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[00:00:00] Dr. Sharp: Hey y’all, this is Dr. Jeremy Sharp. This is The Testing Psychologist podcast, episode 38. Hey, before we get into today’s episode, I want to give another shout-out to our podcast sponsor, Practice Solutions. Practice Solutions is a full-service billing company for mental health professionals so that you don’t have to spend your valuable time working on mundane tasks like billing.

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Hey everybody. Welcome to another episode of The Testing Psychologist podcast. I’m Dr. Jeremy Sharp. We are back today with our first interview in several weeks. We just wrapped up our 5 quick tips series and I am thrilled to jump back into the interview game with someone that many of you have probably heard of or read some books or read some articles. I’m here today with Jacobus Donders.

Dr. Donders is the Chief Psychologist at Mary Free Bed Rehabilitation Hospital in Grand Rapids, Michigan. He is board-certified in [00:02:00] Clinical Neuropsychology, Pediatric Clinical Neuropsychology, and Rehabilitation Psychology through the American Board of Professional Neuropsychology.

In addition to being an active clinical practitioner, he has served on multiple editorial and executive boards, has authored or co-authored more than 100 publications in peer-reviewed journals, and has edited or co-edited 5 textbooks. Dr. Donders is a current associate editor of the journal Child Neuropsychology and Archives of Clinical Neuropsychology.

He’s a Fellow of the American Psychological Association and of the National Academy of Neuropsychology. His main interests, at this point, include validity of neuropsychological tests and prediction of outcome after brain injury.

Dr. Donders or Jacobus, welcome to the podcast.

Dr. Donders: Nice to be here.

Dr. Sharp: Thank you so much for taking the time to come on and talk with us. That’s a heck of a bio. You have a lot [00:03:00] of very esteemed titles and designations in there. I’d like to maybe start a little bit with where you’re at right now with your career and what you’re doing day to day in your work, and we can take it from there.

I know people are really excited to get into some discussion about feedback and reports and report writing but tell us a little bit about what you’re doing these days and what your work situation looks like.

Dr. Donders: Sure. Being 58 years old, I’m supposed to call myself late career, my job at the hospital is about half-time clinical and half-time administrative research in nature. Most of my work involves outpatient neuropsychological evaluations of persons who have either suspected, confirmed [00:04:00] or disputed acquired or congenital brain injuries.

I see a lot of head trauma in the adult population. I see a lot of mild cognitive impairment on the pediatric side, anything from spina bifida to cerebral palsy, you name it. I’ve always adhered to a lifespan approach.

I was initially trained to deal primarily with pediatrics. I later did some adult training. So I feel comfortable at both ends of the age spectrum. I enjoy children a little bit more but I see individuals across the age span, really.

My practice involves about, it varies on the year, but about between 12 and 14% forensic work as well. Forensic I mean personal injury, medical, legal. Besides the clinical work, I’m involved with some training. We have an APA-approved residency in clinical neuropsychology and [00:05:00] I have about a half a day a week to do research.

Dr. Sharp: Okay. What’s your research looking like these days?

Dr. Donders: There’s two things we’re looking at, right now we’re looking at subtypes of MMPI-2-RF profiles in individuals who have sustained a traumatic brain injury and see whether the different profiles are related to either demographic variables or injury variables or comorbid psychosocial factors or financial compensation seeking or any combination of the above.

We’re also looking into the concept of what’s called sluggish tempo in children with brain injuries that’s becoming a more hot topic in general cognitive psychology, but neuropsychology has not looked into that very much.

Dr. Sharp: Both of those sound relevant and super interesting. Am I remembering right that I see an article [00:06:00] you are part of that was a review of neurofeedback as well. Is that …?

Dr. Donders: I don’t think so.

Dr. Sharp: No. Okay. That might just be me. There’s a lot out there. Just from this little brief introduction, you’re involved in a lot of things that I think would be incredibly interesting to our listeners. What we are going to focus on today is a lot around report writing.

This is something that you’ve been involved with for a long time, at least as far as I know. I remember that 1999 article that you wrote about reports being too long. I don’t know if you were doing research or looking into it before that, but it’s been at least 18 to nearly 20 years. And you just, within the last few years, wrote another book Neuropsychological Report Writing. Is that right?

Dr. Donders: Yeah. [00:07:00] I edited it. I had some of my colleagues be generous enough to donate their time and treasure to write chapters in it.

Dr. Sharp: Sure. I found that book very valuable and I think there are a lot of great chapters in there. I am curious how you decided to go down that route. You’ve written or edited several books, but why a book about reports? What led you down that path?

Dr. Donders: This is the one I actually always wanted to do. I wasn’t always sure whether it had merit to the book or yet another article in the peer-reviewed journal. When I wrote that original article in Child Neuropsychology in the mid to late 1990s, it was more out of frustration with what I saw coming across my desk in terms of reports from other psychologists and [00:08:00] neuropsychologists that would go on for 12, 18 or more pages and basically said very little.

The tipping point for me came when, and that was actually included in that article that I wrote, there was a principal from a high school who had paid out of his own budget to get a neuropsychological evaluation of a young adolescent girl who had sustained a stroke. At that time, keep in mind, this was mid to late 1990s, so they spent more than $1,000 for that out of a rural school budget, and got a long report back that said, yes, she has brain damage. It’s on the left side of the brain. You need to work with visual methods and instruction.

That’s pretty much all it said. The rest was very detailed description of test results, scores, and everything. The man called me [00:09:00] and said, I already know she had brain damage. I’ve seen her hospital discharge summary. I know she had a stroke. I also know it’s on the left side of the brain. Look at her, she can’t even move her right side. This doesn’t help me. What does that mean, visual methods?

So I did that. That’s why I decided, okay, let’s write an article encouraging people to cut down on the unnecessary detail and focus more on what the reader is actually looking for. Doesn’t mean you have to tell them what they want to hear, but answer a question in a way that gives people new insights that tells them something they didn’t know before. And that then results in some practical recommendations that people can actually implement in a feasible or practical manner.

And then two years later, I did a nationwide [00:10:00] survey about report writing because I wanted to know why do people write the way they do because one psychologist or one neuropsychologist spreads differently in another way. I wanted to figure out what do people do and why do they do it?

It turned out there was no consensus in the field about how you should write a report. A lot of it differed with the practice setting. If you are in a medical setting and you write for a neurosurgeon as part of an epilepsy team and neurosurgeons, they’re very good at their job but with regard to reading reports, their attention spans probably 5 minutes at tops. So you need to get very concise information to them.

There’s very specific information that they’re looking for, such as, is this patient going to or not going to be at increased risk for cognitive decline after surgery? They don’t care about all this other stuff [00:11:00] about on this test and that test, they’d want that question answered.

On the other hand, if you are doing a child custody evaluation and you have to explain to a judge why parent A might be a better custodian of the person than parent B, you’re going to have to give some more information.

If I see a young adolescent who has a history of brain injury who is now approaching the age of majority and I’m asked to determine if this person has the mental capacity to function as his or her guardian, I need to answer very specific questions and using very specific terminology that are dictated essentially by the probate court.

I found out it depends a lot on who you’re writing with, what you’re comfortable with yourself. People doing pediatrics write different reports than people doing older adults. So it was a hodgepodge, [00:12:00] but there were several things that a lot of people agreed on what should be in the report.

I’ve seen reports where it was not at all clear who referred the patient. It’s important to know, is this a referral from a physician or from an attorney? I’ve seen reports where the date of the individual was not even mentioned. A person’s referred as a child, but I don’t know if I’m dealing with a 6-year-old or 12-year-old or anything in between.

What I wanted to write eventually, so we did that originally before a paper in the 1990s. It’s a survey published in early 2000, 2001, I think it was. What I wanted to write is one book that gave examples of if you write in this situation, be that a school, be that a court system, be that a medical system, here are some things that you need to know, here are some things that will be helpful in terms of serving your clientele. And the [00:13:00] clientele would be both the patient and the referring physician most of the time.

I wanted to do it in a format that eschewed the traditional cut-and-paste options that you get from some of these books. Okay, if you want to write a report here, just put this boilerplate in there, because that’s what I wanted to stay away from.

I wanted it to be meaningful and I wanted it to be individualized, but I wanted a format that in each chapter had, okay, here’s a good example of how to address this, and here’s a not-so-good example of how to address this. Here’s why example A is better than example B. That’s what I always wanted to do. It just took a long time to put it out here.

Dr. Sharp: Sure. I think that’s something that I appreciated about that book is that:

1. That it addressed writing reports for different audiences.

2. That you did give examples of [00:14:00] here’s a good way to do this and here’s a not-so-good way to do this. It’s nice to have really clear examples like that.

I would imagine I’m not the only one that found myself doing some things that were not so great but it’s nice to be able to change that up and have some examples from the field.

I think that we could certainly delve into the process of writing that book, I’m personally curious about that, but I know that a discussion that’s come up a lot in the podcast community and the Facebook group for testing psychologists is reports are just, they’re the bane of our existence in a lot of ways; the time involved and not getting reimbursed and things like that.

And so a lot of people are really excited to hear [00:15:00] about specific ideas about writing quality reports, but also balancing that with efficiency and making sure we’re not wasting time. At this point, I know it’s hard to cut across audiences, but do you have any general tips or thoughts on what are the core elements of a good report that should always be there?

Dr. Donders: What always should be there is who referred to patient and why, and what was the referral question? If I get a referral, it says, please evaluate, I typically send it back or I pull back and say, evaluate for what? Because I can throw a ton of tests at this individual, I don’t mind making the money. Tell me how I can best help you.

So if there’s a question about, does this patient have depression or dementia or does this child have a learning disability or attention deficit, is that what you’re worrying about? Okay, [00:16:00] that gives me an idea of what you’re struggling with.

That does not mean I cannot address anything else in my report or in my evaluation. If that child comes in and has a big bruise on their cheek, then I want to know where that bruise comes from. If that person comes in as an adult and looks very depressed, yes, then I will address their emotional adjustment, but who referred a patient? What was the referral question?

I am not in favor of regurgitating everything else that is already in a medical or in the school record that is already known to the reader. I might reference it very briefly but I’m going to assume that if a pediatrician sent that child to me, that pediatrician will know that child’s birth weight, her Apgar scores, the developmental milestones, and blah, blah. I don’t need to investigate all of that in the report.

Dr. Sharp: That’s interesting. Can I jump in real quick and ask how you handle that then? How would you [00:17:00] write the, let’s say, medical history then if you don’t regurgitate that stuff?

Dr. Donders: I had available to me the office notes from Dr. so and so, they revealed that Johnny’s medical history, language and motor development prior to the car accident in question were entirely unremarkable. Hearing it.

Dr. Sharp: Okay.

