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Hello, everyone. What’s going on? Welcome back [00:01:00] to The Testing Psychologist. We have another business episode for you today. No, no, no, no. What am I talking about? It’s a clinical episode. Oh, my gosh. Clinical episode for you today.
We are talking about one of the most exciting and rapidly evolving areas of testing. That is Virtual Reality and Holistic or Ecologically Valid Assessment. Traditional assessment methods are incredibly valuable, but they often have limitations.
There are all these questions about how well these standardized tests translate to real-world functioning. Are we truly capturing the full picture of a client’s needs? What if we could combine some of these VR techniques and a comprehensive holistic approach to bridge those gaps?
So that’s exactly what we’re exploring today. If you’ve ever wondered how technology and psychology can merge to create a more accurate, immersive, and personalized assessment process, this episode is for you.
If you would like some support with [00:02:00] building your practice, scaling your practice, hiring in your practice, systemism in your practice, really anything related to your testing practice, I would love to work with you with a strategy session.
So strategy session is an hour where we will dive in and get through as many questions as we can. I’ll try to give you some solutions and some ideas that you can walk away with. They’re pretty action-oriented without having to commit to a full consulting package. You can go to thetestingpsychologist.com/consulting and book your strategy session right there.
And while you are considering that, we will jump to our episode on VR and Holistic Assessment.
All right, people, let’s get right into it. As always, I’m going to start with [00:03:00] the idea of VR in psychological assessment. Many of you have probably heard of the Nesplora. The Nesplora is one of the best examples of using VR or virtual reality in the assessment process.
VR essentially allows clinicians to put clients in the real world interactive simulations rather than relying solely on self-report measures or traditional testing environment. So instead of asking a client how they feel in social situations, we could theoretically place them in a virtual party setting and measure their reactions in real time.
In the case of the Nesplora, which I’ll talk about a little bit more in just a bit, it places kids or adults in a real world environment and then introduces a number of distractions to see how they react to those distractions.
So what does the research say about VR and assessment? Studies have shown that VR- [00:04:00] based assessments provide higher ecological validity, which means that they more closely resemble real-life experiences compared to traditional testing methods.
For example, a 2022 study published in Frontiers in Psychiatry found that VR-based cognitive and emotional assessment correlated strongly with real world behavioral outcomes, which tells me that there’s a lot of potential there.
In the case of the Nesplora, like I said, it’s geared toward assessing executive functioning and specifically, ADHD in kids and adults. It’s probably one of the best real-world applications of VR in assessment right now.
It’s a test that doesn’t rely solely on parent or teacher reports at all. Clinicians can immerse kids or adults, but let’s stick with kids, can immerse kids in a [00:05:00] simulated classroom environment where it will track shifting of attention, impulsivity, and response time in a way that mirrors a real school experience.
There’s always going to be gaps there in virtual, at least at this point, virtual reality, I don’t think has come that far to completely mirror a real-life experience. There’s going to be some awareness that it’s not real life, but it’s pretty close. The idea is that this provides a much richer data set than traditional paper and pencil tests alone.
And so the question is, why is this important? It’s important because there are a lot of questions, a lot of uncertainty about whether the tests that we are giving are measuring what happens in real life and whether we can translate what we find in testing to [00:06:00] real life.
I’m not saying this is a perfect solution by any means, but introducing something like VR does take a step toward more of a real-life, ecologically valid assessment. You can dive a little deeper, though I’ll link to the Nesplora in the show notes.
I also did an episode on Continuous Performance Tests, probably six months ago with Dr. Chris Mulchay. It was really good where we dove deep into the research behind the Nesplora and other Continuous Performance Tests. And the research is pretty good.
I will say, for our practice, we are moving to the Nesplora because the Conners CPT moved to an online format where they’re charging per use instead of an unlimited use model and the Nesplora is also pretty cost effective. I think it’s $180 for an unlimited use model per month. For us, [00:07:00] that’s a steal compared to $10 per administration of the Conners CPT.
I’m not endorsing the Nesplora, I’m just saying that’s where we’re probably moving to, and it dovetails nicely with this episode on VR and ecologically valid assessment. So again, not sponsored by Nesplora. I don’t get anything from referring to them or anything like that.
So that’s VR. We’re coming along there. There are also some advances in VR treatment. So VR for OCD, for example. In terms of exposure and response prevention, there’s some cool stuff being done there. I’m not going to dive deep into that because it’s not assessment related, but a lot of people are doing some cool stuff with VR in both treatment and assessment.
The other half of this episode is on holistic assessment, and why context matters. I don’t think VR alone is enough [00:08:00] by any means. So even with these highly realistic simulations, we have to go beyond isolated test scores, and that’s where this concept of holistic assessment comes in. It’s all under this umbrella of ecologically valid assessment. So are we tapping into behaviors, attitudes, experiences, and abilities that match real life?
So holistic assessment considers the full picture. It’s a client’s medical history, psychological profile, social environment and daily functional capabilities. So we pull all these things together to try and create a comprehensive, personalized treatment plan.
You might be saying, oh, I already gather all of that information, but it goes a little deeper than just a questionnaire like the ABAS, for example, to measure adaptive functioning or the SRS for social functioning.
[00:09:00] So why is this important? I want to take two clients with similar ADHD test scores. One lives in a highly structured home with a lot of family support. The other is in a relatively chaotic environment with little routine. You could potentially get the same test result, but vastly different treatment needs. And so, considering the environment and these outside testing factors can be super important.We’ll go a little bit more in depth to figure out what this might look like. Let’s just say during the initial consultation, like our interview, I think a lot of us are doing this. It’s gathering client background, medical history, and lifestyle factors.
