our educational system. I’m guessing, I’m not that person.

Michelle: There’s certain components of the WIAT which are fairly easily generalizable. For example, reading speed, decoding ability, numerical fluency, even numerical operations. Yes, it [00:43:00] is age based, but it’s a fairly broad band, and those concepts are taught at fairly similar ages. I have less difficulty interpreting the WIAT than I do the IQ assessments.

Dr. Sharp: Got you. Oh, that’s interesting.

Michelle: With norms, it is difficult, the comparative analysis is challenging, but you are able to get a very concrete evaluation of what a child knows and what a child does not know and the level that you would be expecting of a child of a certain age band.

Dr. Sharp: Okay. Fair enough. That’s fascinating. Are there any measures that are normed on South African kids in any of the native languages there?

Michelle: There are, but they’re really old and it’s very difficult to find [00:44:00] someone to administer them; to have someone who has that as their own mother tongue or is proficient enough to be able to administer it to a first language child.

There are some, they’re interestingly enough based on the very old Weschler concepts. For example, they will include things like Block Designs and similarities. Those type of subtests are replicated to some extent in those subtests with a lot of cultural references, which are more valid.

Dr. Sharp: Okay. Got you.

Michelle: So for example, on vocabulary, when you ask a child who lives in a country where they frequently travel, what is the definition of a pilot? They will immediately be able to tell you, but if you’re asking a child, what is a coat and they live in very humid hot weather, they will [00:45:00] not know what a coat is because they don’t use coats.

Dr. Sharp: Yeah. Sure.

Michelle: They’re more qualitative valid.

Dr. Sharp: Okay. You said, otherwise, you do the BASC, the BRIEF, for checklists.

Michelle: Yeah.

Dr. Sharp: It’s very similar.

Michelle: Because South Africa is such an unequal society, the children who I work with in private practice are a lot closer to a Western level of standard and so it is easier to interpret those kind of results because the environments that they’re expected to function in are fairly similar to, for example, a U.S. system. And so that does make it a lot easier.

Dr. Sharp: I see what you mean. That’s interesting. I’m just thinking about how you have to be fairly fluid with your [00:46:00] administration and interpretation, working with kids from such different levels of socioeconomic status.

Michelle: Yeah, that’s very much the case.

Dr. Sharp: Sure. What’s your general structure, the battery, for an evaluation? Do you do an interview and then testing on a different day and then report on a different day or how’s that work?

Michelle: That’s interesting that you ask that. If a client is going to claim from their medical insurance, you only are allowed to assess and do interventions or interviews for a certain number of hours per day.

So if a client is going to claim from their medical insurance, then I will do an intake evaluation, interview with parents on one day, and then I will do part of an assessment on one day, usually about 2 [00:47:00] hours, and then the rest of the assessment, however long it takes on the next day. And then usually 2 hours for interpretation on the last day of the testing and then report writing or feedback after the report writing.

Dr. Sharp: I got you. How much time generally passes between seeing the person for the interview and doing feedback?

Michelle: I try not to make it more than 2 weeks.

Dr. Sharp: It’s pretty quick turnaround.

Michelle: Yeah.

Dr. Sharp: Very cool. Would you say, from what you know, are your reports fairly similar to what others of us might write in the U.S. or around the country and around the world?

Michelle: No, I have never seen an equivalent evaluation from the USA. [00:48:00] I have seen one from India, and mine was pretty similar to theirs.

Dr. Sharp: Oh, yeah.

Michelle: I’ve seen one from Australia and New Zealand and mine was pretty similar to theirs. So I’m not entirely sure, but I think that there’s definitely some commonalities.

Dr. Sharp: I would imagine so. Seems like there are pretty similar components.

Michelle: Yeah.

Dr. Sharp: Got you. And then does that typically go back to the school? Then do you interface with the school a good bit or is that left to the parents or what?

Michelle: It depends on the case. A lot of parents will come for an independent opinion if they disagree with their child school’s handling of whatever learning difficulty the child has. So sometimes it will be independent and used to inform parents thinking, but yeah, very often it will be interacting with the school and I’ll give feedback to the [00:49:00] parents and then we’ll usually have a transdisciplinary team meeting at the school and the parents will share the report with the school as well.

Dr. Sharp: Do the school districts have special education services for those kids, then, if you’ve identified them as having a learning disorder or additional concern? Do they provide support?