Dr. Donders: Sometimes I do that and if I don’t have that information, I will do an interview with the parent.

I will get all those milestones. I will know when that child started sitting up. I will know when they started crawling. I will know that when they said that first word. I will know when they got potty trained and all that. If I don’t find anything of significance, then I can say there was nothing unusual about this child’s development prior to the age of whatever we’re talking about.

And the people that I have worked with will know that I have asked, that is not boilerplate, that I’ve asked all those questions. [00:18:00] What I do feel strongly about, if you uncover something that people don’t know or have not appreciated, you need to draw attention to that in the report, whether that’s something about the history of observation it.

I have a patient here who supposedly was in a car accident and I read the emergency room report. There was nothing wrong, but now this patient’s sitting across from me at the table and I see a distinct nystagmus. I’m not an ENT, I’m not a neurologist, but I can’t ignore this nystagmus. So I will document that’s present.

Or if the person tells, my doctor has recommended this medication for me, this antidepressant and I told him I will think about it, but I don’t want to do that because I’ve tried that before and I had bad side effects, but there’s nothing in the doctor’s notes that the person has been tried on [00:19:00] psychotropic medication before, then I want to draw attention to that. Not to call the patient an evader or a liar, but that’s something that the referring physician should know that there’s a prior psychiatric history.

So tell the reader anything about the background that the reader doesn’t know yet. In your test results, focus on, and that includes also the behavioral observations, focus on what really makes a difference. If all the scores look normal, I’m not going to belabor them all of them.

I have a habit of attaching to my report a brief summary of all the standard scores, let’s say, a summary of the formal psychometric data is attached. The vast majority of these are within normal limits, specifically with no deficits in attention, language, perceptual skills, or memory. Only area where we find some difficulty is whatever x, y, and z, [00:20:00] and the nature of that difficulty appears to be a, b, and c, as evidenced by performance on these and these tests.

And that’s all I say if it’s a very uncomplicated situation. If it’s a very complicated situation, I will still say, I’m not going to go through every single test or every score, but let me highlight the most significant findings. This child has two problems:

1. This child can only pay attention to one thing at a time. You give him more than one thing to do, he gets lost, he starts missing things, starts making mistakes.

2. The second thing that’s going on with this child, he’s very critical of himself, any negative feedback, he panics, he has a catastrophic reaction, and that anxiety or that frustration associated with that will make him look more impaired than is in fact the [00:21:00] case. Here are some examples of how that played in the test.

I try to highlight what are the main findings and what are the main red threads throughout the report. When I come to the end, I am not in favor of appending a summary because I just went through a short report that should be one or two pages at most, why do I need a summary?

I’ve seen summaries that were a page and a half long. That’s not a summary. That’s basically saying the same thing. In the conclusions and recommendations, I basically say, listen, I do not think that this person has a learning disability. I do believe that they have post-traumatic stress disorder associated with the car accident in question.

I don’t believe that they need special education services because of head trauma because that head trauma is very minor. I am concerned about the way this person’s emotional status may negatively affect their educational success, so I’m going to ask for consideration of special education support [00:22:00] under the emotional impairment qualification. Here’s what I would do in a school setting. Beside that, this child needs individual psychotherapy or we should try a medication of Prozac or whatever.

I try to keep to the point very specific and then have some directions for follow-up. That’s pretty much what needs to be in the report; who referred? What was the question? What new information did I uncover? What does the balance of the interview, background, behavioral observations, and test results really tell me? What does that imply for this individual’s treatment and what’s the follow-up?

Dr. Sharp: Got you. I have a lot of questions about that. When you think about the history, I totally get doing a short medical history, getting really comfortable with the phrase within normal limits or unremarkable or whatever you might use.

How do you handle the, [00:23:00] let’s say, the presenting problem? How do you document that? Because that ends up being, for me, just being honest, probably at least a page where I’m talking about the parents or adults presenting concern; the history of that, the way it manifests. How do you handle that?

Dr. Donders: I focus on the highlights. A person comes in and says, I have memory problems, but then the more I talk to that person, they’re not talking about memory problems, but talking about the word-finding difficult.

I may, for example, say, even though the primary subjective complaint pertained to a memory problem, I got the distinct impression that there were more word retrieval issues, whereas this person did not indicate any problems with leaving the stove on, paying his bills, taking his medications or with a child doing his homework, remembering to turn in the homework, doing his chores, [00:24:00] whatever.

If the timeline is important, then I will elaborate on that. For example, if it’s an older adult who has a question about Lewy body disease, and according to the criteria, the emergence of cognitive and motor symptoms should be within approximately one year or less of each other, well, I will comment on that because that’s important for the diagnostic criteria. If it’s not all that important, I will not elaborate on it.

What I try to focus on is what is really important for the reader to understand in the conceptualization of this patient versus what might be interesting tidbits, but in the larger scheme of things really don’t matter all that much.

Dr. Sharp: I think that gets maybe a bigger question of or maybe logistics of when do you write the history in relation to the rest of the report? [00:25:00] Are you writing the history to fit the diagnosis or vice versa? Does that make sense?

Dr. Donders: I think the history is important regardless of the diagnosis. I may end up with a final diagnosis that this young boy indeed suffered a significant traumatic brain injury in the accident in question and that this child doesn’t need special education support and also needs outpatient occupational physical speech therapy services.

If I also uncover a history that this child has been sexually abused in the past on more than one occasion by close male relatives, I will probably put something in the recommendations that the therapy, particularly if it’s going to be physical therapy, should probably be done by a female, and that it’s very important if you’re going to touch that child, you’re going to [00:26:00] tell him in advance why you’re going to touch him, where you’re going to touch him, and you do it while you’re making eye contact with him instead of approaching him from behind.

I may not go into great detail about why that’s necessary because I consider that confidential, but I will put that in. So that’s where the history still becomes an issue even though it’s not necessarily germane to the final diagnosis.

Dr. Sharp: Right. That’s a great example. And so thinking about moving through the rest of the report, I think a lot of us separate into, there’s a section for test results and we go through each domain maybe or some people probably list out specific tests. And then there’s the section; interpretation or summary or conclusions, however you might phrase that.

Could you break that out a little bit more and say [00:27:00] what you would include in the test results versus the summary/interpretation and how those breakdown?

Dr. Donders: The test results should focus on exactly what it is. What tests did you give? What are the results? Again, I’m favoring of attaching a list of the standardized scores, and those should basically focus on what do those scores tell you sometimes with caveats based on behavioral observations like it might seem that this child is very poorly on block design, but you need to keep in mind this child has motor limitations as a result of his cerebral palsy.

Every time we gave him extended time or 10 or 15% extended time, he got them. There were several items, if the time limit was 60 seconds, he got it in 68 or 72 seconds. That should be in the test results.

The [00:28:00] interpretation/recommendation section should focus on how do I integrate those test results with what I’ve known from the medical records that I reviewed, sometimes academic records of this child, with the interview that I conducted, and the behavioral observations that I did.

So here I have all these test results that seem to suggest that this child has difficulty with word finding. There is some indication for relatively greater motor impairment on the right side of the body. I have a history from the hospital that this child had a tumor on the right side of the brain. And so my God, what’s going on here?

This doesn’t seem to fit, but then I need to keep in mind that this child is left-handed. Therefore, probably has atypical lateralization. So it still fits with the overall idea of some cognitive [00:29:00] impairment, language impairment, motor impairment, as a result of acquired neurological history, and therefore, I am recommending special education support.

So the integration part, and that’s what we’re getting paid to do for as neuropsychologists, anybody can give tests, it’s really not that hard to do. I prefer to use masters-level clinicians to do the testing for me because they’re also my eyes and ears. So the guy getting very good behavioral observations.

What you need a doctoral-level psychologist or neuropsychologist for is the integration of those test data with the history, with the interview, with the observations, and other information that you need to know. Like if you do evaluation for a probate court, there’s certain rules, certain criteria you need to follow. If you do an educational evaluation, you need to have some understanding of what special education law is in your state. So you need to integrate all of that.

[00:30:00] Dr. Sharp: Sure. You said you do append the scores at some point, at the end of the report, do you …?

Dr. Donders: It’s a one-page thing that lists, in a normal battery, it would list the IQ scores. If it’s a child and I could get achieved scores, main results from tests of memory or problems or whatever tests were given with a caveat on the top of that page that those scores are for professional use only and they should never be interpreted without consultation of the accompanying report because scores are just scores. They need to be integrated with something else.

Dr. Sharp: Of course. Yes. I got you. Let me ask then, how long do your reports end up being generally, because there is variation?

Dr. Donders: If I had to write them on a normal letterhead, they would probably be two [00:31:00] to three pages plus that addendum of the test scores. Some of my reports are very brief. There’s a lot of physicians in my hospital I know that they actually never read my full report because what I do when I’m done with a patient, I’ll send that physician an email that basically says, listen, this is Mr. Jones or child’s name, whatever, who you saw on clinical, that date, who has a history of fill in the blanks.

We will policy to multi-branch or whatever like that. You had a question about this, here’s what I think; A, B, C. I do it in bullet point. I recommend X, Y, and Z. There’ll be a full report to follow next week. I know they never read that full report. They want that email with those bullet points [00:32:00] that’s probably less than 500 characters total.

Dr. Sharp: That makes sense in the hospital.

Dr. Donders: The other day I called a physician from the outside and said, I know you’re concerned about the differentiation between mild cognitive impairment versus depression. I think it’s depression, but what I’m even more concerned about is that this person is self-medicating with alcohol. You should know about that because you’re also treating this person with pain with a narcotic.

This physician had absolutely no clue that this person was self-medicating with alcohol. In fact, he was washing his if I get in down with the alcohol. Then I said, you need to know this, you probably want to follow up right away.

The length of [00:33:00] report; I’d like it to be concise, I’d like it to be brief, I’d like it to the point, but length is not as much as important as content. What matters to me in terms of content is what does it tell the reader that the reader doesn’t know yet that helps the reader change or improve care for this particular patient.

My pet peeve about many neuropsychological or psychological reports is they go on and on, it becomes verbal diarrhea. It really doesn’t give the reader, whether that’s a teacher or an attorney or a physician, any new insights, anything new that they can actually work with and do something with.

As long as we focus on that, I don’t mind the report being a little bit longer, even though I prefer it concise, if it really accomplishes that. My concern is that many individuals seem to confuse quantity with quality. [00:34:00] If you just focus on, let’s put out a quality report that helps whoever sent this patient to me and in the end, my report will help improve care for this patient, that’s all that matters.

Dr. Sharp: I think a lot of people are probably out there thinking, oh my gosh, how do you get reports down to three pages? So I want to ask you about that but before we get to that kind of stuff, I am curious, the quality is so important, where do you find you spend the most energy or have the most focus? What section of the report is taking up the bulk of your time or your energy?

Dr. Donders: The bulk of my time probably is the interpretation and then subsequent recommendation section because that’s where the integration of everything is. It’s going to be lots of fun for a nerdy psychologist [00:35:00] to calculate where the score A is statistically significant different from score B and whether that meets the criteria for minimally clinically important difference.

The history might be juicy and all that, but what it boils down to is how do I integrate all this and how do I integrate this in a way that I can explain this to whoever reads this report, referred this patient to me in a succinct, intelligible manner that is going to ensure the best follow up?

The way I’ve taught myself to do this and the way I teach my residents to do it is, there’s two tricks that we use. One is, okay, the big news on when I was watching CNN this morning is that Twitter is going to go to 280 characters. All right, Twitter is just [00:36:00] 280 characters.

Let’s say you need to send out a tweet, and let’s say this tweet only goes to the referring physician, what can you say in 280 characters about this patient? I may change it to 280 words because 280 characters is a little bit too short, but let’s say 280 words. Or let’s say you need to leave a voicemail on this person’s voicemail machine, and you only have 100 seconds, what are you going to put in that voicemail?

That’s how you get to the point. In order to do that, in order to get to the point where I can say, okay, I can say in 280 words or in a little bit over 1.5 minutes, what I think is going on with this individual and what should happen to them, I need to do that integration.

I need to cut out the irrelevant details. I need to focus on the nitty gritty. I [00:37:00] need to keep in mind what the physician or the referring party already knows. I need to keep in mind all those external contingencies such as in the court or in special education law and say here is the bottom line.

If there’s anything I want you to know about this individual, if there’s anything I want you to do about him, here it is. If you train yourself to complete that task before you start writing or dictating anything, then your time to actually do the report is going to become very brief. I dictate most of my reports in less than 20 minutes.

Dr. Sharp: Less than 20 minutes, oh my goodness. I know there are people out there just crying right now.

Dr. Donders: I’m not trying to make anybody uncomfortable. I may spend more time than 20 minutes with the integration. I’m [00:38:00] thinking for a long period of time to how do these test data fit with this history. If I want to make a case for this child to get these kinds of services, what I’s do I need to dot, what T’s do I need to cross?

The way I try to think about it and the way I explain it to my residents is it’s an inverted pyramid. The top of the pyramid is where you want to be, you want to climb to the top of the pyramid. That’s where the golden ball is. And that’s my conclusion/recommendation.

And then I go back down and say, what are the foundations of that pyramid that allow me to say, yes, this is my conclusion, I need to address. A, B, C, and D. Another level down is here are some specifics if people need to get convinced or I need to put a little bit more meat on that bone that will support that I actually have looked at all those pillars for all those foundations.

So I begin with [00:39:00] what’s my top ideal, where do I want to go? In order to make that case, what issues do I need to address and what sprinkling of details do I need to put in there? So if I’m ultimate conclusion after doing all that integration is, yes, this person does have cognitive difficulties that are a direct consequence of his traumatic brain injury, and they cannot be solely attributed to his premorbid history, then what do I need to say?

I want to say something about test results that are selectively impaired in areas that are typically affected by traumatic brain injury, such as processing speed. I also need to make a comparison between this child’s premorbid test scores and his post-morbid test scores, because I have a WISC from two years ago, where they fortunately gave the processing speed of this, and there’s a decline of 14 points that exceeds the minimally clinically, that’s a reliable change, [00:40:00] exceeds the criteria for minimally important.

I have been able to rule out that this child has a complicating anxiety or depression as has been suggested by some of the other providers. The child is frustrated. Here’s how I can tell because I did a PHQ-A, I did a GAD-7, I had the parents fill out a PIC and none of it suggested a complicating disorder.

Those are my three pillars. I can show that this child has impairments selectively on tests that are known to be sensitive to brain injury. I have compared this child’s test performance pre and post morbid, and I’ve ruled out other complicating factors. I sprinkled in there some details because I had processing speech scores, I had formal standardized ratings of mood and behavior. Now my inverted pyramid is essentially done.

Dr. Sharp: And that’s your interpretation section, huh? [00:41:00] That’s fantastic. What do you think about the, I’ve heard people call it the inverted pyramid of report writing, where you put the interpretation and maybe even the recommendations first and foremost at the front of the report and then follow with everything else. What do you think about that?

Dr. Donders: That’s personal preference. I know that if I write a report where I put in interpretation and the recommendation at the end, more than 90% of physicians really flipped to the last page.

They will not always tell you that. They say, oh, yeah, you’re right. I read your whole report. I know they’re lying but that doesn’t bother me. I’m more concerned about that they read that section that really bothers where I do the integration, where I pretty much advise them what to do, that I’m pretty confident for.

To me, it doesn’t matter upfront or in the back as long as it’s evidence-based, as long as it achieves [00:42:00] that objective of telling the reader something they don’t know and eventually helping the patient.

Dr. Sharp: I got you. I think listeners are probably dying to hear a little bit about how you get down to the point where you’re writing two or three page reports and dictating in 20 minutes. Did you start at that point or have you worked down to that point? And if so, how did you do that? What helps you with that? Tools, tricks, anything.

Dr. Donders: When I first started out, particularly during my internship and postdoctoral residency, of course, I took a lot more time. At that time, I was hand typing my report. I’ve been doing this for 29 years as an independent practice now, not counting my training, you get more [00:43:00] experience, you get more efficient.

There’s two things that I found helpful to do. One thing, for example, and some things are extremely simple. One thing is that my psychometrist, when she hands me the test data, the protocols, they’re always in the same order and always keep them in the same order because so if I know that I’m going to look for a certain test result, I don’t have to wade through all kinds of, oh, where is the test? Oh, where is this? I just saw it. No, it’s always in the same order. That sounds very little, but that saves a lot of time.

I’ve learned to, when the test results come back and the psychometrist gives me that summary sheet with all the test data on it, I eventually will append to the report. I will try to do a very [00:44:00] quick masked, we used to say blind, but you’re supposed to say masked.

We review those test results first because I’m involved with at least 6, sometimes 8 or 10 evaluations per week, and sometimes these test results come to me later in the day or the next day so it’s just, okay, let’s just look at this blindly and say, okay, I’ve got a 50-year-old man with 12 years of education who’s right handed or a 7-year-old girl who’s left handed. I look at these test results, what do I make of that provisionally? And just as an academic exercise. It takes me about 5 minutes.

Then I go back to my notes from the interview, I say, oh, okay. I need to keep in mind that this child is left handed or I need to keep in mind that this child has a history of foster placements, has been bounced around a number of times. Now it’s time to take a look at the behavioral observations from the psychometrist and the child was very anxious, withdrawn. Okay, [00:45:00] let’s now go back to the test results.

Yeah, no wonder that there’s some inconsistencies in these test results, because she’s anxious. She’s typically anxious when she’s being timed. Yeah, that appears to be a pretty consistent pattern. Her feeling being watched, judged, such as being timed, or only getting very succinct feedback, like on the Wisconsin Card Sorting Test, or a similar test where you don’t read, don’t write, or wrong, without an explanation why, we get more anxiety.

So I see a pattern here. This is a child with a lot of anxiety. You learn to do that in that fashion where you basically say okay, I’ve got all the test results on the same mark. I’m not wasting time waiting to see that. I can give a brief general conceptualization.

I’m going to check how that holds together with my history. I see a pattern emerge, but it’s okay. Let’s hold on to that pattern. Anxiety is one of the things I need to address in my report. That will be one of my pillars. [00:46:00] What’s another pillar? What’s another issue? And then I can put it all together and say, okay, here’s the final interpretation.

I think that the main keys is being organized. When I do reports, my door is closed. I typically have open door policy. Everybody in my department means that if my door is closed, I’m either with somebody discussing something confidential or I’m dictating, please do not interrupt me.

And since my dictations do not take all that long because I don’t close that door until I’m ready to start dictating and not ready to start dictating until I’ve actually already done my integration, that door is only closed for 20 minutes and people will respect that. So I don’t get interrupted, and I’m organized before I start dictating.

I spend more time on integration of findings than I do on dictating the report. People often make the mistake and say, I’m going to [00:47:00] start writing and I’m going to start dictating and somehow magically God’s greatest insight into the nature of mankind will come to me while I’m doing that, and then they find themselves on page 11 or 12 or 13 while they’re still trying to figure it out. And then it takes so long.

I think if you do the integration beforehand, before you either even write or dictate a single word, then your work is already half done.

Dr. Sharp: So do you actually, I know I’m getting into the nitty gritty here, but do you physically write out these pillars in that pyramid model, or are you just thinking of it in your mind or how do you do that?

Dr. Donders: I do it now in my mind. When I first started doing this, I would sketch them out and I might sketch out a pyramid that says here’s the top and says, so conclusion child has PTSD, not both concussion syndrome.

[00:48:00] What are the pillars? I have a history here that the child has nightmares with accident-related content, is still very uncomfortable being a passenger in cars. Doesn’t appear to be generalized anxiety because there’s no anxiety about playing soccer with his friends.

Why is not post-concussion syndrome? Because I don’t see any indication on any of the tests for cognitive difficulties, particularly not in areas of novel learning or speed of processing that I know are relatively sensitive to brain injury. I also know from the history there’s nothing in the pediatrician’s notes for this child prior difficulties with anxiety. So I know this is not a pre-existing condition.

So now I know I have the symptoms that fit with the diagnosis. I can rule out another diagnosis, potion question, because I have the data to do that. I can also say it’s causally related to this accident, not only because of the nature of the nightmares, but because also there’s nothing used in this child’s medical records. [00:49:00] This is just a prior interview or a prior problem with anxiety.

I used to sketch that out. I would have a triangle at the top with three or four columns at the bottom. And then under each column, I might write down, okay, make sure you discuss the Achenbach with regard to the anxiety or make sure you discuss Dr. Jones’s office notes or a few key words.

Having done this for more than 24 years, I can now do this in my head. I usually recommend to my residences sketch it out first, but don’t make it an art project.

Dr. Sharp: That’s a good way to put it. Sure, I like that. I think that’s something that over time I’ve probably been doing in my mind, but even to hear it articulated like that helps, it gives a little more organization and structure to [00:50:00] it. I know there are probably folks out there who are thinking, okay, this is good. I’m going to start literally sketching it out before doing the interpretation. I like that visual. That’s very cool.

Do you use any, aside from dictation, any sort of technology or apps or anything like that to keep you on track or stay efficient in your report writing?

Dr. Donders: I use a transcription service, so I think they can send back to me, I typically always review them to make sure that there’s no mistakes. The mistakes are usually mine that I mumbled too much and insignificant might come out as a significant.

