Insider’s Guide: Psychological Testing and Evaluations

Right after we moved to Indiana, something under the hood of our car started rattling loudly when it was first started-up each morning. I was sure the engine was failing and we’d either need a new car or, at minimum, a new engine. Fearing the worst, I took it to the dealership and tried my best to describe the noise. They took the car, hooked it up to their computer and ran diagnostics. Based on their findings, they adjusted some engine controls and replaced a sensor. Total cost was under $150 and about an hour of time. I was lucky it wasn’t more expensive. The technician said that if I had driven muh further, the engine would likely have overheated, blah, blah blah ….basically, bad things would have happened if I had not run the diagnositics. Money well spent.

My experience with our car reminded me of psychological evaluations and how often I talk with parents that want to wait a bit longer, save a bit more money or hold off until ‘things calm down’ before getting some diagnostics run. A shot engine would cost a few thousand dollars. Untreated behavioral health issues can cost tens of thousands of dollars and leave perminant scars. 

But when are things bad enough that you need to get a psychological evaluation? When is a car sounding bad enough to get diagnostics run? My definitive answer is this: When the symptoms are impacting a life domain (eg. school/work, relationships, family, activities) …and yes, this holds for both cars and people I believe. If things are bad enough to keep you up at night, it’s probably a good time to get evaluated.

The Basics

A psychological evaluation is a generic term used to describe a clinician’s use of tests, assessments and clinical interviews to determine a diagnostic presentation. Or, more simply put, what do all their symptoms add up to. There is no single test that makes up a psychological evaluation. A psychologist (often the most qualified type of behavioral health professional to administer testing), based on basic initial information about the client, chooses from a menu of tests and assessments all of which are evidence-based tests and procedures of assessing specific aspects of a person’s psychological profile. Some tests are used to determine IQ, some are to determine processing speed, others are used for personality, and still others for something else like depression or delusions.

Testing can be used to identify and sometimes determine the severity of just about any behavioral health disorder. Psychological testing is not definitive. While it can provide significant insight and give us a solid understanding of why someone is experiencing the symptoms they are, it can never provide certainty or causation. Clients can be found to ‘meet criteria for depression’ though, technically, we can never say without doubt they have depression. Sounds crazy but that’s how science and scientific testing works.

Here are the steps you should expect for the evaluation:

  1. Initial Intake: Initial intake appointment gathering basic background, symptoms and goals (1 hr)
  2. Testing: Psychological testing (1-6hrs)
  3. Write-Up: Psychologist writes-up the results (2 weeks)
  4. Results Session: Review of results and recommendations for treatment

Initial Intake and Testing

Let’s drill down into the details of testing. Once the tests are chosen, the evaluation is typically done in a formal manner by a licensed psychologist or therapist in their office. Depending upon what kind of testing is being done, it can last anywhere from 1 hour to a full day and consists largely of computer and paper-and-pencil tests.

There are generally four categories of tests:

  • Clinical Interview. The clinical interview is a core component of any psychological testing. Some people know the clinical interview as an “intake interview”, “admission interview” or “diagnostic interview” (although technically these are often very different things). Clinical interviews typically last from 1 to 2 hours in length, and occur most often in a clinician’s office. Many types of mental health professionals can conduct a clinical interview — psychologists, psychiatrists, licensed counselors, clinical social workers, and psychiatric nurses.
  • IQ. The most commonly administered IQ test is called the Wechsler Adult Intelligence Scale—Fourth Edition (WAIS-IV). It generally takes anywhere from an hour to an hour and a half to administer, and is appropriate for any individual aged 16 or older to take. (Children can be administered an IQ test especially designed for them called the Wechsler Intelligence Scale for Children – Fourth Edition, or the WISC-IV).
  • Personality Assessment. Personality assessment is designed to help a professional better understand an individual’s personality. Personality is a complex combination of factors that has been developed over a person’s entire childhood and young adulthood. There are multiple variables that influence our personality such as genetic, environmental and social components. Personality tests take this into account. There are two primary types of personality tests 1) objective, by far the most commonly used today, and 2) projective. Objective tests include things like the Minnesota Multiphasic Personality Inventory (MMPI-2), the 16PF, and the Millon Clinical Multiaxial Inventory-III (MCMI-III). Projective tests include the Rorschach Inkblot Test, the Thematic Apperception Test (TAT), and the Draw-a-Person test.
  • Behavioral Assessment. Behavioral assessment is the process of observing or measuring a person’s actual behavior to try and better understand the behavior and the thoughts behind it, and determine possible reinforcing components or triggers for the behavior. Through the process of behavioral assessment, a person — and/or a professional — can track behaviors and help change them.