Michelle: Sometimes, depending on the school. Officially, yes, and so there are supposed to be learning support services allocated but in some cases the demand is much higher than the supply but a lot of schools, if they have additional funding, they will employ learning supports staff independently.

Like I said, the higher brackets of income people that I work with will often have their children at a school that has those kind of services. [00:50:00] So that’s really a blessing for me to work with but huge portion of my job is school training and teacher training so that my report does something and go somewhere and that they can utilize the concepts within the classroom.

Dr. Sharp: Got you. When you say school training or teacher training, what does that look like?

Michelle: Just the basics of how to differentiate, how to support, and even the understanding of the basic concepts of, for example, working memory and processing speed. What does it mean when you get a report where a child has working memory difficulties? And how to apply those recommendations in a practical way.

Dr. Sharp: Oh, I see. Do you like that part of your job?

Michelle: I do.

Dr. Sharp: I think that would be fun. We don’t do a whole lot of [00:51:00] that here, or I don’t, but I’m sure there are other folks here in the U.S. that do more of that. Our school districts are generally on top of things.

Through the evaluation process, are you making diagnoses? And if so, what manual do you use or a standard for that?

Michelle: We were trained in both ICD-10 and DSM-5. I predominantly use DSM-5, just personal preference. I do make diagnoses of specific learning disorder. It’s probably the most common.

We are allowed to diagnose ADHD and certain mood difficulties like the anxiety and OCD type of behaviors specifically only in [00:52:00] children but I infrequently do that because I usually will get a psychiatric consult for that.

Dr. Sharp: Okay. So you, for the most part, stick to learning issues, ADHD.

Michelle: Yeah.

Dr. Sharp: Do you get into brain injury kind of stuff or concussion or genetic medical disorders, things like that or who might handle that kind of evaluation?

Michelle: In South Africa, it usually goes a medical route, so a neurologist but there’s a bit of moving and shaking in the field of neuropsychology and neuropsychiatry. So the five categories that I mentioned of psychologists, neuropsychologists is not one of them, but there is a petition to include that.

There is an organization that has [00:53:00] developed a system of exams and peer-reviewed reports and assessments which gives an extra credential for neuropsychiatric and neuropsychological evaluations. If I were in the field and I had a child or adult who had that type of concern, I would refer probably to someone who had gone through that training process although it’s not officially recognized.

Dr. Sharp: Oh, that’s interesting. Okay.

Michelle: With my current qualifications, I could go through that additional examination process and I could go down that road of that specialization if I wanted to.

Dr. Sharp: I see. So now, at this point, it’s just folks who have gotten extra [00:54:00] random education around neuropsychological assessment or is there anyone who can call themselves a neuropsychologist there?

Is that recognized at all?

Michelle: Legally and officially, no, but in practice, there are people who I would refer to as neuropsychologists.

Dr. Sharp: I see. Okay. So interesting.

Michelle: Complicated.

Dr. Sharp: It’s complicated. On these international interviews, I’m thinking through how I would explain our system as well and it’s complicated.

So you dwell a lot in the DSM, ICD, it’s pretty similar, it sounds like too. I’m trying to think what else feels [00:55:00] important for this conversation here as we’re talking about assessment. Oh, what if a U.S. psychologist wanted to come to South Africa and practice? Is that even a viable option?

Michelle: What do you mean by viable?

Dr. Sharp: Would South Africa recognize our licensure?

Michelle: From my understanding of your licensure, it’s quite varied as well. There’s various training institutions, organizations, levels and specializations. My understanding of the process is that you would submit to our Health Professions Council, your qualifications and training would be evaluated.

An American psychologist would need to write out South African ethical board exams which includes [00:56:00] understanding of relevant legislation specifically about mental health, healthcare, children, justice, those kind of concepts.

They could either immediately be registered after they have gone through the board exam process, or they may have to do a supervised internship program of about 6 months to demonstrate understanding of the South African context.

Dr. Sharp: I see. Do you know any U.S. psychologist who have come over there to start practicing?

Michelle: I know of one U.S. psychologist, but he works for the U.S. State Department and so he does not work with South African clients. I guess, he practices based on his U.S. licensure with U.S. patients.

I don’t know of any [00:57:00] any American psychologist. There are two British psychologists around and they would have gone through similar process.

Dr. Sharp: Yeah. That’s all right. I always ask because I think, for better, for worse, that’s a fantasy of some psychologists here and many people, honestly to move to a different country and be able to work, just have a new life in a way. I’m very curious what that might look like and if it’s even possible.

