Practical ideas on how to streamline assessments and report writing


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A look at how software, technology aides, and other streamlining techniques can allow you to focus on what you do best (clinical assessment and interpretation) while outsourcing the small details and other busy work tasks that cripple your workflow.

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Practical ideas on how to streamline assessments and report writing

  1. 1. Fostering Efficiency and Flexibility inYour Psychology PracticeYour Psychology Practice... or ... How to caffeinate your workflow without getting the shakes
  2. 2. Michael Decaire, M.A., C.Psych.Assoc.Credentials/BackgroundMember of the College of Psychologists of OntarioPractice in Clinical Psychology (Child; Adolescent; Adult)Specializing in psycho-diagnostics: learning/attention disorders; full spectrumAXIS-I/II disordersPrivate Practice (Hamilton/Toronto) & Hospital (Lindsay/Virtual)Former clinical consultant with PsychCorp Canada
  3. 3. Michael Decaire, M.A., C.Psych.Assoc.DisclosuresBusiness: FLEX PsychometricsSpecial Interest Group Work: Ontario Association of Psychological Associates(President); Coalition of Regulated Health Professional Associations (BoardMember); College of Psychologists of Ontario (Task Force Work)Honoraria: Purdue Pharma
  4. 4. Workflow AnalysisA different world. Several years in the testdevelopment and publishing worldprovided a unique environment ofworkflow efficiencies and quality controlmechanisms.Big Surprise. The psychometric expertsspent a lot of time measuring themselves.Overwhelming? 1000+ clients; 100+ clientcontacts a day; 80%+ of the month out ofthe office/town.Self-evaluation, focused strategies, and supportmechanisms kept it together.
  5. 5. Returning to the real world...I returned full-time to the clinical worldin search of a more balanced and lesspressured work life.Reality. Leaving the business world alsomeant leaving structures that I had inplace to manage information and to getthings done - well.Overwhelmed! My first year back saw novacation, many evenings of scoring andreport writing, and literally dozens of 7day work weeks.
  6. 6. Workflow AnalysisThe reality of the situation was that Ihad lost all my structure and wasworking from A to Z in one not so fluidstep.I needed to realize that I was still in thebusiness world. All that had changedwas what business I was in.Turns out I was well prepared to reversethis trend by combing big-businessprinciples and psychology strategies.
  7. 7. Self-EvaluationWhat am I being asked to do?What steps are there to reach this goal?Am I combining more than one step at a time?How much time is each step taking me?Am I the best person to be doing this step?Where am I feeling overwhelmed?
  8. 8. Before the solution - the results..Year Two33% increase in clients500% decrease in evening/weekend workTook a vacationYear Four90% increase in clientsEvenings and weekends down to a handful6 weeks off for vacations and conferencesYear Five (so far)Maintaining same client loadTwo weekends worked so farDown to four days a weekAway 4 weeks so far ...
  9. 9. Examining The Process: A to ZLet’s walk through my current workflow.Remember that this has been the culmination of afour year process of self-assessment,development, and a bit of trial-and-errorTrying to adjust all of this at once would haveundoubtedly failed.Everyone’s workflows (and brains) are differentso some of this may not fit with you, your clientbase, or your environment.Is there one thing here that could make a changefor you tomorrow?
  10. 10. Assessment WorkflowIntake and booking the clientPlanning the assessmentThe assessmentScoringInterpretationReport WritingFeedback
  11. 11. Booking & Client ManagementIf you start off disorganized you are not likelyto become increasingly streamlined or focusedas you move through the assessment process.The reality is that many of us don’t integratethe administrative and clinical aspects of ourwork in a way that promotes fluid and flexiblemovement towards are end goals.We spend a lot of time with logistical busywork, when we should be spending time beingclinicians (and office managers).We asked ourselves if there was a better way?
