Dr. Jeremy Sharp (00:34)
Hey folks, welcome back. Today is, let’s see, episode three in pillar three of our March marathon. We’re talking about technology and today’s topic is tele-assessment. So tele-assessment remains a hot topic in our field. Since COVID, I think we are all way more aware of tele-assessment. I don’t know about y’all, but I can remember like frantically digging into the research back then, buying extra monitors for my staff.
talking with the test publishers about how to make it work and clinically sound ethical way. And since then, know, teleassessment has continued to grow significantly for many reasons. I would say it’s no longer an emergency backup. There are many practices out there who are making, you know, full time go of teleassessment. I saw a post just yesterday in the Facebook group about, you know, fully remote work. This is super common right now.
So, you know, I think it’s a tool at this point and this is kind of how it started, but it’s evolving into this even more, but it’s a tool for access and equity. It allows the rural patient or the housebound senior patient and the overwhelmed parent to access your expertise regardless of where they might be. And that can be really nice, especially, you know, in a rural area like where I’m at, Colorado.
There are lots of states that are very similar. But as we discussed in a previous episode, the medium matters, right? So moving a battery from like a quiet clinic into a chaotic living room changes the extraneous load on the client. And today we’re going to be looking at the research support for remote testing from toddlers to older adults and hardware protocols that you need to make sure that your remote data is just as valid as your in-person work.
So I’ll continue to share the information about crafted practice, which is my in-person business retreat. It’s happening this summer for the fourth year in a row. It’s amazing. You know, it’s 20 people, 20 psychologists who come together to work on their businesses. We have three full days and two half days to talk business, do some small group coaching, go to happy hour, have awesome discussions and just laugh a lot. it’s been great feedback. It’s been great.
it’s all inclusive. So all you have to do is get yourself here to Denver and take a quick shuttle about an hour north and it’s beautiful here. It’s great. I’d love to see you. So, we can do a call beforehand if you want to check it out and see if it’s a good fit for you, but you can get all the info and schedule that call or just register at the testing psychologist.com slash crafted practice. All right, let’s jump to this discussion on
the state of Tela assessment in 2026.
Dr. Jeremy Sharp (03:34)
All right, people, we’re back. We’re back. And I’m going to dive right into it, per usual, with these sprint slash marathon episodes. Again, this is meant to be an overview and time to give you some of the latest research, but then some actionable takeaways in this area of tele-assessment if you’re considering adding it or expanding it in your practice. So let’s dig into some research first. The foundational research in tele-neuropsychology
is led by Brearley, I think is how you say it. There’s a pretty big meta analysis. after reviewing all of those studies, I think the conclusion was pretty clear. Verbal tasks like memory and language and general knowledge are highly, highly reliable via video. The scores are nearly perfectly correlated with in-person administration. However, we did find that we have to face the spatial problem.
And that is the tasks that require the patient to manipulate blocks, draw complex figures, or point to small details are where the like tele assessment penalty tends to occur. So if your camera angle creates a parallax error, a mirroring error, or if the patient’s screen resolution is low, you are not measuring their visual spatial ability, you’re measuring their tech setup essentially.
So the research tells us essentially that for complex evaluations, hybrid model is often the best approach where interview and verbal tasks can be done remotely while manipulable, visual spatial tasks are done in person, if at all possible.
Let’s talk about specific populations though. In the pediatric world, you we’ve seen a surge, I think, in validated remote observation tools. You may have heard of the tele-ASDPs. So this is a tool that allows us to observe a parent interacting with their kid in the natural environment. Research indicates a pretty high diagnostic agreement with in-person tools like the ADOS2 with added benefit of seeing natural behavior that often disappears in the clinic setting.
And this is just personal experience, you know, during COVID particularly. I personally shifted over to the tele ASDPs and conducted that assessment several times and really enjoyed it. There are a lot of parallels to the ADOS. It feels very familiar if you are well versed in the ADOS. So it’s an easy transition, but I really liked being able to see the kiddo in their home environment. And we got to, you know,
use toys that were familiar to the kiddo and see them interacting with their parents in a more naturalistic way. So just speaking for that measure specifically, I really loved it and continue to use it. And that makes sense. mean, the tele ASDP was developed before COVID and it was, I think, originally developed to help rural folks access services. So it’s been around for a long time and was well validated, I think, before COVID came.