Michelle: I think it is possible and there might be some hoops that you need to jump through and depending on how motivated you are, it is feasible.

Dr. Sharp: Got you. Okay. Very cool. What have I not asked about? What else feels important about practicing over there that we have not touched on or might need to talk more about before our time runs out?

[00:58:00] Michelle: The one benefit of having grown up in South Africa and having done my training here is that it comes with a really implicit knowledge of the context. So for us, apartheid is really entrenched in our society and in our systems. You take it for granted when you’ve grown up in a system like this.

There were some American students who studied with me in my undergraduate years and if we needed to talk about local issues or even just the application of the theory within a context, not having that understanding was really difficult for people outside of South Africa to really grasp. I feel [00:59:00] really privileged in being able to understand it from a measure of an insider’s view.

I think that’s one of the major factors in it and it influences everything in terms of psychological services, access to services, perceptions of organizations and government institutions, it all becomes closely tied together.

Dr. Sharp: Sure. I’m glad that you are bringing this up because I had that in the back of my mind, but admittedly, I just said, I’m not sure what to ask because I don’t want to sound dumb but knowing that this is a huge deal in political history, I am curious [01:00:00] for a lot of folks out there may be like, can you talk more about that?

When you say apartheid, some people might not know what that is. And then how that does influence things in specific ways and especially for your field and for being a psychologist there. I know that’s a huge question so I’ll just acknowledge that.

Michelle: It is. I’ll touch on what I think is most relevant or what I found to be most relevant. Just as a brief understanding; apartheid was a system of institutionalized and legalized racism where there were absolutely horrific and appalling laws that differentiated people based on race.

In South Africa, there are three main race categories. It becomes quite crass talking about these, but it is a reality in South Africa where [01:01:00] the categories are black, which is a fairly dark skinned person; white, which is a person who is Caucasian and then we have a category that they call colored, which is not the same as the American understanding of colored. It is also not a mixed race person, but it is a person of moderately dark skin.

So you can see how barbaric these concepts were within a South African context but people were differentiated based on those various categories. It was almost as stupid and basic as the darker your skin, the worse the treatment you got was.

There was also a lot of political violence and general [01:02:00] severe poverty and isolation of specific race groups which has not been infrastructurally or however you would say that; in terms of infrastructure, it has not been rectified. It’s also created very specific class divides, which I think are present all over the world, but class is very closely related to race in South Africa.

The most important aspect of all of that in my field is the compounded intergenerational trauma. South Africa also had institutionalized discrimination in terms of education, where black people were specifically given subpar education so that they were completely disenfranchised. And so the parents of a lot of the kids that I work with [01:03:00] are now children of parents who are predominantly illiterate, so that becomes really complex and compounds the kind of economical cycle.

Dr. Sharp: Of course. I might highlight too, that this is a relatively recent period in your history, we’re not talking like 100 years ago, this is …

Michelle: We were liberated in 1994.

Dr. Sharp: Yeah. My gosh. There have been threads of this throughout our conversation I think when you’re talking about working with kids from different areas; underserved areas and very rural areas and so forth.

Again, this is maybe a hard question, so feel free to ignore it or whatever you want to do appropriately, but how does that show [01:04:00] up specifically in an assessment? How might you handle that or address it or do you address it? That’s a very open ended question.

Michelle: The first thought that came to mind is very early on in the assessment process, it makes things extremely difficult if you have parents who it’s difficult to get basic historical information from them. Also, there’s been a lot of migrants work processes happening in South Africa, where children are very often not with their parents until they’re about 6 or 7 years old.

They generally stay with grandparents in rural areas and then parents will bring them into the city to be educated from when they start school. [01:05:00] So very often, the parents don’t know their children very well. Just doing a basic intake interview can be exceptionally challenging. You can’t ask about developmental milestones and those type of factors makes it really difficult.

The migrant worker process also has huge trauma on a child. And so you’re just trying to unpick and unpack; what is trauma? What is learning difficulty? What is language factor? What is environmental deprivation? It’s so complex. There’s so many extraneous variable that you’re peddling always.

I don’t know if I answered your question there probably in a really roundabout way.

Dr. Sharp: No, I think you nailed it. That was the piece that I was [01:06:00] really curious about is just how do you even start to separate some of these generational experiences and that trauma, like you said, from some just basic learning issues or attention issues or mood when that’s such a part of the fabric of the culture there?

