Category: Neuropsychological Evaluations

Revised Safety Protocols for In-Office Visits

In Neuropsychological Evaluations, Practice Information, Psychotherapy

Updated May 17, 2021

Our office recognizes the CDC’s recent guidance on lifting mask restrictions for vaccinated individuals. However, as a healthcare setting that serves many individuals who cannot be vaccinated due to age or health condition, as well as many individuals with underlying health conditions that may be more vulnerable to the effects of COVID-19, at this time our office will continue to require masks for all in-person appointments at all times. Please see below for our office’s health and safety procedures.

Effective May 1, 2021

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. In order to continue to serve our clients and patients, Neurodevelopmental Assessment & Consulting, LLC has put in place the following preventative measures to reduce the spread of COVID-19 in our office. In order to participate in in-person appointments in our office, we ask that you read through this document carefully. By participating in an in-person appointment at our office, you acknowledge that you understand the risks of an in-person appointment and agree to the procedures below. Neurodevelopmental Assessment & Consulting, LLC reserves the right to change or modify these procedures at any time in order to protect the health and safety of our patients, clients, and employees and/or to comply with local, state, or federal mandates or public health directives.

Continued Telehealth Appointments As Appropriate

Neurodevelopmental Assessment & Consulting, LLC will continue to continue to make telehealth appointments available for services that can be completed via telehealth. These services include, but are not limited to, therapy/counseling appointments, executive functioning/academic coaching appointments, psychological or neuropsychological testing interviews and feedback sessions, clinical and professional consultations, attendance at meetings, ASD diagnostic evaluations (for ages 3-7), ADHD screening evaluations, and career assessments.

Virtual appointments will be conducted using GoToMeeting (with SpruceHealth as a back-up, if necessary); both of these platforms are HIPAA-compliant in order to protect privacy and provide a high-level of security.

Due to state licensing laws, virtual appointments can only be conducted with clients/patients who are located within the states of PA, DE, AL (starting 6/1/2021), AZ, CO, DC, GA, IL, KY (starting 6/29/2021), MO, NE, NH, NV, NC, OH (starting 7/26/2021), OK, TX, UT, VA, WV (starting 7/6/2021), or NJ (temporary NJ license is valid only through 06/30/2021) at the time of service.

School/Home Observations and Meeting Attendance

At this time, we will not be conducting any school/home observations or visits or attending any off-site meetings in-person (though we are happy to participate virtually).

In-Office, Face-to-Face Appointments

Neurodevelopmental Assessment & Consulting, LLC is offering limited, in-office appointments for psychological, diagnostic, psychoeducational, and neuropsychological testing, starting May 1, 2021. Additionally, we plan to allow in-person, face-to-face appointments for therapy starting July 1, 2021. The office will be using the following procedures:

We will continue to conduct certain parts of psychological, psychoeducational, and neuropsychological evaluations virtually, including interviews, rating scales, and feedback sessions, to minimize contact and exposure.
In-office appointments will be staggered to reduce the number of people in the office/waiting room at the same time, to allow for adequate time between appointments for cleaning, and to reduce airborne transmission of COVID-19.
We are resuming offering full-day appointments for psychoeducational and neuropsychological evaluations, which will also reduce the number of visits required and shorten wait times for these appointments.
We will continue to contact all clients and patients via email to screen for potential COVID-19 symptoms or exposures and provide informed consent for in-person appointments. It is very important that clients and patients (or their parents/guardians) respond to these screening questions and sign these documents. If we do not receive the answers to these screening questions prior to the appointment, the appointment will be canceled and rescheduling options will be offered. If anyone in the household has displayed any symptoms of COVID-19 or has been diagnosed with COVID-19 in the 14 days prior to the appointment, a telehealth appointment will be offered (if possible) or the appointment will be rescheduled. Cancellation fees will be waived for appointments canceled for these reasons.
We continue to request that parents, guardians, and others who accompany a patient or client to an appointment wait in their cars in the parking lot or leave and return at the conclusion of the appointment. However, you may choose to wait in the waiting room at your own risk.
All clients and patients will be required to wear a mask at all times when in the office suite and throughout the entirety of the appointment. The clinician will also be wearing a mask for the entirety of the appointment.
There will be no in-person contact (e.g., handshakes). Live video monitors will be used to monitor those entering the office (no recordings will be made).
Psychological and neuropsychological testing will be completed face-to-face. Clinicians will be seated across the room from clients and patients in order to maintain social distancing. Masks will be worn at all times. Plexiglass shields and air purifiers will be used to minimize airborne transmission. Whenever possible, iPads will be used to administer tests in order to minimize the exchange of materials.
All test materials will be disinfected after each use. Furniture will also be wiped down with disinfectant after each appointment. Air purifiers will be kept in each room and run regularly. Additionally, the building cleaning services will be cleaning the office nightly.

