Telepractice and the WRIT
The telepractice information in this document is intended to support specialist teachers and education professionals in making informed, well-reasoned decisions around remote assessment. This information is not intended to be comprehensive regarding all considerations for assessment via telepractice. It should not be interpreted as a requirement or recommendation to conduct assessment via telepractice.
Professionals should remain mindful to:
- Follow professional best practice recommendations and respective ethical codes.
- Follow telepractice regulations and legal requirements from local authorities, licensing boards, and professional liability insurance providers.
- Develop competence with assessment via telepractice through activities such as practising, studying,consulting with other professionals, and engaging in professional development.
Professional clinical judgment should be used to determine if assessment via telepractice is appropriate for a particular examinee, referral question, and situation. There are circumstances where assessment via telepractice is not feasible and/or is contraindicated. Documentation of all considerations, procedures, and conclusions remains a professional responsibility.
Several professional organisations and experts have provided guidance on telepractice assessment in decision making and ethical and legal practice issues.
The Wide Range Intelligence Test® (WRIT;Pearson, 2000) can be administered in a telepractice context by using digital tools from Q-global®, Pearson’s secure online-testing and scoring platform.
Specifically, Q-global digital assets (e.g. stimulus book) are visible to an examinee in another location via the screen-sharing features of teleconference platforms. Details regarding Q-global and how it is used are provided on the Q-global product page.
It is important to consider the fact that the WRIT normative data were collected via face-to-face assessment. Telepractice is a deviation from the standardised administration, and the methods and approaches to administering the WRIT via telepractice should be supported by research and practice guidelines when appropriate.
Practitioners using telepractice assessments may train facilitators to work with them on a regular basis in order to provide greater coverage to underserved populations (e.g. only two providers within a 75-mile radius, shortage of specialist educators within city/county council). If such a facilitator is well trained and in a professional role (i.e. aprofessional facilitator), they can help present the entire WRIT as would be expected in a face-to-face mode. If a professional facilitator is not used, it impacts the workflow of the session, subtest selection, and the approach to deriving composite scores.
In times when social distancing is necessary (such as the COVID-19 pandemic), using a professional facilitator may not be safe or feasible. If testing is considered a requirement, the examinee can assist with technological and administrative tasks during testing and should be oriented to these responsibilities prior to the testing session, and again at the beginning of the session. An initial virtual meeting should occur in advance of the testing session to address numerous issues specific to testing via telepractice. This initial virtual meeting is described in the administrative and technological tasks portion of the Examiner Considerations section and referred to in various sections below. The examiner should consider best practice guidelines, the referral question, and the examinee’s condition, as well as telepractice equivalence study conditions to determine if this is possible and appropriate. Independent examinee participation may not be possible or appropriate, for example, for examinees with low cognitive ability or with low levels of technological literacy and experience.
If the examiner determines that the examinee cannot participate independently, and testing must occur under social distancing constraints, the only facilitator available may be someone in the examinee’s home (e.g. a parent, guardian, or caretaker). If the onsite facilitator is not in a professional role (i.e. non-professional facilitator), they can assist with technological and administrative tasks during testing and should be oriented to these responsibilities in the initial virtual meeting and again at the beginning of the session. It is not recommended to send out WRIT Diamond chips for assessments where parents/guardians are acting as facilitators for the administration. it is not recommended to allow a parent/guardian to present test items or materials (such as the chips for Diamonds) to examinees. The parent/guardian may only make audiovisual adjustments as required.
Professional and non-professional facilitators typically do not remain in the room with the examinee throughout the testing session. The examiner should plan to minimise (as much as possible) the need for the facilitator to remain in the room. In rare cases when the facilitator must remain in the room, they should do so passively and unobtrusively, and merely to monitor and address the examinee’s practical needs, as well as any technological or administrative issues as necessary. The facilitator’s role should be defined clearly by the examiner. The facilitator should only perform those functions the examiner approves and deems necessary. In any case, if a facilitator is necessary it is preferred that the facilitator remain accessible.
