Using a Process Approach to High Stakes Testing
Considering context in assessment interpretation is the only ethical option.
“High stakes tests” encompass any
tests used to make significant decisions about a person’s care and are
intimately tied to an individual’s medical treatment, social perception
by others, and often even one’s financial well-being (e.g. whether
insurance companies cover expenses or not).
Although psychological assessments vary in type, length, standardization procedures, and intended purpose, importantly, all fit the high stakes test category. Given the potential weight of these tests, perhaps the most essential component of psychological assessments is how the raw data from them is initially interpreted and how this information is conveyed in reports by health care providers. Often, these assessment reports stick like glue, moving forward with patients, clients, students, and public consumers in their medical or school records and can significantly impact quality of care options. Not to mention, a wrong diagnoses based on incomplete information can devastate families, sending them down the rabbit hole seeking unhelpful treatments…
Although the American Psychological Association Code of Ethics delineates the importance of attending to test factors intrinsic to patients as well as extrinsic factors of the environment
which shape patients’ responses, countless health care professionals
attend exclusively to the content of test results without considering
the process by which the results were derived. Intrinsic factors could
encompass the client’s test-taking abilities in the moment of testing
(e.g. if a person is experiencing depressive symptoms, whether he or she
has eaten, his or her IQ). Extrinsic factors include situational
contexts and opportunities the client may have had prior to testing
which may help or hinder his or her testing results (e.g. lack of access
to consistent education, distraction due to family disagreements at home, gender or ethnic discrimination).
Equally crucial to test interpretation is vigilance regarding any linguistic or cultural differences that may influence the professional’s judgments about the client and reduce the accuracy of test-based interpretations. Thankfully, the Boston Process Approach (Kaplan, 1988) developed in recent decades at the Boston Veterans Medical Center has become increasingly utilized across private practices, hospitals, and research institutions across the country. This approach emphasizes a more holistic evaluation of the client and suggests that psychologists not only attend to scores (e.g. this child has or doesn’t have Autism Spectrum Disorder based on an arbitrary cutoff) but to the client’s methods of approaching problems throughout assessment. This approach also helps to provide a more just interpretation for underserved populations from various ethnic backgrounds because it emphasizes using tests which have been created for multiple language backgrounds. The approach cautions professionals about making conclusions regarding “ability” or “diagnosis” if the client is from a socioeconomic background in which he or she simply did not have the resources or exposure to have certain knowledge which assessments frequently test or may be experiencing elevated life stressors due to socioeconomic status and lack of social supports.
Critically, psychological assessments represent only a snapshot in time, not a static conclusion about a person. Too many patients, families, schools, and health providers themselves forget this fact. Results of assessments are not etched in tablets as they derive, in part, from the health professional’s ability and motivation to consider both “performance” and “process” factors. Because assessments are high stakes by their nature, their results might be better considered as working starting points, rather than permanent labels. Patients must know their rights and feel empowered to ask their providers questions such as, “how did you come to this diagnosis?” rather than complacently walking away with a label which will impact their care without full understanding.
This will create more transparency in the dynamic assessment process and increasingly push health care professionals to take contextual factors into account, which follows best practice ethical care.
Although psychological assessments vary in type, length, standardization procedures, and intended purpose, importantly, all fit the high stakes test category. Given the potential weight of these tests, perhaps the most essential component of psychological assessments is how the raw data from them is initially interpreted and how this information is conveyed in reports by health care providers. Often, these assessment reports stick like glue, moving forward with patients, clients, students, and public consumers in their medical or school records and can significantly impact quality of care options. Not to mention, a wrong diagnoses based on incomplete information can devastate families, sending them down the rabbit hole seeking unhelpful treatments…
Source: Sarah-Nicole Bostan
Equally crucial to test interpretation is vigilance regarding any linguistic or cultural differences that may influence the professional’s judgments about the client and reduce the accuracy of test-based interpretations. Thankfully, the Boston Process Approach (Kaplan, 1988) developed in recent decades at the Boston Veterans Medical Center has become increasingly utilized across private practices, hospitals, and research institutions across the country. This approach emphasizes a more holistic evaluation of the client and suggests that psychologists not only attend to scores (e.g. this child has or doesn’t have Autism Spectrum Disorder based on an arbitrary cutoff) but to the client’s methods of approaching problems throughout assessment. This approach also helps to provide a more just interpretation for underserved populations from various ethnic backgrounds because it emphasizes using tests which have been created for multiple language backgrounds. The approach cautions professionals about making conclusions regarding “ability” or “diagnosis” if the client is from a socioeconomic background in which he or she simply did not have the resources or exposure to have certain knowledge which assessments frequently test or may be experiencing elevated life stressors due to socioeconomic status and lack of social supports.
Critically, psychological assessments represent only a snapshot in time, not a static conclusion about a person. Too many patients, families, schools, and health providers themselves forget this fact. Results of assessments are not etched in tablets as they derive, in part, from the health professional’s ability and motivation to consider both “performance” and “process” factors. Because assessments are high stakes by their nature, their results might be better considered as working starting points, rather than permanent labels. Patients must know their rights and feel empowered to ask their providers questions such as, “how did you come to this diagnosis?” rather than complacently walking away with a label which will impact their care without full understanding.
This will create more transparency in the dynamic assessment process and increasingly push health care professionals to take contextual factors into account, which follows best practice ethical care.