Limitations to face-to-face appointments:

Appointments for therapy/counseling or evaluations/assessments may be discontinued if the client or patient is unable to maintain appropriate social distancing or use PPE. In these cases, we will discuss potential options via telehealth.
Neurodevelopmental Assessment & Consulting, LLC cannot guarantee, nor do we promise, that evaluation results conducted remotely will be accepted by school districts, court systems, Social Security/Disability, Veterans Administration, etc. In fact, it is likely that these organizations will also be grappling with a new reality and their policies may change. We will attempt to keep up-to-date on changing policies of our referral sources and will do our best to meet their requirements. If you need an evaluation for a specific purpose, such as a disability claim or special education eligibility, please discuss your options with our office. In some cases, we may recommend waiting until evaluations can be conducted under standardized conditions, as we do not want to put our clients in the position of completing an evaluation that cannot be used for the intended purpose.

Conclusion

We thank you for your continued support of our efforts to continue to serve our clients and patients while also adopting to new processes and procedures. We are attempting to balance the integrity and quality of our services, the needs of our clients and patients, and the health and safety of those we encounter in our work. We reserve the right to change or modify these procedures at any time as circumstances change or to comply with local, state, or federal mandates or public health guidance.

Office Re-Opening Procedures in the COVID-19 Era

In Neuropsychological Evaluations, Practice Information

Effective June 5, 2020; Most Recent Update January 12, 2021

Continued Telehealth Appointments As Appropriate

Neurodevelopmental Assessment & Consulting, LLC will continue to hold telehealth appointments for all services that can be completed via telehealth. These services include, but are not limited to, all therapy/counseling appointments, executive functioning/academic coaching appointments, psychological or neuropsychological testing interviews and feedback sessions, clinical and professional consultations, attendance at meetings, ASD diagnostic evaluations (for ages 3-7), ADHD screening evaluations, career assessments.

We will not be conducting any school/home observations or visits or attending any off-site meetings in-person (though we are happy to participate virtually).

Due to state licensing laws, virtual appointments can only be conducted with clients/patients who are located within the states of PA, DE, AZ, CO, GA, IL, MO, NE, NH, NV, NC (starting 3/1/2021), OK, TX, UT, VA, or NJ (temporary NJ license is valid only through 02/28/2021) at the time of service.

Limited In-Office Appointments

Neurodevelopmental Assessment & Consulting, LLC is offering limited, in-office appointments using the following procedures:

In-office appointments will only be offered for psychological or neuropsychological testing that cannot be completed remotely. All components of the evaluation that can be completed remotely (such as interviews, rating scales, and feedback sessions) will continue to be conducted via telehealth.
In-office appointments will be limited to Tuesdays and Thursdays from 9:30 am-12:30 pm only to allow for adequate time between appointments for cleaning and to reduce airborne transmission of COVID-19. Because appointments will be limited in both frequency and duration, clients and patients may require between 2 and 4 visits to complete testing.
Prior to the appointment, all clients and patients will be contacted via phone and/or email to screen for potential COVID-19 symptoms or exposures and provide informed consent for in-person appointments. It is very important that clients and patients (or their parents/guardians) respond to these screening questions and sign these documents. If we do not receive the answers to these screening questions prior to the appointment, the appointment will be canceled and rescheduling options will be offered. If anyone in the household has displayed any symptoms of COVID-19, traveled outside of the area, or has been diagnosed with COVID-19 in the 14 days prior to the appointment, the appointment will be rescheduled. Cancellation fees will be waived for appointments canceled for these reasons.
Upon arriving for an appointment, clients or patients should send a text to (215) 515-2388 to notify the evaluator. Please do not proceed to the office suite until the evaluator has responded and indicated that you may enter.
Parents, guardians, and others who accompany a patient or client to an appointment will not be permitted to enter the office suite or wait in the waiting room (with limited exceptions for young children or those who require assistance). We request that these individuals wait in their cars in the parking lot or leave and return at the conclusion of the appointment.
Upon entering the office suite, all patients and clients will be asked to use hand sanitizer and to proceed directly to the testing room, following the signs. All clients and patients will be required to wear a mask at all times when in the office suite and throughout the entirety of the appointment. The evaluator will also be wearing a mask for the entirety of the appointment.
The evaluator will remain in his or her office with the door closed when the client or patient enters the office suite. There will be no in-person contact (e.g., handshakes). Live video monitors will be used to monitor those entering the office (no recordings will be made).
Testing will be completed using a “remote, in-office” procedure. This means that the client/patient will complete the evaluation in the testing room, while the evaluator is located in another office in the office suite. Laptops, document cameras, live video monitors, and iPads will be used to administer tests, observe client and patient performance, and monitor the testing process. There will be no face-to-face contact between the evaluator and the client or patient.
All test materials will be disinfected after each use. Furniture will also be wiped down with disinfectant after each appointment. Air purifiers will be kept in each room and run regularly. Additionally, the building cleaning services will be cleaning the office nightly.