Conducting Telepractice Assessment
Conducting a valid assessment in a telepractice service delivery model requires an understanding of the interplay of a number of complex issues. In addition to the general information on Pearson's Telepractice page, examiners should address five factors (adapted from Eichstadt et al., 2013) when planning to administer and score assessments via telepractice.
1. Telepractice Environment and Equipment
2. Assessment Procedures and Materials
3. Examinee Considerations
4. Examiner Considerations
5. Other Considerations
1.Telepractice Environment and Equipment
- Computers and connectivity: Two computers with audio and video capability and stable internet connectivity – one for the examiner and one for the examinee – arerequired. A web camera, microphone, and speakers or headphones are required for both the examiner and the examinee. A second computer screen or split-screen format on a large computer monitor for the examiner is helpful to allow a view of the digital administration and scoring manual, but the examiner can also use the paper format manual (if available) or the Q-global® platform. The second computer or large screen also tends to make sharing test content more straightforward for the examiner.
- Image/screen size: When items with visual stimuli are presented, the digital image of the visual stimuli on the examinee’s screen should be at least 9.7” (24.6 cm) measured diagonally, similar to an iPad or iPad Air. Some teleconference platforms shrink the size of images, so the image size should be verified in the initial virtual meeting. It is recommended that computer screens used for teleconference assessment be at least 15” (38.1 cm) measured diagonally. Smaller screens, such as those of iPad minis, small tablet PCs, and smartphones, are not allowed for examinee-facing content, as these have not been examined empirically and may affect stimulus presentation, examinee response, and validity of the test results. Similarly, presenting stimuli on extremely large screens has not been examined, so the same precaution applies. At the beginning of the testing session, the examiner may ask for a peripheral camera or device (as described later in this section) to be aimed at the examinee's screen to ensure the examinee's screen is displaying images in the correct aspect ratio and not stretching or obscuring the stimuli image.
- Teleconference platform: A teleconference platform is required. Screensharing capability is required if anything other than items with verbal stimuli and responses are administered.
- Video: High-quality video (HD preferred) is required during the administration. Make sure the full faces of the examiner and the examinee are seen using each respective web camera. The teleconference platform should allow all relevant visual stimuli to be fully visible to the examinee when providing instruction or completing items; the view of the examiner should not impede the examinee’s view of visual test stimuli.
- Screensharing digital components: Digital components are shared within the teleconference platform as specified in Table 1 (PDF | 139 KB). There are two ways to view digital components in the Q-global Resource Library: through the pdf viewer in the browser window or full screen in presentation mode. Always use full screen (i.e. presentation) mode for digital components viewed by the examinee. This provides the cleanest presentation of test content without onscreen distractions (e.g. extra toolbars). Refer to Using Your Digital Assets on Q-global in the Q-global Resource Library for complete directions on how to enter presentation mode.
- Test item security in the audiovisual environment: The examiner is responsible for ensuring test item security is maintained, as outlined in the Terms and Conditions for test use. The examiner should address test security requirements with the examinee (and facilitator, if applicable) during the informed consent process. The examiner should make it clear that the video should not be captured, photos should not be taken, and stimuli should not be copied or recorded, as this is a copyright violation. The examinee must agree that they will not record (audio or visual) or take photos or screenshots of any portion of the test materials or testing session, and not permit anyone to observe the testing session or be in the testing room (except for a facilitator, when necessary). See Assessment Procedures and Materials for more information.
- Peripheral camera or device: A stand-alone peripheral camera that can be positioned to provide a view of the session from another angle or a live view of the examinee’s progress is helpful. Alternately, a separate device (e.g. a smartphone with a camera or another peripheral device) can be connected to the teleconference and set in a stable position to show the examinee’s pointing responses. The device’s audio should be silenced and the microphone should be muted to prevent feedback. The examiner should guide positioning of the peripheral camera/device before administering subtests that elicit pointing or gestured responses (refer to Table 1 (PDF |139 KB) so that the examiner can see the examinee’s real-time responses are captured.
