Author: Dr. Jeremy Sharp

[00:00:00] Hey, y’all. This is Dr. Jeremy Sharp. Welcome to The Testing Psychologist podcast episode 13.

Hey y’all, welcome back to another episode of The Testing Psychologist podcast. This is Dr. Jeremy Sharp. I hope all is well today wherever you are. As far as I know, we aren’t having any major snowstorms anywhere in the country right now. So that’s always a good thing.

Speaking for us here in Fort Collins, Colorado, we have had an amazing run of pre-summer springy weather, which is awesome as far as I’m concerned. I think I’ve mentioned before that I grew up in South Carolina. I’m definitely a summer person as opposed to a winter person. So this is excellent for me and also for our family.

I’ve mentioned that I have 2 little kids and having some nice weather has let us get outside and just do some really cool, fun things with the kiddos. The biggest thing is that my 3-year-old learned to ride her bike just two weeks ago. So we’ve been really getting into family bike rides and cruising around. It’s just been awesome to spend some time with them and share something that we really love to do.

Today, I am doing a solo episode. I wanted to talk with y’all about what I would think about as the vulnerability of going through the testing process. I had two things happen over the last few weeks that really got me thinking about what a vulnerable process it is for parents to go through the evaluation process or for anyone really. Again, I work primarily with kids, so I think a lot about [00:02:00] vulnerability from the parent side, but certainly applies to adults or to anyone who’s coming in for a psychological evaluation.

I just wanted to talk through some of that, some of the ways that I handle that from the clinician side and really I think just go out of my way to help parents feel comfortable and provide services that really address what they’re looking for, and try to help them go through the process with grace and ease.

So, like I said, two things really got me thinking about this. One is that our oldest kid I think is, oh, how would I describe him? A lot of people would probably describe him as a spirited child. You maybe have heard that term before. He has just been that way since he was born. I think it’s a temperament kind of thing.

And that’s brought with it some challenges and a lot of positive aspects as well, but one of the secondary factors with that is that he has actually been evaluated in two different settings over the years. And so, I’ve had some experience with this from the parent side.

The first time, it was fairly benign. It was a grad student who was just getting some practice with administering some tests and wanted to do a little bit of testing with him when he was, I think about 2, just to practice like I said. Of course, being in the field, I thought, this is great. Let’s see what’s going on.

Even with that, back then, we weren’t really concerned or anything like that, but I was very aware of how much I was wrapped up in the outcome: how he was doing, was he bright, and was he on track? Even in this practice setting, it was something that was really weighing on my mind. There was a lot wrapped up in it for [00:04:00] me as a parent and how he was doing. So that was my first experience with that.

And then later down the road, it was probably, I think when he was 4, we took him to occupational therapy for the first time. I was the one that took him to that appointment. We had been having some trouble with him just getting overwhelmed in the classroom, striking out at other kids, yelling, melting down, and stuff like that.

We took him to OT and they did an evaluation there just to gauge how he was doing. And that was really eye-opening for me. I was aware, just sitting in the waiting room, of what it’s like to be in a doctor’s office and the emotional mindset that I was in at that time- feeling a little nervous and having this dichotomy between wanting them to see what was going on and validate my experience and my wife’s experience with him, but then at the same time, not wanting anything to be “wrong.”

That is an intense process. And then, of course, going through the actual evaluation and some of the appointments with him afterward, there’s, like I said, a vulnerability associated with being in that parent position and bringing your kid in for an evaluation. So that’s the personal side.

And then from the professional side, I had something happen last week or two weeks ago where I did a feedback session with a family. This happens rarely but it does happen, being a human like everybody else, I was not on my game during this feedback session at all.

I think the night before, our 3-year-old had been up throughout the night and so I was groggy. Basically, I did not review that file as thoroughly as I should have prior to the [00:06:00] feedback session. And the parents rightfully so called me on it. They got in touch afterward and said, Hey, we felt like this was not as thorough as we thought it would be. We were really disappointed.

That hurt but it also was good motivation and really got me thinking again about just how much families invest in this process and how valuable it is to deliver good service and really take care of them. They’re putting their family and their kid and their well-being in your hands and trusting a lot to you. All these things combined got me thinking about vulnerability in the testing process.

So that’s what I’m going to be talking about a lot today. And I’m going to talk about it primarily from a procedural standpoint. So the things that I do throughout the evaluation process to help parents and adults who come in for evaluations, just help them feel comfortable, try to provide them good service, let them know that we’re here and we care and that we’re aware that it’s a vulnerable process.

I think that we’re working uphill, to be honest, when people come in for an evaluation. Unless they’ve done it before, they generally don’t have an idea of what it looks like.

We do not get a great representation in the media. I think I’ve talked about this on other podcasts just briefly, but what people see in the media for a psychological evaluation is usually not great. It’s some variation of the Rorschach, which is the Inkblots test, or maybe a discussion in a forensic setting or courtroom drama about the insanity defense or something like that.

I think it’s pretty rare that we get a positive representation in the media, and so, most families or individuals don’t really come in with a great [00:08:00] idea of what to expect. They just hear the term psychological evaluation or psychological testing or even assessment and those terms are loaded. They usually don’t have a positive connotation.

I start from the initial phone call by doing my best to help families and individuals feel at ease. And what I do to help with that is, in the end, initial phone call, I give a really clear description of the evaluation process. Usually, they call with some variation of hey, my doctor so and so said that I should call for an evaluation, with that implied question mark at the end. And then it’s just an open conversation like where do I go from here? I don’t know what to do. I don’t know what this is about.

So I just immediately jump in, say something really affirming like, thank you for calling. It takes a lot to make that step. Let me talk you through the evaluation process and what you can expect. I’ll also get some information from you about what’s going on and why you might be coming our direction. Let’s get started. Do you have a few minutes to have a 10 or 15-minute phone conversation?

So I prep them and just let them know we’re going to be spending a fair amount of time on the phone here initially to talk through your concerns and make sure that this is going to be a good fit.

If they say that that’s all right, then I will dive in and say, tell me a little bit about what brought you here, just to make sure that an evaluation is appropriate for your concerns. And, of course, listen to that, validate that. At some point, of course, if it is an appropriate concern, I will say something like, that’s great. That’s exactly what we specialize in. I definitely think that there’s room that we can help you out and we can shed some light on some of these concerns for you. I’m glad you called.

Throwing in [00:10:00] those little small affirmations throughout that initial phone call can be super helpful.

I do give a really clear description of the evaluation process. I’m not going to dive totally into that here in this episode, but suffice it to say that I have typed out a clear description of our evaluation process and have developed almost a script for that too where I can talk with parents, or at this point, our admin assistant can talk with parents or individuals on the phone and just tell them exactly what to expect.

We even break it down into here’s how much time we spend with the initial interview. This number of days after that, we’ll schedule your testing day. And then this number of days, we’ll do a feedback session. Here’s how long that is. Then you can expect to get the report this many days after that. So we’re prepping them right from the very beginning about what they can expect with the evaluation process.

Now, after they go through that initial phone call and schedule, the next step in our process is the initial interview. So again, just thinking from the very beginning about that initial interview and what will help families or individuals feel at ease.

I greet them in the waiting area. I always make sure with initial interviews that I walk out, I have a smile, I’m very welcoming. I, of course, over the years have developed some amount of small talk and a bank of comments to make to them:

Did you find our office okay? How are you doing this morning? How’s the day treating you? Stuff like that. Just little things like that to communicate that I’m totally on board with them and I’m going to not make this a super clinical process, that we are able to have some conversations. We can ry to be at ease right from the beginning.

[00:12:00] And that sounds pretty basic and pretty simple, but that is something I think, as we greet clients over and over for interviews over the years, can be easy to forget. And just easy to forget that they are sitting there, especially before the initial interview, probably really nervous, and unless they’ve been through it before, really have no idea what to expect.

I’ve had folks come in and think that right in the initial interview we are going to hook them up to machines and do brain scans or draw blood and stuff like that. So you never know what people might be expecting when they come in for that initial appointment. So like I said, really friendly cordial greeting in the waiting area. Definitely have some things to chat about walking back to the office.

And then, as soon as they sit down, they’ll usually ask politely, of course, kind of making conversation. How are you today? And I generally try to actually answer that question. That’s a good opportunity for me, if our kids did something a little crazy that morning or something funny happened, I’ll always try to find a way to share that in an appropriate way, not overly disclosing, of course, but something to connect with them.

So as we get started, I spend a fair amount of time at the beginning of the interview just explaining the process again; just making sure that they’re on the same page with how things will go. So I talk about how much time we have in the interview. And that’s actually another piece that I could talk about is we do spend two hours on the initial interview with people, which I think is maybe a little different than some other models, but I made that shift actually pretty early.

Doing an evaluation like this, I think with [00:14:00] most cases, it’s really hard to do a one-hour interview, or at least it was for me because, by the time I’ve talked about what’s going to happen in the interview and go over confidentiality and office policies, that’s burned 15 minutes right there. And then we take usually 10 minutes at the end of the interview to schedule the testing day and answer any questions they might have. So right off the bat, that’s almost a half-hour gone just with logistics and procedures.

I shifted to doing a two-hour interview years ago and have not looked back since. It’s very rare that I will use less than an hour and a half in that initial interview, even with the most straightforward cases.

So that in itself, I think is a client care policy that communicates that I’m totally on board with them. I’m invested. I’m going to spend the time to really learn about them or their kiddo and their family and the environment. And that just gives me plenty of time to ask all the questions that I need to.

So I’ll talk with them about how we have about two hours for the initial interview. I tell them that it’s very structured. I’m going to ask a lot of questions. I’m going to touch on certain areas and will guide us through the interview. So they don’t have to worry about freestyling or knowing exactly what to talk about. I will help with that. But I also tell them that at some point, I’ll turn it back over to them and make sure that I didn’t miss anything so that they can relax a little bit if they have really big things that they want to make sure to talk about.

As we go along, I make sure to do a good interview, but as we get toward the end of the interview, I always ask several times, what questions do they have?  How can I help you? Do you have any concerns? And at the end of the [00:16:00] interview, what I do is I put together a while back a sheet that is called what to expect on testing day. I have a separate one for kids and for adults.

That what to expect sheet just gives some basic information. It says get a good night’s sleep before, make sure to eat breakfast, drink coffee, or take medication as usual, whatever the specific instructions might be. It also gives an idea of the schedule. So we start at 9 o’clock. We take a lunch break at 1200hrs. We’ll be done around 1400hrs or 1500hrs. I give them options for lunch nearby so that they know what to expect there and whether to bring lunch or not. That sheet also we have a little space to put in any financial information like if they need to bring a payment. It also gives a general overview of what kinds of tests we’re going to be doing. I think that’s important just to prepare people as much as possible. So they walk out with the what to expect on testing day sheet.

Often, parents will also ask, how do we talk with our kid about this evaluation, because parents are understandably concerned about their kid thinking something is wrong with them and that kind of thing.

What I generally tell them is just to say something general and fairly vague; not to name any diagnostic concerns or anything like that, but just to say something like, we’re going to go to see the doctor and he’s going to do some tests to help figure out how your brain works, figure out what you’re good at and maybe give us some help to make school be a little bit easier. Generally, we’ll just leave it at that. Kids seem to really like the idea of finding out what their brain is up to. So we’ve stuck with that line over the years.

[00:18:00] During the testing day, now this is, I think really important. Again, people come in, they have this idea that they’re going to be evaluated and they really have no idea what that will actually be, even though we’ve given them some sense from the what to expect on testing day sheet.

They come in and often they are fairly nervous. So right off the bat, if it’s a kid, I am jumping in and trying to make some joke, be friendly, engage them if they brought a toy or if they’re holding a game or something like that. I’ll just make a little bit of conversation. Definitely try to be animated and engage the kid as much as possible.

Now, I have mentioned, I think before that I run a tech model where graduate students administer a lot of the testing as well. That’s just a quick side note that if you do run a tech model or thinking about running a tech model, make sure if you work with kids, hire people who actually like kids. That is huge. That’s just made such a huge difference. I have great graduate students right now who do a really good job in engaging with kids and really being silly and helping them feel comfortable.

So as they get started with the testing process, the instructions for most of the tests say, you’re going to be doing a lot of different things today: some will be hard, some will be easy, just try your best.

Of course, we read all of that, but I will go above and beyond and just try to reiterate that and break from the script a little bit and try to reassure the clients or the kid that things are probably going to be hard at some point. These tests are not the kind of tests that you can get 100%. They tend to just get harder as you go along. [00:20:00] So don’t get discouraged. If you do, we’ll take breaks. Just try your best and let me know if you need anything.

We let people take breaks as often as they need to, try to pay really close attention to whether they are getting anxious or frustrated or tired or down on themselves, any of those things, and really being proactive to coach people to take breaks when they need it even if they’re not asking for it.

We do spread the testing day out. We make sure to give a pretty long lunch break. We are in an office park where there’s the opportunity to take a walk. There’s a coffee shop. So that’s getting into environmental things that I think are important, but if you are in the position where you’re considering office space or have the opportunity to move or anything like that, I think those are important things to think about when you’re doing testing is to make sure you’re in an environment where clients can take off and get a little breather if they need it.

After the testing session is done, then people come back for feedback. Now, I tend to think that, well, and others do too there, that the feedback is just a whole separate beast on its own.

I will mention, there is a great book by Karen Postal. It’s called Feedback that Sticks. I will definitely have a link to that in the show notes. She just goes into so much detail about how to do a good feedback session, how to explain results, how to be compassionate, how to deliver hard results like for low IQ or difficult diagnoses or things like that.

I will likely do an entirely separate episode just on the feedback session, but generally speaking, you want to be clear, you want to be concise. I tend to spend about 40 to 50% of the feedback session [00:22:00] talking about results and the tests that we did; explaining those, what they mean, and what they looked at.

I definitely start with talking about the person’s or kids strengths- emphasizing those and talking about how those are going to prove helpful in different environments and making some comments about how we can play to people’s strengths especially kids like in the school environment, what kind of learning environment might be helpful, that kind of thing.

So I spend a fair amount of time on strength before transitioning to what I call challenges. Even using the word challenges for me is very deliberate rather than using a more maybe clinical model and saying deficit or even weakness, words like that. I tend to stick with challenges or frame it more casually and say just things that so and so is not so good at.

So we’ll talk through challenges. And then, I quickly transition and spend at least half the time on recommendations and what to do. I try to focus on specific concrete ideas that folks can take away so that they have a really good idea after the feedback session of what the next steps are and where to go from that point.

And the whole demeanor that you employ during that feedback session, I think is huge. It’s hard to articulate that, but I think it’s safe to say that just coming from a place again and reminding yourself before you go into a feedback session that this is really vulnerable for folks and they have no idea what to expect.

They might think you’re going to tell them exactly what’s wrong with [00:24:00] them or that they’re crazy. I’ve heard that a lot. You’re going to tell me I’m crazy. Parents are often quite nervous. Individuals are quite nervous. They had likely no idea what the tests they did were and what they mean. And so just keep that in mind as you go along.

I will say to them at the beginning of the feedback session, I know I’m jumping around a little bit, but I will say something like, do not hesitate to interrupt me. This information is really important, but it’s also a lot in a relatively short period of time. And a big part of getting together face to face is that you understand all the testing we did and where to go from here. So do not hesitate to interrupt me. That’s really important and that’s not offensive to me at all. I just try to give them permission as much as I can to jump in whenever they want to.

So feedback session again, just generally keeping in mind that this is super important for people. Most of the time, people just want concrete strategies about where to go and what to do from that point.

So I will often send them away with a referral sheet. We’ve put together a referral list that is printed out here in the office. Often, a big part of the feedback is referring folks to other services either within our own clinic or mostly out in the community, to be honest. So I have a nice lengthy referral list for any number of services that clients might need.

I always hand that to them. I really try to talk through each of the providers I’m recommending. That sheet has the provider’s name, a little description, their phone number, and what they do. And I try to communicate with folks at the feedback session why those individuals would be a good fit and really try to match them up based on everything I know about the family or the individual and [00:26:00] everything that I know about that provider.

Now, when I deliver the full report, that’s another place to, again, just take into account this vulnerability and try to support people and help them feel comfortable with the process. So here you have this very concrete tangible result of all the testing that you did. So there’s a lot of power with that. 

And again, report writing as a whole, I could probably do a series of episodes on that, but generally speaking, you want to make sure to write up the history accurately. I always go out of my way to give it a little bit more of a narrative feel where it’s not just super short and clinical. Of course, this depends on the setting that you’re practicing in. Are you writing for physicians or other medical professionals or more for parents or the client? I tend to err on the side of being a little more narrative instead of brief and short, just to fill it out a little bit and hopefully make it a little more relatable and personable.

I always think that even though I’m going to be sending that report to a bunch of different folks usually, the parents or the individual are really the individuals who is going to be reading that report. And that’s who I tend to write to. I consider the client to be my audience.

So I spend a lot of time both in the history, in the interpretation, and in the summary, again, just focusing on strengths. I try to play that up and make it really clear. In the history, I have a whole section just on strengths and places that people excel and what they’re good at.