Michelle: There’s also a huge rejection of Western concepts such as psychology and learning diagnoses are very Western concepts. And so for the local population, that can sometimes be conflated with the machine which in South Africa comes with a huge value judgment associated with previous legislature and government systems.

So it’s almost like hospitals are, they’re designed; their architecture, [00:07:00] everything is associated with apartheid. Visibly, they look like apartheid. When you drive past the hospital, you see what apartheid looked like.

And so having a parent coming into that environment can be extremely traumatic but then also acceptance of an engagement with any kind of concepts that come from those kind of organizations or institutions is really hard.

Dr. Sharp: Of course. I think about, in a trauma context, just triggers and if there are these visual triggers all over the place, those does not go away.

Michelle: No.

Dr. Sharp: Gosh, I know we have just touched on this very briefly and there’s so much more that you could say about it, but I appreciate you even being willing to dive into it for a few minutes. It’s clear that that’s such an important [01:08:00] part, just historically, of what you’re doing there.

Michelle: Yeah.

Dr. Sharp: Being mindful of that. I do have one last question with that. Was that addressed in your training at all, in your master’s program?

Michelle: Yeah.

Dr. Sharp: It was.

Michelle: Very strongly. It’s a constant factor and it’s addressed in almost every single professional development program but regardless of how much it is addressed, you never feel fully equipped to deal with it.

Dr. Sharp: Sure. I get that. I’ve really valued everything that you have said here, and this has been a great conversation. I’m still struck by the similarities here between our practices.

When I went into this series, I have [01:09:00] still got two more folks to interview, but so far, I thought it was going to be very different and it’s actually much more similar than I was anticipating in the interviews I’ve done so far.

Michelle: Yeah.

Dr. Sharp: Do you ever come to the U.S. for training or anything like that or is that pretty self-contained in South Africa?

Michelle: I have one trip planned probably in about a year’s time when funding has accumulated. Yeah, there’s great training in the USA, which isn’t always available in South Africa. So I’m looking forward to that. That will be in 2 years’ time. I have visited on vacation, but nothing professional as of yet.

Dr. Sharp: Got you. I didn’t mean to imply that all the good training is here by any means, but I was curious where you might go for continuing education; is that Britain or is it there or Australia or [01:10:00] where’s that?

Michelle: It depends on your area of interest or expertise. There are some local ones but if you’re really specialized or if you’re wanting to look at very specific things, for example, something simple like the ADOS, we don’t have ADOS training, so if I wanted ADOS training, I would go to the USA or the UK.

Dr. Sharp: Got you. Thank you. If anybody wanted to get in touch with you to ask questions of any sort, what’s the best way to find you?

Michelle: Probably email.

Dr. Sharp: Okay, great. I can get that from you. I can put that in the show notes.

Michelle: Sure.

Dr. Sharp: If anyone wants to get in touch, just shoot you a message. Do you have a website or anything?

Michelle: I do. It’s out of date. I do have a website. I also use Skype a lot or equivalents, Zoom, et cetera. [01:11:00] I’m happy to have conversations with interested people.

Dr. Sharp: Okay. All that will be in the show notes if anybody wants to get in touch with Michelle. Thank you very much. Like we talked about before, this is your dinner time and maybe getting into bed time, so I’m going to let you go and get on with your evening, but thank you so much. It was great to talk to you, Michelle.

Michelle: Okay, sure. Thank you so much for having me.

Dr. Sharp: All right, y’all. Thanks so much for listening to that episode with Michelle Ireland. I continue to be intrigued and fascinated by this idea of international assessment. If you’ve enjoyed these past two conversations, I think you will definitely enjoy my conversation next Monday with Dr. Joseph Graybill talking all about assessment at an international school in Moscow, Russia. So stay tuned for that.

If you have not subscribed to the podcast, now’s a great time to do that. We’re pushing out a lot of cool content, clinical episodes on [01:12:00] Monday; business episodes on Thursdays, and it’s been exciting to increase the content and see the response from everyone.

If you have a quick minute and are willing to do me a big favor, I’d love for you to rate the podcast in iTunes, it’s pretty easy if you just go on your phone and give it a quick tap, that helps increase the exposure of the podcast. Thank you to all of you who have jumped in and given ratings over the past few weeks. It’s been super helpful and much appreciated.

All right, take care. We’ll talk to you on Thursday.

The information contained in this podcast and on The Testing Psychologist website are [01:13:00] intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric or medical advice, diagnosis or treatment.

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