  12. 12. The New Way... CRMAmongst my partners we literallyevaluated dozens of cloud (online) andlocally based CRM’s before I settled onCapsuleCRM ( my client management.It is an entirely mobile solution thatallows me to manage a client’s entire filefrom any computer, tablet, orsmartphone.It integrates with other free or for-feesolutions that allow me to expand mybusiness.Cloud SolutionCurrent Cost:$36/month (3 users)
  13. 13. The New Way... CRMI initially explored this option because I was having difficultykeeping up with a lot of the small logistical aspects of mypractice:Documenting all points of contactKeeping track of to-do’s that were not in my normalworkflowKeeping track of my team when either of us are off-siteIn the end, a good CRM solution solved all of these problemsand added structure to all aspects of my practice.
  14. 14. Keeping Track: Contact/IntakeA phone call, email, orweb-inquiry comes inregarding a potential clientThis is added as an“opportunity” in order tonot fill our client files withpeople we’ve never seenWe can assign a step-wise“track” (workflow) at thispoint (e.g., therapy;psychoed; gifted)Assign to a specific staff
  15. 15. Keeping Track: WorkflowClient either books during the initial call, calls back later, ordoes not book.If they go ahead with the booking, they are converted at thepress of a button to an active client.Those who do not book are left as opportunities (just non-active ones)These are not deleted because we can use the opportunityvs. converted data to plot our intake conversion rates
  16. 16. Keeping Track: BookingNow that they are a client wego ahead with collection ofadditional information.The actual client becomes an“organization” (main client)which is then tagged withsupplementary “people” (e.g.,parents).This keeps the system cleanerregarding who is the actualclient.
  17. 17. Keeping Track: WorkflowOnce they become a client the“workflow”-track tag initiates a seriesof to-do and appointment items thatwill be completed as part of theassessment.Each individual team member isalerted to their new tasksAnyone can view the progress ofthe case and what the next step isWe can make sure that we’vealways dotted the i’s and crossedthe t’s.
  18. 18. Keeping track: Points of ContactFrom either a computer, tablet, orsmartphone I can click on the emailaddress to open my email client andsend an email that will automaticallybe attached to the client file.I can forward replies back to theCRM with a push of a button andthey also get attached.On my phone I can click on thephone number to initiate a phonecall.
  19. 19. Keeping track: Notes and filesAll of the teams session notes areorganized in one place, by date, andidentifying who made the entry.Paper based notes, consent forms,releases, and other small paperworkare taken as a photo. This can beattached as a JPG or as a PDF (e.g.,JotNot app).Reports attached as PDF’s and/oreditable formats.Rest of file scanned (Fujitsu), backedup, and into shredder.Productivity boost: Dictate notes fromyour computer or smartphone.
  20. 20. Keeping Track: CalendarYou can view any or all teammembers calendars in either atraditional format or as a task list.This can be exported securely to adiverse range of calendarapplications (e.g., iCal; Outlook;Google Calendar)The task list workflow allows you tosee the clients progress regardless ofthe team member involved and toquickly assess what step is next.To-do’s can be sent as a daily email.
  21. 21. All of this is integrated in a single “client file” page
  22. 22. When away ...The majority of this is also availableon my smartphone:Contact informationNotes and email historyTasks and calendar entriesAssign new tasks with fulldelegation featuresAvailable on and offline
  23. 23. Keeping Track: BillingCRM’s generally don’t have billingand invoicing integrated in directlyLocal (non-cloud) CRM’s generallypair well with other local invoicingsolutions (e.g., QuickBooks)Cloud CRM’s often allow you tointegrate your workflow with cloudinvoicing solutions (e.g.,Freshbooks)
  24. 24. Keeping Track: ExpandingCloudCRM’s generally include anumber of additional integrationopportunities that may expand orstreamline your practice:Estimates and time-trackingInvoicing and accountingMailing lists / NewslettersWebsite contact formsSurveys for collecting clientinformationEmail automation
  25. 25. CRM: SummaryOrganizing your client information and workflow from the very start will allow you to stopspending mental and physical resources keeping track of logistics and instead focus on whatyou do best.Onsite hardware/software combinations (e.g., Microsoft Dynamics CRM; Daylite CRM):Powerful tools that can usually be adapted to your specific work environmentHefty set up costs and will usually require initial consultant supportMay lock you in to specific technologyCloud based CRM software (e.g., CapsuleCRM; Salesforce)Powerful if they can fit your workflowMobile access and cross-technology compatibleLess risk of theft
  26. 26. AssessmentWhile assessment (and treatment) isthe first time we can flex ourpsychology muscle in an assessment,there is still a marked difference inhow smoothly this process can go.Many small and easy to implementsteps can focus your work andprovide information that easilyintegrates into your report writingworkflow.How can we see the forest thoughthe trees?