And then in the interpretation and the summary, I have two separate paragraphs, one at the beginning, one at the end of the interpretation that go over strengths and what they’re good at and how those are going to serve that individual or that kid out in the real world. I really try to tie it, like I said, to pretty [00:28:00] realistic scenarios and talk about how those strengths will help them in day-to-day life.

In the report, like I said, you have a lot of opportunity to talk about strengths and again, reassure folks that all is not lost. There is hope. Recommendations are a big part of that. So writing recommendations that feel doable and clear and concrete. I like to write recommendations that actually play to people’s strengths in addition to supporting their challenges. So that’s just a mindset thing to be thinking about.

An example of that would be, let’s say I have a kid who has really high verbal skills, they’re really outgoing and have a great personality, and maybe they struggle with some attention issues or they have a reading disorder or something like that. I’ll include a recommendation that says something like, play to leadership skills. First name kiddo has excellent verbal ability and strong ability to connect with other kids in the classroom. So please utilize so and so in a leadership role to help build confidence and capitalize on these excellent skills. Something like that.

After you deliver the report, many families or individuals will also ask for a certain amount of follow-up. Again, I just make it really clear and go out of my way to tell them that I’m available for any amount of consultation or follow-up that they have after they get the report. That could be connecting them to resources. It could be reiterating or doing another meeting to go over the report, and answering any other questions that they have.

And even years down the road, I’ll get emails from families or individuals saying, hey, we did testing a few years ago, [00:30:00] such and such has changed, what would you recommend? Most of the time, that’s a pretty quick email just to think about additional resources or things that could be helpful. And I’m okay with doing that.

Of course, if it turns into more of a lengthy process or if they ask for another meeting or something like that, then you can charge for that time. But I find that people are often very willing to pay for that time if you’ve front-loaded with a positive demeanor and just make it really clear that you are totally happy to consult with them and will just be a resource going forward and be something that they can utilize if they really need it.

I think it all just gets back to families and individuals just wanting to be able to rely on you and have a bit of a guide throughout this whole evaluation process that is very familiar to us as clinicians, but very unfamiliar and fairly scary at times for parents or individuals who are coming to go through the process.

So, those are just a few ideas and things that I do here in our practice and have done over the years to really try to address folks’ vulnerability and honor that vulnerability. Even if they may not name it, just to know that it’s a fairly intimidating process sometimes. Folks come into it with any number of expectations or hopes. They really are putting their lives in your hands. I think you having that mindset can be super helpful and really supportive for those folks.

Any resources that I mentioned here during the show will go in the show notes, like I said. I would just encourage you as you go along, [00:32:00] if there are any small places where you might be able to tweak your process a bit or even developing, like I mentioned, a referral sheet or a what to expect sheet or a script for that initial phone call and just revising some of that and making sure that it’s really going in the direction of catering to folks and helping them feel as comfortable as possible through the process, I think will really help.

And then that can really extend and go a long way even beyond your evaluation. I think that a big part of referrals and word of mouth. People having a good experience is as important if not more important than the actual clinical piece.

Thanks as always for listening. Love doing these podcasts. I love talking through these different aspects of testing. I hope that it’s helpful. If it is helpful or if you’ve enjoyed the podcast, do me a huge favor and think about spreading the word in any number of ways. You can share the podcast on your Facebook feed or other social media, you can rate or review the podcast and iTunes, you can share it on your own website, you can blog about it or you can send me comments and questions. That’s always really nice too. I love getting those, thinking through things, and just hearing what’s helpful, what’s not helpful, and maybe other topics that folks are interested.

We have a number of really cool interviews coming up. Like I mentioned last time, I’m going to be talking with Maelisa Hall from QA Prep all about having your paperwork in order and documentation when you’re doing testing. Also, going to be talking with Kelly Higdon- one of the premier mental health consultants and private practice coaches here in the country. Allison Puryear, we have an interview with her coming up in the next month or so. So there’s a lot of exciting conversations that we’re going to be having here over the next several [00:34:00] weeks.

All of you take good care. Enjoy the spring weather, whatever that might look like in your area. We will catch you next time. Bye bye.

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[00:00:00] Dr. Sharp: Hey everybody, this is Dr. Jeremy Sharp. Welcome to the Testing Psychologist podcast episode 12.

Hey everybody, welcome to another episode of The Testing Psychologist podcast. This is Dr. Jeremy Sharp. Today, I am talking with Amy Fortney Parks. I’m really excited for our conversation today. Amy and I originally connected in the practice of the practice Facebook group, the online community there.

I was really taken by Amy’s enthusiasm and her energy for marketing and some of the things that she’s put together for her practice. She actually reached out to me to talk through some aspects of testing and integrating with schools and recommendations and things like that. So [00:01:00] I’m excited to have this conversation with her today.

Let me do the official introduction for you, Amy, and then we will jump into our conversation. Okay?

Amy: Sounds great.

Dr. Sharp: Great. Amy Fortney parks describes herself as a life-long educator, a passionate psychologist, and often stressed-out, but mostly happy mom of four. She is the Executive Director of Wise Mind Solutions, LLC, a Northern Virginia-based practice focused on children, teens, and families. Amy is also the owner of The Wise Family, a comprehensive brand for kids and parents designed to inspire, educate and energize families.

Amy brings with her over 25 years of education and experience working with children, adolescents, and families as both an educator and psychologist. Her focuses include individual counseling for kids, tweens, and teens, parents and educational consulting. She is a passionate “BRAIN-trainer” and strives to help everyone she works with understand how their own unique brain works. I [00:02:00] like that.

Amy holds a Master’s degree in Psychological Services and is just about to wrap up her dissertation and get her Doctorate in Educational Psychology. Congratulations on that, by the way.

Amy: Yay.

Dr. Sharp: That’s a big yay. We’ll talk as we go along about how to get in touch with you and learn more about your services and about you here toward the end of the show but for now, welcome Amy to The Testing Psychologist podcast.

Amy: Thank you so much. I appreciate it, Jeremy. I didn’t realize how many times the word passion is in my bio. I’ll have to modify that a little bit.

Dr. Sharp: That just says that you are very passionate.

Amy: Obviously, maybe a little overly passionate.

Dr. Sharp: That’s fair. We’ll sort through that. We’ll see. Well, how are things in Northern Virginia today?

Amy: Everything’s fine. We’re back to school. A little bit of snow on the ground, but not much. It’s a sunny day. Everything’s going well. I think that kids are [00:03:00] getting ready for the start of the spring break season, that’s an exciting time for families, but in our state, we also have some testing coming up around that time, so some anxiety starts to happen pretty soon here, so we’ll have an uptick in some of our work.

Dr. Sharp: Absolutely. I know that pattern well, gosh, standardized testing has just gotten so ubiquitous. For a lot of my kids anyway, that’s a pretty rough time.

Amy: Yeah. We see that too. So everything’s going great. We’re busy and we love working with families. I binge listened to your podcast on a trip and I was really excited to connect with you and agreed with everything you said and was so excited to hear your journey. And I thought, I have an area that might be something that would be helpful for your listeners. So [00:04:00] that’s why I reached out and said, hey, you want to talk about recommendations and some stuff that involves schools. And you were like, yeah, great. Sounds awesome. So I was excited to connect.

Dr. Sharp: Yeah, absolutely. As listeners know, the last episode that I did was on doing a school observation and some aspects to consider, so this is a great little two-part series and maybe more than that, who knows but right now we’ve got two ongoing episodes on integrating with schools and how to work with schools and integrate testing with the public education system. So super excited to talk with you today.

Amy: I’m not sure you’re going to even get away from, you’re going to probably do a lot of episodes on school because, of course, there are lots of opportunities to do testing for adults but not nearly the volume or the need as young people. And then they’re going to always be in school or homeschooled or getting educated in some way, so we always have to figure out [00:05:00] that partnership.

Dr. Sharp: Oh, absolutely. Well let’s jump into it. It sounds like you’ve had a long career and a lot of experience in schools and as a mom and as a clinician, so can you just tell me a little about your life and what your work has looked like, and how you got where you are?

Amy: Yeah, when you look at those numbers, you’re like, shoot, I didn’t realize I was that old, that’s a long time, but it does add up fast. I started as a teacher. So I graduated, my undergraduate was in psychology. Scarily, I had a triple major. I was English, Education, and Psychology.

I started in teaching because I actually didn’t know that schools had school counselors. I went from kindergarten to 12th grade to an all-girls Episcopal school in Virginia. I didn’t know there was such a thing as school counselors.

So when I graduated, I went right into teaching and [00:06:00] I found that I was spending an inordinate amount of time talking to families about their family situations versus their child’s English grades. A girlfriend of mine said, well, why don’t you look into becoming a school counselor? I was like, oh, I didn’t even know that was a job.

And so I went back and got my master’s degree in a now-defunct program, but the program was actually psychological services. It’s a dual master’s degree in school psychology and school counseling. So I had all the same training for school psychology as masters plus then the additional counseling and clinical work.

And so after that, I began to do a lot of work in alternative education because in alternative education, there were many times when somebody that could look at a child through various lenses was really valuable. And so I did a lot of work with families and kids and [00:07:00] teens who were having difficulty in the traditional classroom and trying to figure out what was going on with them.

Oftentimes, what we see is children that are having difficult time in a traditional classroom have either a confidence or a competence issue. And so my job was to tease those things out and figure out what was going on, and quite often, many of our kids had both confidence and competence as concerns. So I was able to help them and work with them.

So I did that. And during the time I was doing that, I also had some kids along the way. So my oldest one is actually 24 and my youngest is 17. So I have two in college, one who has graduated and has a real job, which I think is an exciting thing to mention.

Dr. Sharp: Wow, congratulations.

Amy: It’s very exciting. And then I have one that’s a tutor in high school. So had some kids, did some of that. At some point in time, I realized that one of the hardest things for [00:08:00] me about education is that oftentimes schools and teachers try so hard, no one goes into education for the paycheck, they go into it because they care about kids. However, oftentimes I was witness to what we would know is best practice for kids but something we couldn’t execute on a system level.

That was hard for me because I would know something would work or something would help but we couldn’t really do it, for whatever reason, there was some restriction. At some point, I decided, hey, I want to do more of this on my own than be in the school setting. I want to have more freedom to be able to pick my instruments. I want to have more freedom to be able to try different modalities, so I started a private practice and worked part-time in the school system for a while and then went to full-time private practice probably about five years ago now.

[00:09:00] Dr. Sharp: It sounds like you’ve seen things from both sides and run the gamut with perspective in terms of what is helpful for kids and how to work with kids.

Amy: Yeah, I think so. I talk and we talked a little bit about this before, but I always talk to families about what I consider to be the trifecta, which is the family, the school and then the outside support system, whatever that means. Maybe it might be occupational therapist, it might be speech and language, it might be psychologists, it might be nutritionist, it might be the pastor, who knows? I think that that trifecta is so important.

I was thinking this morning about, this is a little off topic but still on topic, I was thinking about the March Madness and I was thinking about the big rabid fans around these teams, these people that are so rabid about these different basketball teams and stuff. And I thought, you know what, that’s how I feel about kids. I’m a [00:10:00] rabid fan of kids and so I was just thinking about how it feels to just be a big fan.

I tell kids all the time and teens and families that I’m totally team Jeremy. That’s my deal and families are really excited to hear that.

DR. Sharp: Oh, I’m sure. Well, I know at least with a lot of the families that I work with for whatever reason, they have come to a place of feeling like they may maybe not have an advocate or don’t have folks on their side who have their kids best interest at heart. And so I would guess that that is really valuable for the families that you work with just to feel that from you, that energy.

Amy: And even to know that even when it doesn’t feel like people have their kids best interest at heart, there’s a way to reorient the focus. For example, [00:11:00] when I’m working with families, I always make sure that there’s a picture of the kid on the table. Oftentimes in our system, the teenager is coming to IEP meetings, but if it’s a younger kid, I always make sure I have a picture of the child because we’re talking about a human being.

Dr. Sharp: That’s great.

Amy: I know it’s really important to honor that and honor the family and to be sure that they have all their questions answered. Maybe they don’t get all the right answers or all the answers they want right away, but we still have their kids best interest at heart.

Dr. Sharp: Yeah, even something small like that, that’s a cool idea. You’re right, I would imagine we both been in a number of IEP meetings where things spin out a little bit and it gets easy to lose the fact that this is a real kid and we’re talking about their life and this is really important stuff.

[00:12:00] Amy: I think that we can have that perspective even if we don’t have kids. I know plenty of clinicians that don’t have children who are absolutely the best and phenomenal at what they do. I will say that my whole approach changed when one of my sons was in the 5th grade and he did poorly on the writing SOL,

those standard of learning tests that we have in the state of Virginia and they have all over the country at different varying degrees.

He had not done well. He had failed it. They called me into the school but no one ever told me why they were having the meeting. I’m working full-time in a local school system. I know exactly what it is that schools do and how they’re supposed to do things, and yet they called me into this meeting and there is this big table full of all these people and I’m like, what the heck? Why are all you guys here? You just said you wanted to chat with me or something.

It turned out [00:13:00] that they were saying, well, we’re concerned because your son didn’t pass the writing SOL and he has to go on to middle school and blah, blah. I’m like, you guys didn’t even tell me why you were having this meeting. I actually know you’re supposed to. Imagine if I didn’t know that, imagine how it must feel.

It became a pretty big, I had to come to Jesus with them about it because I’m like, this is not cool. You can’t just do that. This is me, I’m okay, but you can’t do this on a regular basis. And that was a real awakening for me to make sure that families really were so clear as to what our goal was, where we were going, how we were going to get there and how we were going to measure that progress.

Dr. Sharp: I think that’s so important and that’s validating maybe it’s the right word, that it’s happening elsewhere too. I feel like so many parents I work with have had that ambush experience in a meeting like that [00:14:00] or are clueless about the process. I feel like it is on the school and on us as private practitioners to a degree to help prepare parents for that and give them an idea of how to navigate that process.

Amy: Yeah, I think that you can’t go wrong with overeducating. I really don’t think you can, because this is not a parent’s frame of reference necessarily. They come in with their own specialties and they look at us to be able to use our expertise. It’s important for me to establish that kind of trust, but also to establish that ability to say, hey, look, here’s the law, here’s what it looks like, here’s what you can do, here’s what we can do.

I don’t think it needs to be contentious. It becomes contentious when people aren’t feeling they can trust the situation.

Dr. Sharp: I totally agree.

Amy: I guess there’s a lot of reasons for that.

Dr. Sharp: Sure. [00:15:00] Maybe that’s a nice segue into, what thoughts do you have on how a clinician maybe in my place or the psychologist who’s doing the testing, how would you prepare parents for navigating the special education process or asking for 504 or IEPs, what feels important for them to know coming off an evaluation in private practice?

Amy: Of course, lots of these things could be changing in the coming months and potentially years, but let’s just hope that things stay stable. Just to clarify for your listeners, there are basically two different and I’m taking it slow so I don’t make a mistake and speak about something that I’m not sure about but two different types of supports that schools can provide and this is public school systems.

There are independent school supports that are oftentimes maybe available in specialized schools that [00:16:00] are available for kids with different needs but at the public school level, there’s what’s called a 504 plan and then there’s what’s called an IEP, an individualized education plan. Both of those serve the purpose of supporting kids in the classroom, but they’re very different in the teeth behind them or what they can do for kids and how they’re executed.

So a 504 plan is a general education function, meaning it’s generally supported and executed by the school counselor. Sometimes other staff might do it, but oftentimes it’s the school counselor. It’s not a special education trained individual per se. It’s funded through general funds by the school. In fact, there’s generally no funding underneath a 504 plan.

Oftentimes 504 plans look like what we consider best practices in the classroom but sometimes we have to put some specific things in place. [00:17:00] For example, proximity to the teacher or access to a water bottle during class, some things like that we have to put in place because not every teacher teaches the same way and certain kids respond to certain supports.

Usually a 504 plan, it was originally designed under the Americans with Disabilities Act as a way to support children and teenagers who had a physical disability, like if you broke your leg and you needed to use the elevator, or for example, we have two kids on our practice that have leukemia and they have low stamina and so they have a different schedule and things like that.

So that was originally how it was designed, but now it’s often used for ADHD because ADHD is considered a medical diagnosis. Often used for other kinds of things like POTS or migraine disorders or things like that. That’s how [00:18:00] a 504 plan works. Do you want to add anything to that though? You may have a different perspective on it.

Dr. Sharp: No, I think you nailed it. I will say, usually for kids who have fairly significant anxiety or depression that doesn’t reach the level that it’s truly disruptive to their classmates, I would consider them in 504 territory and often we’ll talk with parents about that.

Amy: Yes, absolutely. Thank you for adding that because I had neglected that part. So absolutely. And then there’s the Individual Education Plan, which is a part of IDEA, which is a federally funded and sponsored program for children with specific learning disabilities; it could be reading, it could be math, it could be writing, it could also be a specific emotional disability that is severely impacting their learning. It could be an autism spectrum related disability that’s also [00:19:00] significantly impacting their learning.