In addition to these primary types, other kinds of psychological tests are available for specific areas, such as aptitude or achievement in school, career counseling, management skills, and career planning. For instance, in our Kentucky office, we provide neuropsychological testing for head trauma, sports injuries, pre-employment and a bunch of other neuropsychologically-related areas. 

Results Session – What Next?

At the results session, you will meet with the psychologist and go over the results. You should get a copy of the full psychological evaluation (typically 5-20 pages). It should be broken down into the following format (or something very similar):

  1. Basic Demographic Information
  2. Reason for Referral
  3. Names of Tests Administered
  4. Data from Each Test
  5. Results (Diagnoses)
  6. Recommendations
  7. Signature and Title of Psychologist

A good psychologist will go through the entire document, explain the tests used and results fully. He or she will also review all the recommendations which will likely include one or more treatments like outpatient therapy, medication evaluation with a psychiatrist or placement in residential treament. The most important sections are the Results and Recommendations. The Results are the psychologist’s list of diagnoses that were supported from testing and observation. The Recommendations is the ‘what now’ piece where you understand your options for treatment based on the results. If you don’t understand something, ask. They should completely answer any questions you have.

A great psychologist will either offer a list of specific providers who offer the type of intervention or care recommended or refer you to a therapeutic placement consultant or educational consultant who can help with treatment placement.

Cost

If you are paying out of pocket, expect to pay $500-$2500 for the entire evaluation service. If you have insurance, contact the insurance company before scheduling an evaluation and ask what their coverage is for outpatient therapy and what your copay will be.

FAQ

Q: What if I disagree with the results or think the psychologist did a bad job?

A: During the final session when results are discussed, present your concerns and be a specific and factual as possible. Psychologists can only test based on information they have. If the psychologist had all the information but ignored important pieces, discuss this and, if necessary, make sure they do retesting to capture what they missed.

Q: Our daughter needs testing for an IEP at school. Is there a difference between psychological testing and testing at her school?

A: The testing you need is referred to as psychoeducation testing and often includes IQ testing. Testing for an IEP within a school system is not supposed to be used for diagnoses, only determining elegibility for an IEP or 504.

Q: How do we find a psychologist to do an evaluation?

A: If you are working with a therapist, start by asking if they have any recommendations of someone they trust and have worked with. If you are flying solo and have no one in your corner yet, check out Psychology Today (https://therapists.psychologytoday.com) > Type your Zip code into the search box > Under the Treatment Orientation on the left side, choose Psychological Testing and Evaluation. You should get a list of providers that conduct evaluations.  

Opioid Epidemic: John Oliver Sums it Up Best on HBO

Don’t Think Pain Meds and Heroin is Really a Big Deal? Check Out What the Surgeon General Just Did…

Surgeon General Writes to Every Doctor in U.S. About Opioid Epidemic

Opioid abuse is not like other problems. With very little use, pain meds and heroin can quickly become an addiction. This addiction has unusual drug dealers. Some are intentional (Big Pharma like Purdue Pharma, Cephalon, Janssen Pharmaceuticals, Endo Health Solutions and Actavis) that exploit our pain and desperation. Other’s are likely well-meaning like primary care doctors most of whom are manipulated by the pharmaceutical companies to write prescriptions.

If you or a loved one is prescribed pain meds, take this seriously. Use as little as possible and work closely with your doctor. If you can’t stop, get help immediately. The longer someone abuses opioids, the harder it is to get back on track.

Insider’s Guide: Top 5 Things for Your College Student Transitioning to Fall Semester

Most of the students with whom I work have depression, anxiety and mild substance abuse. One of the easiest, cheapest and most effective tools for combating these struggles in college is detailed planning. Below, I’ve outlined the Top 5 things I tell every student to implement as they are showing up for Fall semester.