  27. 27. AssessmentI looked at how we could streamline, focus,and improve each major step:Assessment PlanningClient-Parent interviewsStructured ObservationsDiagnostic VerificationsDigital Administration
  28. 28. Keeping OrganizedSimilar to most of you, I keep a list ofpotential tests that I can use as achecklist of “to-do” and “completed”items for myself and mypsychometric team.I generally label this by the sessionnumber, whether something is awish-list, and whether something isto be done through a prescriptiveapproach (e.g., if this - then that)With a few exceptions, each area isbroken down in a manner similar tohow the report will be divided.
  29. 29. Parent InterviewParent interviews are developed tomatch the manner in which I reporton these in my background:Birth, Developmental, andMedical HistoryBehavioural, Social, andEmotional DevelopmentAcademic HistoryAssessment and TreatmentHistory
  30. 30. Observation SheetsMy goal was to be able to write reports off-site with literally no paper on hand.A missing element was when I came across outlier data that I could not easilyexplain during my interpretation and report writing without referring back tonotes within the original record form.Borrowing a great idea (now abandoned) from the WIAT-II record form, I createda series of “observation” checklist sheets to be used by my psychometrists andmyself during each assessment.Currently we are using this on paper and scanning to PDF - but we will all bemoving to an iPad/iPen (an alternative stylus from Cregle) shortly.
  31. 31. Observation Sheets
  32. 32. Diagnostic InterviewsMuch of my graduate research and my early clinical career was in forensicsThat environment demanded that diagnostic decisions be made on the basis ofquantifiable criteria and not just statistical elevations on surveys and generalperception that a person has a disorder or notWhile I left forensics behind, this approach always stuck with me and seems tohave inadvertently led to a great deal of referrals from physicians andpsychiatrists in my area (which at first surprised me outside of LD cases)
  33. 33. Diagnostic InterviewsI spent a lot of time speaking to these referrals (and I continue to do this) todetermine what exactly they wanted from psychology, given that they are just ascapable of making most of these diagnosesLooking for a fine tuned assessment that will sort out diagnoses inlogistically complex cases (e.g., comorbidity vs. differential diagnosis)Want a step-wise evidence based approach to diagnosis that they can standbehind for the purpose of disability applications and program referral
  34. 34. Diagnostic InterviewsProviding a criteria driven approachto diagnosis used to mean that I hadto lug around the DSMI did use the SCID, which I continueto use in many cases, but severaldisorders were almost entirelyignored (e.g., GAD).DSM-IV on iPad/iPhone was alogistical nightmareMy DIY Solution: PDF’s of diagnosticcriteria stored on my iPad (can befilled out right on the device with astylus or Cregle iPen)
  35. 35. Digital ExpansionThe DSM project made me think about how I can digitize other aspects of myassessment process:How can I have more of my toolkit on-hand when I need themHow can I do this without breaking the assessment flowWhere do I risk compromising standardized administration proceduresWhat can I do that does not violate copyright/fair-use laws in my region
  36. 36. Digital ExpansionA long history of damaged audioCD’s and now useless cassettesmeant my first step was to makeelectronic copies of my audio-stimuli for tests like CTOPP, TEA-Ch/TEA, & SCAN-A/C-SCANThese can be managed through anMP3 player or computer or acrossall platforms through cloud serviceslike DropboxNow no matter where I am (or whatI forgot) I have easy access to myaudio stimuli
  37. 37. Digital ExpansionDigitizing visual stimuli like figure drawing and projective activities has beentempting, but do bring up potential standardization concerns (e.g., Can the sizing bedone correctly? Does the medium impact attention?).The test publishers have increasingly promised computer and tablet based productsso the future may be increasingly expansive in this regardWhile there may be little else that can be done from a stimuli perspective (I’m opento ideas!), these devices can also be used to record oral responses or to take photos ofnon-permanent stimuli (e.g., the dry-erase activities on the Test of EverydayAttention; Behavioural Assessment of Dysexecutive Syndrome).
