Information For Lawyers
We have a packet containing detailed information about our financial and other policies which, on request, we are happy to send to anyone considering referring a client for a forensic neuropsychological assessment. The following section contains more general information regarding the nature of our practice and issues you should consider when making such a referral.
Fortunately, there are training standards in these fields which are available. The “gold standard” for demonstrating that an individual has expertise in their area of stated specialization is the Diplomate credential awarded by the various boards that make up the by the American Board of Professional Psychology (ABPP). ABPP offers speciality certification in a variety of fields including clinical psychology, clinical neuropsychology, school psychology, industrial psychology and so on. To obtain the Diplomate the individual must have his or her educational background and credentials reviewed by the board to assure that they meet the standards of that speciality, submit work samples to be reviewed by Diplomate psychologists in that area of specialization, and undergo a written and/or oral examination designed to assess professional competence, appreciation of ethical standards and so on. You can hence rest assured that anyone who is an ABPP Diplomate has gone through this review process. Other Diplomate programs exist which are not affiliated with ABPP. Most of them have far lower standards and are often not recognized within the field.
Not all qualified individuals have obtained their Diplomate. In those cases we recommend that you assure that they at least meet the requirements to obtain a Diplomate in their field of self-declared specialization. These typically include having completed a doctoral-level degree and a predoctoral internship from accredited institutions and having done at least two years of post-doctoral supervised practice. The more detailed criteria, together with accepted definitions of clinical neuropsychologists and clinical psychologists can be found at http://www.theabcn.org/content.aspx?id=8 for neuropsychology and http://www.abpp.org/i4a/pages/index.cfm?pageid=3307 for clinical psychology.
We strongly recommend that you assure that the individual from whom you seek clinical psychological or clinical neuropsychological services meet these criteria.
Assessments are hence appropriate in both cases where the individual, as a result of an accident or other circumstance, has suffered emotional trauma, brain injury or physical trauma resulting in pain or physical dysfunction and in cases where the individual presents with unrelated pre- or co-existing psychological issues that might affect their recovery process.
Pain and Other Physical Problems: Psychologists are not qualified to determine the physical bases of pain complaints, sleep-wake cycle disorders and other physical conditions. Rather, the focus of the psychologist in individuals with pain or other disorders is to determine the nature and adaptive versus maladaptive qualities of their beliefs about their physical problem and the methods they use to cope with it. Psychologists also have expertise in determining whether an individual has a personality structure that might predispose them to develop a psychogenic pain or other physical disorder.
Emotional disruption: Psychologists are well-trained in how to assess psychological dysfunction, including both psychological disorders that might pre- or co-exist with an individual’s injury, and psychological disorders that might arise from such an injury. The latter include both disorders due to the traumatic nature of the injury itself such as Posttraumatic Stress Disorder and disorders arising from the individual’s difficulties in adjusting to the impact of their injuries on their lifestyle, such as Major Depressive Disorder, Adjustment Disorder or General Anxiety Disorder.
Malingering: The term malingering refers to a conscious or purposeful intent of the individual to, in a particular situation, exaggerate or minimize the presence of conditions that may or may not be present. As such, it is a conscious, volitional, situation-based behavior rather than a personality trait or psychological disorder. Psychologists do have a variety of methods that we use to determine whether an individual is exerting good effort on testing or has tendencies to minimize or exaggerate problems. However, the purpose of these measures is to determine whether we can reasonably rely upon the results of the other psychological tests we administer. Such tests tell us nothing about the extent to which these patterns are trans-situational versus situational or conscious versus unconscious in nature. It is hence a misnomer to refer to these measures as tests of “malingering” as opposed to tests of effort level or tendencies to under- or over-state problems.
Multiple diagnoses: Many of the above-described conditions often coexist in the same individual. Hence a key component of the comprehensive psychological and neuropsychological evaluation is to consider all such factors, and to determine, as far as possible, the relative contribution of those factors to the individual’s presentation. If such a determination cannot be made, we will often make recommendations as to how such differentiations can be accomplished through the provision of treatment and so on.
We typically bill for five items. First, a flat rate of one hour to cover the time it takes our psychologists to manage the file in terms of thinning it, storing it for the prescribed time in a secure and accessible place, destroying records we have received and destroying the file itself after the appropriate time frame. The second item covers the time the psychologist spends reviewing the records. The third item is for the time spent by the psychologist interviewing and testing the individual and collateral sources. The fourth cost item is for the time spent scoring, interpreting and integrating results of the tests. The fifth and final cost item covers the time spent consulting with the referral source and/or generating the report. In our experience, there is a great deal of variability from psychologist to psychologist in the community, as to the amount of time that they spend on these items, particularly with respect to reviewing records and preparing reports. It is hence appropriate to ask the psychologist for their hourly fee but also for an estimate of how many hours they are likely to spend on each of these items. We at Schmidt, Trentadue and Associates are happy to discuss this at any time.
In that context, in forensic cases where traumatic brain injury or cognitive dysfunction is not an issue, assessments typically take approximately seven hours of direct contact time. In cases where brain injury or cognitive dysfunction is an issue the direct contact time is typically ten to eleven hours. Test scoring and interpretation typically takes 1 ½ to 2 ½ hours, report preparation typically taking from two to three hours. Time spent doing record review varies considerably from case to case, depending on the volume of the records, the quality of the records in terms of how well-organized and decipherable they are and so on. Again, we encourage perspective clients to feel free to contact us to discuss this in more detail as needed.
In addition to providing comprehensive assessments as described above, we also provide preliminary assessments. The preliminary assessment is specifically aimed at answering the question of whether it is reasonable for the client to have a comprehensive psychological/neuropsychological assessment at this point in time.
When is a Preliminary Assessment Indicated?
Preliminary assessments for the following types of individuals among others:
• Individuals with mild injuries who seem functionally recovered but have ongoing subjective complaints or concerns are reported by them, their attending physician or another health professional. In such cases, those individuals can often be reassured and a costly assessment and prolongation of the process can be avoided.
• Individuals with multiple problems, including brain injury, where it may or may not be possible to determine the unique effects of the brain injury. In such cases, the outcome of the preliminary assessment is often to recommend treatments or interventions that should be undertaken before considering a full assessment.
• Cases where the lawyer had concerns with the findings of previous neuropsychological assessments. On such occasions, the lawyer may feel that a neuropsychological assessment was not comprehensive or was deficient in some other way and may wish to consider getting a second opinion. The preliminary assessment can address the likely utility of such a step.
• Individuals where the timing may or may not be right to do a full evaluation. Occasionally, it is not clear whether a neuropsychological evaluation should be done “sooner rather than later” and a preliminary evaluation can clarify this issue.
• Individuals who seem to have made a full recovery from a significant traumatic brain injury. In such cases the preliminary assessment can often shed some light on whether the recovery was indeed complete or there are some residual problems that should be identified in a full assessment.
• Individuals who are early in the recovery process and baseline information is needed in case their problems persist.
What does a Preliminary Evaluation Involve?
The preliminary evaluations involves a preliminary review of the records, a 3 ½ hour session with the client and an integration of the test, record and interview information to answer the question of whether the individual should have a comprehensive assessment at this point in time, later, or not at all. The time spent with the client is devoted to a detailed clinical interview as well as administration of screening measures of cognitive, emotional and/or behavioural functioning. We are also happy to provide brief reports stating our opinion about this and its bases. It must be emphasized that the preliminary evaluation is not and should not be seen as a fast-tracked or inexpensive substitute for a comprehensive evaluation.
What are the advantages of a Preliminary Assessment?
There are three main advantages for the Preliminary Assessment. The first is the reduced cost of the process (typically between 40 to 50% the cost of a full assessment.) The second is that it can typically be scheduled earlier than a full assessment. The third is that by avoiding unnecessary testing the stress on the client is reduced.
What if a Full Evaluation is recommended?
Because the procedures used in preliminary assessments overlap full assessments, the time spent in the preliminary assessment reduces the time that will be spent in the full assessment, if it proceeds. Typically the preliminary evaluation will reduce the time required to do a comprehensive evaluation, if one is recommended, by between four and five hours.
• The individual might still undergo further spontaneous recovery.
• Treatments have been recommended or are ongoing which might have an impact on the individual’s cognitive, emotional and/or behavioural functioning.
• The individual will be undergoing life changes, such as returning to school or work, terminating a relationship, moving out of their home, or moving to a different city which will present them with new challenges that may have an impact, either positive or negative, on their cognitive emotional behavioral functioning.
