Ethics of Technology and Clinician Responsibility

By Anne-Marie Kimbell, Ph.D. and Amy Dilworth Gabel, Ph.D.
March 5, 2018 - Last updated: March 4, 2018

psychologist ethicsRapid advances in technology are everywhere, including in the field of clinical assessment. These changes have prompted many clinicians to ask the question, “Will technology soon take the place of the clinician in assessment?”

Although recent technological advances now improve adherence to standard administration procedures, accuracy in scoring and allow clinicians to conduct near-seamless digital assessments, there are essential activities or components of the act of assessment, not just testing, that cannot be performed by technology alone.

We believe that current evidence and ethical guidelines suggest that clinical assessment will continue to require the skills and knowledge of a trained clinician. Specifically, assessment, rather than simple administration of test items, involves activities that require the application of knowledge, skills and experience that can only be achieved with a trained clinician.

In this brief piece we will describe several key clinician responsibilities that must remain part of the assessment process for the uniqueness of each client to be recognized and described.

Specific clinician responsibilities include, but are not limited to:

a) making informed decisions regarding test selection based on the unique characteristics of the individual being assessed and the questions to be answered;
b) using clinical observation skills during the assessment to better understand how the client solves problems;
c) using clinical knowledge and judgment to address behavioral difficulties, questions and unusual responses during testing;
d) making informed decisions about the need for accommodations or adaptation during testing.

To obtain accurate results from testing, clinicians have a professional responsibility to apply their clinical skills in establishing rapport so clients are motivated and encouraged to perform to their best ability, be candid about concerns and/or demonstrate typical behaviors, appropriate to the needs of the evaluations.

Clinicians must observe the processes and behaviors of the client throughout the session to understand scores. They must also be able to describe how any modifications to standard testing procedures may impact the reliability and validity of the assessment.

Application of normative comparisons requires that reliability and validity be preserved. Technology can assist in this regard because of the scaffolding that it can provide in proper test administration. However, the “correct” administration of a test that was not designed to adequately assess a particular construct results in non-meaningful data inappropriate to the referral question and could potentially result in adverse outcomes for the client.

Our ethical guidelines and, in most cases, legal requirements require that we be responsible advocates for the health and well-being of our clients. Consequently, the process of assessment rests on more than just perfunctory test administration.

All of these nuanced clinical skills must be applied within the context of formalized training related to testing and measurement standards and knowledge of general and test-specific administration guidelines, as well as familiarity with the test materials, including any technology being used in the assessment session.

Assessment should not be confused with “testing” and thought of as just a single point in time. Following the actual testing session (which likely will be time-limited), the process of assessment continues as the clinician applies his or her knowledge of test interpretive guidance often provided in manuals coupled with client background, experiences and conditions in making sense of the data.

Skilled clinicians possess an understanding of a) how and what each test measures, b) test construction, c) how to apply principles of measurement, d) knowledge of what the objective results of an assessment session mean and e) how to use the results to inform intervention and treatment planning.

The skilled clinician understands the cognitive processes and behaviors required to complete tasks. Using their clinical observation of the examinee during the testing session and ideally at other points in time, he or she gathers and uses this information concerning process and strategies undertaken by the examinee to provide informed input into treatment and rehabilitation strategies applicable in “real-life.”

These are all essential components of the process of assessment and cannot be provided by the technology itself. Rather, the clinician must translate the scores and findings into application and derive meaning from the numbers using knowledge of educational and/or psychological theory and that of the individual examinee to develop meaningful recommendations.

Completing this task often requires the integration of the current results with results of other evaluations, observations, history and clinical and collateral interviews. Most importantly, all results must be interpreted within a context, taking into account the individual differences and experiences of the client.

The many forms of technology may be means by which clinicians improve their ability to help clients. However, while many of the high-stakes decisions that are informed by testing and assessment will likely benefit from the improved adherence to standardized administration procedures and scoring accuracy afforded by technology, these decisions still require clinician knowledge of human behavior and the theoretical constructs that are relevant to the assessment situation.

At present, technological applications as they pertain to assessment should be considered as part of the toolkit that clinicians have available.

Technology in its present state, however, should not be considered a replacement for the judgment and knowledge of a trained clinician.

It is the active participation of the clinician that allows the use of what we know about individual differences, behavior and brain functioning that would be lost when solely relying on technology.

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Anne-Marie Kimbell, Ph.D. MSEd, is a licensed psychologist in Texas. Amy Dilworth Gabel, Ph.D., NCSP, is a licensed school psychologist in Virginia. Disclosure: Kimbell and Gabel are employed by Pearson Assessment, publisher of clinical and educational tests and technologies. Kimbell is Pearson’s senior educational consultant and Gabel is director of client training and consultation.

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