  1. Syllabi Dates. Encourage your college student to plug-in all dates into their calendar from the syllabi they receive over the coming days. Once all the test dates are put in, reverse engineer two weeks prior to the test dates and put study dates into the calendar for no longer than 90 minute chunks. If it’s not scheduled, it will get pushed off till the last minute.
  2. Professor Office Hours. Everyone will want to meet with professors the Thursday and Friday before Thanksgiving. Have your above-average college student pull their professor’s office hours from the syllabus (yes, all professors put office hours on there) and plug into the calendar.
  3. Download Your University’s Academic Calendar. In June, I downloaded the Indiana University’s academic calendar for Fall 2016. It is a small file from Indiana University’s Academic page for any student or parent to view or download. Once downloaded, your college student can upload it into their calendar. Now, they’ll know Add/Drop dates, Fall Break, Winter Break, Finals, etc.
  4. Don’t Talk Every Day. Plan to talk 2x/week – (eg. Wednesdays and Saturdays). It’s time to intentionally create more autonomy, build trust, and not feel like you need to hover over them.
  5. Set up Counseling Early. Counselors and mental health providers get slammed since there are so few of us in most college towns. There are even fewer psychiatrists for medication management. Start looking for a counselor/therapist now before the semester gets in full swing. Psychiatrists are often scheduled out 2-3 months.

Good luck and please reach out for more suggestions and strategies to mitigate the challenges your college student is facing with depress, anxiety or substance abuse. Don’t go it alone.

Missouri: Only State Not on Prescription Drug Monitoring Program

It was a mystery for the last few years – why were so many people going to Missouri to get their prescriptions (…mostly opioids like Vicodin/Lortab or Oxycodone)? Mystery solved. As of 2012, Missouri was the only state in the United States that did not participate in a national registry for prescription drugs.

Just in case you forgot where Missouri is

Just in case you forgot where Missouri is

Let’s dive a bit deeper…

What’s The prescription drug monitoring program?

Better known as PDMP, it’s an online database that collects data on controlled substance prescriptions dispensed within each participating state. It can act as an early warning system for prescribers to avoid dangerous drug interactions and to ensure quality patient care. 

PDMP is also a tool that also can be used to intervene in the early stages of prescription drug abuse, as well as to assist providers in preventing prescription drug abuse and enable providers of pain medications to know if they are treating someone who has been “doctor shopping”  (going from doctor to doctor for multiple prescriptions).

PDMP does not impact the legal prescribing of drugs by a provider – it simply makes it possible to spot a potential problems or trends.

Why Missouri Doesn’t want PDMP?

Well, Missouri kind-of does want PDMP. In 2012 the state came oh so close to enacting PDMP. But while proponents say most Missouri citizens and legislators support participation in PDMP, it has been blocked by lawmakers like State Senator Rob Schaaf, a family doctor who argues (…inaccurately in my humble opinion) that allowing the government to keep prescription records violates a patient’s personal privacy. He’s probably referring to HIPAA and/or HITECH which are privacy laws that protect a patient’s health records. After successfully combating the 2012 version of the Missouri legislative bill, Dr. Schaaf said of drug abusers, “If they overdose and kill themselves, it just removes them from the gene pool.” Dr. Schaaf is seemingly more focused on individuals liberty (…for prescription drugs) than on life. Fortunately, he appears to be in the minority within Missouri.

How to access the PDMP information

It’s not so easy. You’ve got to be a doctor, part of the legal system or law enforcement to get access. The PDMP data is stored by specified statewide regulatory, administrative or law enforcement agency as designated by state law. The agency distributes data from the database to individuals who are authorized under state law to receive the information. Information is shared across state lines when needed. 

Trails Carolina Buys Stone Mountain School Property

Trails Carolina announced the acquisition of a new property to host the Trails Family Institute. The property in located in Black Mountain, NC on the former Stone Mountain School site. The Trails Family Institute will be led by Jason McKeown, Director of Family Services. Trails Family Institute will be a 5 Day add-on to the Trails Carolina program and focus on extended lessons and skills from traditional wilderness programming into the family context. Screen Shot 2015-08-25 at 11.57.53 AM

Trails Carolina, Trails Academy and Trails Family Institute are ‘partnered’ with Family Help and Wellness, a parent company based in Salem, Oregon. They oversee many other treatment facilities such as the following:

  • Asheville Academy for Girls 
  • Blue Fire   
  • Elevations  
  • The Journey Home
  • Red Mountain
  • Sedona Sky 
  • Seven Stars
  • Solstice  
  • Solstice East 
  • Talisman Camp 
  • Timbersong Academy  (This is a school that operates solely for residents of Solstice East and Asheville Academy for Girls.  
  • Viewpoint Center 
  • Wingate Wilderness  