As an interesting tidbit, my main transcriptionist is blind. [00:51:00] She transcribes in the most accurate manner, I watched her do it once. She has the option of playing back what she just wrote. Of course, she can’t see anything. She rarely makes mistakes.

She will email me, say, hey, you forgot to put a section on the CPT codes or whatever, very accurate. I use a transcription services, how we got on this topic. I know some of individuals like to use dictation software like Dragon or one of the other ones, either way, the necessity of being organized and doing the integration so forth, it will be the same.

One of the things that I’ve found just being organized, as I said, get all your ducks in a row before you start what you’re doing. While I’m dictating, I can see how much time has elapsed [00:52:00] since I started. It keeps track for me on the phone.

So if I’m only halfway down what I want to say and I’ve already 20 minutes in the same, then I probably pause the whole dang thing, I said, what am I really doing? Why am I getting off track? What do I need to do?

As I said, I avoid interruptions. Somebody has a patient on across the hall holding a gun to his head or somebody else’s head, yes, I will deal with that but otherwise, please do not interrupt me while I’m dictating, because I need to get this done in one session, if at all possible, because else I’ll lose that train of thought.

I do at least one and most often two neuropsychological evaluations per week. If I get distracted and I start breaking up in different time slots, I lose track of what I wanted to say because I do all the integration in my head. So making sure that I have the time to do that, it’s now almost [00:53:00] 11:30 AM, I can do this report in 20 minutes, but I need to do the integration. So let me do the integration between 11:30 AM and 12:00, let me dictate between 12:00 and 12:30 PM.

Do I have that on my calendar? No, because I already have a new meeting. Okay, then I’m going to set this report aside. I’ll do that later this afternoon when I have the time for it, and between now and twelve o’clock, I’m going to do something different. Those basic time management issues help me out quite a bit.

Dr. Sharp: Yeah. I think that’s what is really standing out. There’s a lot of maybe self-awareness or self-monitoring in this process. I hear you also talking about batching your time which I’ve talked about a lot on the podcast in terms of being efficient.

So it’s like you know exactly how long a report should take you and then you just match that to your schedule. And if it doesn’t match, then you wait till you have the time, that sounds like.

Dr. Donders: Yeah. That works for me because I know what my schedule is, the [00:54:00] people around me know about my open-door policy and there’s a good reason for me to have the door closed. I know some people don’t have offices, they have cubicles or they may have more chaotic lifestyles, but try to make it easy for yourself. If at all possible, try to do that integration before you dictate so that way your dictation time will be actually be very brief and try to get it all done in one sitting.

Dr. Sharp: Yeah, that’s fantastic. Goodness, an hour has gone by really quickly. I feel like I’m looking at this long list of questions that we didn’t even really touch on, but this has been super valuable. I want to be respectful of your time.

Anything else, any kind of parting thoughts or strategies or anything like that, or even resources for folks who are trying to really tighten up their reports and make sure they’re doing a good job and not spending their lives [00:55:00] writing reports?

Dr. Donders: You mentioned my book. I don’t want to oversell it or anything like that, but I’ve pretty much put in a book on Neuropsychological Report Writing; what I think needs to be in there in terms of general guidelines and specific illustrations.

One thing that we haven’t touched on a lot is forensics or any other arena where you might beg to differ with another psychologist. What I have learned is I sleep much better and in the long run, I have much better relationships with my colleagues if I take the high road. I mean that the report is not a place to make snide remarks about another psychologist. It’s not a place to go into a micturition match. It’s not a place to be [00:56:00] passive-aggressive.

So even if I think that other psychologist is an idiot in terms that he can’t tell a cucumber from a frontal lobe, I’m not going to say that. I’m going to say, I’m a little bit puzzled by Dr. So and So’s conclusions because I don’t see a clear foundation for that. In fact, there are some other facts and those facts would be A, B, and C that would suggest otherwise.

If I find myself disagreeing, I try to phrase that in words that if my mother read it and would understand it with her 6th grade education, she would not be mad at me for being nice. You can disagree with somebody, but try to address it in a professional way.

Dr. Sharp: Yeah. Can I put you on the spot a little bit [00:57:00] to ask for maybe another example of how you would do that? What the wording would sound like to politely disagree?

Dr. Donders: This patient had a prior psychological evaluation with Dr. Jones. Dr. Jones gave her a diagnosis of a major cognitive disorder due to traumatic brain injury. I find this somewhat puzzling because we’re talking about an individual who is now more than two years after an uncomplicated mild traumatic brain injury and the literature suggests that the vast majority of people typically recover with a matter of weeks to months. That’s not just my private opinion, but here are some different literature references.

I questioned the terminology do too, because there’s clear evidence in the school records that this child had special education services because of cognitive impairment well before is brightened. It is excellent to ever have. And that’s all I say.

[00:58:00] Dr. Sharp: Okay. I like it. That was a great on-the-spot performance. Thanks for entertaining that. Like I said, this has been incredibly valuable. I’ve been taking a lot of notes. I think that listeners are going to find this very informative. I really appreciate your time. We will have links in the show notes to your book and any other resources that I might be able to dig up to support anything that you’ve said.

So Jacobus Donders, I really appreciate it. Thank you so much for coming on The Testing Psychologist.

Dr. Donders: Oh, you’re welcome. It was fun.

Dr. Sharp: Good. Take care.

Dr. Donders: You too. Bye bye.

Dr. Sharp: Hey, y’all. Thanks again for listening to this interview with Jacobus Donders. Dr. Donders is obviously a very well-decorated member of our field and has done a ton over the years. I found this conversation valuable just to get some insight into [00:59:00] the elements of a report that are truly helpful and some ways to cut down our report writing time to deliver what is most important.

Like I mentioned during the podcast, we’ll have links to his book in the show notes. He has several articles published on a variety of topics that you can look up through Google Scholar or your university library.

A final shout-out to Practice Solutions. They’re a full-service billing agency just for mental health professionals. They do it all. They have greatly helped our practice. They will give you 20% off your first month if you follow up with them and mention The Testing Psychologist, or go to practicesol.com/jeremy.

So thank you as always for listening. This has been a big week. The size Facebook group has literally grown by about 20% maybe [01:00:00] 25% just this week. So something is happening. The word is getting out and people are jumping in, which is fantastic. If you are not a member of the Facebook group, come check us out. It’s The Testing Psychologist Community on Facebook.

If you’re enjoying the podcast, I would invite you to take 30 seconds and subscribe and rate, or even review the podcast. I’m very grateful for any of those thoughts that you are willing to share or the time you’re willing to take.

Of course, as always, if you are looking for consultation for your testing practice, feel free to give me a shout. That is what I do. That’s what I specialize in. I would love to talk with you about how to grow your testing practice or hone your testing services to make things more efficient and make sure that you’re making money like you should be. You can get that contact information at thetestingpsychologist.com. All right, y’all, take care. I will talk to you next time. [01:01:00] Bye bye.

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[00:00:00] Dr. Sharp: Hey everyone, welcome to The Testing Psychologist podcast episode 37. Hey everybody. Welcome to another episode of The Testing Psychologist podcast. I’m Jeremy Sharp. Today, I am talking with Dr. Molly McLaren.

Dr. Molly: Hello everyone. Happy to be here.

Dr. Sharp: I’m excited to have Molly for two reasons; one is that Molly is probably my most familiar guest because we have worked together for the past many years, five maybe six years.

Dr. Molly: Has it been that long?

Dr. Sharp: It’s been a long time.

Dr. Molly: Wow.

Dr. Sharp: Molly started working with me back when she was a graduate student, she was a psychometrician here in the practice and [00:01:00] then went on to do her postdoc here in our practice, and now she is a staff psychologist in our practice so we have a long relationship. Molly’s a pretty amazing person in lots of ways.

Let me introduce you real quick, Molly, and then we can jump right into it. We’re going to be talking all about evaluations for emotional support animals today. This is something that has popped up in the Facebook group quite a bit and maybe a lesser-known area of evaluation but one that we get a lot of requests for, and I know, a lot of listeners get a lot of requests for. We’re going to talk with Molly all about emotional support animal evaluations.

In the meantime, though, Molly is currently a licensed psychologist. She is practicing, like I said, here in Fort Collins, Colorado with us. She graduated and got her doctorate from Colorado State University. She has many years of clinical experience in university counseling centers, college career centers, and community [00:02:00] mental health settings.

She was also a psychometrician, not just for me, but for a clinical neuropsychologist in the community during graduate school as well. Molly has done all of her dissertation research on, how would you phrase it, career assessment, and vocational services.

Dr. Molly: I think that’s fair, about career matching based on fit and online assessment.

Dr. Sharp: Cool. Molly brings a wealth of experience to our practice and we’re super lucky to have her here.

One of the things that we’ve gotten into and started to dig into over the last several months is evaluations for emotional support animals. Do you remember what those initial referrals look like or where those came from? I’m trying to think.

Dr. Molly: I think the first ones I received were from therapy clients who were struggling and end up in a [00:03:00] situation where they’re hoping to get emotional support animal living with them in an apartment.

Occasionally, it was after other types of evaluations like ADHD. I had one after a PTSD evaluation and she came back and asked for an emotional support letter.

Dr. Sharp: Got you. Some of those flow from other evaluations or therapy clients. I know that we’ve gotten some calls from out in the community as well. I think for me, that was the impetus to start looking into this and figure out what’s the deal here.

We’ll talk about all sorts of things related to emotional support animal evaluations, but maybe we could just start with defining what an emotional support animal even is because I feel like I see emotional support animals everywhere, like those vests in airports or in schools or the grocery store. [00:04:00] What is an emotional support animal?

Dr. Molly: That’s the tricky thing because people can just buy a vest and designate their dog emotional support animal in some ways, walking around and pretending that that’s an official thing because people don’t know what the definition is or how it goes about getting official. And so I think you touch on a controversial aspect of emotional support animals.

Technically, how they are meant to be defined is an animal that provides emotional support to someone who has a mental health disability, meaning a diagnosis of some sort, like major depression, anxiety, some phobia issues, or things along that line. The thing about emotional support animals that’s often confused is that they’re different from service animals.

Dr. Sharp: Okay. I didn’t even know that.

Dr. Molly: In a lot of ways, [00:05:00] the best way to define them is what they’re not.

Dr. Sharp: Okay.

Dr. Molly: So a service animal specifically, is an animal that’s trained in several ways to help someone with a disability. That’s usually some sort of physical disability such as maybe blindness or some sort of mobility issue. A dog might be trained to be, can be a guide dog or fetch things, be able to get things for an owner who has mobility issues whereas an emotional support animal is not necessarily trained in any way whatsoever.

