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.  

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.

 

Elements Behavioral Health Expanding

Elements Behavioral Health has been actively expanding as evidenced by the purchase of  Park Bench Group Counseling in New Jersey and the opening of Brightwater Landing in Pennsylvania right outside Harrisburg and Hershey.

Elements portfolio are also ramping up programs to meet increased market demands. Centers in Texas and Tennessee are adding new services, and a detox program in Florida launching in the first quarter of the year.

On The Market?

Within all this activity, observers are reporting that Elements is for sale. Reuters reported in December 2014 that private equity and venture capital firm Frazier Healthcare is potentially looking to sell Elements, and that  investment bank Jefferies Group LLC has been retained to facilitate the next steps. Across the entire industry, valuations are up, and the market is ripe for activity.

Elements has been estimated to be worth $30 million in EBITDA (earnings before interest, taxes, depreciation, and amortization) and get 10x more in actual negotiations.

Acquisitions!

Founded by two clinicians in 2006 the newly acquired Park Bench in New Jersey provides day treatment and intensive outpatient services, including an individualized aftercare program (…often a big missing piece in substance abuse treatment).

Elements was targeting the Northeast for some time, particularly in the New York/New Jersey Tristate area because of population density and the need for young adult treatment. The services they’re providing, which are addiction and co-occurring disorders, fit with the Elements family of programs.

Elements has an existing property in York, Pa., and this month, it added a new location, Brightwater Landing in Lancaster County – west of Philadelphia. The center is on a 150-acre campus that lends itself to treatment interventions that require more outdoor space as well as landscape features appropriate to experiential and adventure-based therapies.

Treatment at Brightwater will include equine therapy and a ropes course to enable clients to process the emotional and behavioral parts of their addiction. The experiences will address not just the substance-use disorders but also the underlying trauma that contributes to using. The center will offer primary psychiatric and active mental health models of care – early on-ramp for those seeking treatment for the first time. 

Elements Behavioral Health is part of a trend within the industry where small mom and pop outpatient and treatment centers built over the last few decades are being gobbled up by some big players. We expect more merger and acquisition activity in 2015.

Acadia Buys CRC Health

Acadia Healthcare Company Inc. said it will acquire CRC Health Group Inc. for $1.18 billion, expanding its in-patient mental health and substance abuse treatment facilities. Acadia is headquartered in Franklin, TN and owns 76 facilities with about 5,800 beds in 24 states, Puerto Rico and the U.K. CRC Health Corporation was founded in 1995 and is headquartered in Cupertino, California. CRC Health Corporation operates as a subsidiary of CRC Health Group, Inc. They have about 120 facilities and sees about 40,000 patients daily. CRC was expected to generate $450 million in revenue in 2014, and adjusted earnings of $115 million

The acquisition is Acadia’s fifth in the past 12 months, adding 27 facilities and more than 1,500 beds. Earlier this year, Acadia purchased Partners in Care, a U.K.-based company for $662 million.

The behavioral health and substance abuse industry is considered by business analysts to be highly fragmented in the U.S. and the U.K. with significant room to add new beds in existing facilities. Growth and consolidation is on the horizon for all these big players.

CRC Health, based in Cupertino, California, is a substance-abuse treatment provider that has about 120 facilities and sees about 40,000 patients daily, according to the statement. CRC is expected to generate $450 million in revenue this year, and adjusted earnings of $115 million, Acadia said.