In a typical telepractice session, it is more feasible to make a document or moveable camera available in the examinee’s location. However, while social distancing is necessary, the only camera available may be a stationary camera integrated into the examinee’s laptop or computer screen. It is unrealistic to expect examinees to have document cameras within their homes. It may be necessary for examiners to think creatively about how to use a smartphone in the examinee’s location to gain a view of the examinee’s progress when pointing at a screen. Prior to attempting this with an examinee, the examiner should work to become fluid and competent at directing examinees in these methods, which can require extensive practice with varied individuals and types of smartphones. In addition, this requires planning and practice in the initial virtual meeting to prevent technical difficulties, and so the examinee feels confident doing this when it is time. Many online instructional videos demonstrate how a smartphone may be used with common household objects (e.g. a tower or stack of books, paper weight, ruler, and elastic band or tape) to create an improvised document camera for use during tasks involving the response booklet. Similarly, for multiple choice tasks, some examinees tend to point to responses rather than say the number or letter corresponding to their response, and other tasks (e.g. Matrices) require the examinee to point at the stimuli. In this situation, other everyday household objects (e.g. books) could be used to form an improvised stand upon which to position the device to provide a second-angle view of the examinee pointing at the screen. Typically, devices provide the best view of the examinee’s screen and pointing responses when positioned in landscape format. While using a smartphone as the peripheral camera is not an optimal solution for telepractice, it can be functional if executed well.
- Gesturing: When gesturing to the stimulus book is necessary, the examiner should display them as digital assets onscreen and point using the mouse cursor. Refer to Table 1 (PDF | 139 KB) for specific instructions by subtest.
- Audioconsiderations: High-quality audio capabilities are required during the administration. An over-the-head, two-ear, stereo headset with attached boom microphone is recommended for both the examiner and examinee. Headphones with a microphone may be used if a headset is not available.
- Audio check: The examiner should test the audio for both the examiner and examinee in the initial virtual meeting and at the beginning of the testing session to ensure a high-quality audio environment is present. Testing the audio should include an informal conversation prior to the administration where the examiner is listening for any clicks, pops, or breaks in the audio signal that distorts or interrupts the voice of the examinee. The examiner should also ask if there are any interruptions or distortions in the audio signal on the examinee’s end. Any connectivity lapses, distractions, or intrusions that occurred during testing should be reported.
- Manage audiovisual distractions: As with any testing session, the examiner should do everything possible to make sure the examinee’s environment is free from audio and visual distractions. If the examiner is unfamiliar with the examinee’s planned physical location, a visual tour of the intended testing room should be given during the initial virtual meeting. The examiner can then provide a list of issues to address to transform the environment into one suitable for testing. For example, remove distracting items, silence all electronics, and close doors. The examiner should confirm that these issues have been addressed at the time of testing. If possible, the examinee should be positioned facing away from the door to ensure the examiner can verify through the examinee’s camera that the door remains shut and can monitor any interruptions. The examiner should confirm that all other applications on the computer, laptop, or peripheral device are closed, the keyboard is moved aside or covered after the session is connected, and alerts and notifications are silenced on the peripheral device. Radios, televisions, other mobile phones, fax machines, smart speakers, printers, and equipment that emit noise must be silenced and/or removed from the room.
- Lighting: Good overhead and facial lighting should be established for the examiner and examinee. Blinds or curtains should be closed to reduce sun glare on faces and the computer screens.
- Disruptions: The examiner should record any and all atypical events that occur during the testing session. This may include delayed audio or video, disruptions to connectivity, the examinee being distracted by external stimuli, and any other anomalies. These can be noted on the record form and should be considered during interpretation and described in the written report.