  38. 38. Scoring and Interpretation
  39. 39. ScoringEveryone’s favourite activity!Some of us may have convincedourselves that the time lost duringscoring is an opportunity to beimmersed in the data.Would we encourage educationalclients to study by simply note-taking?Reality is we should get throughscoring as quickly as possible andfocus on interpretation distinctly.
  40. 40. Hand ScoringA test like the CTOPP can take longer to score by hand than a WISC-IV whenusing the scoring assistant.A test like the Beery VMI can take longer to score than it takes to administer.Unfortunately, the inordinate cost of building scoring software means thatsoftware solutions are unlikely to emerge for many of the tools we use on a day today basis.
  41. 41. Hand ScoringWhile I have not found a way to resolve this issue, one of my partners came upwith an idea to streamline the hand-scoring process.We photocopied the scoring and norms pages for all manual based tests.These were filed into a scoring binder that also included any templates (e.g.,symbol search) and other scoring tools (e.g., ruler and protractor).This meant less trips, flipping through books, and missing manuals.Then I timed it - old way: 40 minutes; new way: 30 minutes
  42. 42. Hand ScoringThat wasn’t good enough for me, so Idecided to go digitalRevisited DropboxPlaced all my norm pages in onefolder, synced across my workand home computers, myiPad/Android tablets, and mysmartphoneThis means I can look up scoringdata anywhere and at anytime.No more return trips to the office!
  43. 43. Computer Based ScoringScoring assistants can be a huge time saver when they are available.Surprisingly, these have been quite difficult to sell in the pastTechnophobiaThe “interpret as I score” argumentComplaints regarding cost
  44. 44. Computer Based ScoringMuch of this software is also locked into one ecosystem (e.g., windows PC)You have to be on-site or use a laptop that can’t be easily shared amongst off-sitestaff.Some companies have moved towards online scoring options, but these can bringbrowser limitations (no tablets) and may have a cost per use despite having all-you-can-score solutions available for on-site use
  45. 45. Computer Based ScoringWhile I’m a long time user of scoring software and have seen substantial gains inmy workflow and what scores are available to me as a resultI’m not willing to have multiple copies of the same program just so I can scoreoff-site once and a whileI’m not willing to pay a per-use fee for something I already own unlimitedaccess rights to.Came up with my own do it yourself cloud scoring solution
  46. 46. DIY Cloud Scoring SystemIngredients:A low end windows computer($300)Local backup hard drive ($50)Secure online backup service(free)A LogMeIn account (free)LogMeIn Tablet/Smartphoneapps (free)
  47. 47. DIY Cloud Scoring SystemThis allows you to login wheneveryou want and wherever you are. Ican login with my iPad/ Mac/ Pc orin a pinch my iPhone and control myscoring assistants back at the office
  48. 48. DIY Cloud Scoring SystemThe system has worked amazingly well for us and we’ve now implemented“Cloud” scoring computers across each of my practices.I’ve scored from different offices, coffee shops, a pub, bed, my car, and even in theCaribbean.The downsides are minor but include the inability to have multiple users on thesoftware at the same time and the inability to print at your location without thepro version of LogMeIn.Printing limitations were easily resolved by adding a “pdf printer” that savesthe files to a dropbox folder that then auto-syncs with each of our personaldevices.
  49. 49. Interpretation
  50. 50. InterpretationI used to sit there with all the data around me and try to formulate the ins-and-outs of a clients clinical profile.Information overload. This used to work when first preceptorship advocated forWISC and WRAT.Those days are over. Now I have such a diverse test list that I was forced to use asmaller font for my title page.In keeping with my previous format-for-the-report approach to parent interviewsand assessment design, I created interpretation sheets that follow my assessmentplan and tie directly into my reporting workflow
  51. 51. Report Writing
  52. 52. The Forbidden Word:TemplatesTemplating certainly has become a negative word and is usually thought to meanpoorly written reports.It did not help that a significant number of end-users started using softwaredriven interpretive writers back in the mid to late 90’s.We’ve all seen bad templated reports that convey data and definitions but don’ttell you a storyTemplates fail if they are used in place of clinical judgement (report writers), afocused description of the current client beyond the scores, and are inflexible todifferent referral concerns.