When a reassessment is recommended, we typically suggested to be done in approximately one year. Again, however, this is subject to modification depending on the specific situation.
We nevertheless are happy to take appointments at times further in the future and recommend making an appointment as soon as you realize that one will be needed.
We also maintain a wait-list for individuals who need to be seen earlier than our first open appointment and in most cases can fine an earlier time.
Our goal is to complete our written report of the assessment within six weeks of having all of the information we need for that report (i.e., testing is completed, records are in-hand, etc.) If you have any deadlines, please let us know what they are as soon as possible.
How the Client should be told to prepare for their assessment:
• The client should try to get lots of rest before the assessment session.
• The client should continue to take any regularly-scheduled medications. The client should avoid using alcohol or street drugs for at least 24 hours before each appointment, and should try to take minimal amount of as-needed medications (e.g., Tylenol-3).
• Some clients find it useful to prepare notes of problems or questions for the first session.
• We will generally ask to speak to someone (“collateral”) who knew the client before and after the accident or injury. This is usually a parent, spouse, sibling, or friend. Typically the collateral interview occurs during one of the assessment sessions, but other arrangements can be made to accommodate the collateral, including telephonic interviews when the collateral cannot attend in person.
• The client should be sure to bring any aides they use, such as glasses or hearing aides. They should dress comfortably.
• Clients should not be “coached,” shown sample reports, or told anything specific about the tests that are to be given.
What the client should expect during the appointments:
• Testing is done on a one-on-one basis. No group testing is done.
• All assessment sessions are either 3 ½ hours (half day) or 7 hours (full day) long. Breaks are taken during that time to allow the client to rest, use the washroom and so on. On full day appointments the client will have a one hour lunch break.
• The testing is not physically painful, but can be frustrating. Most of the tests are designed so that no one can do 100%, so the client should try not to get discouraged if they can’t answer some questions or can’t do some tests.
• It is critical for the client to do the best they can on each test. Likewise, the client should be encouraged to be as open and frank as possible during the interview. The client has the right to refuse to answer any question we ask or refuse to do any test.
• School Records: At a minimum, the B.C. Permanent School Record or its equivalent. Individual report cards, results of testing, and relevant letters are also of use, if available.
• Work Records: Resumes, job performance evaluations, records of job training, etc. as available.
• Pre-injury Medical Records: Family physicians’ records, consultations from relevant health professionals (see below), and records from previous hospitalizations (see below).
• Military Records: If available.
• Ambulance Report(s)
• Hospital Records: If they are brief, please send all records. If lengthy, the following are especially important: Admitting and discharge notes; records of medications given in hospital; all consultation reports; nursing notes; ratings of Glasgow Coma Scale scores (often given on an observation or “neuro” sheet); results of Neuropsychology, Occupational Therapy, Speech Pathology, and Physiotherapy assessments; early blood work including blood alcohol levels; X-ray reports, especially CT or MRI scans; EEG results. Physiotherapy notes, lists of valuables and similar administrative documents, doctors’ orders, and lab tests (other than as above) are generally not relevant.
•Consultation Reports: All reports prepared by neurologists, neurosurgeons, psychiatrists, psychologists, neuropsychologists, and family physicians; family physicians’ notes; additional consultation reports from other physicians (e.g., orthopedic physicians) as they shed light on additional problems (e.g., pain) or address neuropsychological status. Physiotherapy notes, and notes from other doctors are generally not relevant unless the doctor is providing care or has lab results such as those discussed under hospital records above.
• Rehabilitation Reports: All reports of rehabilitation consultants, occupational therapists, psychotherapists, counselors, speech pathologists, and similar individuals are of relevance.
• Neuropsychological Reports: If previous neuropsychological evaluations have been conducted, it is important that we receive the raw test scores from those evaluations as well as any reports that might have been prepared.
We recognize that not all of these records are available in every case, especially at the time of our assessment. The fact that some records are still not available is not to be a reason to delay the assessment. In such cases, we will generally provide an addendum to the original report as records become available.
The above list is intended to create a set of documents that will allow us to conduct a comprehensive review of the case while at the same time avoiding the time and cost of us reviewing excessive irrelevant documents. If you have any specific questions regarding whether to supply various documents, please do not hesitate to call us.