Odyssey Behavioral Healthcare Buys Pasadena Villa and Lifeskills

Odyssey Behavioral Healthcare, a partnership between Nautic Partners, LLC and CEO Scott Kardenetz, announced it completed the acquisition of residential/outpatient mental health and addictions treatment providers Pasadena Villa (TN, FL) and Lifeskills South Florida (FL). Screen Shot 2015-08-22 at 9.23.56 AM

Odyssey, headquartered in Brentwood, TN, was formed to build a diverse platform of behavioral healthcare facilities across the treatment spectrum in psychiatric and addiction care.  Scott Kardenetz is a 25-year veteran with former leadership positions at Ardent Health Services, Psychiatric Solutions and Universal Health Services. Nautic and Odyssey plan to invest $50 million of equity capital to support its strategy of growth.

Behavioral Health mergers and acquisitions experts expect this trend to continue, with a growing emphasis on the development of a full continuum of services and settings which promises to be an even bigger market than the strictly luxury-leaning residential programs that historically been the focus of consolidation. 

About Odyssey Behavioral Healthcare

Odyssey Behavioral Healthcare was formed in 2015 as a partnership between Nautic Partners and Scott Kardenetz. Odyssey’s treatment centers include Pasadena Villa and Lifeskills, which provide adult residential treatment care in three primary facilities and outpatient care in Tennessee and Florida. Odyssey will seek to expand the platform through new development and acquisition. In developing its platform, Odyssey seeks to acquire and develop treatment facility leaders in their therapeutic niche and that can benefit from senior management leadership and support.

Why Entrepreneurs Kill Themselves

First of all, a disclosure: I’m a therapist. I work with individuals and families. I meet with people in their homes and offices. Many of my clients from around the country are entrepreneurs. Many are high income earners. A few are on the post-exit side, financially comfortable but bored as hell. I’m also an entrepreneur. I consider my behavioral health agency a business with a product. I consider my patients as customers and treat them as such. I’m not sure which came first, entrepreneurship or being a therapist. Both have existed since I can remember (though not always tied together). When I hear about another entrepreneur’s suicide (referring to Austen Heinz), I cringe. I react as an entrepreneur and I react as a therapist who knows how to stop this. I also beat my head against the wall trying to figure out how to get those hurting to connect with those, like me, that can help. 

Entrepreneurs are a unique bunch. They (…we?) have large egos, low self-esteem (when no one is looking), we work stupid hours, are running from fear, elated when the needle moves slightly in our favor, we are hard to live with, have unrealistic expectations, are judgmental of others (more so of ourselves). There’s a ton of research that affirms this (borrowed from FeldThoughts):

Of the 242 entrepreneurs surveyed, 49% reported having a mental-health condition. Depression was the No. 1 reported condition among them and was present in 30% of all entrepreneurs, followed by ADHD (29%) and anxiety problems (27%). That’s a much higher percentage than the US population at large, where only about 7% identify as depressed.

What’s Helpful? Posting the National Suicide Prevention Hotline (1-800-273-8255) might make some bloggers or journalists feel like they are contributing to the solution. A few folks reading articles might actually call and some might find some solace. But for most entrepreneurs, it’s way more complicated. I’d also like to dispel another myth that most, if not only, tech entrepreneurs struggling with launching a product and desperately reaching to become the next unicorn, are the ones hurting. Not true. You do not need millions of dollars from a VC to have anxiety, depression, imposter syndrome, fears that at any moment it will all come crashing down and your ego will get sucked down with it. Pain comes from only a few places. The major one I’ve seen as a therapist for years is the gap between our expectations and our reality.  

 

What’s the Problem?

 

Therapists don’t advertise. They don’t connect to the outside world. When was the last time you read coverage of a therapist’s thoughts in Business Insider, Forbes or Inc.com? You don’t because we don’t think about communicating to the outside world. We hide in our comfy offices waiting for nice people with insurance (…or those few souls left that private pay) to trip over our profiles on antiquated therapist database websites. 

Therapists are not well-trained. We have minimum continuing education requirements, most of which are required to be on ethics (Don’t have sex with patients!). Even when we are trained to handle suicide intervention, only a handful of us are available 24/7 unless they work for behavioral health company that requires on-call responsibilities. I’ve been ‘on-call’ my entire professional life. At first it sucked. I felt tethered to my cell phone. But as I matured and as I started and ran my own agency, I understood that being available for those in pain is part of my business. It’s not only me being a good person, it’s a good business model and excellent customer service. 