Limitations to remote, in-person testing:

Because the evaluator will be in a separate room, this type of testing process will be most appropriate for individuals who are able to sit at the computer and participate in the assessment for approximately 2-3 hours at a time. While breaks will be provided during that time as needed, individuals who require frequent prompting back to the task or who cannot remain at the workstation may need to discontinue the evaluation, as results may be invalid. Therefore, this evaluation process is likely most appropriate for individuals who are roughly age 10 and up. For younger individuals, or those who are unable to comply with these requirements, our office is happy to discuss assessment options via telehealth, though these may be more limited, or in-room support provided by a household member.
Evaluations may also be discontinued if the client or patient is unable to maintain appropriate social distancing or use PPE. In these cases, we will discuss potential options via telehealth.
Neurodevelopmental Assessment & Consulting, LLC cannot guarantee, nor do we promise, that evaluation results conducted remotely will be accepted by school districts, court systems, Social Security/Disability, Veterans Administration, etc. In fact, it is likely that these organizations will also be grappling with a new reality and their policies may change. We will attempt to keep up-to-date on changing policies of our referral sources and will do our best to meet their requirements. Indeed, the Pennsylvania Department of Education issued guidance on April 22, 2020 that evaluations for educational purposes that include IQ and academic achievement testing should be conducted in-person and postponed until it is safe to do so. If you need an evaluation for a specific purpose, such as a disability claim or special education eligibility, please discuss your options with our office. In some cases, we may recommend waiting until evaluations can be conducted in-person, as we do not want to put our clients in the position of completing an evaluation that cannot be used for the intended purpose.

Conclusion

We are living in an unprecedented time and our staff is doing our best to continue to serve our clients and patients while also adopting to new processes and procedures. We are attempting to balance the integrity and quality of our services, the needs of our clients and patients, and the health and safety of those we encounter in our work. We appreciate your patients with us through this transition period. Additionally, we reserve the right to change or modify these procedures at any time as circumstances change or to comply with local, state, or federal mandates or public health guidance.

The Differences Between Public and Private Educational Evaluations

In ADHD, Autism Spectrum Disorders, Education, Learning, Learning Disabilities, Neuropsychological Evaluations

When a child is struggling with learning, parents may wonder what to do. Usually, the first step is to get a comprehensive evaluation in order to identify the nature and severity of the child’s problem and determine what interventions are likely to be useful and helpful. Under the Child Find provision of IDEA, states are required to find and evaluate any student suspected of having a disability, even if the child attends private school or is homeschooled. Specifically, IDEA states that any child who needs special education and related services is to be “identified, located, and evaluated” (IDEA, Section 300.111). In many states, this requirement falls to the local school district to evaluate any child who may need special education and related services at public expense. In other words, the school district is ultimately responsible for ensuring that a child with special needs is identified and evaluated. However, some parents may choose to pursue a private evaluation, for some of the reasons below. In this article, I am hoping to clarify the main differences between evaluations conducted in the public education sphere and those in the private realm. (Disclaimer: I am not an attorney and nothing I have written should be construed as legal advice. The information presented is my opinion based on my experience and understanding of the regulations. Please refer to an educational attorney in your area for more specific guidance and information).

Choice of Evaluator

Typically, parents do not have a choice in who will evaluate their child in the public school environment. Most often, the evaluation is assigned to a specific school psychologist who is assigned to that child’s school or grade level (in larger districts, there are sometimes school psychologists who specialize in certain types of evaluations, such as autism spectrum disorders). In the private realm, parents are free to go to an evaluator of their choice, provided that evaluator has the appropriate credentials and experience to conduct an evaluation. Parents may seek out an evaluator with experience and expertise with the issue their child is facing, specialized knowledge and training (such as a neuropsychologist), or who is referred by family members or friends. Parents often have more access (or can request access, such as asking for a CV) to an evaluator’s experience and credentials in the private realm.