Those do have funding underneath them because generally a staff member is tasked with the responsibility of managing those IEP plans. There are a lot of laws in place that protect them and there are a lot of laws in place that protect children who continue to maybe be chronic disruption and may need to find a different school environment.

So lots of different supports and laws underneath an IEP that gives it some more teeth in the scheme of things but either way, they’re designed to help kids and teachers too. They’re also designed to help teachers to be the best they can be.

Dr. Sharp: Right. Let me ask you, would you provide parents with all of that information that you just shared [00:20:00] with me as they head out to the school? Would you go into that much detail and let them know what they’re in for?

Amy: Well, to back up a little bit, if a family calls me, and this happens to us a lot, I’m sure it happens to you too. A lot of families call and they say, I think that or my pediatrician said my kid might have attention issues or my teacher says my son might have attention issues or we think he’s having some trouble with math and learning, they come with a vague question that they’re asking about.

And so the first thing we always talk about is, okay, well, where are you in school? What have you already explored and done? What do you know? Also I ask, what do you want to come out of this? What is the resulting outcome that you’re looking for? Because sometimes kids that are in certain situations, maybe they’re in a private school, they’re not going to get the kind of supports that they need from that school and they need to find a [00:21:00] different school or whatever.

So we ask all those questions first and in that process, then in that discovery, we do some education around, okay, this is what you could expect from this. This is a place you might want to look at for this. This is something you might want to investigate here. Those kinds of things. So we do that to start with.

We do a lot of education around that as well, especially if it’s a kid with an emotional issue, then of course, probably we’ve already been working with them and we’re at a point where they maybe need an evaluation or we need to work with the school to support an evaluation being done at the school.

Dr. Sharp: Maybe that’s something we could touch on just real quick because I run into some confusion around this a lot, but can you speak at all to what the schools are “required” to do if a parent asks for testing for their kids?

Amy: Right. A school is required currently by law within [00:22:00] 10 days of a written request to convene a meeting to discuss the child. Many school systems call it something different. They call it a child study. They might call it a local screening committee; they have all different kinds of names for it.

Basically, it’s a group of people that know your child and that are familiar with the system in the school, et cetera. They get together with the parents and have a conversation about, okay, what’s going on? Do we see the same things that the parents are reporting? Is this something that we have some concerns about that we may need to do some more investigating?

So there’s a whole big conversation around these questions. Is this something that we might need to look more into or do we need to maybe collect a little more data about what’s happening with that child in the classroom, pay a little bit more attention, put a few more eyes on them, and then reconvene this meeting in, say, 60 days or 30 [00:23:00] days and talk about this again.

They’re obligated to have a conversation. They’re not obligated, necessarily, to do anything beyond that unless it’s agreed by the committee and it is a committee decision, not an individual one. The committee agrees that they will they will then do the testing.

Dr. Sharp: Okay. Let’s jump ahead a little bit and assume, I see a lot of parents who, for whatever reason, they have not had testing through the school or been able to do that and so what I ended up doing a lot is helping bridge the gap between my private practice evaluations and the school, making recommendations that are helpful for school, helping parents take the report and put it in place at school. I would love to talk with you about your perspective on that and we could get into any number of things. Maybe we could start with how is it [00:24:00] to have a parent come in with a private evaluation and make requests about services, how do the schools perceive that in your experience?

Amy: Well, you’re right that for any number of reasons, a family may not be getting tested through the school system. Sometimes they are tested through the school system and the parents still want assessment outside the school system. We are just careful to make sure that they fully understand what it is that they’re asking for and of course, we have to make sure that we don’t give the same batteries that the school gave because we can’t have them get the same test and within a year. That’s a little bit tricky sometimes.

And so what we try to do is we try to make it as collaborative and friendly a process as possible. I guess I’ve been really lucky, I haven’t had a contentious situation [00:25:00] where the school hated us and was so mad at us for doing something. It’s hard for me to speak to that but I will say that we do try hard to make sure that the school understands that the parents requested this additional information and our job is to provide them with all the data and all the information that they might need to do the best job that they can.

We do convey that confidence in them that we know that with this data, they’ll be able to make even better informed decisions about the way they teach. That might be the difference versus, I know some clinicians will go in and say, well, this is the way you have to do it and why don’t you do it this way? This is the way the kid needs to be learning.

Well, it’s a little tough because not every teacher teaches the way that kid needs to learn, and we have to figure out [00:26:00] where is the happy medium. That’s where your classroom observation comes in handy, and we always do a classroom observation because sometimes we find that the way that the teacher is teaching needs some discovery. We have to have some conversations about, okay, well here’s where the kid is, here’s where you are, how can we find that happy medium? How can we help you?

That generally goes fairly well because we go in again with that confidence that we know that you are the experts in education and we’re giving you as much data as we can help you get about this kid. You see how that frame is a little different? The frame around we’re telling you what to do versus we’re giving you more information to do your job even better.

Dr. Sharp: Oh, absolutely. That feels entirely different to me. I wanted to maybe ask you, are there [00:27:00] anything in particular that you use to be collaborative with the teachers aside from just reaching out and saying, how can we help you? Here’s the data, anything else, tips you might have to actually collaborate and get on the same page as school staff during the course of the evaluation?

Amy: I take a two pronged approach to that. I take a short view and then I take a long view because I figure I’m going to be in business for a while and this teacher is probably going to be at Claremont Elementary for a while. I want more kids from Claremont Elementary come to my business.

In the short view, I make sure that I convey that confidence that here’s some more data. How can we work together? How can I help you? I do lots of, yeah, that sounds like a great idea. I love that idea. That sounds terrific. Lots of real positive affirmation.

But then in the long view, I also make some very copious notes for [00:28:00] myself about say, for example, Mrs. Jones, who teaches 3rd grade at Claremont Elementary School. I get a sense of what are the things that she might need. So for example, if she says to me something like, oh yeah, I always have kids every year who struggle with anxiety or gosh, yeah, I always have parents every year who ask me questions about how to help their kids do their homework.

I make a note of that and it’s like a good mom who keeps track of her kid’s Christmas wish list during the year, which I’ve never done, but I do this from a business perspective really well. And so if I come across something that I think that would help that teacher, I’ll send it. I’ll say, hey, Mrs. Jones, I know that when we talked before you mentioned such and such, I saw this and I thought you’d really like it.

Of course, sometimes I do that, even if I didn’t just see it. I know that I can send this thing to them and make that connection but I’m [00:29:00] always doing that. I probably spend probably a good hour a week doing that kind of thing; connecting with teachers and administrators and other psychologists and doing that kind of networking.

Dr. Sharp: Absolutely.

Amy: And then the other thing I do in the long view is I always offer as much education as I can to the school and I do it for free. I’ll do parent workshops. I’ll do teacher workshops. Usually, they’re only 60 minutes. I’m not going to be there all day long, but I will do them and I do them as almost like community service. So I don’t charge. I do a lot of them.

Frankly, it’s a referral source for me. I get paid that way as getting new clients, but also I’m just offering them something that they maybe haven’t had the opportunity to hear in that certain way or that they need to [00:30:00] know or that they’ve been looking for.

Dr. Sharp: How do you initiate those presentations? Do you reach out to them? Do they ask you? What’s the language you use?

Amy: It’s a little bit of all of that. When I first started doing this, I started offering and I would offer it to everybody and anybody. I made a double-sided sheet that talks about the workshops that I offer. It was really easy to get ahold of me and it was easy to schedule. I made it as easy as like no barriers to entry at all. Just made it super easy.

And so I did it enough that then people started to hear that I was doing it. And then I got more and more people to ask for me. Of course, I can say, no. I don’t spend all my time giving it away, but I do make a point of doing several workshops a month so that I’m out in the community and that’s another way that I get to know the school. They get to see my face.

[00:31:00] There’s so many clinicians that we work with, never see the school, never meet anybody there. It makes such a big difference when you have a personal connection and when you’re giving them something that they need.

I’ll tell you, the number one thing a counselor needs every year is an updated referral list on a magnet because every year you move offices and you lose all your stuff and all the referral sources you have from the year before are moved or they are out of business or they’re doing something new. And so now I’m starting to give a mini referral magnet that’s just like, okay, here’s the local child protective services number. Here’s the local community services board. Here’s the local food bank or whatever, because I’m just telling you, I knew from experience every year I lose that stuff because I’d have to move and I couldn’t find it and I wouldn’t have referrals and of course, I’m [00:32:00] on the referral magnet. So that works out perfect.

Dr. Sharp: Right. That is a fantastic idea. I love these very concrete ideas. And that is something honestly, I would never ever guess to think about, but that’s great insight. Thanks. Goodness.

I like these concrete strategies. I like that short view and long view. I will say too, I talked last week in the podcast about the importance of being out in the schools and that gives me a chance to get to know the front desk staff and sometimes the principal because they’re hanging around the main office. And then, of course, the teachers, when I’m in the classroom, that’s a big deal and it’s really nice for me to have that personal connection too because then that helps me know schools better and help the kid ultimately.

Amy: It sounds like I spend all my time doing this and I want to clarify that I don’t. Obviously, I do other things too. If we have [00:33:00] kids in our practice and they’re going to be in a play or they’re having a concert, a lot of times I’ll go to those and of course, I’m going there for the kid, but I’m also going there so I can meet the staff.

I always have cards and I’m like, hey, I don’t tell them who I’m working with, of course, because that’s confidential but I say, hey, I’m working with a few kids in your school and just wanted to say hi and I’d love to offer your staff a workshop on blah, blah, blah. 9 times out of 10, they’re like, oh, that’s great. That would be terrific. When can we get that scheduled? I follow up and boom.

Dr. Sharp: There it is.

Amy: Yeah.

Dr. Sharp: That’s great. Well, I know that, gosh, we have a lot to talk about. There’s so much that we can cover with schools. One of the really important things that you and I spoke about before was making recommendations that are useful and helpful and doable for the teachers when clients come from private practice evaluation back to the school. [00:34:00] Maybe we could jump to that because I think that’s super important and really helpful.

Amy: Absolutely. I was thinking, I know your podcast is designed for people that are in all different varying decisions regarding bringing testing to their practice. So some people who are super experienced already do this, but new people, I thought I would share about the recommendation bank because I think it works really well for me.

So what I have and I’m looking at it right now is a whole pack of files, there’s probably 50 files in this particular file folder. Each one is titled recommendations, and then it says what the recommendations are for. For example, Recommendations ADHD College Age, Recommendations ADHD Elementary Age. They go all the way down; Recommendations for Memory and Test Taking. [00:35:00] Recommendations for Mixed Dyslexia, et cetera.

So when I’m writing a report, I pull the most appropriate list of recommendations. And then of course, I go through them one by one and think about, okay, well, is this recommendation helpful for Johnny at school? Because there’s a section that’s school and then there’s a section at home. And then is this recommendation helpful for Johnny at home?

I also consider, is it realistic? So for example, if I know that a kid goes to a particular school that, I’m trying to think of a good example. Say that I know that this kid needs a lot of extra movement and a lot of extra opportunity to stand up and move around, but I know they go to a super traditional school where all the kids sit in desks, that I’ll make an important point around a recommendation.

I’ll add a little bit to it to say why this is really important so that they [00:36:00] can understand I’m not just saying it just because it’s on my list, I’m saying it because I know this is a must have for this kid. And so I make sure that they’re really good.

I started out giving a whole laundry list of recommendations when I first started doing this because I was so proud that I had such a long list of recommendations because that would, of course, make me so much smarter and better because I was giving all these recommendations and then I realized, no, that’s not really very valuable, just giving a whole big laundry list. It was overwhelming. I was excited because I thought it was so good, but then I realized, no, this isn’t adding value. It’s just adding volume.

I’ve toned that down a little bit, but there are times too and the one thing I was thinking about when we talked before was that there are times that people that are clinicians that have never worked in a school don’t really think through their [00:37:00] recommendations well because there’s sometimes people give recommendations that can’t happen or would not happen or don’t even really make sense.

Dr. Sharp: What are some examples?

Amy: A perfect example was I saw this report two years ago and it was by a clinician who I, and I respect anybody that’s doing this work because it’s a lot to do, but I knew they had not had been in the school and I was specifically keen to look at the recommendations. This kid was a third grader. The recommendation said, the teacher should provide copies of their classroom slides and/or daily lesson plan notes.

I thought, okay, well that makes a lot of sense if he was in 12th grade, if he’s lucky, maybe college, but there’s no 3rd grade teacher that teaches from slides and lesson plan notes. They have a plan but they don’t have that kind of material to give to a kid. That’s a very busy day with lots of things happening and it just didn’t [00:38:00] make sense as far as for that kid and knowing what was realistic for the teacher.

Sometimes you’ll see these recommendations where it says a teacher should be touching base with this child every 10 minutes. Well, okay, yes, maybe someone should be checking in with that kid every 10 minutes, but really, can we tell a school to do that or can we say the school should figure out … What I’ll say is something like, the school and classroom teachers should work together to figure out an appropriate schedule of intervening or communicating with the child to discuss progress, or something like that, because every 10 minutes, that just freaks people out.

And what happens is parents see that I said every 10 minutes and they think, okay, well, Amy said every 10 minutes, that’s what we have to have and when the school’s like, uh-uh, we can’t do that, then it seems like they don’t want to or they can’t. It seems like they’re just being mean and they don’t want to give it to the kid when it’s really [00:39:00] not about that. So then that’s where that contention comes up, I think.

Dr. Sharp: Yeah, I think you’re exactly right. I’m curious, thinking about clinicians and folks who are doing evaluation in private practice, is there any place to look or any guidelines for what might be appropriate versus not appropriate knowing that it could be school and classroom dependent, any resources that you know of that might help bridge the gap a little bit for realistic recommendations?

Amy: I think it’s funny and I feel like I’m preaching to the choir because I’m sure you have the answer to this already, but for your listeners, I think the smartest thing to do is start with some of the basics that you know are important for that disability, important things that would help be helpful, but then you have to continue to do your homework and you can’t stop.

So once you have your file that’s called Recommendations ADHD College Age, when you read research, when you go to the CHADD [00:40:00] organization website, when you go to a conference and you hear a good recommendation, or you do a classroom observation and you see a teacher doing something, a strategy that’s really good, you have to put it in your idea bank right away. You just have to put it right there and you just have to keep building it. It’s like saving money. You have to keep putting the money in, putting the ideas in and then modifying as you go along.

So I look everywhere for recommendations. I will say there are quite a few excellent books on recommendations that you can access through a variety of places. There’s one particular book that I use quite a bit. One particular website that’s excellent is, I don’t know if you’ve ever seen it, it’s wrightslaw.org.

Dr. Sharp: Oh, of course.

Amy: Yeah. So Pete Wright lives in Virginia and he is, for those that don’t know, an attorney and has worked representing [00:41:00] children for nearly 30 years. He was the representative in some big cases and then his wife is a psychotherapist. So he has many excellent recommendations on his website. I reference it frequently and also his book, the Special Education Law book which I have notes all in. I’m looking at it right now and there’s notes and tabs and earmarks and all kinds of things that explain IDEA and all of those kinds of things.

So wrightslaw.org, which is again, an excellent site with lots of good recommendations. ADHD, you can find lots of great stuff on the CHADD website and bp kids, which is bipolar kids, bpkids.org also has a number of recommendations for mood dysregulation in the classroom [00:42:00] and a few other places I’ve seen executive functioning issues in the classroom as well so it’s kind of a hunt and pack.

Dr. Sharp: We’ll link to all of those in the show notes just for those listening who might be driving or running or something. We’ll have those for you to check back out.

Amy: The other book that I like is called The Complete Guide to Special Education. It’s by Linda Wilmshurst and Alan Brue. It’s designed for parents, teachers, and administrators. Actually, this may not even be the newest edition. So there may be even a newer edition. This is 2010.

It talks a lot about all the different disabilities, and the evaluation criteria. And then it has a whole section on guidelines for successful interventions. So lots of different interventions are listed in here that are really helpful.

Dr. Sharp: Fantastic. I have not seen [00:43:00] that one. I’m going to go look it up.

Amy: The thing I missed doing is some of that more of the motivational side of things, understanding some of the things that are barriers to kids that maybe are not necessarily learning related; motivation and depression and anxiety, bullying, those kind of things. I do miss that kind of stuff when I’m doing a lot of educational evaluations, but those are interesting.

Dr. Sharp: Sure. One thing I wanted to ask about before I let you go, and I really appreciate your time today.

I wanted to ask, we were talking just in supervision this morning with my graduate students about how to word things in the report so as to not step on any toes at the school. To just use the right language, I think that’s collaborative and supportive for school counselors and school staff. I’m not sure [00:44:00] if that’s clear or not, but in our reports, for example, I’ll say something like, it’s recommended that parents consult with staff at school to determine eligibility for special education support, and I’ll leave it open like that.

I have seen reports though, where they say, based on such and such diagnosis or disability, first-name kid should be considered for an IEP immediately or something like that. I’m curious, how do you approach that? What are your thoughts on that?