Dr. Sharp: Oh, okay.

Dr. Molly: It’s just a pet that a person with a mental health diagnosis has found to be supportive for them and helped them feel better, maybe eases their anxiety or brings joy in their life if they’re depressed, that sort of thing, or in the example of maybe flying on a plane, if you have a phobia of flying, having your animal with you maybe helps you stay calm. [00:06:00] But that animal to be designated an emotional support animal doesn’t necessarily have to have any kind of training whatsoever, which is tricky.

Dr. Sharp: Oh, got you. Yeah, I would imagine. I have a lot of questions with that; can service animals be considered emotional support animals?

Dr. Molly: That’s a good question. It’s like a hierarchy; a service animal could provide emotional support but in order to be defined as a service animal, it would have to be trained beyond what an emotional support animal is.

Dr. Sharp: Okay. Got you.

Dr. Molly: Does that make sense?

Dr. Sharp: Yeah, certainly. It sounds like service animals actually go through specific training. Now that I’m talking about, I feel like I’ve heard of them being specifically trained to provide support for a seizure or something like that. They’re pretty specialized in what they can do, but an emotional support animal could be any animal.

Dr. Molly: A lot less than that. Yeah, it could be any animal. I think a lot of people think of [00:07:00] dogs initially. Dogs are probably the most common, but it can be any animal. That’s not even defined.

Dr. Sharp: Oh, wow. I’m getting a little bit ludicrous, but you could have an emotional support fish or frog, okay

Dr. Molly: Yeah.

Dr. Sharp: Good to know

Dr. Molly: As far as I know, that’s my understanding.

Dr. Sharp: Okay. That sounds good. The majority though, I would imagine are dogs or cats maybe.

Dr. Molly: Mm-hmm.

Dr. Sharp: Okay. Anyway, that opens up a lot in terms of how we handle the evaluation, what we’re recommending but I wonder, just in general, before we dive too deep, when would someone perhaps seek an evaluation for an emotional support animal?

Dr. Molly: The main benefits or permissions you get with an animal that is designated emotional support [00:08:00] animal is that they can be allowed under the Fair Housing Act to live with you in a residence that does not typically allow pets, for instance, sometimes that’s apartment complexes.

Sometimes, they will waive the fee as well. So sometimes it’s an apartment that you can have an animal, but you have to pay a pet deposit, rent and you can get that waived if it’s an emotional support animal or if they’re not allowed, you can then have them.

College dormitories is becoming a more common thing that students are requesting to bring their pets with them to college dormitories and they’re having to figure out how to handle that. Additionally, I mentioned earlier, flying on a plane. Those are the only two places that emotional support animals are actually allowed.

There’s a big misconception that they, like you had said, are allowed grocery stores, out and about while you’re shopping. I think the public thinks that and a lot of people think that so people bring their animals and then [00:09:00] there’s no repercussions for that because people assume it’s allowed. They have the vest on. They don’t want to pry or ask and so people get away with having their animal in public places. Even if they were designated emotional support, they aren’t allowed.

Dr. Sharp: Oh, that’s interesting. So all those signs that you see are specifically only for service animals.

Dr. Molly: Just service animals, yes.

Dr. Sharp: Okay. That’s really important. I don’t know if there’s any way for you to know this, but do people try to bring their emotional support animals into those situations?

Dr. Molly: My understanding, I believe that does frequently happen.

Dr. Sharp: Yeah, I would imagine so.

Dr. Molly: It’s controversial for that reason.

Dr. Sharp: Yeah, sure. That word, controversy, has come up two times already, so I think it’s probably worth diving into that. A lot of the testing and assessment that we do is [00:10:00] presumably empirically supported and we’re making recommendations that we think are going to help with whatever the person’s concerned with or their problem might be or their diagnosis might be.

We’re pretty big on empirically supported interventions. How does an emotional support animal fit into that paradigm? Do we have research to say that an emotional support animal is an empirically supported treatment for anything?

Dr. Molly: I would say the short answer is probably no. There’s research that definitely suggests animals can provide a soothing impact for people. There’s research suggesting that petting a dog, for instance, lowers blood pressure or increases oxytocin, serotonin, other feel-good chemicals in the body. [00:11:00] There was a study about older adults in nursing homes that their depression and loneliness somewhat alleviated by having companion animal or even a plant to take care of.

There’s some research that it can be a positive thing, but surprisingly the research isn’t very convincing that they mitigate mental health disorders. There’ve been meta-analyses on the research that is out there and it’s borderline and more research is needed for sure to fully determine that.

Dr. Sharp: Certainly. It seems like one of those things that, on the surface, it would make intuitive sense that an animal would certainly help you feel better, certainly if you’re an animal person and you choose to be [00:12:00] around an animal, it would help you feel better. I wonder if it’s one of those areas where the research maybe hasn’t caught up or there’s not enough yet or something along those lines, I don’t know.

Dr. Molly: That’s certainly plausible. It’s also plausible that there’s a specific subset of people and disorders that might be benefited by emotional support animals. And then it’s possible that some could be harmed and we don’t know that.

Dr. Sharp: Sure.

Dr. Molly: So it’s definitely tricky.

Dr. Sharp: Do you have thoughts just off the cuff about when an emotional support animal would not be helpful or people who might not benefit from that?

Dr. Molly: I could conjecture.

Dr. Sharp: Sure.

Dr. Molly: I don’t have any evidence other than my own opinion based on working with clients but I could see potentially someone with maybe severe [00:13:00] social avoidant tendencies, social anxiety feeling better having an animal companion, but then maybe feeling less motivated to go out and make human friends because it’s easier to have a canine friend and as such, their life getting limited or potentially their mental illness getting worse because they can rely on that animal rather than getting out.

Dr. Sharp: Sure. That makes sense.

Dr. Molly: Not that I’ve necessarily seen that happen, but could see it being a possibility.

Dr. Sharp: That makes sense. I can absolutely see that. On the flip side, though, are there things that you have worked with or maybe common concerns that people come in with that you think an animal is more beneficial for has more propensity for helping?

Dr. Molly: I do think that animals make people feel better in their home if they’re [00:14:00] anxious or feeling low, or if they, again, the same example, the flip side of social anxiety, if you’re struggling to make human connection and you can make animal connection, that can probably make you feel better but you have to be able to balance it by continuing to work at what’s going on for you.

Same thing with depression, having an animal in your home could potentially boost your mood, make you feel a little happier as long as you’re continuing to combat the depression in other ways. People who are not in favor of emotional support animals argue that other strategies could do that, too and so do we really need to have emotional support animals?

Dr. Sharp: That’s always the question when we’re talking about treatment efficacy; is it better than whatever the standard is, CBT or medication, whatever [00:15:00] intervention might otherwise be used.

Dr. Molly: And in this case, that’s maybe even particularly important because we’re talking about giving special permission to people to have these animals in places that they wouldn’t ordinarily be because it needs to be far and away better than any other options they have to get that access.

Dr. Sharp: Yeah, that’s a good point. This came up in the Facebook group maybe, if anybody’s not a member of the Facebook group, it’s The Testing Psychologist Community on Facebook. We have a lot of cool discussions in there about testing-related stuff.

When we were talking about emotional support animal evaluations, someone brought up the point that there’s a certain amount of the population who is actually allergic to animals, and that’s something that we have to consider when we’re granting treatment, so to [00:16:00] speak, that happens in public that puts other people at risk

Dr. Molly: For sure, especially on an airplane.

Dr. Sharp: On an airplane, yeah, exactly. I wonder, this is totally spinning off, do they ask the other passengers if someone can bring in a service animal or emotional support animal? I’ve never been asked.

Dr. Molly: I don’t think so. You can bring your pet on a plane if you pay.

Dr. Sharp: That’s true.

Dr. Molly: In the cabin, if they’re small enough. This just waives the fee.

Dr. Sharp: Oh, got you.

Dr. Molly: And let them sit in your lap rather than under your seat.

Dr. Sharp: Yes, right. It seems fair to say the jury is maybe out on the efficacy of emotional support animals. Anecdotally, it seems to make sense. I’ve certainly heard stories of folks on the autism spectrum who have a good connection with animals and that can sometimes facilitate connecting with people as well.

You move in this direction of doing an evaluation [00:17:00] to see if this would be helpful. What does that process actually look like?

Dr. Molly: So again, that’s not very well delineated. To put it out there, my bias, initially going into this as we were talking, one of yeah, sure, of course, that’s helpful. I was all gung-ho about doing these ESA evaluations until I started looking into the research and I’m like, wow, this is a lot more complicated than I had realized.

So I had a protocol set up that would involve a clinical interview with the client, collateral interviews with people in their lives, whether other professionals that they’ve worked with around their mental health concerns or family, close friends, that sort of thing, who could corroborate their symptoms and concerns for a little bit of extra data there.

And then also personality assessment of some sort, so PAI, MMPI, MCMI, one of those [00:18:00] to get an assessment and some backup objective data of their symptoms to document that there’s truly a mental health concern present.

I think the biggest concern with the evaluation is making sure that people aren’t just trying to game the system in some way and save $1, not have an animal with them when they’re not supposed to, because they love their pet, which I sympathize with. I love my dog but there’s rules in existence for a reason with these institutions that aren’t allowing animals to make it important that we are being thorough in how we do this evaluation.

Dr. Sharp: Sure. But there’s no standard, you said, set forth by any agency or APA or anything like that. It’s not like we have standards of care for emotional support evaluations.

Dr. Molly: Unfortunately, no. It’s not empirically supported so there’s no [00:19:00] empirically validated way of measuring something that we don’t even know necessarily helps.

Dr. Sharp: Yeah, that’s true. Circular argument there.

Dr. Molly: You can certainly argue that there’s an empirically validated way of establishing diagnosis, that mental health disability exists. That’s about as far as the evaluation process goes. That they have social anxiety, that they have major depression but not to say necessarily, that the animal is going to lose help.

Dr. Sharp: Right. That makes sense. In that way, it’s similar to any number of other, I would say, personality evaluations for like egg donation or adoption or something; you’re just getting a good, and I don’t mean to minimize by any means those types of evaluations, but getting a good sense of someone’s personality, mood, [00:20:00] social-emotional functioning just to see what’s going on with them.

Dr. Molly: Yeah, definitely.

Dr. Sharp: Sure. I know that you have to document those results somehow, so what does the documentation look like? Do you write a report? Is it something different? What’s that look?

Dr. Molly: You certainly could write a report. I’m not big on report writing so my plan was to focus on the necessary documentation for their request. For instance, most of the time people are coming with something specific that they’re wanting.

They usually have some sort of form that they need filled out from their apartment complex or from their dormitory or you can write a very generic kind of letter acknowledging that you did the evaluation with them, that you’ve diagnosed them with a mental health disorder and you’re prescribing [00:21:00] an emotional support animal for that.

Dr. Sharp: Oh, that’s an interesting word, prescribing.

Dr. Molly: Yes, that’s the word they use.

Dr. Sharp: Huh?

Dr. Molly: It is interesting.

Dr. Sharp: Wow. That is interesting. That makes me think, can a physician write a letter for an emotional support animal?

Dr. Molly: I believe so, yes.

Dr. Sharp: Okay. That’s good to know. So the prescribing, so you are actually saying, yes, this animal …

Dr. Molly: Prescribing it for this issue.

Dr. Sharp: Absolutely.

Dr. Molly: And sometimes the forms also have some liability language as well, which is interesting.

Dr. Sharp: What do you mean?

Dr. Molly: That you would be willing to go to court if something were to come up and testify that everything was legit and that you do support this emotional support animal for this person.

Dr. Sharp: Got you. I think that’s maybe where we were getting stuck within the practice in whether we do these evaluations or not. I’ve talked before on the podcast about [00:22:00] scope of expertise and using that question, what if you had to defend this in court, would you feel comfortable?

And so when it comes down to it, when you’re actually signing a letter that says, I will testify that this person needs an emotional support animal, that’s hard when there’s not a ton of research to back it up, right?

Dr. Molly: Yeah, definitely. It definitely gave me pause and was part of why we were like huh, let’s think a little bit more about this and do some good research to make sure that it feels valid to prescribe an emotional support animal for someone.

Dr. Sharp: Absolutely. There are a lot of questions with these, in terms of moving forward with the process though, if it felt like that was reasonable, you can write that letter or sign that form. Before we started to pull back from these, did you ever have to tell someone that they did not [00:23:00] qualify for an emotional support animal or deliver that kind of feedback?

Dr. Molly: I did not. I think that brings up another interesting issue is that when we were planning to do this, it was something that we thought about ahead of time to make sure was in the disclosure that just because someone is coming in for an evaluation does not mean that they would necessarily get support. The people I did see for a support evaluation, I did end up supporting, I felt like it was valid.

Another piece of that that I was planning to do was to make it pretty comprehensive, thorough, that it would be a lot of work for someone to go through just to save a few bucks and that it costs money for them. So it’s not necessarily just about that, it’s about a need for them to try to weed out people that maybe are trying to gain the system, [00:24:00] so to speak.

At the outset, that would be a tricky conversation to have with someone. The good news would be that if they aren’t qualifying, it’s because you didn’t find them meeting criteria for a mental health disorder. And so I think one way to frame that would be like, hey, you’re actually functioning pretty well, I don’t think you meet criteria for a mental health disorder. In some ways, that’s very good news.

Dr. Sharp: Sure.

Dr. Molly: That could help soften the blow, but I do think it would be tricky, especially if you’re their therapist.

Dr. Sharp: Right. So then we get into that dual role issue. You said that you had some therapy clients that were requesting these letters, how did you handle that?

Dr. Molly: Fortunately, if memory serves, I’ve had two. I felt, at the time, comfortable recommending the emotional support animal for [00:25:00] them. I felt that it was valid and that they did have a documented mental health disorder that was mitigated at least in their eyes by their animal.

I think that it could really put a rift in rapport with a therapy client if that therapy client asked you and you said, no, I don’t think that is appropriate. If you say you’re not comfortable doing it, they probably roll with that, but it’s hard to know who then to refer them to.

Dr. Sharp: It’s a good point.

Dr. Molly: So that’s where we were thinking about coming in but it’s hard.

Dr. Sharp: It is hard. I think that’s the thing that’s come out of this conversation is that there’s still a lot of question marks with how to do an evaluation like this. We’re still waiting for the research to catch up and better guidelines for how to do it.

Dr. Molly: Yeah. [00:26:00] A lot of people are, and I think there’s frustration across the board for providers that don’t know how to handle it, don’t know what to do, don’t want to turn people away, especially with no good person to refer them to as an expert in this. So there’s a gap.

Dr. Sharp: Sure. That makes me think, I know that there are a lot of resources online to, if you google emotional support animal letter, there are all kinds of places that you can fill out an online survey. Maybe you meet with someone over Skype, I don’t know, but they’ll give you a letter just over the internet. Do you have thoughts on that process or the validity of that or what do you do with that? Because I would imagine clients would just walk away from the psychologists and go google it online.

Dr. Molly: Probably. In my opinion is [00:27:00] that it seems sketchy. It seems like a way to make money because they charge $150 or something for this letter, maybe. I don’t know, don’t quote me on that, but a little fee.

And then they say that it gets reviewed by a mental health professional and you just send in information saying, here’s what’s going on for me. They review your case, and maybe they look at some documentation. I don’t know how thorough, some may be more thorough than others but having not met the person and the fact that it’s just all over the internet seems a little sketchy.

Dr. Sharp: Sure. I’m with you on that. There’s a lot to sort through here. It’s an interesting situation in that there aren’t a whole lot of other evaluations that you can also just go to the internet [00:28:00] for, right?

Dr. Molly: Very true.

Dr. Sharp: It’s got me thinking about is this a service that psychologists need to think about providing or not.

Lots to think about.

Dr. Molly: Indeed.

Dr. Sharp: Like I said, we’ve talked about this topic a lot in the Facebook group and it’s popped up here and there, other places as well. It was when we started talking about doing the evaluations and then the podcast and digging into it, I was surprised that the research was not present. I just assumed that it was out there.

Dr. Molly: Me too and as a dog lover, there was something I was reading brought up the point that media tends to support emotional support animals. Everything that they put on media is yay, emotional support animals and so people assume that it’s well documented.

There’s [00:29:00] also an important downside. I want to just mention that a lot of people don’t think about as well is that, the fact that emotional support animals are not well trained and if people are taking them in public places, even though they’re not meant to, and their animals misbehave or goodness, bites somebody, think about how badly that reflects then upon service animals, because people don’t know the difference.

Dr. Sharp: Sure.

Dr. Molly: Service animals are not going to misbehave like that. They’re so well trained, but people who have are dependent upon their service animal have to have the animal out with them in public, but then gives that service a bad reputation because people are bringing their untrained animals out and about with them. That’s a big concern.

Dr. Sharp: Sure. I would maybe even take it a step further and then say that some of the empaths falls on us to take some [00:30:00] responsibility for that and really be mindful certainly of the person’s presentation and the evaluation results, but also of the research in general to say yeah, this has got to be an ironclad kind of thing to recommend that folks are allowed to take, you never know, I hate to assume worst case scenario, but untrained animals in public where they maybe shouldn’t be.

Dr. Molly: Yeah, for sure.

Dr. Sharp: And then does that reflect poorly on us as well?

Dr. Molly: And one thing we can do is recommend to the client that they get basic training for their animal. As long as it’s not a gerbil, I don’t know if they have, but assuming it’s a dog of some kind, but there’s no way of following through with that or enforcing that. There’s not a framework in place for that yet.

Dr. Sharp: Sure. This is interesting. I appreciate your time and willingness. I know that you’ve spent a lot of time digging into [00:31:00] this and we’ve talked about, is this a worthwhile service and if not, why not? And if so, why so. I know you’ve spent a lot of time with it and appreciate you being willing to come on and chat and talk about it. Hopefully, it’s been somewhat informative for other folks out there who are considering taking on these evaluations.

Dr. Molly: Yeah, absolutely. Thanks for having me.

Dr. Sharp: Of course. I should ask, putting you on the spot, but any resources or things to look at if someone is considering doing these evaluations, anything?

Dr. Molly: I don’t know the website; web address is offhand. When I was doing some hunting, I was able to find some pretty good resources. Psychology Today had some but just discussing the pros and cons and the complications of it. So keyword searching for ethics in emotional support [00:32:00] animal evaluations or empirical support and emotional support evaluations, you can find a lot of good websites discussing the issue and both sides of it.

Dr. Sharp: Okay. That sounds good. I’ll dig around and try to find some of those links to put in the show notes in case people are curious and want to look more into it.

Dr. Molly: Great.

Dr. Sharp: It sounds good. Dr. Molly McLaren, it’s great to have you on the podcast and provide another dimension to our working relationship. So thank you so much for coming on and sharing all of your knowledge.

Dr. Molly: Absolutely. Thanks for having me.

Dr. Sharp: All right. Hope you all enjoyed that interview with Dr. Molly McLaren talking about emotional support animal evaluations. That’s something that we get a lot of questions about. Hopefully, that shed some light on that whole process.

As always, I would love to hear from y’all about your own experience with emotional support animal evaluations, or particularly in this case, letting me know if there’s any [00:33:00] research out there that I might not be aware of that could support doing these evaluations and feel a little better about recommending emotional support animals.

Once again, I want to thank this month’s podcast sponsor, Practice Solutions. Practice Solutions is a full-service billing company that specializes in mental health practitioners and practices. They integrate right into TherapyNotes, which is their preferred EHR. So if you use TherapyNotes, they’ll be a great fit for you. If not, they’ll help you get up and running with TherapyNotes.

They do everything. They do benefits checks, claim submissions, follow-up billing, collecting payments, and anything you could ask for on the billing side. They’re very knowledgeable, like I said, about mental health. They have really helped our practice. So if you are interested in a billing service, give them a ring or a click rather, you can get 20% off your first month’s service at [00:34:00] practicesol.com/jeremy.

Thank you again for tuning in. Great to be back with you doing some interviews and gaining some knowledge from other folks. There are a lot of great folks out there and we have some cool interviews coming up. Hope to catch you next time and take care in the meantime. Bye bye.

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[00:00:00] Hey y’all, welcome to The Testing Psychologist podcast, episode 36. I’m Dr. Jeremy Sharp.

Hello everyone and welcome back to The Testing Psychologist podcast. Today is episode 3 in the 5 Quick Tips series. I hope you’ve enjoyed the previous two. If you haven’t listened to them, maybe go back and check those out. I did Five Quick Tips for Billing Testing Services and Five Quick Tips for Getting Reports Done Efficiently. Check those out. They’re definitely on the website, thetestingpsychologist.com.

Today, I’m talking all about Five Quick Tips for Marketing.

Before I jump into that, let me give a shout [00:01:00] out to Practice Solutions who is sponsoring the podcast this month. They help you to not waste your valuable time and energy focusing on an administrative task like billing. They save you time. They make sure your billing is done with integrity and transparency, and they are a fantastic choice. We have used them for the past few months. Even in what I would have considered a pretty efficient practice, they’ve increased our collections significantly. So I can vouch for their services. They’re kind. They’re always available. They’re around 24/7. They’re very transparent and very skilled.