2.Assessment Procedures and Materials
- Copyright: Obtainpermission for access to copyrighted materials (e.g. stimulus book) asappropriate. Pearson has provided a letter of No Objection (PDF | 77.5 KB) to permit use of copyrighted materials for telepractice via non-public facing teleconference platforms and tools to assist in remote administration of assessment content during the COVID-19 pandemic.
- Digital assets: Practise using the digital assets until the use of the materials is as smooth as a face-to-face administration. Do not display items from the paper stimulus book on a camera.
- Considerations: Review Table 1 (PDF | 139 KB) for the specific telepractice considerations for each subtest to be administered.
- Input and output requirements and equivalence evidence: Consider the input and output requirements for each task, and the evidence available for telepractice equivalence for the specific task type.
Telepractice Versus Face-to-FaceAdministration
Although there are no published studies that examine the equivalence of telepractice and face-to-face administration and scoring of the WRIT specifically, a number of studies support equivalence of tasks that are highly similar with respect to constructs assessed and input/output demands. These studies include non-clinical examinees (Galusha-Glasscock et al., 2016; Brearly, et al., 2017; Sutherland et al., 2017; Wright, 2018a, 2018b; Stolwyk et al., 2020), as well as examinees with specific learning disabilities, (Hodge et al., 2019), intellectual disability (Temple et al., 2010), and other clinical conditions (Cullum et al., 2006; Galusha-Glasscock et al., 2016; Grosch, Weiner, Hynan, Shore, & Cullum, 2015; Hildebrand, Chow, Williams, Nelson, & Wass, 2004; Ragbeer et al., 2016; Stain et al., 2011; Temple et al., 2010; Wadsworth, Dhima, et al., 2016; Wadsworth, Galusha-Glasscock, et al., 2018).
It is important to consider the conditions under which equivalence studies of telepractice and face-to-face assessment modes are conducted and attempt to reproduce these as closely as possible if testing via telepractice. Typical telepractice studies that support telepractice and face-to-face equivalence involve the examiner becoming very familiar with the teleconference platform by using it for its intended purpose for several hours, and administering tests, even those that are familiar in face-to-face mode, multiple times to practice examinees. Most studies that have established telepractice and face-to-face mode equivalence involve an onsite facilitator who is in a professional role. However, preliminary research conducted with parents serving as an in-home facilitator who managed audiovisual needs and response booklets found no significant differences across
modes (International Neuropsychological Society [INS], 2020). Finally, the examinee is typically in an office- or school-based setting (with the exception of the study described in INS, 2020). Therefore, if in-home assessment is taking place, it is advisable to prepare a similar environment as much as possible as described in Audio/Visual Environment section.
- Appropriateness: The examiner should first ensure that a telepractice administration is appropriate for the examinee and for the purpose of the assessment. Clinical judgment, best practice guidance for telepractice (e.g. BPS, 2020), information from professional organisations and other professional entities (e.g. licensing boards, legal resources, professional liability insurance providers), consultation with other knowledgeable practitioners, existing research, and any available government regulations should be considered in the decision-making process. Consideration should be given to whether the necessary administrative and technological tasks involved in a telepractice session can be accomplished without influencing results.
- Preparedness: Before initiating test administration, the examiner should ensure that the examinee is well-rested, able, prepared, and ready to appropriately and fully participate in the testing session.
- Facilitator role: If using a facilitator, the role of the facilitator must be explained to the examinee so participation and actions are understood.
- Headset: It may not be appropriate or feasible for some examinees to use a headset due to behaviour, positioning, physical needs, or tactile sensitivities, or if a headset is not available. Clinical judgement on the appropriate use of a headset in these situations should be used. If a headset is not utilised, the examiner’s and examinee’s microphones and speakers should be turned up to a comfortable volume.
- Mouse: On some teleconference platforms, the examiner can pass control of the mouse to allow the examinee to point to indicate responses; this is an option if it is within the capabilities of the examinee. However, best practice guidelines provide cautions about this. For example, the IOPC guidelines suggest examiners be alert throughout administration, return control of the screen once the task is finished, and never leave the computer unattended while the examinee has control over the examiner’s computer (IOPC, 2020).
- Practice: During the telepractice setup, and before administering to any actual examinee, the examiner should rehearse the mechanics and workflow of every item in the entire test using the selected teleconference platform so that the examiner is familiar with the administration procedures. For example, a colleague could be used as a practice examinee.
- Standardised procedures: The examiner must follow the administrationprocedures of face-to-face administration as much as possible. For example, ifa spoken stimulus cannot be said more than once in face-to-face administration,the examiner must not say it more than once in a telepractice administration unless a technical difficulty precluded the examinee from hearing the stimulus.
- Administrative and technological tasks: In order to conduct a smooth telepractice session, audiovisual needs and materials must be managed appropriately. The initial virtual meeting involves the examiner, examinee, and/or the facilitator (if used), and is the opportunity for the examiner to provide information about the audiovisual needs and materials. During the initial virtual meeting, the examiner should provide training in troubleshooting audiovisual needs that arise during the testing session, including camera angle, lighting, and audio checks. The examiner should provide verbal feedback to guide camera adjustment, checking the onscreen video shown by the peripheral camera/device to provide information about how to reposition it until the proper view is shown. The examiner should emphasise that no materials should be opened until the examiner provides instructions to do so, if applicable. The examiner should also expect to provide verbal guidance about these issues during the testing session. Refer to the Telepractice Environment and Equipment section and to Table 1 (PDF | 139 KB) for specific subtest telepractice considerations.
If used, the facilitator is to assist with administrative and technological tasks and not to manage rapport, engagement, or attention during the testing session. The examiner should direct them not to interfere with the examinee’s performance or responses. Any other roles and responsibilities for which an examiner needs support, such as behaviour management, should be outlined and trained prior to the beginning of the testing session. The examiner is responsible for documenting all behaviours of the facilitator during test administration and taking these into consideration when reporting scores and performance.
5. Other Considerations
There are special considerations for written reports describing testing that takes place via telepractice. The professional completing the written report should state in the report that the test was administered via telepractice, and briefly describe the method of telepractice used. For example, ‘The WRIT was administered via remote telepractice using digital stimulus materials on Pearson’s Q-global system, and a facilitator monitored the administration onsite during the live video connection using the [name of telepractice system, e.g. Zoom] platform.’
The professional should also make a clinical judgment, similar to a face-to-face session, about whether or not the examiner was able to obtain the examinee’s best performance. Clinical decisions should be explained in the report, including comments on the factors that led to the decision to conduct testing via telepractice and to report all (or not to report suspect) scores. In addition, it is recommended that the report include a record of any and all atypical events during the testing session (e.g. delayed video or audio, disruptions to connectivity, extraneous noises such as a phone ringing or loud dog barking, a person or animal unexpectedly walking into the room, the examinee responding to other external stimuli). Notes may be recorded about these issues on the record form. List and describe these anomalies, as is typical for reporting behavioural observations in the written report, as well as any observed or perceived impact on the testing sessions and/or results, and consider these in the interpretation of results. For example, ‘The remote testing environment appeared free of distractions, adequate rapport was established with the examinee via video/audio, and the examinee appeared appropriately engaged in the task throughout the session. No significant technological problems or distractions were noted during administration. Modifications to the standardisation procedure included: [list]. The WRIT subtests, or similar tasks, have received initial validation in several samples for remote telepractice and digital format administration,and the results are considered a valid description of the examinee’s skills and abilities.’
The WRIT was not standardised in a telepractice mode, and this should be taken into consideration when utilising this test via telepractice and interpreting results. For example, the examiner should consider relying on convergence of multiple data sources and/or being tentative about conclusions. Provided that the examiner has thoroughly considered and addressed the factors and the specific considerations as listed above, the examiner should be prepared to observe and comment about the reliable and valid delivery of the test via telepractice. Materials may be used via telepractice without additional permission from Pearson in the following published contexts:
- WRIT manual, stimulus book, and associated administration materials via Q-global®
Any otheruse of the WRIT via telepractice is not currently recommended. This includes, but is not limited to: digitising the paper record forms; holding the materials physically up in the camera's viewing area; or uploading a manual onto a shared drive or site.
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(See Table 1 (PDF | 139 KB)
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3. Galusha-Glasscock, J., Horton, D., Weiner, M., & Cullum, C. M. (2016). Video teleconference administration of the Repeatable Battery for the Assessment of Neuropsychological Status. Archives of Clinical Neuropsychology, 31(1), 8–11.
4. Grosch, M., Weiner, M., Hynan, L., Shore, J., & Cullum, C. M. (2015). Video teleconference-based neurocognitive screening in geropsychiatry. Psychiatry Research, 225(3), 734–735.
5. Hildebrand, R., Chow, H., Williams, C., Nelson, M., & Wass, P. (2004). Feasibility of neuropsychological testing of older adults via videoconference: Implications for assessing the capacity for independent living. Journal of Telemedicine and Telecare, 10(3), 130–134. https://doi.org/10.1258/135763304323070751
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7. Ragbeer, S. N., Augustine, E. F., Mink, J. W., Thatcher, A. R., Vierhile, A. E., & Adams, H. R. (2016). Remote
assessment of cognitive function in juvenile neuronal ceroid lipofuscinosis (Batten disease): A pilot study of feasibility and reliability. Journal of Child Neurology, 31, 481–487. https://doi.org/10.1177/0883073815600863
8. Stain, H. J., Payne, K., Thienel, R., Michie, P., Vaughan, C., & Kelly, B. (2011). The feasibility of
videoconferencing for neuropsychological assessments of rural youth experiencing early psychosis. Journal of Telemedicine and Telecare, 17, 328–331. https://doi.org/10.1258/jtt.2011.101015
9. Sutherland, R., Trembath, D., Hodge, A., Drevensek, S., Lee, S., Silove, N., & Roberts, J. (2017). Telehealth
language assessments using consumer grade equipment in rural and urban settings: Feasible, reliable and well tolerated. Journal of Telemedicine and Telecare, 23(1), 106–115. https://doi.org/10.1177/1357633X15623921
10. Temple, V., Drummond, C., Valiquette, S., & Jozsvai, E. (2010). A comparison of intellectual assessments over video conferencing and in-person for individuals with ID: Preliminary data. Journal of Intellectual Disability Research, 54(6), 573–577. https://doi.org/10.1111/j.1365-2788.2010.01282.x
11. Wadsworth, H., Galusha-Glasscock, J., Womack, K., Quiceno, M., Weiner, M., Hynan, L., Shore, J., & Cullum, C. (2016). Remote neuropsychological assessment in rural American Indians with and without cognitive impairment. Archives of Clinical Neuropsychology, 31(5), 420–425. https://doi.org/10.1093/arclin/acw030
12. Wadsworth, HE, Dhima, K., Womack, K.B, Hart, J., Weiner, M. F., Hynan, L. S., & Cullum, C. M. (2018). Validity of teleneuropsychological assessment in older patients with cognitive disorders. Archives of Clinical Neuropsychology 33(8), 1040–1045. https://doi.org/10.1093/arclin/acx140
13. Wright, A.J. (2018a). Equivalence of remote, online administration and traditional, face-to-face administration of the Woodcock-Johnson IV cognitive and achievement tests. Archives of Assessment Psychology, 8(1), 23-35.
14. Wright, A. J. (2018b). Equivalence of remote, online administration and traditional, face-to-face administration of the Reynolds Intellectual Assessment Scales-Second Edition. https://pages.presencelearning.com/rs/845-NEW-442/images/Content-PresenceLearning-Equivalence-of-Remote Online-Administration-of-RIAS-2-White-Paper.pdf