My answer: certainly not a great deal of what comes across my desk these
days. All too often when preparing to evaluate a student for a school or for parents
I have the feeling I am part of a huge conspiratorial joke. I get that feeling when
I read many of the "reports" already in the student's file because so many of
them are just plain bad reports from all sorts of "professionals".
I'm not the world's leading expert on assessment, never claimed to be and
don't really want to be that person. Most of my work is directed at changing
dysfunctional behavior so that kids, and the people around them, can live better lives.
The problem is that often one needs to look deeper into what may be contributing to
the problem or what the child is capable of in order to maximize the help provided to that
child. I've taught psychological assessment to doctoral candidates in clinical
programs, supervised pre-doctoral practica and post-doctoral fellows on assessment, and
worked with a variety of non-doctoral level psychometrists over the years. I have
done traditional psychometric (IQ, Achievement, etc.), personality (MMPI, MMPI-A, MMPI-II,
etc.), and Functional Behavior Assessments (direct observations, ABC charting, etc.) over
the years and have even managed to integrate the various forms of assessment into the same
evaluation. When teaching and supervising students doing psychological assessments,
I expect to see mistakes, but I also expect the basics to be done by anyone who wants to
apply any psychological knowledge to real human beings. This means that BEFORE they
go around administering tests and interacting with real live patients with actual reasons
to be evaluated the students have to have mastered a good bit of basic knowledge. I
require such preparation work by anyone (no matter what their degree status or level of
training). It is therefore very strange to see so many reports, that I would never
have allowed students to have begun, with signatures on them in files as if they were
finished.
One thing that most psychologists of my acquaintance don't appear to
understand is that most psychological evaluations are not written for use by other
psychologists, or even other mental health professionals, but for use by parents,
teachers, administrators, lawyers, and even by the student themselves. For this
reason a psychological report needs to include accurate, objective, timely, and useful
information in a manner in which a reasonably well informed lay-person can access.
When an evaluation is written in jargon or does not include enough information it it then
easy for any of these consumers to take the wrong information from the evaluation and make
decisions based on this mis-information. Let me give just one
example: a report I read recently stated that the child was the product of a full-term
normal delivery (what everyone hopes for because this presents the fewest problems in a
number of ways for both the mother and child). So, you might ask, "What is the
problem?" Well, that child was the subject of a lawsuit in which the parents
were suing the obstetrician for negligence during the caesarian delivery of their 2 month
pre-mature infant! Did the psychologist even bother to ask the mother, father, or
even the lawyer that referred the child to him any of this or did he simply start typing
his report over an old one on his work-processor and forget to change that material?
In either case this is unacceptable performance for a "professional".
There are some specific learning issues that go along with premature birth, and so if this
report remained in the file and the child went to school with it available to the teachers
it might have undercut the appropriate evaluation of that child for learning
problems. So why is it that so many reports are inadequate, bad, or just plain
wrong?
Assuming that the examiner can adequately administer and score/interpret
the devices used in assessing someone, there are two main ways that a psychological
evaluation can be inadequate. In the first, the examiner can fail to review the
background material and previous reports thoroughly. In the second, the
examiner can present a battery of devices (tests) which do not address the areas of
concern (either completely enough or at all). When asked to evaluate a student the
first question that should be asked is "Why?". What is the "referral
question" that the person asking for the report wants answered - essentially why did
they think an evaluation by a psychologist would be helpful and what specifically are they
looking for from the report. Early in my career I worked in several medical settings
with physicians. Now physicians know a great deal about the biology of behavior and
the drugs that can be used to alter behavior, thought, and emotions but they know darn
little about psychological assessment and formal psychometrics because they just aren't
trained in those areas. I would routinely have physicians write orders for me to do
"projectives" on a child without any rationale or "context". Now
it might be fine for a physician, who knows more about such things than the nurse, to
order blood work and to specify the blood tests to be run by the nurse or technician - but
this does not work for psychological tests because they need a context in which to be
placed and the physician normally just doesn't possess the training to make the right
selection. Most of the time I would just talk with the physician and ask them what
they were thinking and what question they wanted answered and then tell them I would do
such-and-such tests and that worked out fine. Occasionally I would run into a real
"gunner" who would reiterate their "order" for "projectives"
and instead of butting heads with them I would read as much about the patient as I could
(in order to develop a context) and do the tests I thought appropriate. More often
than not such "gunners" would thank me for having done the
"projectives" even when none were conducted or included in the report! The
right tool for the right job should be the watch words of anyone psychologically
evaluating anyone under any circumstances.
Does this mean that I look over a patient, their records, and decide what
tests to do for the evaluation and then just do it? Of course not. A good
evaluation is an evolving process in which questions are formulated, tests administered,
information reviewed, theories constructed, additional assessments done, and both
confirming and disconfirming information integrated into some coherent picture of the
person being evaluated. However, there are indications in both the question and the
history that point an aware evaluator to certain starting points among the vast array of
testing devices available today.
The second thing that an evaluator should require is for copies of all
past evaluations (including social, emotional, learning/cognitive, psycho-motor,
neurological and neuropsychological, speech/language, physical and occupational therapy,
and medical) to be made available for review. This information, the question and the
history, provides the context in which the psychologist operates when designing and
conducting the evaluation. This context is the foundation upon which the selection
between various devices and procedures is initially based by the psychologist.
Without a context such a process is worse than useless - it is a waste of resources (both
time and money) better spent elsewhere. An inadequate foundation renders any
information gathered meaningless - just as any series of words taken out of context
are devoid of a broader meaning. I can not tell you the number of reports I review
annually that have neither a referral question nor a detailed history of the person being
"evaluated".
The answer to the question "What makes a Good Psychological
Report" is - a solid understanding of the questions being asked and a complete review
of the materials available including history and previous evaluations which lead to
questions being formulated, tests administered, information reviewed, theories
constructed, additional assessments done, and both confirming and disconfirming
information integrated into some coherent picture of the person being evaluated. The
resulting report will be functional and useful to those who are working with the person -
and that is the true purpose of any psychological report.
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