Check out Practice Solutions. The website is www.practicesol.com/jeremy. If you sign up through that link, or even just tell them that you signed up or heard about them through The Testing Psychologist, you’ll [00:02:00] get a 20% discount on your first month. So check them out if you’re in the market for a billing service.

Today, we are talking about five quick tips for marketing your testing practice. These are things again, that I’ve found over the years that have certainly proven helpful and things that we do in our practice day in and day out.

Quick tip 1, very easy. Send thank you faxes. Every interview that I do, I always ask who referred to the client for testing and if I have permission to contact that person just to say thank you in an anonymous way. I rarely run into anyone who does not want me to do that or is not okay with that. So after the interview, I fill out an interview follow-up form, which we have developed here in the office, and one of those items on the [00:03:00] follow-up form is a checkbox where I can say send a thank you fax to the referral source and then I write in the referral source and our admin assistant faxes that over to the referral source.

Make sure that it’s on your letterhead. Make sure to craft a nice message that is personable but not so personal that you have to rewrite it every single time. I found that that helps to get our name out in front of other people’s faces and it was just kind to let them know that you appreciate their referral. So sending thank you faxes.

My second quick tip is go to the schools as often as possible if you are testing kids. I’ve talked before about school observations and how valuable those can be from a clinical perspective. I also think that they are incredibly valuable from a marketing perspective. Again, it gets you out in the community. [00:04:00] It lets you meet educators, administrators, teachers, and counselors at the schools, and it gives you a good sense of what different schools are like in your area.

So as much as possible, and as much as is clinically relevant, do school observations whenever you can. Get out there and make sure to meet people to always introduce yourselves to the teachers, to the counselors, even to the principal, if they’re around. Over time, you can develop nice relationships with schools. We’ve gotten many referrals from schools because of that.

Quick tip 3, always do collateral interviews with any other providers involved. This is maybe a no-brainer, but I have found that sometimes it can be hard to make the time- both making the time to schedule those collateral interviews and also coordinate schedules and actually finding the time [00:05:00] to talk with other providers because we’re all so busy.

This is another place where I would give a shout-out for having a virtual assistant or even an in-office assistant as someone to help you schedule those interviews. So you can add that to your list if you’re trying to decide if you need a VA or not as that person who could help schedule collateral interviews.

I always do collateral interviews with any other providers involved. Through that, I have talked to countless other therapists, psychiatrists, medical practitioners, massage therapists, acupuncture, like anyone that seems like they would have relevant info and would be a valuable person to chat with for your testing case. Go for it. Do those collateral interviews. It doesn’t have to be long. 10 or 15 minutes usually gets the job done. I’ve heard so many times those folks say, thank you for reaching out. [00:06:00] We don’t hear from evaluators very often. So, again, that’s a great way to network and build relationships in the community and subsequently get referrals.

Tip 4 is to ingratiate yourself and get to know the referral coordinators at various medical practices. So at least in our community, we have probably three, I’d say big medical practices that have multiple locations here in town and serve a lot of people.

In some cases, the referral coordinator is a person that oversees referrals for the entire office or medical practice in multiple locations. In some cases, each office location has its referral coordinator. So I would do some research again, a great task for a VA, and figure out who the referral coordinators are. It’s [00:07:00] easy to shoot them over some information, a quick one-page fax, or a little a one-page brochure flyer, and make sure that you know their names, you know where they work and they have your information.

Related to this, you can keep a spreadsheet or contact sheet with all these referral coordinators’ contact information, locations, and all of that so you’re not reinventing the wheel every time you want to send out an update for your practice or just get some information out there.

So get to know your referral coordinators. They are the ones who are talking with the physicians most frequently, networking with the patients, and sending those patients out when they need to get connected with services.

My last quick tip for marketing is to consider digital marketing as part of your practice profile. [00:08:00] A few episodes ago, I interviewed John Clarke from Unconditional Media. I will link to that again in the show notes here. 

There are a variety of ways to do digital marketing. I think it can be particularly helpful if you are adding clinicians and you need to get referrals quickly, or if you’ve moved to a new town and you need to get referrals quickly in a place where you maybe don’t know folks to do the networking.

There are many different forms of digital marketing. I would highly recommend not trying to do it yourself unless you want to spend the time and energy to figure out how to do it well. I’ve said since way back in the beginning when I started my practice and started to do these private practice talks that digital marketing, search engine optimization, AdWords, Facebook ads, all of that are science unto itself. I have personally lost a lot of [00:09:00] money trying to do it myself and not doing it well. So take it from me. If you consider digital marketing, talk to a professional, but it can be really helpful for your practice.

All right, folks, that concludes my last 5 Quick Tips episode. I hope you took a little something away from these tips for marketing your practice.

As we conclude this 5 Quick Tips little series, I’ll give you the info again, just for the website. If you want to find out more or check back on past episodes, you can go to thetestingpsychologist.com and check out all of the past podcast episodes. There’s also a link there to the Facebook community, which is fantastic. It just continues to grow. We have 300 people in there now at this point, probably more by the time you hear this episode. We’re talking the business of testing insurance, billing, different [00:10:00] measures, all kinds of good stuff. So you can find that Facebook community either by searching Facebook for The Testing Psychologist Community or by clicking through on the website.

If you’re interested at all in talking about consulting or collaborating on how to grow your testing services, you can find out more about that on the website as well. You can also give me complimentary anything, but I will give you a complimentary 20-minute phone call just to talk about whether consulting could be a good fit for you or anything else that would be helpful in moving forward with your practice. So if you are interested in that, feel free to shoot me an email, at jeremy@thetestingpsychologist.com. We can talk for a few minutes and figure out if consulting might be a good fit for you.

Finally, I will give one more shout-out to Practice Solutions. They’re a fantastic full-service billing [00:11:00] company. They do eligibility, benefits checks, statements, insurance verification, and collections. They do it all. They are kind. They know what they’re doing. They’re very responsive and they’ve increased our collections significantly just in the few months that we’ve been working with them. So I can highly recommend them from working with them in our practice.

If you do want to check them out, the link is www.practicesol.com/jeremy, and they will give you 20% off their first-month services if you mention The Testing Psychologist or go through that link. So check them out if you’re looking for a billing service.

So, like I said, we have some cool interviews coming up. I’m looking forward to getting back to the interviewing game and bringing some great content to you from some well-respected folks in the field. As always, if you have any ideas for podcast [00:12:00] episodes or anything you want to hear about, feel free to shoot me an email. Otherwise, I will talk with you next week. Thanks. Bye bye.

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[00:00:00] Hello everybody. This is Dr. Jeremy Sharp and this is The Testing Psychologist podcast episode #35.

Hey yáll, this is Jeremy. Welcome back to The Testing Psychologist podcast. I hope everybody is doing well. We are definitely full-on fall here in Colorado. I am looking out the window of my new office, which I love. It has an amazing mountain view off to the west, but in between my office and the mountains, there are a ton of trees with the leaves changing yellow. A lot of them have the leaves totally gone. We’re getting there. It snowed two weeks ago. That’s what it’s like to live in Colorado here. It’s a little crazy.

Hope y’all are doing well. Hope that you were enjoying the weather, whatever that looks like for you [00:01:00], and heading into the holiday season.

Today is the second episode in a series of 3 of 5 Quick Tips. Today, we are talking about Five Quick Tips for Billing.

It’s a nice segue, I think before I get into billing to give a shout-out to this month’s podcast sponsors, Practice Solutions. They are a full-service billing company.

Spending valuable time and energy focusing on an administrative task like billing can be the biggest limiting factor to your practice’s growth. I experienced this in our practice even. Between saving you time and making sure your billing is done with integrity and transparency, Practice Solutions is a great choice for that.

We’ve been working with them for a few months now, and they are doing a fantastic job. Our collections have gone up at least 20% month to month. They’re doing a great job [00:02:00] from eligibility and benefits checks to denial follow-up, they will get you paid as quickly and efficiently as possible. Their services are very transparent and easy to understand. You’ll know the status of your billing 24/7. They’re super nice and friendly. So that helps too. If you sign up through the podcast link in the show notes, they will give you 20% off your first month as well.

Talking about billing, we have several things to consider today. I have five quick tips for you with a little bit of a bonus tip as well.

If you are billing insurance, my first tip is to keep a pretty comprehensive spreadsheet for the information that each insurance company requires; whether they need a pre-auth for testing services, which codes they authorize- whether 96101 or 96118, and how many [00:03:00] hours they typically approve. Now, some of this information you can get from the insurance company’s website. Some of that information you learn over time. Another piece that you can include on that spreadsheet is whether they require preauth for specific diagnostic codes or not. I like to keep track again, like I said, of the CPT code, the diagnostic code, how many hours they typically approve, and whether they require a preauthorization.

That’s tip number one, keep a good spreadsheet based on your experience and based on your research on the internet and in your contracts with the insurance companies.

Relatedly, my second tip is to make a template for pre-auth forms. Most insurance companies do require pre-auth. They have a form that you have to fill out. I’ve created fillable PDF documents that [00:04:00] have the critical information already filled in. So depending on what diagnoses you typically test for, as I’ve said many times, I work with kids, so we have pre-auth forms that have the questions already filled in relevant to whether we’re testing for ADHD or autism or a mood disorder or some other differential diagnosis, brain injury, whatever it might be and we have a separate pre-auth form for each of those primary diagnoses so that once we go in to fill out on the pre-auth, all we have to do is fill in the client’s personal information; their insurance ID, their date of birth, address, that kind of thing. And then if there’s anything you have to tweak specific to that client.

I found that most insurance companies that require pre-auth want you to say [00:05:00] the same thing each time. They have the same questions that you want answered and goals of testing and things like that. So templates can help you there.

My third quick tip is to outsource your billing as much as possible. Unless you have someone in-house or you have a family member or something who is pretty skilled in mental health billing, I think it makes sense to consider outsourcing your coverage and benefits. I’ve talked before about the benefits of knowing coverage and benefits for clients. So when I say outsource your coverage and benefits, if you’re not ready to outsource your entire billing operation, which is fine, I would at least outsource the coverage part. Again, this is if you’re taking insurance. So when I say outsource your coverage and benefits, I [00:06:00] mean, contract with a company who can check benefits for the clients before they come in for testing. This will allow you to give people an estimate of their cost right up front. That way, there are no surprises. Now, if you’re not billing insurance, then that’s a moot point, I still think it’s helpful to talk with people upfront about the cost.

In fact, that is my fourth tip. So three and four, I separated, but they’re kind of like the same tip. Tip number three was to outsource your coverage and benefits if you’re taking insurance. Tip number four is more be sure to speak very clearly about the cost right up front. I think some of us can shy away from talking about money and you may have to do a little bit of work around that. I always say, just practice saying your fees over and over again in the shower, while you’re driving to your friends, to your partner, to [00:07:00] get used to it because testing is expensive and it can feel intimidating and a little shaky to put that out there with our clients right up front, but I think it’s really important for clients to know what they’re getting into.