Amy: No, I’m not in the position of telling people what to do. I’m in the position of building teams, not building dictatorships. I would say exactly what you say, which is, it might be something to consider or the family should consult with the school staff to discuss a plan moving forward to support this child. It could potentially be helpful to execute an IEP plan, or something like that, or based on [00:45:00] this child’s diagnosis, they would likely qualify for special education services, something like that, I might also say, if I think it’s an urgent matter.

Also somebody, oh, gosh, now I’m laughing because I think this might have been on your podcast. I was going to say someone gave me this idea the other day, and it must have been you, which is writing a cover letter. Actually, we do that more now than we used to before. A cover letter that summarizes the report.

I know you do it for the referral source which we’ve always done that, but what we’re going to do now, in addition to that is, if there’s a classroom teacher, we’re going to do a brief bulleted strengths and weaknesses kind of thing with some brief strategies on it for the classroom teacher because I know classroom teacher can read a 33-page report. Well, they can, but they don’t [00:46:00] want to, and they don’t have time to so I’m going to try to do some more summaries for them, which I think will be really helpful and I think they’ll appreciate.

Dr. Sharp: Yeah, absolutely. I like that idea. I will do that, actually, not as frequently as I should. We do with the referral sources, like you said, but if parents request a short summary, I’ll give that to them to pass along to the school but now you’ve got me thinking, that’s a fairly not very time intensive task that is pretty easy to put together that would help the teacher.

Amy: Because I figured just like my referral letter, I can have a template and I’m going to make it a little bit more reader-friendly. It’s not going to be like a letter format. It’s going to be more like an infographic, is my thinking about it. I haven’t actually conceived of the whole thing yet, but I was thinking like an infographic that gives you some insights into what this kid can do really well and what this kid needs some support in [00:47:00] and two quick things on how you could support this kid. So that’s what I’m thinking.

Dr. Sharp: I love it. Well, Amy, thank you so much for your time. Before I let you go, two things; one, any other parting thoughts about bridging the gap from private practice to schools or related to anything we talked about today?

Amy: The main thing I’ve been thinking about ever since even I started hearing your podcast was how little we collaborate because so oftentimes we feel this sense of, well, I don’t want to give away business or that person is my “competitor”. I think that’s a big mistake. I think families connect with who they connect with and if we don’t talk about things, oftentimes we get stuck in our mold and we do things the way we’ve always done them, the way we learned in graduate school and this is the way that Professor Z taught me this, and I don’t know any other way.

A lot of times other people do things different ways that are better and we should be willing to hear them. [00:48:00] And so I would say my main thing is to say we should be working together more because we’re here for kids and if we all work together, then the things will ultimately be better for everyone.

Dr. Sharp: That’s a great message. I have to say too, just in the brief time that we have been talking with one another, I think that’s really jumped out about you too, is that you have been really free with sharing information and how you do things. All of this, including our podcast today has got me thinking about how I might do things differently and shift in our practice. It’s really exciting. Like you said, it’s all in the name of helping kids and that’s what it’s all about.

Amy: Exactly.

Dr. Sharp: Well, Amy, thank you again. If people want to get in touch with you or learn more about you or your practice, how can they do that?

Amy: We have a website. It is thewisefamily.com [00:49:00] and they can connect with us there. There’s a link to schedule an appointment with me. I have office hours three days a week and I give away 15 minutes of my time and 15-minute increments as often as I can to talk to families about what’s going on with them and how I can help them. So you can do that on our website.

I have three clinicians that work for me that see kids in therapy and then one that does just testing and assessment. We always appreciate people connecting with us and working together and being part of our family, The Wise Family.

Dr. Sharp: I like that name.

Amy: Thanks.

Dr. Sharp: Yeah. Well, thank you so much. This was great. I really appreciate your time. I think this will be helpful for a lot of the folks who are listening. So thanks, Amy.

Amy: Terrific. I can’t wait to hear your next podcast. Keep them coming.

Dr. Sharp: Thank you. Take care.

Amy: Okay.

Dr. Sharp: Bye-bye.

Amy: Bye.

[00:50:00] Dr. Sharp: All right, everybody. Thanks for listening to that interview with Amy Fortney Parks. Like I said during the interview, I feel like I’ve learned so much just in the relatively brief time that I’ve known Amy. She is so free to share information and she has some great ideas about how to connect with schools, do marketing, build your practice, and bridge the gap between private practice evaluations and the school district. I hope you learned something there and hope that you’re enjoying the podcast.

If you are enjoying the podcast and like what we’re doing here, there are any number of ways that you could help me promote it; you can share it on social media. You can share it on your own blog or your own podcast.

You can leave a review, you can rate the podcast in iTunes or Stitcher or Google play or anywhere you might listen to your podcasts and any of those things will be so appreciated here as I continue to build this and grow and try to develop [00:51:00] this community and resources for folks who want to do testing in private practice.

If you want to find out more or get more resources, you can always head over to the website, which is thetestingpsychologist.com. Check out any number of articles, or past podcast episodes.

If you want to get some guidance or strategies to build testing services in your practice, you can check out the four-week blueprint, which is at thetestingpsychologist.com/fourweekblueprint. And that’s a weekly series of emails over four weeks that’ll give you some pretty concrete ideas for launching or growing testing services in your practice.

So thank you as always for listening. Like I said, this is the second in what’s turned out to be a two-part series on schools. We’ll see what happens next week if we continue that trend or shift to something different but I do know that we have some cool interviews coming up with [00:52:00] Maelisa Hall of QAPrep and with Erika Martinez, a neuropsychologist in Miami who’s now focusing on career enhancement and building the ideal life for 20 and 30 somethings. So we have some cool interviews coming up. Thanks for listening and we’ll catch you next time. Bye bye.

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[00:00:00] Hey everybody. This is Dr. Jeremy Sharp. Welcome to The Testing Psychologist podcast, episode 11.

Hey everybody. Welcome back to another episode of The Testing Psychologist podcast. Today’s a little bit of a different day. We’re going to switch it up a little bit from the prior weeks in that I will just be talking with you by myself here today. I did two really cool interviews over the last few weeks. So if you haven’t checked those out, definitely go back and take a listen.

Today, I am going to be talking with you all about how to do a school observation. I test a lot of kids. I’ve talked about that in the past. And one of the primary components of my evaluations is a school observation.

[00:01:00] I have met a lot of other clinicians and folks doing testing with kids and seems like a school observation is not always part of the package. And so, this has really come to be something that defined our practice, at least here in town. So I wanted to talk with you about what my process is, what makes a good school observation, and how to go about that and integrate it into your evals.

One of the things to consider right off the bat is that there are a lot of really positive aspects to doing a school observation. One of the things that can be just procedurally important is that some districts, I’ve heard this in other parts of the country and here locally as well, but some districts are actually really hesitant to accept outside evaluation results for consideration of special education services or other [00:02:00] school-based services unless the outside psychologist has actually been on-site at the school. So in some cases, you have to do a school observation if you want those outside testing results to be integrated with the kiddo’s 504 consideration or IEP in school services.

Another reason that I really think it’s important to do a school observation is because often parent and teacher reports can sometimes be incomplete or inaccurate even. I’ve found that in many cases over the years, actually, where a lot of the time parents honestly will maybe have talked to the teacher, maybe have some input from the teacher, but a lot of the time, parents don’t really know what happens at school. They don’t know exactly what the classroom setup is like, what the kids do during the [00:03:00] day, or how they’re behaving at recess.

I find this is especially true for kids who don’t necessarily fall in the extreme range for behavior or academic concerns. And a lot of time, those parents are understandably naive about what happens during the day. It’s like this black hole that their kids go into for 7 or 8 hours and then they’re home all of a sudden.

On the other side, teacher reports can also be a little bit, I don’t want to say inaccurate or misleading, but even with checklists, I tend to do the BASC-3, the Vanderbilt, and a variety of other things depending on the presenting concerns. So I get a lot of behavior checklist data but sometimes, as we all know, checklists are not super precise.

I like to go and just get a good sense of what’s actually happening in the classroom [00:04:00] on any given day for that kiddo. I think that’s probably the main reason for me to go into the school is just to give me a much better picture of what’s happening socially and behaviorally in the classroom for these kiddos.

I can think of a lot of examples over the years where I have been in the school and the information that I gathered there just totally alters the course of the eval or really pushes me in one direction or the other with the diagnostic impressions and certainly the treatment recommendations too and thinking about what sort of interventions might be helpful for that particular kid.

I can think of one kid right off the bat where parents were pretty concerned about disruptive behavior in school and at home to a degree, some learning concerns, and maybe some attention issues. And so with this particular kid, I [00:05:00] walked into the school and almost literally walked right into this particular kid kicking the vice principal in the hallway right as I was walking into the school.

I, for better or for worse, got a front-row seat to this disruptive behavior that parents were describing. I got to say to myself, this is really happening. Here we go. And so I got to observe that outburst, which ended up going on for quite a bit of time.  And I got a good sense of what they were talking about and what the school was concerned about.

Also, thinking of that same kiddo, after he calmed down and got back into the classroom, I was able to observe what he’s like in the class. He did have some trouble staying in a seat and paying attention and that sort of thing.

[00:06:00] I can think of many other stories where I’m questioning whether a kid is on the autism spectrum and I’ll make sure to go to the school during a time when I can catch an unstructured time, like lunch or recess, and I will get out there on the playground and be able to see how kids interact with other kids.

Gosh, I had many occasions where I have observed kids spending time by themselves on the playground, walking around alone, counting rocks, or something like that. And that gives me some insight into how they interact with other kids and how they’re handling the social demands.

Now, on the flip side, I have also seen many kids who behave really well in the classroom environment. And then that makes me question, what’s going on here? The parents are [00:07:00] either perceiving things to be really bad or maybe things are just bad at home and not so bad at school. So it can go both ways. It can either push me in the direction of maybe a more significant diagnosis or maybe give me some information to say, okay, things are going right with this kiddo. Not a big deal.

Now, of course, I always check in and see how my observations during the school observation jive with the kids’ history. Was that a good day? Was that a typical day? Was that a bad day? So you always got to check those things out, but getting into the school for a little while can give you some really good insight into their behavior there in general.

The other thing that I think is fairly important about doing the school observation is that it gives me really good information independent of what kind of day the kid is having. It gives me good information about the classroom environment. [00:08:00] And I have found that that can be really important in considering what might be going on for a particular child.

What I’m talking about when I say classroom environment, I mean, it could be basic things like class size, is this a school where we’re more down toward 15 to 20 kids per class or more up toward 30 or above? It makes a big difference. Lets me see what the classroom setup is like. Do the kids work in those little pods- small groups of desks clustered together or is it more rows or a circle or an independent workspace?

Also, it gives me a sense of just what the classroom is like; what does it look like?  Is it clean? Is it organized? Is it chaotic? The population of the class more, are they more energetic as a class, or [00:09:00] is it more of a docile classroom? And all of that just gives me an idea of how this kid might be functioning in that particular classroom. And that can make a really big difference.

Another piece of that is teacher personality, classroom management, and how they handle different kids behaving well and misbehaving.

So there’s a ton of good data that can be had just from sitting in on the classroom for a few minutes. And you get a sense of that pretty quickly, I think.

Another thing that I like about a school observation, on a very basic level, it just gets me out of the office, which is really nice. I don’t know if you call that self-care or just variation or work satisfaction, but it was really nice to just get out of the office for a little while and get out and drive around. I can listen to podcasts and just get out in a different setting.

[00:10:00] Another thing that I think is a huge advantage, actually, two big advantages of doing a school observation. One is that parents absolutely love it. Every time, if parents, for whatever reason are not aware that I typically do a school observation, when I talk with them about it, they are so excited to know that someone is actually going to go see what’s going on at school.

I’d say the majority of kids that I work with are parents that bring their kids in. School is a part of the concern. And so, they’re just super excited to have me go out and check things out there in the school environment. And like I said earlier, at least in our town, this has become somewhat of a defining feature of our clinic, I think. As far as I know, other folks are not doing this. And that’s a nice feature to set us apart.

That leads me to the last element that I think [00:11:00] is pretty important about doing a school observation, and that is the marketing element. You could also call it networking or just building relationships, but having done this for several years now here in our community, I am, I wouldn’t say on a first-name basis with a lot of teachers or front office staff, but I am really familiar with a lot of the school staff around town, and that has been a huge asset in building our practice and getting referrals.

Having some familiarity and positive energy just from being out and about in the schools and being visible, I think is a really big deal. Teachers seem to appreciate it whenever I come out to do the observations. The administrative staff really appreciate it just to know that as a clinician, I’m invested to that degree in really [00:12:00] helping the kiddo and figuring out what might be going on.

However you think of that as marketing or relationship building, either way, I think it’s really important and has been a nice byproduct of being out in the schools. And that works back for me too because then I have knowledge of each school’s environment: what the administration is like, what the teachers are like, the community, and what different schools look like.

And then that can help me to make recommendations to parents because parents are often asking me what schools should my kid go to? Where’s the best fit? What’s his learning style? How will that fit in here in the district? So it works both ways. I think it’s a really cool thing to have those relationships in place with the schools.

In terms of the actual process of doing a school observation, I thought I could talk about that a little bit. I’ll just get into some of the nitty gritty here assuming that [00:13:00] some of you might be listening and want to say, okay, I want to put some school observations in place. How do I do that?

So this is just my process. This is what I’ve honed over the years and settled on from doing this for a while.

It starts right off the bat with parents from the initial phone call. When they call asking for an evaluation, we walk them through the process and say, first we’ll do an interview, the next step is a school observation, then the kid will come for testing, and then we’ll do feedback. We mention it right off the bat, just so parents are aware, hey, this is going to be part of the process. Let’s get prepared for this. And this is something that you can count on.

Once they come in for the initial interview, I also talk with them again about the school observation. So, during the interview process, I’ll walk them through and give an overview of the rest of the evaluation. And part of that is [00:14:00] always talking about the school observation.

So what I will say is, okay, now that we’ve done the interview, the next point of contact with your kid will be an anonymous school observation. I typically go to the school before I meet the kid for testing so that I can remain anonymous and hopefully not influence that kiddo’s behavior in the classroom knowing that someone is observing them. So I try to remain anonymous.

I always say to parents, I will go in. I assure you, no one will know that I’m watching your child aside from the teacher. None of the other kids know, none of the parents know, nothing like that. I tell them that what I typically do is I just go in, our district here allows me to stay for an hour at a time usually, so I stay for an hour. I always try to catch an academic period and an unstructured social period if possible, and if relevant. I typically just sit in the back of the classroom, don’t take up too much space, and don’t [00:15:00] disrupt anything. And just try to get a sense of what’s going on in the school environment.

I also tell the parents that we take care of the scheduling. I have that go through my admin staff and I’ll talk you through what that looks like here in a minute. But as far as parents are concerned, I say, if you could just give the teacher a heads up, give the principal a heads up if you’re close with that individual, and that can often help the process go a little bit more smoothly when those folks know that I’ll be getting in touch with them.

So that’s what I present to parents. I also have to talk with them about the billing aspect. So if any of you are maybe doing evaluations and are saying to yourselves, but we take insurance. Does insurance cover that? Well, the answer is usually not. As best I can tell, going into the school, it’s a different location [00:16:00] setting on your claims. I think that 03 is the service location code. A lot of insurances don’t cover it.

I’m just upfront with parents. I just tell them that I do charge a flat hourly rate for the school observations. I include any travel time. 15 minutes or less one way I do not charge for. If I have to drive over 15 minutes one way, I do charge an extra $100 to cover travel time. But I do tell the parents, I’ll submit this and try to get reimbursed for the school observation, but usually, insurance doesn’t cover it and that’s going to be about an extra $100 to $150. And most parents don’t even bat an eye at that. They’re actually pretty thankful and they say, that’s totally a worthwhile expense [00:17:00] to add on to get a sense of what’s going on in the school environment.

After I’ve talked with the parents and we get on the same page, this is getting into some of the procedures of our clinic, but we have what we call an interview follow-up form. And on that form, I will mark the school and the teacher’s name and what kind of time I would like to observe at the school or what setting or what class.

And then my admin staff sends an email to the teacher or makes a phone call to the teacher and says, “Hey, I’m contacting you on behalf of Dr. Sharp. We’re doing an evaluation and working with one of your students. We typically conduct a school observation as part of that process. Could we find a time when Dr. Sharp can come by for an hour or so? He typically likes to see an academic period as well as an unstructured time like lunch or recess. Are there any times in the next week or two that [00:18:00] could work for you to have Dr. Sharp come by?”

So, just shoot out an email like that to the teachers. I found that they are very responsive. A lot of teachers are totally willing to have me come. It’s very rare that that does not work out and I’m not able to get into a school.

In terms of the nuts and bolts of scheduling, I think that’s important. School observations can take up a fair amount of time. Like I said, I’m there for an hour and usually, I’m driving 5 or 10 minutes to get there, at least. Sometimes I will go to neighboring cities and it might take up to a half-hour or an hour each way, but it can be a big chunk of time.

So what I do, I think I’ve talked in prior podcast episodes about the schedule that I’ve set out for myself to do evals and make sure that I’m making the most of my time. If you don’t remember that, or haven’t heard that, or maybe I haven’t said it, [00:19:00] I’m not sure. The schedule that I keep these days is, I do a week of what I call on time, where I see people face to face from about, for me, that’s 7 AM to 3 PM doing interviews, feedback, testing, one on one meetings, that kind of thing. So face to face time with clients.

And then I do an entire what I call an off week where during that week I do administrative tasks here in the practice, I write reports and I do school observations. So during those off weeks, I basically have a blank slate where I just block out big chunks of time to get out and do these observations and also have big chunks of time to write reports.

That works for me really well. It also allows me to stack my school observations all on the same day or maybe two days. I tend to do maybe 4 to 6 a week, something [00:20:00] like that, during my off weeks. I also have my admin staff always try to schedule the school observations in close time proximity when they are geographically close.

That was a really complicated way to say something that’s pretty simple, which is schools that are located near each other, I try to stack on the same day and do them back to back. So I’m not driving all over the place. That’s relevant for me. Like I said, I can sometimes go to neighboring cities that are pretty far away. So, I usually try to line those up and just make it efficient in terms of driving.

While I’m thinking about that, I’ll just throw in a little side note that there are a lot of apps out there that can help you track the time and distance that you drive for work. Right now I’m using one called Everlance. I think mile IQ is another popular one. So like I said, just a side note, you [00:21:00] could check those out if you need a mileage tracker. And that’s right on your phone. A lot of them do automatic detection of trips. So soon as you start moving, they’ll start to register a driving trip and then you just classify them as you need to.

After I get the scheduling worked out, then I want to talk about the whole process of actually doing the school observation. So once I get into the school, I think it starts right from the very beginning. Again, that relationship building or marketing piece where I’m very nice to school staff.

The front desk staff are often fairly protective of the students. So I get a lot of, “Yes, who are you? Uh-huh. And what are you here for?” That kind of thing. At the risk of generalizing quite a bit, it’s a little bit of that Mama Bear [00:22:00] kind of mentality, which is totally understandable.

So right off the bat, I’m really nice. I say, Hey, I’m Dr. Sharp. I’m just here to observe one of your students in such and such as classroom. Would that be okay? I’ve already arranged it. I think that person knows I’m coming. Is there anything you need from me? So just try to be disarming and courteous and nice and just know that they’re just doing their job.

You often have to sign in and all that stuff. Often, I will get an escort back to the classroom. Someone will walk me back to the classroom. And that’s always a great time to just make some small talk and try to connect with that person, whoever it is in the front office. Sometimes it’s the principal or vice principal. So that’s a great time to just make some small talk and try to build some of that relationship.

Now, once I get in the classroom, I’m very courteous to the teacher as well. Right off the bat, “Thank you for letting me come.[00:23:00] I’m just going to sit here in the back. I don’t want to get in your way. Let me know if I need to move or if I get in your way in any capacity.” Teachers are usually great. I end up sitting at a lot of teachers’ desks which is fun. They tend to have really nice chairs.

So I will sit in the back of the room, make sure that I can see the kids’ faces. Depending on what grade I am observing and how old the kids are, they may come up and talk to me. They might ignore me. That’s more of a middle school thing. They might be super interested. They might not.

Some teachers handle it differently. Some will announce me or introduce me right off the bat. I always tell them, whether they introduce me or I introduce myself, I always just say, Hey, I’m here to just observe your class and see how your school works [00:24:00] and get a sense of what your teacher is doing and how things are working here. And that usually pacifies the kids. They forget about me pretty quickly.

I take notes on my computer at this point. So I just take my laptop out and will put it on the desk or put it on my lap. I like to take pretty detailed notes while I’m doing the school observation. So there are a few components that help make that possible. One is that I am very descriptive in terms of, well, certainly classroom environment and what the activity is and things like that.

I always note what subject they’re working on, what time of day it is, and how long they work on a particular activity or subject. And I’m taking some type of note, at least every 30 seconds or so. I think [00:25:00] that, again, if you’re submitting the school observation as part of your eval report, it’s really helpful to structure it like the school psychologists do their own evaluations. And those are pretty detailed and contain a lot of standardized information.

So as I’m in there, I’m looking at a lot of different things. I’m always noting, again what the kids are doing, how long they’re doing it for, when they transition, all those pieces, I’ll record on my note.

I should say it’s okay to move around the classroom. Of course, try not to disrupt anything or bother anyone, but I’m totally okay moving around, just making sure that I can actually observe whatever kiddo I am trying to get a handle on.

In terms of the things that I actually pay attention to during the observation, [00:26:00] of course it varies depending on the referral question. So if we’re talking about ADHD, of course, I’m looking at the activity level, distractability, organization, impulsivity, things like that. Social skills are a big one. I’m often trying to figure out how kids are interacting with other kids.

As I’m paying attention, not just to the specific kid that I’m evaluating, I tend to watch the other kids almost as much as the “target kid.” That gives me a good idea again, of what’s this classroom environment, what’s the culture like. And I think sometimes as clinicians, if you don’t spend a whole lot of time observing kids in a group or haven’t spent a whole lot of time around kids, I think kids can act really different in the testing environment. It’s a fairly [00:27:00] structured situation and it’s novel and it’s not distracting, all those things.

I can sometimes get wrapped up in thinking that kids are either really, really good in the testing environment or not so good in the testing environment because I just don’t have other kids to compare them to. So being in the classroom, I always check out the other kids and see what they’re doing just as much as the kiddo that I’m observing.

So I look at things like, are they paying attention? Do they seem focused? Do they seem on task? Are they off task? If they are off task, how much? What are they doing? Are they getting up? Are they wandering? Are they blurting? Are they interrupting? Are they engaging in actual misbehavior or disruptive behavior like the little kid that I described earlier? So I’m paying attention to all those academic pieces.

If I can, I try to get a good sense of how fast they’re working, how efficient they [00:28:00] are. Are they finishing their work at the same time as other kids or are they lagging behind? Do they take longer to transition or are they more efficient with their time and straightforward? All these pieces are pretty important with what you’re actually observing. 

Now, specifically, I use a hash mark system on my notes. So if I observe one behavior, let’s say it’s interrupting, I’ll just write interrupting and then make a series of hash marks every time that happens. And then I pair that with the timeframe that the behavior happened in. So then when you go to write the school observation up in your report, you can say something like, first name was off task 10 times within an 8-minute span during a group reading activity, for example. So just a little bit more of an efficient way I think to mark off [00:29:00] behaviors that are happening.

I’d imagine some of you out there maybe even have a spreadsheet or something super organized to do this. I don’t have that right now, but that could be a good idea. So I’ll just take note of all those behaviors. I like to go out to recess and to lunch, like I said earlier, to catch an unstructured time and just pay attention to, are they socializing with other kids? Are they doing so appropriately? Do they have friends? Are they up in people’s space? Are they not? So there are a lot of things to pay attention to.

I should say too, again, that theme of being kind to school staff, when you’re out on the playground, you again, can get some of that protectiveness from school staff. Playground staff will be out there. I get a lot of, “What are you doing here? Why are you here? Who are you watching?” Stuff like that.

So [00:30:00] again, courteous. Make some small talk. Of course, I always try to protect confidentiality as much as I can. I’ll just say like, I’m observing a student. I’m in private practice. I’m a psychologist. I work with kids and see how they’re doing in school. I leave it at that. I don’t make it super clinical or formal or anything, but I do try to make some small talk and continue to build relationships there with any school staff that might be out on the playground.

Now, as the observation is wrapping up, I always try to catch the teacher’s eyes. I say thank you again. Slip out quietly. Try not to disrupt.

Often, during the course of the observation, I’ll at least get a second of the teacher’s time. So they might come over or maybe we’re walking down the hall as the kids walk to lunch or something like that. And I always check in and just say, Hey [00:31:00] anything that you would like to share with me? Anything that feels important for me to know? What else is on your radar? Stuff like that just to make sure that I touch base with the teacher a little bit and get a sense of what they feel is important. I think that’s really big.

After you leave the school and get back, like I said, I take notes on my computer, so that all goes to our HIPAA-compliant Google Drive cloud-based records so I can have access to that whenever I need it. And then it’s all about integrating that school observation info into the rest of the report which is up to you and how you might pursue that. I just do a pretty big written paragraph or two in the section of my reports where I do the interviews and observations. I’ll just put it in there and make it available for [00:32:00] anyone who’s reading that report.

I often find it interesting doing feedback sessions. Parents can be really curious about what happens at school. They just like to have a sense of my thoughts and my opinions and what I saw. Like I said, it’s almost like this black hole or something where kids go and parents don’t often know what happens there, which I would say is definitely true for me. I, to be honest, have very little idea of what my kid is doing in school all day long. Even though I’ve done some observations there, it’s still hard to picture sometimes. So I think this is valuable.

Doing a school observation can be valuable for parents, can be valuable for teachers, certainly is valuable for me from a clinical perspective. It gives me a lot of great information to integrate into the report. And like I said, there have been several, I mean, more than I can count, situations where the school [00:33:00] observation and the info I got there really influenced the diagnostic picture and helped me tailor recommendations. I think that’s a really big piece.

For those of you who work with a lot of kids and submit eval reports to the school, I’m sure you have heard at one point or another, something about how to make your recommendations helpful. Are they realistic? Can the teachers really do this? Something along those lines.

And it’s been my experience that doing a school observation really helps with that and gives you some credit as an outside evaluator to where you can say, yeah, I have been in the school, I know what this classroom looks like. I’ve seen this kiddo and I’ve seen the classmates. Here are some things that I really think could be helpful and hopefully doable in the classroom.

So those are my thoughts on doing a school [00:34:00] observation. I would love to hear from any of you about your own strategies for school observations. If there’s any discussion to be had around this, that would be super valuable. Always looking to incorporate any new strategies or techniques or tips during any part of the process, but this is the way that I approach it. And like I said, I think it’s been something that’s been really helpful and a defining feature here of our evals here in the community. So I will stick by them. I think they’re helpful.

Now, this is likely going to be the first in a series of probably two episodes where we’re talking a little bit more about the school environment. 

Today we talked about school observations. Next week, I’m excited to, I’m trying to line up the interview, I think it’s going to work out, but I’m going to be speaking with Dr. Amy Fortney Parks- a psychologist out on the East Coast in Washington, DC. [00:35:00] We’re going to be talking all about integrating recommendations from an outside evaluation with the school and with special education services. Amy has experience as a school psychologist who’s now in private practice. She’s going to be talking with us all about how to bridge that gap between a private practice eval and making recommendations for the school that are doable and helpful and not overwhelming.

So hope you might tune in and listen to that one. Like I said, hopefully coming up in a week. I think we’re going to get the interview time worked out. So look forward to that.

Thank you as always for listening. This has been awesome. It’s really cool to see the podcast continue to grow and to see our Facebook community continue to grow. You can search on Facebook for The Testing Psychologist Community. We are adding members every week and having some cool discussions about technology, [00:36:00] testing and private practice, and different aspects of the evaluation process in the business there.

If you like the podcast, there are a number of ways that you can support it. You can certainly like it or rate it or review it in iTunes or wherever you listen to your podcast. You can share it on your Facebook page or on your blog or on your own site. You can also just tell your friends and find any colleagues or peers, anyone that you think might enjoy or benefit from the podcast. I’d be super grateful here as we continue to grow if you take just a minute to share the podcast with them.

As always, you can go to our website, thetestingpsychologist.com, and you can find articles, resources, and past podcast episodes. And [00:37:00] if you’re interested in really growing your testing services, you can check out my four-week blueprint, which is a four-week strategic plan to add or grow testing services in your practice. You can find that at thetestingpsychologist.com/fourweekblueprint. 

I think that is it for today. So thank you again for listening. Talk to you next time. Bye-bye.

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Dr. Sharp: [00:00:00] Hey everybody. This is Dr. Jeremy Sharp. Welcome to The Testing Psychologist podcast, episode 10. 

Welcome everybody to another episode of The Testing Psychologist podcast. I’m excited to be talking with Dr. Megan Warner today.

Megan Warner, PhD is a clinical psychologist and the owner and founder of Guilford Psychological Services, in Guilford, Connecticut, a practice that’s currently in the process of being developed. After running her private practice for a number of years, Megan saw a need to form a central location where individuals throughout the region could find compassionate, nonjudgmental, and scientifically-driven providers that offer high-quality individual and group support to help people find and reclaim themselves and build the lives they yearn to have.

Guilford Psychological Services expands upon Megan’s thriving private practice and will offer individualized, high-quality, high-end support, informed and designed by science. In her practice, Megan specializes in trauma, mindfulness-based approaches, perinatal and postpartum mood and anxiety, and collaborative therapeutic assessment, which we’ll be talking about today.

In addition to running her practice, she is an Assistant Clinical Professor in the Department of Psychiatry at the Yale School of Medicine. She is also a wife and a mother to two young children.  

Megan, welcome to The Testing Psychologist. 

Dr. Warner: Thank you so much for having me. I’m so excited to be here. 

Dr. Sharp: Yeah, of course. I have to ask right off the bat doing that introduction. When you tell people that you work at Yale, how do they respond? 

Dr. Warner: If I tell people in like Arkansas that I work at Yale, they think that’s amazing. But if I tell people up here in Connecticut, that I work at Yale, that’s the most ordinary thing you could ever hear up here. [00:02:00]”Why are you telling me that?” is their response, and “What about it?” Everybody works at Yale up here. That’s the position, although it’s great. It’s wonderful. 

Dr. Sharp: Sure. It’s all relative, I suppose.

Dr. Warner: It’s all relative. Not everybody works at Yale, but it’s a lot of therapists and a lot of people have shared appointments or do a lot of things because it’s nice to work over there. I love it. 

Dr. Sharp: Sure. That sounds great. I have to admit, I had a little employment envy reading that description.

Dr. Warner: I should say, I volunteer. Let’s call it voluntary, but I get access to the library. There are all sorts of perks they give you, so it’s good.

Dr. Sharp: That’s worth it.

Dr. Warner: Yeah, it’s totally worth it. It’s good. 

Dr. Sharp: Fantastic. Well, thanks for coming on the show. This is, like I said, really exciting. We are going to be having a chat about therapeutic or collaborative assessment, which is something that you have integrated into your practice over the years. I’ve got lots of questions for you, but maybe we could just start with how you got into assessment and decided to integrate that into your practice in the first place. 

Dr. Warner: I’ve always liked assessment. I’ve always liked data, numbers, how things look statistically and how they match, and how we experience them in our lives.

And so what drew me to the field in the first place was the study of personality. So I was at The University of Iowa learning about personality. And that’s what really sealed my desire to go into the research side of psychology for a while because personality measurement is really interesting.

So, my background was at first in personality. And so, when I was looking at grad schools, I was really drawn to places where I could continue measurement and look at measurements and also develop my clinical skills. So on the scientific side, I liked that measurement side and it goes so nicely [00:04:00] with clinical work when you can use it in a way that you can marry the two.

Dr. Sharp: Absolutely. So you specifically look for graduate programs that integrated more assessment into the training, is that right?

Dr. Warner: Yeah. The advisor that I was drawn to… I ended up going to Texas, and the guy that I ended up working with, his name is Leslie Morey, and he’s fabulous. He wrote the PAI. When I found that school and knew I had the chance to be working with them, I was pretty excited because the PAI is a great measure. It’s a clinical measure. You get some personality data from it. And so that was the draw. And then obviously once you’re working with someone who developed a measure, you get a lot of measurement experience. And so, it was great.

Dr. Sharp: Yeah, absolutely. Wow. He was an author of the PAI. That’s incredible that you got to work with him.

Dr. Warner: Yeah, he’s incredible. I was very lucky. 

Dr. Sharp: That’s great. So, just in case, for anyone who’s listening who might not know, the PAI- Personality Assessment Inventory is one of the, I’d say, major personality assessments for adults. There’s an adolescent version as well. Right, Megan?

Dr. Warner: Yeah, it’s a great clinical measure. So you get things like depression and anxiety. For example, the depression scale goes into subscales like cognitive signs of depression and affective symptoms of depression, physiological. Most of the scales are like that where you can break down something that feels like a diagnostic issue into their subsets. And there’s quite a bit of personality data mixed throughout. You can take it online. It’s great. It’s like a rival to the MMPI, so people that use the MMPI can also check out the PAI.

Dr. Sharp: Right. I know everybody has their preferences in what measures they use.

Dr. Warner: Certainly.

Dr. Sharp: And I actually, with all the testing that we do here in our practice, I switched over to primarily using the PAI probably [00:06:00] 18 months ago, something like that. And I really like it. I think it serves me.

Dr. Warner: Do you like it? 

Dr. Sharp: I do really like it. We can always dig into the nuts and bolts of different assessment measures, but I like it because it feels a little bit more accessible to me than say the MCMI-IV, which is my alternative personality measure. It just feels a little more easy to read, and like I said, maybe more accessible or personable, if that’s a better way to describe it.

Dr. Warner: Totally. I say, good choice with the PAI. 

Dr. Sharp: Yeah. You’re not biased? 

Dr. Warner: No, not at all. 

Dr. Sharp: I was going to ask why you use the PAI, but that answers that question. So, let me go back a little bit and just talk with you. Our topic for today is therapeutic assessment or collaborative assessment. So can you just speak a little bit to what that is and how that might be different than a typical evaluation or assessment? 

Dr. Warner: If you think about a typical assessment, the traditional approach is, we’re hired by a parent or a psychiatrist or primary care or a client comes to us saying, so, and so says, I need to be assessed, I need a neuropsychological assessment or I need a diagnostic assessment.

So the client comes in a position of seeking our expertise and our authority, but it’s certainly not an equivalent dynamic in any sense of the word. So traditional assessment, there’s a little bit of a power differential or a lot of a power differential depending on who’s doing the assessment. And the goals are to diagnose, or treat, to increase understanding, but it’s not usually a collaborative process. Obviously, the assessment process involves two people or more, but it’s not necessarily a therapeutic assessment or a collaborative assessment.

The idea is that you’re working with the client to try to answer questions or to try to give them something that’s positive as a result of the [00:08:00] assessment. So really it’s kind of like who the client is, is shifted. The client isn’t necessarily the psychiatrist or the teacher or whatever the client really is. The client who’s coming in to be assessed. What can you give them when you’re generating data and you’re also of course generating the data that you can use for a bigger assessment measure. But the idea is that assessment in itself, that assessment experience can be something that is positive and therapeutically may help the client have some positive impact on their life. 

Dr. Sharp: I really like how you put that phrase of the focus. The client shifts from being the referral source to the actual person who you are working with, which makes intuitive sense, but, you’re right, that’s not always how it works out with traditional evaluations sometimes.

Dr. Warner: Right. The idea is that we say, okay, well, I’m an expert on this test. Sure, I’m an expert on the PAI at this point in my life, but who is the expert on the client really? It’s the client. So, we really just put our trust and that just is a spirit of equality, which I think is really nice for the clients because it’s really intimidating to come in and get assessed. And if they think that you’re working for them and with them, instead of like, oh, I just want to evaluate you. You’re a set of numbers. I’m going to write a report on you. It’s scary. And it’s not really so direct. It’s about them, but it’s not immediately clear how they’re going to gain from all that data. 

Dr. Sharp: I couldn’t agree more. I have so many folks who come into the office and one of the first things they say is some variation of, we’ve never done this before. I don’t know what this is about. Finding some way to voice their vulnerability or apprehension about being there. And we don’t get a great representation in the media, I think, especially with assessment and evaluation. It doesn’t typically look good. So, this is really important. 

Dr. Warner: That’s exactly right. And maybe you may want to try this. I’m hoping that a lot of the people that’ll listen [00:10:00] to this will give this a shot. When you have somebody come in and you say, okay, well…

The main therapeutic assessment idea is that you say, well, what 3 or 4 questions do you have about yourself? What do you actually want to know? And when clients can say, well, like, gosh, nobody’s actually ever asked them what they want to know about themselves. When you’re going for an assessment, you’re deferring to the expert about what you should be knowing about yourself. So if you ask the client, Hey, what have you always wondered about yourself and what feedback are people giving you about how people say you are, how people say you function? Usually, people will say, “Well…”

I have two cases that I can sprinkle in through here. And a good example is, I saw somebody years ago whose parents had said, you’re so angry all the time. And so, one of her questions was, I don’t feel like I’m so angry all the time. Am I so angry all the time? And as it turned out, she was just extremely introverted and painfully shy and her parents had been misconstruing this shyness.

So she had a question. It was a really easy question to answer with the assessment. And she was able to bring them the assessment report which was tailored to her questions and they healed a rift. They came to understand that it wasn’t anger at all. She was just not really that verbal and preferred to be alone.

Dr. Sharp: Oh, I love that.

Dr. Warner: Yeah. And there are a lot of stories like that. It’s really empowering to the clients. I should also say as we talk about this, just to add that therapeutic assessment, collaborative assessment, I’ll probably suggest you put a book on your show notes, right?

Dr. Sharp: Yes.

Dr. Warner: Okay, perfect. A really good book is this book called In Our Clients’ Shoes, which talks about one type of therapeutic [00:12:00] assessment. So the idea of therapeutic assessment with “ta” is it’s a spirit of having an attitude that assessment is more than just collecting information and that we want this to be a positive experience for our clients, but therapeutic assessment with “TA” is a semi-structured approach that has been developed by the guy, Stephen Finn. He’s this like really cool guy. He’s at the University of Texas at Austin. And that’s why I suggest whoever is interested in this to pick up this book In Our Clients’ Shoes.

I’m going to talk about his approach, which is a semi-structured approach of how people come up with their questions and how it works. But in the interest of full disclosure, they do have a certification process, and I don’t want to convey that I’m certified in it. They have a credentialing process. I was trained in it. I feel pretty competent. I feel okay saying I know what I’m talking about, but I’m not technically certified as some of these things have a certification process.

Dr. Sharp: Sure. Yeah, of course. I appreciate that disclosure. So let’s dig into maybe some of the nuts and bolts of this. I’m interested, of course, in the business aspect of it and how you added it to your practice, marketed assessment service initially, got clients, how much you charge for an assessment like this, that kind of stuff. And then, maybe we can transition and talk about what it actually looks like in the room and the experience with the client, that kind of thing.

Dr. Warner: That would be great. Well, I will follow your lead and answer whatever you want.

Dr. Sharp: Great. Well, let’s start with, how did you initially add these assessments to your practice? How did you make time for them? How much time is required? How long’s the report? All that kind of stuff. 

Dr. Warner: Well, when I opened my practice, this was always going to be part of the practice. So this has been [00:14:00] something that has been present in my practice from the get-go because I think the value is so great and it’s really great for new clients. It establishes a collaborative relationship from the start. So it’s always been part of the practice.

How much time I allot for them, usually the assessments I use can be done by the clients at home over the internet. You’ve probably seen this with the PAI. There’s software and you can actually send people the link. I use a few other measures. So I don’t need to allot a tremendous amount of time luckily, because I’m not having to supervise people actually filling out the items in my office. But I would say, a good therapeutic assessment, a good collaborative assessment probably takes maybe 2 to 3 hours total. I probably take longer than I need to conceptualize and look at the numbers and data. I could probably be faster, but I’m a little bit fussy. But I’d say2 to 3 hours a time. 

Dr. Sharp: Okay. So that’s a fair chunk of time, I suppose. Now, do you structure it so that you have time set aside each week to write the reports, or do you just fit it in between your appointments? How does that work? 

Dr. Warner: I don’t have a set amount of time. I don’t have a report writing time. I try to keep my caseload to a number that’s manageable for me. I set aside Wednesday afternoons and Fridays to do administrative things. So that’s where that would fall. Wednesdays and Fridays are the designated writing time and phone call time and catch-up on note time.

I’m not doing more of them than I can handle. So I’m not in a situation where I’m having to kill myself finding time because usually that Wednesday afternoon or Friday time is enough for what I have on my plate. That’s a tenuous balance. I’m working on it.

Dr. Sharp: Nice. Oh my gosh. Yes. No, all too well.

Dr. Warner: Yeah, exactly.

[00:16:00] Dr. Sharp: Okay. I am curious, is a therapeutic assessment something that you would do with your existing clients, like in the middle of a course of therapy, or is it more of a one-off service that other clinicians might refer to you to work with their clients? How does that work? 

Dr. Warner: Both of those. If I had it my way, and I just haven’t made this happen, I would actually do it with everybody that comes in because you have an idea of a case, and it’s so helpful to flesh out your conceptualization. Sometimes I’m just wrong, but for efficiency’s sake, I haven’t done it with everybody that comes in.

Where I trained in grad school, towards the end of my grad school career, we did start doing it with everybody that came in, which was wonderful because you start the therapy process with a lot of data, but at this point how I’m doing it is, sometimes I do it with clients at the start. If I feel like people are really struggling and they know something’s wrong, but they don’t know what’s wrong, and they really have no idea, but they want to figure it out, sometimes that’s a good time to offer it because it’s like, well, why don’t we bring in some numbers? Let’s do an assessment.

Usually, people think that sounds fun and interesting, especially when I say like, what questions do you have about yourself? Because then it doesn’t feel so scary. They know they’re going to get something great out of it. But I do sometimes also introduce it in the middle of therapy because I get stuck with clients just like we all do. And sometimes I think like, there’s something else going on, but I can’t figure out what it is. And so sometimes then I’ll suggest like, have you ever done any assessment? Maybe we should try. I have this really great approach and we’ll answer questions you have about yourself or questions we have about the work. Like that’s where sometimes I’ll say, what about this? Maybe we have a question about this.

But then it can also be a one-off like people can just come in. There’s just value in having the assessment. There are positives that can come from people coming in just for 2 or 3 sessions. And then [00:18:00] also, psychiatrists, other psychologists can send clients that they’re stuck with to me. So, there are a number of avenues in which they come in. 

Dr. Sharp: I like that part that you said about people are just curious and if you frame it like, what do you want to know about yourself, that’s a nice way to open the process.

Dr. Warner: Totally.

Dr. Sharp: So, with the referral process, I am curious about that. How do you get the word out so to speak that you do these assessments and let others in the community know that they can refer their clients for a therapeutic assessment?

Dr. Warner: Well, when I started my practice, I was marketing more. I’m not doing so much of that now, but when I would talk about what I did, I would say, oh, I do this really neat assessment approach which is called therapeutic assessment. This is an approach where we can find out more about clients, where they feel really safe and they get this feedback report and it helps, especially if you’re feeling stuck or you can’t figure out what’s going on with the client.

So with other therapists or psychiatrists, I tended to lead with, “If you’re confused about what’s going on, this is a great way to clarify for both you and the client.” That was a good marketing hook. And then one thing I would offer, and usually other therapists find this very exciting because I’m not trying to take anybody’s clients.

Like you can sort of say, you can come for the feedback session. If you have a really good relationship with a therapist, clients may want to bring their therapist with you for the session where you discuss the results. And the therapist can also be involved in the questions. They can help designate that. I should just say, usually people are very excited by that. That seems really fun.

There are 2 psychiatrists where I just said, listen, just send me somebody you’re stuck with. This is a low investment for me to do 1 or 2 assessments for people just so they can see. And in that case, then they can just send somebody over for a 2 or 3 [00:20:00] session meeting. And then I write the report, and I think the rest is history because they see how valuable it is. 

Dr. Sharp: Mm-hmm. I love that line. Send me someone you’re stuck with. 

Dr. Warner: Yeah. Because we all have those, right? We all have those.

Dr. Sharp: Of course. That’s great. So let’s talk a little bit more about what this actually looks like with the client. So how do you tend to structure your feedback sessions once you’ve given the PAI and have the report ready? 

Dr. Warner: Well, the first thing is, before you even get to feedback, you have to help them construct the question. So the key is really in helping clients come up with questions that are answerable by the data. And almost any question can be reframed. That is something that is answerable depending on the assessment measures that you use. And obviously, you tailor the assessment measures to the question.

So there’s a couple of things. I’ll give another example case that was an interesting one. I saw someone who was, yeah, so I think this is a fun one. I saw somebody who was really high functioning professional, felt really healthy, felt really good about her life, solid marriage, and a good relationship with their kids. We’re modifying a couple of little details in here just to de-identify it. But mainly the questions were, I feel like I’m really healthy. I’ve been in and out of therapy. All my therapists say I’m healthy. I feel pretty good. Am I as psychologically healthy as I think, was one question. That’s a good one. Is my approach to life in terms of relationships as healthy as I think it is?

If you think about the PAI, there are some measures of relationships in negative relationship history and impulsive style, and there’s [00:22:00] also verbal aggression. So you can look if somebody tends to be aggressive versus assertive, all that. So are my relationships is healthy?

And then, the third was, I have this weight that I cannot lose and I feel that I’m really healthy, but all my efforts to diet and get rid of these last 50 pounds, I cannot shake this weight. Is there anything this test can tell me about why that might be?

So that’s all in the questions, right? When she had that question, I was like, what can I do? How am I going to get from what the data are and scales to answering that? But I had this little idea, maybe I would include a trauma measure because I work with trauma. She hadn’t mentioned any trauma, but sometimes trauma comes out in interesting ways. I knew I would get a little bit of trauma data from the PAI, but I wanted a little bit more.  And so that’s what I did.

Just a little bit more about how it’s done. You come up with 3 or 4 questions with the client; you help them. So if someone says like, am I an angry person? You can say like, well, what does the test tell me about anger in relationships? A lot of people ask, am I an introvert? Things like that. Those are more easily answerable.

But Stephen Finn’s way is that you design your feedback in a set of levels. So you have level one questions which are questions that wouldn’t be very upsetting. That would be like if somebody asked, am I an introvert, and they very well knew they were an introvert and they were just curious if that’s what the test said, it’s not that upsetting to hear, yeah, you are an introvert. It wouldn’t be upsetting, right?

Dr. Sharp: Right.

Dr. Warner: Level two questions are like, well, maybe this would be hard to hear. This isn’t how I saw myself, but it makes sense to [00:24:00] me. It’s like, well, I always thought I was assertive, the test says I’m a little aggressive. I get that. That makes sense. All right. Maybe I’m a little more than assertive. Like that’s not such a hard pill to swallow.

Level three questions are ones where maybe it’s painful. Maybe the feedback is hard to take. And that question that this woman asked about her weight, why can’t I lose the weight? I was pretty sure it was going to be a level three question. 

Dr. Sharp: What gave you that impression?

Dr. Warner: Well, it’s such a loaded topic. I’m dieting. I’m trying to lose 50 pounds. What’s wrong. Why can’t I lose the weight? That’s such a sensitive issue; weight and diet and eating, particularly if my clinical knows was right, that maybe there was a trauma piece, that’s going to be a hard message to deliver. It’s like, maybe this, maybe that, but that’s a tough conceptualization. So really these questions are inviting clients to hypothesize with you and case conceptualize with you.

So sure enough, the PAI looked great. She looked psychologically healthy. There was a little bit of hypervigilance and the PTSD subscales were a little elevated, but I probably wouldn’t have looked twice at them. I think I gave her the Trauma Symptom Inventory or something else, and there, she looked elevated intolerance of strong emotions. I forget what the subscale is. And I might be remembering the test I gave her wrong, but it was one that had a measure of tension reduction and affect regulation.

So basically, what the therapeutic assessment suggested was that she was barely effectively compartmentalizing her trauma. She was super high functioning. She didn’t have any depression or anxiety, but she had an [00:26:00] elevation in her need for tension reduction and strategies to regulate affect. So what that suggested, and again, we can’t know for sure, but what that suggested is that weight was probably the last… eating and diet was probably the final defense against the trauma.

And so again, that’s a level three feedback, right? Like, yeah, you’re right. You’re healthy. You’re psychologically healthy. And you know what, you’re right. Your relationship style is wonderful. And this one’s going to be painful, and this one’s going to be harder to hear, but what this data makes me wonder about is if this might be going on. And that was a powerful feedback session.

Dr. Sharp: Oh my gosh. Yes. How did she take that? 

Dr. Warner: She took it great. She was like, I need to learn how to feel. I get that. There are so many people that are high functioning and professional, all of us, regardless of functioning, sometimes we forget that feeling our emotions is an important part of living. And I think she just had a number of strategies to not feel things that were difficult, but she hadn’t thought twice about it because they were working. So it was emotional, but she was also really hopeful because it made so much sense to her. So she was quite happy and she felt very validated and seen.

I think that’s the other thing about therapeutic assessment is people really feel understood like, okay, I am really healthy. She was looking over her shoulder thinking maybe I’m not as psychologically as well as I think I am. And yet she was. She was psychologically doing well, but she just had this one coping strategy that wasn’t working for her.

Dr. Sharp: Right. That is such a nice case where it sounds like it was both validating but also illuminated some things for her that were really valuable and even hard to hear, but that it gave her some really valuable information. 

Dr. Warner: Right. And see, that’s such a great example of a therapeutic assessment case because that’s assessment [00:28:00] being used for therapeutically something very positive for the client. You’re using the data to help you with this conceptualization and clients can take something so positive from it. That’s exactly what happened. 

Dr. Sharp: I love that. And I think I also have to just note too, Megan, that it seems like you have a level of sophistication with the interpretation of the data that is really admirable to pull those things apart and make some of those conclusions. I think that’s one of the downfalls of assessment is people say, oh, it’s just data and it’s dry, but you just gave us a great example of how you can put a couple of measures together and really look at the whole picture and pull something really meaningful from it.

Dr. Warner: That’s so true. That’s such a good point. I’m so glad that you said that because you’re right. To do this, you really need to know the measures very well. This isn’t like getting a printout. I know the PAI has a printout. The MMPI, I think probably has a printout. I use the NEO-PI. It has a printout.

And you cannot rely on just that. You have to really know these measures. I would say, taking workshops in the PAI, or the NEO-PI or the MMPI, or whatever, because again, this is also something that can be used with kids. This can be used in neuropsychology. You have to know these measures really well.

And really, you have to know the whole idea that Stephen Finn is wanting to do, credentialing for therapeutic assessment, is so that people truly know what they’re doing and how to do it because you don’t want to be careless in giving this very deep, important feedback that we’re giving people. So it’s probably something that requires certainly a bit of training and or a lot of training depending on what you’re thinking. But yes, I think you’re right. I feel good about my knowledge of these tests. It’s taken a while, but it helps 

Dr. Sharp: Absolutely. Well, that’s clear that you’re pretty familiar with them. Yeah, that’s [00:30:00] fantastic. Just for people listening, do you have any suggestions, maybe books or websites or articles or seminars, that’s a lot of options by the way, for anyone who is interested in really diving deep into say the PAI and getting past just that printout level interpretation?

Dr. Warner: Yeah. Oh my gosh. I hope. All right. Let’s set the timer. I could go on about this all day. 

Dr. Sharp: Fair enough. Maybe I could help you out here. Would it be worthwhile to just say, Hey, we’ll put some links in the show notes and give you some time to put things together and share some of those resources?

Dr. Warner: For now, I’ll just say, yeah, sure. I’ll give you some. But for now, I’ll say, The essentials series is a really great series. I know a lot of us probably have a lot of the essentials books. The Essentials of PAI Assessment is a great book. It is very helpful because it breaks down the interpretation of the PAI in a few different ways, like just looking at the overall scale. And then it has a code-type interpretation. That book is well used here. So, that would be my thought about the PAI.

Society for Personality Assessment often has great workshops on therapeutic assessment. The website I would go to is therapeuticassessment.com. That’s Stephen Finn’s website. Everything that we’ve just talked about is really summarized. And the book, in the therapeutic assessment spirit, is the, In Our Client’s Shoes book by Stephen Finn. There’s just one more that’s called Collaborative / Therapeutic Assessment. It’s a case book. And that’s also by Stephen Finn and also Constance Fischer, and Leonard Handler.

So there are definitely books. There’s one other thing I didn’t say about how to do a therapeutic assessment, just to add really quick, which is that when you give the feedback, the other thing that you’re giving people is you’re giving a written report, which we could interpret that in so many ways. I always think of it as a bit of a transitional object, which is wonderful. People take it with them, but [00:32:00] they get to have it. They can show it around, they can reread it, but you also do include recommendations. So if someone is struggling with…

You always include recommendations. And again, it’s not just the conventional suggestions and recommendations section, right? It’s like, look, it looks like you are an introvert. Another one I did that was so great is, there was a couple that was having so much marital conflict because the woman was feeling like her husband didn’t want to engage enough in interpersonal situations. To assess this person, the greatest value they had was a high openness score. He really valued aesthetics. He valued art and music, but he didn’t really value interpersonal relationships.

So, on the PAI, there were these measures of dominance and warmth. And this guy was very low on warmth. It just wasn’t a value. The relationship just wasn’t of value. And when he was able to say, and I was able to write in a recommendation, help her understand, explain to her in these frustrated moments that it’s not that you don’t love her. It’s just that interpersonal situations is not what gives you pleasure in your life. It’s going to a museum or a concert.

So, just to say that the recommendations are very specific for the person’s questions and that’s usually very liberating for clients to feel so seen and then to actually have ideas about what to do about their questions.

Dr. Sharp: Yeah. Like, Hey, you get me. I feel heard or something. That’s really appreciated.

Dr. Warner: Yeah.

Dr. Sharp: Oh my goodness. I feel like even being someone who does a ton of assessments, I have learned so much in this half-hour. I’m even thinking, how do I restructure my feedback sessions and how do I make these recommendations more specific? And this has been fantastic, Megan. I really appreciate you sharing all of this. And to be honest, I feel [00:34:00] like we’re scratching the surface. I feel like I could talk to you for another hour about therapeutic assessment, the PAI, and how to do this.

Dr. Warner: Yeah. Well, we can still do that. Maybe not this particular time, but we can speak again for sure.

Dr. Sharp: That would be great. I would love to have you back. So as we wrap up, is there anything else that you would like us to know or final thoughts you’d like to share about therapeutic or collaborative assessment? , 

Dr. Warner: The only other thing to say is that since you’re really targeting the business of assessment, which I think is so important, it’s so hard to get started in a practice. And I think assessment has so much value. Just to say that, for those people that are thinking about doing training or reading more about these things, I really think it’s a smart investment because there’s so much need for assessment. And this is really an attractive way to deliver the assessment. We can really help people and change people’s lives.

I know a lot of people that do assessments don’t necessarily want to take on long-term clients, but you can still have a clinical impact through assessment. So I would strongly recommend trying to find a workshop or go to Austin and do one of the training with Stephen Finn. I think there’s a lot of value in it. And so, for those that this spoke to, don’t leave it here, go do it. 

Dr. Sharp: Absolutely. Thank you so much. If people have any questions or want to get in touch with you, what’s the best way to reach you? 

Dr. Warner: They can send me an email. It’s on my website. My website is meganwarnerphd.com. There’s a little contact form where you can just email me at meganwarnerphd.com, and I will try to help if I can. 

Dr. Sharp: That sounds great. Well, Megan, thank you again so much. I really appreciate your time. This has been fantastic. I hope that we can talk again sometime soon. 

Dr. Warner: All right. Thank you so much for having me. 

Dr. Sharp: Yeah. Take care. Bye-bye.

Dr. Warner: Bye.

Dr. Sharp: All right. Thanks, everyone for listening to that interview with Dr. Megan [00:36:00] Warner out in Connecticut. I really enjoyed that. Megan had a lot to say about therapeutic assessment. I really liked the way that she framed assessment as an intervention and as a way to support and strengthen people’s perceptions of themselves.

Thanks again for listening. Let’s see. I think next week we’re going to switch gears a little bit and we’re going to be talking about how to do a good school observation when you’re doing pediatric psych or neuropsychological assessment.

In the meantime, if you would like to learn more, and get more resources, you can always go to the website at thetestingpsychologist.com and there you can find links to the blog. You can find links to the Facebook community, which is growing and so exciting to see that happening. Otherwise, you can get some resources for testing and building testing in your practice. And you can also sign up for our four-week email course, the four-week blueprint that will give you some really concrete actionable tips on building your testing practice. And that’s at thetestingpsychologist.com/fourweekblueprint.

As always, thank you so much for listening. If you have a minute, do me a huge favor, go into your podcast app and rate, maybe even review the podcast and just help continue to grow this resource. Thanks. Take care.

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[00:00:00] Dr. Sharp: Welcome to The Testing Psychologist podcast, episode 9. This is Dr. Jeremy Sharp.

Welcome to another episode of The Testing Psychologist podcast. Today, I am talking with Dr. Amy Connery. Amy is a board-certified pediatric neuropsychologist in the Department of Rehabilitation at Children’s Hospital Colorado and an Assistant Clinical Professor at the University of Colorado School of Medicine.

She provides neuropsychological assessments and consultations in the Concussion Clinic, International Adoption Clinic, and Non-Accidental Brain Injury Care Clinic at Children’s in addition to bilingual Spanish assessments. Her research is in mild traumatic brain [00:01:00] injury and validity testing in pediatric assessment, which we will definitely get into later on.

Amy’s most recently been involved in research examining neurodevelopmental outcomes after Zika infection, and is currently in the process of putting together a grant and setting up services in Guatemala to do some assessments with Zika.

Amy, welcome to the podcast.

Dr. Amy: Thank you.

Dr. Sharp: I am excited to be talking with you today. Just a little background, Amy and I have known each other for, it’ll be three years this summer, which is hard to believe, it’s gone by that fast. I initially contacted Amy as someone who could maybe provide me with some consultation/supervision on some neuropsychological assessments.

As I’ve talked about here before in the podcast, I’m a [00:02:00] “regular” psychologist who went back after the fact and have been trying to build neuropsychological services and do so in an ethical way. Amy has been a great resource along the way and provided a lot of great consultation over the years. So super excited to have you here, Amy, and get into a lot of different things about your career in private practice and some of the work you’re doing right now.

Dr. Amy: Great. Glad to be here.

Dr. Sharp: That’s awesome. I wanted to start with, maybe you could talk just a little bit about that classic question; why did you want to become a psychologist and then maybe talk a little bit about why specifically neuropsychology?

Dr. Amy: My thinking around being a psychologist happened early and was pretty linear. [00:03:00] I came to neuropsychology in an indirect way. It was not something I knew I wanted to do as a younger person and certainly, even all through graduate school and my predoctoral internship, I still did not know that that was something I wanted to do.

I came to psychology probably like many people. I was interested in child development, attracted to the idea of a helping profession, and thought that I wanted to be a child psychologist who provided therapy. So that is how I trained. I went to a very traditional psychodynamic graduate school and trained in that way.

And then in maybe my third year of graduate school, the training director was encouraging me to get more experience in assessment. And I said, I did not want to do assessment. He said, well, if you want to be a good child psychologist, you have to be able to understand assessment, be able to read a report and so you really need this experience.

And [00:04:00] so I did that in my third-year externship and really loved it. I loved the direct way that you would get a referral question, you would make a plan to answer the question, you would answer the question, make a plan to make things better. It was a great fit for me in that way.

So then from there, I proceeded thinking I was going to do therapy part-time and assessment part-time. And so that’s what I did in my predoctoral internship and my postdoctoral internship. And then in my first job, that’s what I did; a few days a week, I worked in a psychiatry department providing therapy and consultation to children and families and then a few days a week, I worked in a hematology-oncology department doing assessments.

I did that for two and a half years and realized that I was very interested in the assessment part of it. [00:05:00] It felt like a much better fit for me clinically with the way that I thought, with the way that I wanted to work, and that it was going to be hard to do that full-time without getting the extra training and assessment that I needed.

So at that point, I quit my job, went back and did a two-year postdoc in neuropsychology, and then from there sought board certification and my current job at Children’s Hospital Colorado.

Dr. Sharp: You’re right, that’s a bit of an unorthodox journey for most folks who end up boarded in neuropsychology. Is that right?

Dr. Amy: Right. For sure. I think that there are, the generations ahead of me, I think it’s much more common for people to have come to it in different ways and have gotten their training in some less traditional ways too. But now since 2005, we [00:06:00] have what people may know as the Houston guidelines and those were, I don’t know if they were written in 2000, they may have been written before that, but basically what it states is that if you’ve graduated after 2005, there’s some more strict parameters on the training that you need.

And so we think the people before that time period had a little bit more leeway in how they were going to get trained to be board-certified versus people coming out now. Some of that is also that now there’s many more fellowships, much more opportunities for traditional training, and so that’s the benefit but then currently people are going down a pretty traditional route that’s outlined in those Houston guidelines.

Dr. Sharp: Yeah, for sure. I know that things have definitely changed and it seems like a much clearer path at this point especially, if you make that decision early on in graduate school to go the neuropsychology route, it seems pretty well mapped out in terms of the training and the [00:07:00] process.

I am curious, this is an experience that I think paralleled my own in a lot of ways except that I didn’t quit my job and go back for respecialization, which is a big deal. I want to ask you about that, but where did you do your predoctoral and your postdoctoral internships? Just out of curiosity.

Dr. Amy: I did my predoctoral internship at the University of California, San Francisco in what some child psychologists may know of with a woman named Alicia Lieberman and she is a zero to three specialist, a child trauma specialist and a parent-child specialist as well. We were working on doing a parent-child intervention and at the same time providing assessment to babies, toddlers, and preschoolers to see if we were getting any cognitive changes after a good parent-child [00:08:00] intervention. So I was doing both things there. My first postdoctoral internship was at the Children’s Hospital in Oakland and there I was primarily doing therapy.

Dr. Sharp: Okay, I got you. I was actually going to say, so you went even on your predoctoral and you were doing some assessment and were focusing on cognitive measurement and that kind of thing. So I imagine that set you up fairly well going down the road.

Let me ask you then, the first time you described it, it was pretty quick and you said, yeah, I decided to quit my job and go back for my two year. Can you talk me through that a little bit? Putting myself in your place, I guess I have been in that place, I couldn’t pull the trigger like that, that was a really hard thing to do. So help me understand how you made that choice and was that hard and [00:09:00] any of that?

Dr. Amy: Some of it is just a little bit who I am. Big changes are usually something I seek and those things aren’t really stressful for me or a big deal. I think the biggest thing is that I was with my husband at the time, but we were not married and we did not have kids. He is the same way; picking up and moving was not a big deal for him either.

The realities of our lives at the time made it such that it was not a very difficult thing to do. We didn’t have children, we weren’t pulling kids out of school, he wasn’t in a job he loved. We had some things that made it really easy to pick up and go.

For me also, I was probably at that point in my early 30’s and I knew very clearly that I wanted to do the neuropsychological assessment and that I [00:10:00] probably wanted to be in the hospital and that if I didn’t do the requisite training and then couldn’t get board-certified, I would be restricted. I knew I had 30 working years ahead of me. And so to make a short-term sacrifice for the long-term goal of professional satisfaction seemed also like a no-brainer at that time.

Dr. Sharp: I like the way that you say that; short-term sacrifice for long-term satisfaction for what you knew you wanted to do. I think it’s easy for us sometimes to get caught up in the short-term and let that be an obstacle to making what ultimately might be a really good decision, especially with something like this where you did have to do any number of things, I suppose, to set yourself up to actually go back and respecialize.

Dr. Amy: Right. And for me, it’s so clear there, financially, was it the greatest thing to quit your job and [00:11:00] do another two years of postdoc? No, but in the long term, I have been so much more happy than I was when I was also working as a therapist.

Dr. Sharp: That’s awesome. So you followed your dream and it’s working. That’s so cool to hear.

Dr. Amy: Right.

Dr. Sharp: I want to dig into a little bit of the nuts and bolts around how you did that. I don’t want to be presumptuous or anything; can you tell me what that process looked like when you actually decided to go back and respecialize? What did you have to do and what did that entail?

Dr. Amy: I wasn’t feeling drawn to the traditional two-year postdocs and looking back, I think that I was given a lot of misinformation and I had this idea [00:12:00] in my head about being an intern again, after I had been working independently and I was licensed and not having a lot of freedom in choosing how I was going to train and what populations I was going to train with and being in this prescribed two-year postdoc.

In retrospect, I think I had a lot of misinformation about that and misconceptions and that would have been a good thing if I had just done the traditional two-year postdoc but that was my thinking at the time. And so what I did was I, again, because I graduated before 2005, I had some options. So I looked through all of the postdoctoral internships that existed and some that were not in the match and found a board-certified neuropsychologist who was in private practice and also working part-time in a rehabilitation hospital. And so that’s what I did.

[00:13:00] My thinking was that, and this was true, that I had a lot of control over the patients that I saw, the experience that I sought out and I was able to say no to things I already knew how to do or knew I didn’t want to do. So I did have quite a bit of control over what those two years looked like.

Dr. Sharp: Okay. When you describe it that way, it does sound nice. You had the experience and you found a setting that would allow you to continue to grow and not feel redundant or anything like that.

Dr. Amy: Right.

Dr. Sharp: I’m thinking about folks who might be listening, maybe in a similar position, thinking about going back and maybe respecializing; do you know what that would entail these days? For someone who graduated after 2005, how would that process happen?

Dr. Amy: I do think that some people are still [00:14:00] doing things like psychology assistantships, but it’s riskier because you don’t know if that’s going to pass muster with the Houston guidelines to allow you to be eligible for board certification. The people that I know who’ve done it, have done it with real big-name people and things like that. So I think that the best way or the “safest” way is to get into the Match and do one of the two-year fellowships that’s offered through the Match.

When I talked about my misconceptions about the Match, I had this vision of the young green intern, but the people coming into neuropsychology postdoc are not young or green, they are people that have a lot of experience in assessment and so the training is at a high level. We have a postdoctoral fellowship at our hospital at Children’s and our trainees come in with a lot experience and then get a [00:15:00] huge breadth of new experiences and training that I think would be valuable even if somebody was a little bit more mid-career or the beginning of career like I was.

Dr. Sharp: Sure. That’s good to know. I know we’ve talked a little bit, I’m on the search for a pediatric neuropsychologist, and a lot of the resumes or CVs that I’m getting from folks who were in private practice for their postdoc; I’ve noticed there are differences. Some of them do specify ABPP certified or ABPP eligible, to make sure that I know like, hey, this is the real deal even though it’s a private practice.

Dr. Amy: Right. It’s hard because people will try to figure that out beforehand like if I don’t do a certified two-year fellowship that’s in the Match, will this experience count or will that experience count? You can’t always [00:16:00] know ahead of time so it is riskier for sure to do it that way in a postdoc that’s outside the Match.

Dr. Sharp: Sure. So your advice would be…

Dr. Amy: I would say that the other thing is that, but people do that, I think people have moving fatigue, they move for graduate school, they move again for internship and they don’t want to move again for fellowship. So we at Children’s Hospital get huge, large numbers of applications for internship, and then the number of applications we get for postdoctoral fellowship goes down by quite a bit. So there’s definitely are people who are figuring out ways to stay and make it work in these other ways.

I think that the experience is really valuable and the level of people coming in is high that even someone who’s been working in assessment for a while, could feel that it was worthwhile and worth their time to have done it.

Dr. Sharp: Okay. That’s great. That’s [00:17:00] good to know. Folks who might be listening will find that valuable just to know that training can continue and it can be comprehensive and different. That’s really …

Dr. Amy: Right.

Dr. Sharp: Well, let me switch gears a little bit. I know when we met, you had your job at Children’s but you also had a private practice. I’m using past tense. I would definitely like to talk about how you transitioned out of private practice but I would like to talk with you about how you set up your private practice because it was testing specific, right?

Dr. Amy: Yeah, I just did neuropsychological assessment. That’s it.

Dr. Sharp: Right. Talk to me about that. What was it like when you were starting your practice? Were you working full-time? Were you not? What was your setup at that point?

Dr. Amy: We moved here to Colorado because we were having a family and we have some family here. I had, when [00:18:00] we moved, just a one day a week PRN as needed position at Children’s Hospital in the Concussion Clinic. I’m not really clear why but I thought I wanted to do private practice at that point. So I thought, well, this is great. It’ll give me a little bit of, I can keep my foot in the door of the hospital, get a little bit of hospital work but I really want to do private practice.

I never did work at Children’s one day a week. I didn’t even work there one day a week my first week. I think I was two, three, four days a week almost immediately. And then within probably six months or so, it was clear to me that the private practice was, I liked it, I thought it was rewarding in a lot of ways, and it certainly made a lot of sense financially, it was closer to my house, all these things but I really loved the hospital-based [00:19:00] work. And so within about six months, I took a 3/4-time salaried position at Children’s, and about two years after that, I took a full-time position at Children’s and then transitioned out of my private practice.

Setting up my private practice in Boulder was, I would say, very easy. I bought a few things new. I bought everything else used on the listservs. I got office pretty easily.

Dr. Sharp: Can I interrupt you there? I think that’s important. I did an episode a little while back just on how to finance a testing practice. Could you talk a little bit more about how you set aside money or knew how much you needed to spend and these listservs, which listservs did you get your materials from? I’m curious about all that.

Dr. Amy: I cannot remember exactly but I think I [00:20:00] might have gotten mine on the AACN listserv, which is the listserv for board-certified neuropsychologists and it’s adults and people on it. Certainly, the pediatric one would also be a great place because there’s many more people on that listserv.

People were telling me, you need $20,000 to start a practice, you need $30,000. I luckily didn’t listen to them because that was not true for me. I know some people would say that but that was not true for me.

I got a reasonable rent on office space. I bought nice furniture from IKEA, all my office furniture from IKEA. I had a full battery of tests. I added things as I went but I had enough to do full battery with mostly used things that were in good condition.

And so I spent much closer to about $7,000 to get up and going. [00:21:00] I had cases right away so within a month and a half or something like that, I had paid that money back.

Dr. Sharp: That’s fantastic. I think that’s one thing, people get scared with the cost of admission, so to speak, but it comes back pretty quickly if you’re charging for your evaluations in what I would say the appropriate way.

Dr. Amy: Exactly. Some people will do things like, another neuropsychologist moved to our area and I was only using my office one or two days a week. She wanted to do a little private practice so she rented my space and my testing equipment from me while she got hers up and going. So that’s another thing people do. Most people don’t use their office five or six days a week so you can often, if you want to start to get referrals and not invest until you have a steady stream of patients coming in, do something like that and rent somebody else’s space and equipment.

Dr. Sharp: [00:22:00] Yeah, that’s a great idea. I like it. Let me ask you about the, if you’re willing to share, how did you structure the rental cost for her to include both the office and the testing materials. Were those separate numbers or did you pull it all into one fee or how did you do that?

Dr. Amy: Oh, gosh, how did we do that? I know we did the rent just per day. We said, okay, it’s 25 days a week, then we just split it by, I’m here this many days, you’re here this many days, and split the rent. Oh, and I’m so sorry, I cannot remember what we did about the testing equipment.

Dr. Sharp: Okay.

Dr. Amy: But the protocols seemed complicated, she just bought hers and I had mine. We thought it was going to be way too complicated to figure out how much money she would have spent by using my protocols. So we kept that [00:23:00] separate.

Dr. Sharp: Okay. I see what you mean. So she used your test kits but she bought her own response booklets and answer sheets.

Dr. Amy: Exactly. We thought it through and it would have been very difficult. Like days where she sees a six-year-old and does much less testing. She does a 16-year-old, how are we going to figure out how much she owes for all of that? And so we did that just totally separately.

She did do use my, I had an IVA, a continuous performance test that I was paying for per administration and she just kept track of that and then added it to the rent.

Dr. Sharp: Okay. I got you. That sounds good. That’s something I think to consider for anybody.

Dr. Amy: Yeah, very smooth way to start that way. Really smooth for her.

Dr. Sharp: And so going back just a little bit, when you said that you had enough to do a full battery, could you run down just the tests that you felt were absolutely necessary to get up and going where you could do what you needed to do right off the bat? What measures did you [00:24:00] get?

Dr. Amy: I cannot remember if I had a WPPSI right away. I must have had a WPPSI right away. Sorry, this has been a little while, I can’t remember. A WISC, the Wechsler Intelligence Scale, the WIAT, the Individual Achievement Test. What else did I have right at the beginning?

I had a Rey Complex Figure. I had a WRAML for memory testing. I had an IVA for continuous performance attention test. I had the D-KEFS. I had the NEPSY. I had Grooved Pegboard and I had some rating scales. I had the BRIEF, the BASC, the Vanderbilt. I had the VMI. [00:25:00] I think those were the ones that I started with.

Dr. Sharp: Okay. I know you didn’t mention this. Did you happen to have the ADOS? Were you doing autism?

Dr. Amy: Oh, I did have the ADOS. Thanks for reminding me. I did have the ADOS because maybe my second referral was for an autism evaluation.

Dr. Sharp: Oh. Okay. That’s a pretty comprehensive set of materials. I imagine you were good to go with most things that came your direction there from the beginning.

Dr. Amy: Yeah. And then I added a few little things. I added the Test of Word Reading Efficiency and I added the CTOPP. I did pretty well with what I had for a long time.

Dr. Sharp: Cool. How did you get referrals? You didn’t go to school in Boulder. It doesn’t sound like you lived there for very long before you had your private practice. Is that right?

Dr. Amy: Yeah, we had been living [00:26:00] in Utah, which is where I did my neuropsychology fellowship. I sent out a letter introducing myself to the local pediatricians. I had not been in Colorado. We got here. We were staying with some family. We didn’t have a place to live or anything like that, and I had been here maybe six hours when I got my first phone call.

Dr. Sharp: Oh my gosh. That’s wild.

Dr. Amy: Yeah. I hadn’t set up my office. I had found my office. We had come on a trip a few weeks earlier to get the office. Boulder, we have so many providers in some ways but not that many people doing assessment specifically, and I did no marketing from there. If I had wanted to grow it, I would have had to do more marketing than that but I [00:27:00] didn’t.

At the beginning, I was seeing two kids a week about, and then I went down to one kid a week and seeing that really low volume of kids, it was steady. Then parents telling other parents, I got referrals. A few pediatricians kept me on their radar and I got a few from them. Some child therapists and then a few reading tutors like study skills, executive coaches, kinds of folks who would regularly refer to me also.

Dr. Sharp: I hear you. It sounds like a lot of word of mouth more than anything.

Dr. Amy: Yeah, it was word of mouth. I would say, the pediatricians, the reading tutors, the school psychologists, the executive coaches, those were the big ones. I think sometimes people think about psychologists and child therapists and stuff, I know a lot of those folks but I don’t think it’s [00:28:00] as much on their radar as it is those other people. So that was the best bang for your buck for me.

Dr. Sharp: I’ve said before that I think that our reports are one of the greatest marketing tools that we have.

I wonder if that felt true for you as well. If you really put time into your reports and put some effort into that or if you had other ways of following up with those professionals to keep the referral stream going or what?

Dr. Amy: Yes, I agree with you about what you’re saying with the report. I also would say that longer does not mean better and certainly, a busy pediatrician is not going to read a 15 or 20-page report. They’re probably not going to read an eight or nine-page report. So I tried to keep the reports brief and user-friendly.

And then when I sent them to the pediatrician, I sent a quick summary letter. So [00:29:00] nothing long, just a short thing. Thank you for the referral. I saw this kid of yours. These were my two, or three initial findings. I asked the family to come to you for medical consult or the family will consult with you as needed, but the primary recommendations are for school-based intervention or something like that.

So just a one-paragraph letter. So they could throw the report in the chart and then have that letter to say, oh yeah, look at this. These are the results of the evaluation. These are the action items for me and I don’t have to sit through the report.

Dr. Sharp: That’s great. Good point. I think that’s a challenge and something that people are always wondering about, how do we communicate our findings but do it in a way that people will read, especially pediatricians?

Dr. Amy: Right. The pediatricians are not going to read a long neuropsychological report. They’re too busy.

Dr. Sharp: Sure. I [00:30:00] know that we’ve been talking for a little while here. I’m a little conscious of time, but I wanted to ask you, switching gears again, about validity testing and performance testing for kids. That’s a major research area for you and something that I think is important. I want to leave it open. Can you maybe talk about how you got into that as a research area and what you’re finding and maybe best practices with validity testing with kids?

Dr. Amy: I got into it and interested in it starting to work in a Concussion Clinic at Children’s Hospital where I’m working now. When I got there, they had already been running for several years, had several years of data, and we’re finding consistently that in the context of that clinic, mostly teenagers referred for prolonged symptoms after concussion, that [00:31:00] consistently every year between 15 and 17% of kids were failing performance validity tests or symptom validity tests as we sometimes call them.

So what we were doing then was having to give feedback to parents about what happened and why, and think that piece through. And since then, we’ve also done research on, what’s the patient outcome for a kid that failed performance validity testing and a kid who didn’t and we’re finding that they’re all getting better. Those kids are getting better at the same rate as kids who did give a valid credible performance during the consultation.

It’s been fascinating for the amount of times I’ve seen a kid fail and had to give that feedback, it’s just much more than you would see in any other setting, [00:32:00] probably. We’ve done a lot of research on why that happens, what happens afterward, using it as an important intervention and another way of helping to understand the kid, the prolonged symptoms, and how to help the kid get better and help the parents understand the etiology of the symptoms and how to help the kid get better.

And then recently, we also published a model for providing feedback because a lot of practitioners are worried about using symptom validity testing because if the kid fails, then what do you say to the parents and does it feel like you’re confronting them and very difficult and it usually doesn’t feel that way. And so we published a paper in The Clinical Neuropsychologist that provides a decision tree model of how to conduct those feedbacks so they feel productive for the provider and most importantly, they’re productive for the families.

Dr. Sharp: [00:33:00] I think that’s super important. We will link to that article in the show notes and try to help people access that. Could you talk through that quickly? You say there’s a decision tree as to how to do that. Could you give an overview of what that looks like?

Dr. Amy: Yeah, what we do is we do it with the child out of the room first, because we want to be pretty direct and frank with the parents and the kid knows what happened. We don’t view it as an unconscious process. We do view it as important clinical information about other non-neurologic factors or psychological factors that are contributing to the persisting symptom presentation of the kid.

We take it very seriously and we present it to the parents that [00:34:00] we give when we do these kinds of evaluations. We give tests that help to tell us if a child is trying their best to do well because we want to know if we have low scores, if those represent potentially true deficits, or might just be because the child wasn’t trying their best to do well. And then we say, and your child did not do well on those tests.

And then we leave it open. We have found over the hundreds and hundreds of kids we’ve seen, parents say, they say, oh, yes, that makes a ton of sense. I’ve been thinking that myself. Sometimes they don’t understand and they think, well, she never really tries, that it was a withdrawal of effort rather than it was a concerted effort to do poorly, which is more how we view it.

Sometimes people feel like, well, if my kid has headaches or other sorts of [00:35:00] pain, that would have made them score low on those tests or if my child is so impaired that that’s why they scored low. And so then depending on how they answer, we try to talk through with them about the nature of the test without giving a lot of specific information or certainly without naming the test, what that pain isn’t impacted and when kids, even people with more serious neurologic illness generally pass these kinds of tests. So those things aren’t the reason.

We try to help them understand and understand from a place of empathy and not be frustrated or angry with the child. And then when it feels like they have made some sense of what happened, then we try to sort through, well, what do they think is happening for the kid that this happened? What stressors are getting in the way? [00:36:00] What’s happening?

We have that conversation with the parents and then try to make a plan to have things be better, and then at that point, we bring the child in and speak about it in a much softer and maybe a little bit of a less direct way. We never have kids cop to it. Kids never say, oh yeah, I did that. Every once in a while they say, no, I didn’t or get a little bit argumentative but not frequently. Usually, they are quiet and nod, and then we talk through the treatment plan that we discuss with the parents.

Dr. Sharp: I see. I know there’s some debate out there, I could guess maybe the answer to this, but do you just throw out the data for the evaluation if the kid fails or how do you consider the data from that point?

Dr. Amy: [00:37:00] We do a few different things throughout the, our concussion evaluations are very abbreviated, so they’re usually between 1 hour and 1 hour 15 minutes. We have a few standalone measures and a few embedded measures. If things look concerning for effort throughout, then we do not report any of that data. None of it gets reported.

Dr. Sharp: I like how you discuss that model. It seems like a fairly collaborative approach to something that could otherwise be conflictual, potentially.

Dr. Amy: Right. Some people think, oh, the patient failed effort testing so I don’t have any data. I threw out all my data. We don’t approach it like that. We approach it like now I have a very important piece of data and this piece of data tells me that there are other [00:38:00] non-neurologic factors that are at play here and we have to understand them in order to help the child. So I think coming from that stance, that helps it to be collaborative and supportive for families. In our research, we’re seeing that it’s just as a helpful intervention as when kids provide credible data.

Dr. Sharp: That is really cool. Awesome. Well, I know that you’re in a hospital setting and doing primarily concussion evaluations. Do you see any value for validity testing in private practice with kids?

Dr. Amy: Oh, yeah, for sure. I probably do like 30% of my practice at the hospitals with concussions and so I do a variety of other things. In my private practice, yes, I did use validity testing. And then when I do comprehensive full evaluations [00:39:00] in our regular general rehabilitation clinic, I also do validity tests.

I see failure on those less frequently but I do see it enough that it feels really valuable to be doing it and a concern to not be, that you might be missing something really important.

Dr. Sharp: Yeah, absolutely. I feel like this is just, it’s such a big topic. We could probably do a whole episode just on validity or performance testing in kids. I appreciate you diving into it a little bit. Like I said, we’ll have a link to your article in the show notes and give people a chance to check that out because I think y’all, it seems like you frame it in a really nice way that can be helpful for families.

Thank you so much for the time. I know that we’ve spoken for quite a while here and gosh, I feel like we packed a lot of [00:40:00] good and helpful information into this time. So I don’t want to take too much more of your time.

Anything else that you would like for folks to know, anyone who might be getting into private practice with testing whether that be business-wise or validity testing, anything that you wanted to share as a last note?

Dr. Amy: For me, one of the main reasons for me to go back to get that additional training was I just wanted to be good and that’s the advice I would give. If you’re going to open a private practice or work as a staff member at a hospital and whatever you’re doing in terms of therapy, but certainly if you’re respecializing, get the support that you need, the supervision and the training so you can be good at it. I think that benefits all of us in the profession when we have people who have our similar degrees and [00:41:00] training are doing good quality work.

Dr. Sharp: That is fantastic advice. I love that. Dr. Amy Connery, thank you so much for spending time with me here today and running through all these different important pieces of private practice and working in the hospital and respecializing. This has been really fun.

Dr. Amy: Yeah. Thanks for having me.

Dr. Sharp: Take care. Bye bye. Hey everybody. This is Jeremy again. Thanks for listening to my interview with Dr. Amy Connery. Gosh, she talked about a lot of really cool stuff. She’s had a really interesting career so far and continues to do pretty cool things there at Children’s Hospital.

Amy and her team have written a number of articles actually on performance validity testing. We talked about her most recent one that frames how to give feedback for failed validity testing. You can definitely check that out in the show notes.

As always, if you enjoy our podcast, please take 30 seconds to go into iTunes or [00:42:00] wherever you listen and subscribe, rate and if you have a minute and you’re feeling kind, give us a review. That’d be awesome.

If you want to talk with other testing psychologists and join our growing community, you can go to thetestingpsychologist.com/community and that will take you to our Facebook group where we’re having some cool discussions about technology and time management and lots of things that are pertinent for testing.

So thanks as always for listening. We have some cool stuff coming up. I think here in the next two weeks, I’m going to be talking with Dr. Megan Warner out in Connecticut about therapeutic assessment, going to be talking about how to do a good school observation, and all sorts of other good stuff.

Y’all take care and we’ll catch you next time.

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