No One Talks Prevention. Let’s get real. In the world of entrepreneurship, whether you are in tech, making widgets, or busting it out with an Etsy project, there are no systematic behavioral health solutions that cut across industries. Closest thing is Employee Assistance Plans (EAPs), but those are for large companies and tend to be low quality perks. There are a handful of VCs that provide informal emotional support to companies. There are some incubators that do the same. But overall, there is little formal or informal discussion about behavioral health prevention, intervention and resiliency. 

 

Solutions 

 

Yes, there are very real things we can do beyond just herding cattle towards the anemic volunteer force at the Suicide Prevention Hotline. 

1. StartUp: We need someone (maybe I’ll do it…) to start a biz which is the QuickBooks equivalent for mental health. Small/medium size business pays small monthly fee for ongoing support with behavioral health issues. Bizarre? I can think of a ton of services I first thought were stupid that soon became popular and financially successful. Either a platform or solution that cuts across industries, is inexpensive, super user friendly and deeply effective at preventing AND intervening with mental health and substance abuse problems. I imagine it being like a cool version of EAPs, but focused on startups and freelancers hoping to break through. 

2. Conferences: We need therapists to get invited to startup conferences and talk about how to reduce anxiety, depression and feeling like an imposter. Therapists also need to reach out to conference organizers and offer to speak. It’s great marketing for the therapist, it’s great value for participants and creates an opportunity for some cross-pollination between industries. 

3. Go to Therapy!: All entrepreneurs that have a history of depression, anxiety, substance use or other significant mental health issue should go and simply connect with a therapist while they are starting a business. Don’t give the bullshit line about not having the money. If you have enough money for an iPhone 6, you can find the money for a few sessions with a therapist.

4. Find a Qualified Therapist: Find a therapist with entrepreneurs and high achievement folks. You will know them when you first ask about their background. Their blogs will have entrepreneurial language. They will also be able to talk about depression, impostor syndrome, anxiety and money problems – all symptoms of the startup/growth world. Don’t count on finding this info on your basic therapist databases like Psychology Today or Good Therapy.

5. Kill Sacred Cows: You are not going to be a billionaire. Your startup will not change human history. Stop taking yourself so seriously and take a break. Learn to stop work at a certain time each day. Stop lying to yourself, families and friends that you are ‘killing it’ with amazing app or product. Get some sleep, eat some healthy food and get your ass moving for some exercise in the Sun (bright thing in sky from 6am-7pm). You get zero bonus points for how much you (and your family) have sacrificed. Chill out. 

Got your own experiences with entrepreneurship and how it affected your life or family? Email me and I’ll put together a ‘Part II’ of this post on entrepreneurship and behavioral health.  

Sunspire Health Acquired by Private Equity Firm


Kohlberg & Company
Sunspire Health (a private equity firm based in New York) has acquired majority ownership of Sunspire Health a provider of behavioral health services for the treatment of substance abuse and other co-occurring disorders. Headquartered in Lyndhurst, NJ, Sunspire operates a portfolio of independently branded treatment centers in five locations – California, Florida, Massachusetts, and Oregon, with another three locations opening in the second half of 2015. New facilities will be opening in Hilton Head Island, S.C., Gilman, Ill., and Key Largo, Fla..

Acadia Healthcare Set to Buy Belmont Behavioral Health

Acadia Healthcare announced an agreement to purchase Belmont Behavioral Health located in Philadelphia, Pennsylvania. Belmont is part of the not-for-profit Einstein Healthcare Network

Upon completion, the sale totaling $145 million, will include all inpatient and outpatient programs and support departments on the campus of Belmont Center for Comprehensive Treatment, a 147-bed facility located at 4200 Monument Road; Belmont Northeast, located at 10360 Drummond Road; and the Community Outpatient Program for the Elderly (COPE) Germantown Outpatient Program, located at One Penn Boulevard. 

Acadia is a provider of inpatient behavioral health services. Acadia operates a network of 224 behavioral health facilities with approximately 9,000 beds in 37 states, the United Kingdom and Puerto Rico. Acadia provides psychiatric and chemical dependency services to its patients in a variety of settings, including inpatient psychiatric hospitals, residential treatment centers, outpatient clinics and therapeutic school-based programs.