So, speaking very clearly right up front on that initial phone call to help people know what it’s going to cost, I think is helpful. That way, they can plan and there are no surprises down the road.

My 5th quick tip is to seriously consider collecting a down payment or a deposit of some sort for your testing services. The way that we do this is we give people an estimate of the cost right up front when they are scheduling their appointment or when they come in for the first appointment and we collect half of the estimated total cost at the testing appointment. [00:08:00] In our practice, that means that’s the second appointment that families come in for.  And like I said, we collect half of the estimated cost. I found that it is extremely rare that we end up having to give refunds and it has drastically improved collections rather than collecting everything at the end.

I’ve heard of people collecting a deposit of a set amount, that might be $500, it might be $750, might be $1000 depending on what you charge for your evaluations, but I think it helps to greatly increase your collections and make sure that people are invested in the process.

Now, a related tip, I’m just throwing this in here as a bonus tip, but a related tip is to seriously consider taking a credit card on file as part of the intake process. I have found that very few people balk at [00:09:00] giving a credit card number and it again drastically increases your collections if you get to that point where you have to charge a card because someone didn’t pay. So consider taking a credit card as well.

My last tip, another little bonus tip is don’t sell yourself short. I’ve heard some discussion in the Facebook group, even recently around people making comments like I can’t possibly bill for all the time I spend writing reports. Well, I think you should bill for all the time that you spend writing reports because if you’re spending that much time writing reports, my hope is that it’s because you’re being thorough, and comprehensive, and you’re providing a really good testing service.

Now, you can check in with yourself if you are taking too much time for whatever reason; you’re overly meticulous [00:10:00] or unfamiliar with something, or you’re learning about a particular aspect of testing that you’re trying to integrate into the report. I think that’s a different story. But for people who are writing comprehensive reports, especially if you’re not billing insurance and you’re not limited by insurance company reimbursement for hours, certainly bill for the time that you spend writing your report. This is a very specialized service and people find it valuable and you have to spend the time that it takes to write a good report. So don’t sell yourself short. Bill for the time that you take.

Those are my 5+ plus quick tips for billing testing services, a few related to insurance and a few not related to insurance. I hope that is helpful for you as you consider tweaking your billing services a little bit.

Stay [00:11:00] tuned next time for our last five quick tips episode. That episode is going to be 5 Quick Tips for Marketing Your Testing Practice. In the meantime, if you are looking for a billing service, consider Practice Solutions. They’re great. Their website is www.practicesol.com/jeremy is the landing page here for The Testing Psychologist. If you sign up through that link or mention that you heard about them through The Testing Psychologist, they will give you a 20% discount on your first month’s services.

So hope y’all are doing well. Take care. Enjoy the holidays here as they come up and we’ll talk to you next time. Thanks. Bye [00:12:00] bye.

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[00:00:00] Hey everybody. This is The Testing Psychologist podcast episode 34.

Hello everyone, welcome back to The Testing Psychologist. This is Dr. Jeremy Sharp. Glad to be back talking with y’all. I took a two-week break from the podcast here for a big deal in our private practice.

We have spent the last probably 10 days moving offices. We have been working for several months now to find a space that would house all of our clinicians and give us a little bit more room to grow. Prior to this, we were in an office suite. We were spread across two different suites, so it felt disjointed and not good for our staff to be in separate places.

[00:01:00] I’ve been working over the last few months to find a space that would hold all of us, and we did. So we’ve been waiting on the construction to get finished and strategizing for how to move everything and try to be as efficient as possible. That has been happening over the last week or two. So we are here, we are seeing clients, and feels great to have everybody here in the same space and moving forward with a little bit of room to grow.

So thanks for bearing with me as I took two weeks off here with the podcast. I’m going to be back here, I think pretty regularly for the next several weeks. As I mentioned before, I have some cool interviews coming up with some reputable folks here in the field. Catherine Lord, if you’re familiar with ADOS, was an author of the ADOS; and Jacobus Donders who wrote a book all about feedback sessions. Those are [00:02:00] all coming up. I think we have some good interviews for you in the coming weeks.

In the meantime, I’m going to do a little podcast series here called Five Quick Tips. I think I’m going to do probably three of these. Today will be the first one. The idea is to hit you with five really simple, easy tweaks to address some different issues with testing.

Today’s episode is on writing reports efficiently and getting your reports done. We’ve had a lot of questions in the Facebook group about how to get reports done efficiently. So today I’ll be talking with you about Five Quick Tips for Getting Reports Done. And then we’ll move on from there. In the coming weeks, I’m going to talk about Five Quick Tips for Billing. I’m also going to talk about Five Quick Tips for Marketing your testing practice over the next couple of weeks.

Before I jump [00:03:00] into the Podcast today, I wanted to talk with you about Practice Solutions. They are responsible for bringing you the podcast today and for the entire month of October.

Spending valuable time and energy focusing on an administrative task like billing can be the biggest limiting factor to your practice’s growth. Between saving you time and making sure your billing is done with integrity and transparency, Practice Solutions is the best choice. We use them here in our practice and they have just been fantastic for us. From eligibility and benefits checks to denial follow-up, they’ll get you paid as quickly and efficiently as possible. Their services are transparent and unlike any in their field. You’ll know the status of your billing 24/7. They take great care of you.

So if you are looking for a billing service, I would certainly consider Practice Solutions. Like I said, they’ve done a great job for our practice. I can [00:04:00] highly recommend them. And you get 20% off your first month when you sign up from the podcast link, which will be in the show notes.

Moving forward with our Five Quick Tips for Getting Your Reports Done, these are just a few things that I found over time that have helped. I’m not going to go into a ton of detail, but I’ll give you a few things to write down and start to explore to try and make some of these little changes in your practice.

Tip 1. Think about getting a dual monitor set up for your computer. The reason I say this is because it can help with paperless files which cuts down on storage, but more specifically to reports, I find the dual monitor setup to be helpful because I can be writing the report on one monitor while I am looking at relevant documents on the [00:05:00] other monitor. So if you get monitors that are big enough, you can have easily two Word document-size windows open at the same time. So you could be looking at two sets of scores. You could be looking at your history and scores. You could be looking at the report you’re writing and any amount of data on the other monitor. This has helped me switch back and forth quickly and get that data into the report as quickly as possible.

Another thing that you might consider is to extend your intake sessions to include time to write your history. For example, you could extend your intake sessions by, let’s say, a half hour. So, you just know that after that intake session, you go right to the computer or to your dictation software, whatever you might be using to write your history, and you [00:06:00] sit down right there and bang out that history as fast as possible.

This has helped me because, rather than going to write the report, maybe a week or two after the testing has been done, I already have the history there. I don’t have to spend time putting that together. And it’s a lot fresher on my mind right after the intake. So my recommendation is to schedule it right into your EHR. If you’re not using an EHR, block it into your paper planner and include it as part of the interview time.

Tip 3, I would look into software like Text Expander or simply use the autocorrect feature on Word to streamline the report writing process and let you put in familiar repetitive chunks of the report as easily [00:07:00] as possible.

Text Expander is a piece of software that lets you use a shortcut to expand into a longer paragraph. For example, I have a paragraph that I include in my reports pretty often that is an explanation of ADHD; what it is, what it typically looks like, and things like that. I have a Text Expander snippet is what they’re called. The snippet is ADHD explanation. Every time I type ADHD explanation, it expands automatically into this longer paragraph that I have put into the program at an earlier time. So it cuts down, if you have paragraphs like that, that you write pretty often, it cuts down on the time to do that. So you’re not typing them over and over.

You can use TextExpander or Word’s auto-correct function. They serve the [00:08:00] same purpose. I think Text Expander is a lot more detailed, nuanced, and comprehensive, but either would work. I have a video on the website, or let’s see, I don’t know if I have it on the website. I think it is linked in the Facebook group, but I will put a link to the video in the show notes on how to use Word auto-correct to expand your text as well. So consider something like that.

Tip 4. Develop recommendation banks and use the text expansion feature or the insert file feature in Word to insert those recommendation banks. When I say recommendation banks, these are templates, I suppose where I’ll have a set of recommendations, say for ADHD for kids, and over time, I add to that [00:09:00] recommendation bank based on all the kids that I might diagnose with ADHD. I will add those recommendations to that particular recommendation file. And then for future kids who also get diagnosed with ADHD, I will insert those recommendations. For me, it’s a lot easier to go through and delete recommendations that don’t fit than to conjure up new recommendations and type them in. So that’s the approach that I take.

Now, again, you can pair this with a Text Expander or an autocorrect. For example, you might have a snippet called ADHD kid recommendations, and then it just expands into that full set. Alternatively, you can use the insert file feature in Word, which is what I do. You insert the file and then it puts the recommendations in automatically. So you don’t have to copy and paste, which can take up a [00:10:00] lot of time.

The last recommendation that I have for getting reports done is to chunk your time. I’ve talked about this in previous podcasts in terms of scheduling and managing your schedule for testing. But I’ll say it again, chunking your time can be a huge asset. When you chunk your time, you set aside huge blocks, I would say at least 3 to 4 hours to write reports. Unless you are a superhero who can write reports and do meaningful work in a half hour or an hour, which I cannot seem to do, chunking your time can be really helpful.

I would take however much time it takes you to write a report from start to finish and have that many chunks in your schedule. It doesn’t have to be every week, but fit them in a time period that makes sense for how fast you want to turn your reports around.

For [00:11:00] me, I know that I can get a report done from start to finish in about 2 hours if it’s fairly straightforward, maybe 3 to 4 hours if it’s extra complex or have to write a lot of new content. So every other week I block out at least two full weekdays to write reports. Those days I just come in, and I do not check email except at the beginning of the day, maybe once in the middle, and then maybe once at the end. All I do is write reports and it helps to get in the flow and get in the zone to get those reports done.

Those were my five quick tips for getting reports done. I hope that was helpful to you. Again, in the next couple of episodes, we’ll be talking about five quick tips for marketing and five quick tips for billing your testing services. So check those out over the next two weeks.

[00:12:00] In the meantime, if you are in the market for a billing service, like I said, Practice Solutions has been fantastic for our practice. They are sponsoring this month’s podcast episodes and they are giving anyone who signs up through the podcast or this link, a 20% discount on the first month’s services. Catherine and Jeremy are fantastic. They’re a husband-wife team. They are super responsive and super knowledgeable, and they will take really good care of you with everything billing-wise. So check them out if you’re thinking about a billing service and take care in the meantime. Thanks. Bye-bye.

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