Evaluator Training, Experience, and Credentials

All school psychologists working in a public school district are required to meet certain minimum education and training standards, though these may vary slightly from state to state. For example, to become a certified school psychologist in Pennsylvania, the individual must have a master’s degree that covers specific educational content, a supervised internship of at least 1000 hours, and must pass both the basic skills Praxis exam, as well as obtain a minimum passing score on the School Psychology Praxis exam. Since these are minimum requirements, there are many school psychologists with higher levels of education and training or specialized training in specific areas. However, as noted above, parents often cannot choose which school psychologist in a district will be responsible for their child’s evaluation. At the same time, because the evaluation is conducted by a school district employee, families do not need to be concerned about whether the report will be accepted by the district.

In the private realm, states vary in terms of their requirements for who can conduct an educational evaluation. Continuing with our example of Pennsylvania, to practice privately a psychologist needs to have a doctoral degree (though some who were licensed in the 1980s and early 1990s were able to do so with master’s degrees), at least two years of supervised training and experience, and pass both a national and state exam. Parents and families looking for a neuropsychologist should look for someone who has specific training and expertise, beyond the doctoral level, in the study of brain-behavior relationships (in Pennsylvania, there is no separate license or credential for neuropsychologists; instead, they are licensed as psychologists). However, public school entities are not required to accept a private evaluation and can choose to have their school psychologist conduct an evaluation. If the outside evaluator is also certified as a school psychologist in Pennsylvania, then the district is required to acknowledge the evaluator’s report and conclusions (though they may still conduct their own evaluation). Thus, knowing the credentials of an outside evaluator is important and may affect whether the evaluation is accepted in the educational setting.

Comprehensiveness of Evaluation

Both public and private evaluations vary significantly in how comprehensive and thorough they are. Thus, careful choice of an evaluator and examination of his or her credentials and experience is key. In general, though, evaluators in private practice (especially those who are private pay) have lower caseloads than those who work in school districts. As a result, the private evaluator likely has more time to work with your child. Additionally, if the evaluator has advanced training and experience, such as a neuropsychologist, he or she may be able to evaluate areas of function that are not typically included in standard psychoeducational evaluations in the public school setting (including memory, executive functioning, attention). Private evaluators are not beholden to school district regulations, policies, or procedures regarding what is included in the evaluation. Thus, they may be able to evaluate the child in a deeper, more comprehensive manner.

At the same time, school district evaluations are typically multidisciplinary. If your child also needs a speech, occupational therapy, or physical therapy evaluation, these can be included in the school district psychoeducational report. In the private setting, these types of multidisciplinary practices are much more rare; a child may need to see several different providers who all do independent evaluations.

Diagnosis and Conclusions

Public school evaluations typically determine whether a child meets one of 13 educational classifications, which are defined by IDEA. In order to be eligible for special education, a child must meet the criteria for at least one of these categories and show an educational need. Thus, some children may have a diagnosed condition that does not affect education; this child would not meet the criteria to receive special education and related services. Often, school districts will not make diagnoses for conditions that are not defined by IDEA, such as attention-deficit/hyperactivity disorder (ADHD) or dyslexia; instead, they will refer to an outside provider to make these diagnoses. In the public school setting, classification decisions are also typically made by a multidisciplinary team, following the policies and procedures of the district. It is important to keep in mind that school districts often have limited resources and competing interests and goals; these factors can explicitly or implicitly impact the conclusions that are drawn and the recommendations that are made.

In the private realm, evaluations typically determine whether a child has a diagnosis, as defined by specific diagnostic criteria. Whether the diagnosis affects education and learning is irrelevant in this type of evaluation. For example, a child with a severe fear of dogs may be diagnosed with a specific phobia and require treatment to reduce his anxiety and fears. However, this diagnosis is unlikely to affect school functioning, especially if there are no dogs present in the school environment. At the same time, school and learning comprises a large portion of a child’s daily life; therefore, many diagnosed conditions have an educational impact. Private evaluators are not beholden to school district policies and procedures; therefore, their conclusions and recommendations are often viewed as more objective and more aligned with the child’s best interests. At the same time, private evaluations are sometimes criticized as being unrealistic for an educational environment. Nevertheless, an evaluator who is experienced in working with educational settings and has a good understanding of the school environment can usually make recommendations that are relevant, applicable, and flexible enough to be implemented in the school setting.

Timeline of the Evaluation

IDEA regulations require that school district evaluations are completed with 60 days. States vary on whether the 60 days are counted as 60 school days or 60 calendar days and whether summers count toward the 60 day timeline. In any event, school districts are legally required to complete the evaluation under specific timeline guidelines.

Private evaluators vary significantly in their availability. Some evaluators may have immediate openings, while others may be scheduling out several weeks or months or even have a waiting list. Private evaluators are not required to follow a specific timeline; therefore, it is important to inquire about a private evaluator’s availability and typical report turnaround time.

Cost

Evaluations conducted by the public school entity are done at no cost to the family. In contrast, private evaluations can be costly, sometimes up to several thousand dollars. Many evaluators do not accept or participate in insurance for these evaluations; in fact, most medical insurers will not cover testing for primarily educational purposes, stating that this is an educational service that should be provided by the educational entity, not a medical service that should be covered by health insurance. At the same time, some families are approved for an Independent Educational Evaluation (IEE), which is a private evaluation conducted at public expense (typically, the school district contracts with the private evaluator and pays him or her directly). Finally, some families are able to request reimbursement from the school district for private evaluations that they had done, especially if that evaluation was done because the school district evaluation was not done, was inadequate, or did not identify conditions or learning issues that should have been identified and addressed.

When to Consider a Psychoeducational or Neuropsychological Evaluation for your Child

In ADHD, Autism Spectrum Disorders, Education, Learning, Learning Disabilities, Neuropsychological Evaluations, Practice Information

Parents of children with special needs or those facing behavioral or emotional challenges are often told to have their children “evaluated.” Similarly, adults with learning differences or challenges, neurological injuries or illnesses, or behavioral and emotional concerns may be told to get an “evaluation.” But what will an evaluation tell you about your child (or yourself)? And when should you consider an evaluation for yourself or your child?

First and foremost, a psychoeducational or neuropsychological evaluation will help to determine whether there is a diagnosis that accounts for the difficulties the child is experiencing. A diagnosis can be helpful in identifying the nature of the problem, and suggesting possible helpful interventions, accommodations, or modifications. It can be a quick way of capturing what a child, adolescent, or adult is experiencing. Additionally, a diagnosis is often required for eligibility to certain types of programs and services, such as special education, behavioral/emotional services, or medical interventions. However, diagnostic labels are often limited. They tend to describe conditions and disorders in broad strokes, rather than the specific ways they are affecting a particular individual. They do not identify what cognitive, emotional, behavioral, and environmental factors have contributed to the development or maintenance of the condition. They also do not describe the individual’s unique pattern of strengths and weaknesses. Comprehensive psychoeducational and neuropsychological evaluations are individualized, and help to provide a thorough understanding of the individual being assessed. By understanding why an individual is having difficulties, how to help becomes clearer. Therefore, this in-depth understanding of the individual can help those providing treatment to be more targeted and specific in their interventions, and to choose interventions that are more likely to be effective.

Because they are more comprehensive, individualized, and in-depth, psychoeducational and neuropsychological evaluations can be useful in a number of circumstances. Some examples of situations where an evaluation may be helpful are listed below. This list is not all-inclusive; rather, it is designed to provide some common examples where evaluations may be useful:

The person is having difficulties in learning, memory, executive functioning, attention, behavior, and/or emotional functioning.
The person is suspected of having a specific condition (such as an autism spectrum disorder or learning disability), and testing is required to determine whether the disorder is present.
The person has shown a significant change in mood, behavior, or learning. These changes may suggest the onset of a condition in those without a history of difficulties. They may also suggest the onset of an additional condition, ineffectiveness of interventions, a change in course or severity, or an incorrect initial diagnosis in those who have been previously identified and evaluated.
The person has not responded to standard treatment or research-based educational interventions.
The child requires special education or related services.
An adolescent or adult requires accommodations or modifications in a college or job training program, standardized testing situation, or in an employment setting.
The person was previously evaluated, but the evaluation was not comprehensive, inadequate, or invalid.

In general, evaluations may be repeated every 2–3 years for children/adolescents in order to assess progress and update treatment recommendations. In some cases, re-evaluations may be unnecessary, especially if the condition has resolved and the person is no longer experiencing any difficulties. However, re-evaluations should be completed in shorter intervals if there is a major change in functioning, if the person has not responded to treatment or treatment has stalled, or if the person has a condition that is known to cause progressive deterioration in functioning.