So something that can often go overlooked is the lifestyle factor part. What does their life actually look like? What are their relationships like? What is their living situation like? What is the home environment like? [00:10:00] It’s endless what you could ask about in terms of lifestyle factors.
You could also go down the path of culturally responsive assessment and use something like the ADDRESSING framework from Pamela Hays and dive deep into those cultural and environmental factors that shape this client’s experience.
If you have the capability to collaborate with other providers like multidisciplinary collaboration, this is a place where you can work with teachers, medical professionals, and any others involved in the kids’ or adults’ care to get more of a 360-degree view of the client’s needs. So a lot of us conduct collateral interviews with these additional folks involved in the kids’ care.
It’s just a reminder to go deeper if you can. If you’re not at least sending questionnaires to these to teachers, if you’re not doing [00:11:00] collateral interviews with other providers or folks involved with them, then this is just a reminder to do so, assuming they have the time and the energy and of course can bill for that time, that’s important as well. Multidisciplinary collaboration is a big part of holistic assessment.
When we get to the actual assessment component, there is a real-world functional assessment piece to consider here. If you want to get fancy, you could use something like an Ecological Momentary Assessment tool, like a mobile tracking app, something like that, to collect real-time data on attention, mood, and behavior in daily life.
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There are a lot of examples of EMA apps that you could potentially use, depending on what you’re trying to do. So there are a ton of mood tracking apps. Mood tracking is essentially considered Ecological Momentary Assessment. It’s just checking in with a patient at any moment in time and asking them to self-report their symptoms.
There are also a few tools that are geared more toward executive [00:14:00] functioning and other neuropsychological constructs. I’ll provide a list of some of those tools in the show notes. I’m not going to list them all here, but rest assured that there are a lot of options out there to explore real-world functional assessment.
I also talked about the social realm. So social environment. There are a lot of social evaluation tools out there, but structured interview and validated scale is something like the Social Support Questionnaire, which helps to understand the client’s support network. It’s not just the client’s social functioning, but what their social support network looks like, which can be valuable when we’re making recommendations.
And then if you’re looking at real-world executive functioning assessment, you could use something like the Test of Grocery Shopping Skills. This is [00:15:00] a little bit of an extension of something like the CVLT where you’re memorizing a grocery list for kids. It’s a Test of Grocery Shopping Skills to measure real-world executive functioning beyond cognitive assessments.
All right, so let’s talk about how to integrate VR with holistic assessment. We’ll bring it all together here. When we can combine these technologies, I think it can be a powerful client-centered approach that gets closer to real-life assessment, gets a lot closer to capturing the complexities of real life than testing someone in a sterile office with these standardized measures that we’ve relied on over the years.
So how might this work? For example, a client struggling with social anxiety might undergo a VR simulation in a virtual coffee shop where we can track eye contact, physiological responses, verbal engagement, and at the same time, [00:16:00] we can use these holistic assessment tools to look at their medical history and their social support system, their executive functioning, and pull it all together to create a little bit of a richer picture of this person’s functioning.
Now, do I know of an app right now that creates a virtual coffee shop where you can track eye contact and physiological responses? No, I do not know what that app is, but we’re dreaming folks. This is theoretical in large part.
So I would love to see more companies put energy into this and utilize VR to recreate some of these scenarios that would let us measure some of these abilities that we tend to look at.
So as you’re listening, I’m guessing that you have some questions, maybe some objections. I did too. One, is VR technology feasible for small practices? I think so. At this point, you can get a [00:17:00] VR headset, like the Meta Quest 3S, is $300. So it’s about the cost of an iPad.
Then in terms of getting into the software, Nesplora, like I said, is $180 a month for unlimited administration. So that’s not too bad. So I think it is probably feasible for small practices. It costs less than it would cost to get up and running with Q-interactive.
Another question is, how do you ensure VR assessments are ethical and protect client privacy? So this is just one of those places you want to do your due diligence and look for any HIPAA compliant VR platforms and make sure that you get informed consent from clients. So any software that you’re using, it’s worth a mention in your informed consent or office policies to make sure they’re aware of that.
Training is another factor. Most of these VR assessment tools will come with built-in clinician training and most of them are designed to be pretty intuitive for psychologists [00:18:00] without a technology background. So they’ll walk you through the setup process and make sure you know how to implement these technologies.
Just to recap, I think VR based assessment is coming along. Nesplora, like I said, is the biggest step in that direction. I think it’s just going to get more and more populated in that category. They do provide higher ecological validity and richer data sets than traditional testing, as best we can tell.
And then you can combine that with this holistic assessment model, where you’re looking at context for clients, looking at their social, their functional, their medical background and environment. It’s going to help round out the client picture and help us do better work.
But then when you combine the two, it’s like you get a real world picture via the virtual reality simulation, but then you can also pair that with the ecologically [00:19:00] valid assessment. I think it becomes cool when you can combine the two, where you get the virtual reality simulation and see how people react in real life, so to speak, but then you’re also diving deep and getting a good sense of their environment and contextual factors.
You compare those two and that creates a little more powerful recommendation engine and gives us more insight into what’s happening. And it helps answer that question, why are people different in different environments or different contexts? Ultimately, our job is to provide helpful recommendations. And this is a big step in that direction.
All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and your life. Any resources that we mentioned during the episode will be listed in the show notes so make sure to check those out.
[00:20:00] If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcasts.And if you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development; beginner, intermediate, and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.
[00:21:00] The information contained in this podcast and on The Testing Psychologist website are 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. Please note that no doctor-patient relationship is formed here and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.Click here to listen instead!