So that’s just one example. On the other end of the lifespan, though, research has, I think, confirmed that cognitive screens like Mocha maintains pretty high reliability via video. That said, there is a kind of massive confound, which is like the sensory bottleneck, I think you could call it. This next component, I think, is anecdotal, but it is important. And so
Many clinicians would report that using an on-site facilitator improves the reliability of testing for older adults. But it’s uncertain exactly how much that facilitator’s unintentional prompting maybe skews the data compared to a solo proctored exam. Additionally, if a patient has something like
age related hearing loss and they’re using poor quality speakers. The quote unquote memory score is going to be artificially low because they never encoded the words in the first place. there’s a lot to consider here. Generally speaking, think that administration of tele assessment measures is going to be how would I put it?
The administration is going to be a little bit more reliable with kids simply because the, you know, the sensory confounds don’t tend to be there. Most kids I think are really relatively well versed in technology. The confounding factor for kids though is distractions and role of the parent and is the parent influencing the assessment and so forth.
So with older adults, you have less of those distractions and environmental confounds, but, you still run into, you know, what the, the proctor or the facilitator might do and their influence. And then you have again, sensory concerns and.
know, confounds in that regard. So, so, take it with a grain of salt. And I’ll go back to my main, you know, point when we got started that, you know, the hybrid model is likely best if you can swing it where you’re doing the interview and the feedback and the verbal tasks in person or sorry, remotely, but then visual spatial tasks are happening in person. Okay. So let’s pull it all together into what you might consider like a remote protocol for 2026.
If you want to offer tele-assessment, you know, you can’t just like use a laptop and hope for the best. You need like an official kind of access protocol. So this is a little bit tech heavy, but it’s, it’s important because the setup is very important. So the first point here is something called a three camera setup. So this is the setup that you will have in the patient’s environment. So this is a, you know, a main camera for the client’s face.
A second camera like a smartphone on a stand to view the client’s desk and hands and then a third to monitor the room environment. So I don’t know how many folks are actually adhering to this protocol. mean this is kind of like a perfect world scenario but you know unless there are others out there that I have not heard about. I think this is the only way to monitor those behavioral nuances and prevent cheating so to speak.
The second point to consider here is audio priority. So glitchy video is annoying, but poor audio just absolutely destroys, you know, the validity of any verbal task. So use a dedicated external microphone or require the client to have a headset if they have any hearing impairment and just make sure that both parties have really, really fast and reliable internet. And if you need any guidance on
like internet connection and what fast means and how to test the internet connection, that is very easily Googleable.
Dr. Jeremy Sharp (10:06)
The third component to think about is the environment audit. So this is where you might employ something. You could call it like a preflight checklist for the client. OK. So making sure there’s a quiet room closed door 10 inch screen minimum. So phones are not OK typically for a tele assessment and no other devices on the Wi-Fi. I would add to this list that you need to have
Yeah, very fast internet and a reliable connection and a plan for what to do if the connection drops because that does happen Now that leads to the fourth rule, which is what I would call like the discontinue threshold. So you can set a hard rule if the connection drops three times in 30 minutes or the lag starts to exceed 500 milliseconds, then the session stops. You don’t like power through bad data.
So that’s a little bit of a, like I said, four point checklist or plan to think about when you are engaging in teleassessment. Now, as always, there are other folks out there who are way more skilled at this and have put way more time and energy into researching this and practicing this than I have. And so we could go into great detail, I think, on the many facets of teleassessment. There’s some great research groups out there.
You know, Lana Harder down in Texas has been doing research on pediatric neuropsych for a long time or tele neuropsych. And if you’re interested, I would definitely recommend picking up the book, The Essentials of Tele Assessment by Jordan Wright and Susie Rayford. They have much more in-depth discussion. So there’s great information out there and there are practitioners who are doing this day in and day out. So again, this is just meant to be kind of a quick like reintroduction to the research.
kind of anchoring and where we’re at now raising a couple of concerns that we have about tele-assessment, talking about populations a bit and then offering some real life takeaways. ultimately, know, tele-assessment I think is about bringing the clinic to the client, but only if you bring the rigor of the clinic with you. So I hope it’s been helpful in thinking through some of the…
important factors as you consider whether a tele-assessment is right for you.
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