  53. 53. The Forbidden Word:TemplatesAt the same time why would youspend time:Redefining working memory forthe hundredth timeFormatting sections, fonts, andheadersThere is many cases where we do notneed to reinvent the wheel and wecan spent our report writing time onareas of clinical importance.
  54. 54. Step One: TemplatesMy TemplatesFormattingLogistical introductions (e.g., what percentiles are)Find-and-Replace key wordsDomain definitions and introductionsThis lets me to focus on the clients clinical profile
  55. 55. Step One: Templates
  56. 56. Step Two: Text ExpansionEven things that change from one client to the next don’t need tobe reinvented once you have worded it well.How many different ways can you say a developmental historywas normal?Text expansion software (e.g., Text Expander for Mac; Breevyfor Windows)It can turn a phrase like “..‘s health unremark” and turn it into“Jon’s medical history remained unremarkable, with nosignificant history of hospitalization, surgery, medication use,concussion, fracture, or hearing/vision loss.”
  57. 57. Text Expansion:without - 3 minuteswith - 78 seconds (including a mess up)with - 78 seconds (including a mess up)with - 78 seconds (including a mess up)QuickTime™ and aH.264 decompressorare needed to see this picture.
  58. 58. Time can be saved everywhereQuickTime™ and aH.264 decompressorare needed to see this picture.
  59. 59. Step Two: Text ExpansionThe trick with text completion is to introduce only a few short cuts at a time (oryou won’t remember them).I started with having “..” auto insert the clients name and “pp” to insert the wordpercentile.“..” saved me from typing a clients name on average 142 times in my first tenreports.Taken the average length of the name from those clients it saved me 1988keystrokes.For Ms. Smithinovski (not her real name but similar in length, syllables, andmy inability to spell it) this saved me between 12 to 20 minutes!
  60. 60. Step Two: Text ExpansionThis has became such second nature that I am actually unable to typepercentile in full without applying conscious effort to do so.I next moved to expanding composites and subtest names (e.g., VCI turns intoVerbal Comprehension Index; “ SS,” turns into “ Symbol Search,”Next full blurbs: “health unremark” to “medical history remainedunremarkable, with no significant history of hospitalization, surgery,medication use, concussion, fracture, or hearing/vision loss.”In total I’m seeing on Average at least an hour time savings as a result. Over amonth of report writing this single and cheap (<$30) “tweak” has provided mea day off a month.
  61. 61. The Future of ReportingImagine a parent interview that auto generates the background history, butprompts you for input in areas that were atypicalImagine a quick prompt screen that auto generated all of your test data into tablesImagine an adaptive recommendation list builder that creates research drivenrecommendations based on your specific clients profileWhat is the clients gender?What is the clients grade range?What is the nature of the clients disability?What areas needs specific supports?Is the client in a private school setting?
  62. 62. What do referrers think?I’ve maintained a survey-group of parents, physicians, teachers, special educators,peers, and allied health professionals that I run each significant change by.They’ve universally agreed that these reports are clearer, cleaner, and bettermeeting the needs of a diverse support network.Not every change we’ve tried has led to improvements. You’re just not hearingabout those ones!
  63. 63. FeedbackThis has been the biggest struggle to streamlinePrimarily because of diversity of diagnoses and varied client/parent needs,knowledge, and comprehension levels.Tried having a checklist of measure domains to anchor but held things up evenlongerLately simply asking what level of detail/coverage they want helpsNext step is to produce Dx specific information sheets
  64. 64. Questions?I’ve just used up two hours of your time ... I assure you there is information inhere that will make you gain that time back 10 fold.Presentation available online at: www.flexpsychometrics.caEmail: