“She won’t get out of the car.”
An overwrought woman was calling Dr. Loretta Bolyard from the parking lot. The woman brought her 80-year-old mother, Greta,* for a psychological evaluation to see whether she needed to be appointed a guardian. But now Greta refused to step out of the car.
Bolyard is a clinical psychologist based in Butte, Montana, who specializes in neuropsychological assessments. She walked to the parking lot and met Greta by the car, making small talk through the half-rolled-down window.
Although Greta seemed to grow more relaxed, she rejected the invitation to walk into the office, insisting that lawyers were hiding in the bushes. Eventually, Bolyard convinced Greta to simply have tea, sitting in the grass together outside her office building. When Greta agreed, Bolyard ran inside and grabbed two mugs of tea, along with two iPads, on which she quickly loaded a few simple tests.
When they had settled down on the lawn, Bolyard showed Greta the iPads and offered to play some “games.” Greta’s eyes lit up. “My grandkids use these!” she said.
Bolyard administered a few of the tests as Greta became more and more engaged, exclaiming, “I haven’t played games in 20 years!” Bolyard told her if she wanted to play more, she’d have to come inside. Greta followed and Bolyard was able to complete the entire battery of testing, eventually concluding that Greta had levels of paranoia and dementia that required a guardian.
Digital Assessment as an Everyday Tool
Although not all of her cases are as dramatic as the situation with Greta, Bolyard now conducts nearly 100 percent of her assessments digitally. Her first exposure to digital assessment technology was at a conference and as soon as she saw a demonstration she knew it was the future.
“I took a cab to the mall and bought two iPads,” she said. “I brought them straight to the Pearson booth and bought Q-interactive right there.”
Q-interactive is Pearson’s innovative digital system that allows psychologists, speech-language pathologists and special education teachers to administer tests via two iPads connected with Bluetooth. Q-interactive improves accuracy, reduces testing time, increases flexibility and allows for more personalized assessment through features including real-time scoring, audio recording, and on-the-fly editing of tests.
Bolyard spent the evening exploring the system, figuring out how to use it almost immediately. Although it wasn’t without its glitches, she said, she could get help within minutes for whatever she needed. Today, she makes suggestions to Pearson about how to improve the system, which she sees implemented in Q-interactives quarterly updates.
While Q-interactive may seem game-like to some clients, it’s a powerful tool for clinicians. Fifteen of the most widely used psychological tests can be administered on the system, allowing clinicians the ability to customize assessment sessions and edit them in real time while testing.
During test administration, the clinician uses one iPad and the client uses the other. The clinician’s iPad is used to read instructions, record and score examinee responses and send test questions to the client’s iPad. The client can view and respond to test questions on their iPad.
Q-interactive scores the tests immediately, which means that clinicians can change plans by navigating to a different portion of the test or loading and administering an entirely new one.
Is Digital Better?
At Pearson, we’ve done numerous studies comparing the results of digital tests vs. traditional paper tests. Overall, we’ve found that there is no clinically significant difference in the scores obtained from either version. However, there are huge differences from the clinician’s perspective.
- Increased engagement. Most of Bolyard’s patients are geriatric – not the audience you’d normally imagine for a digital tool. If they seem nervous about using the iPad, Bolyard will do some warm-up exercises. “Because the digital format is usually faster than pencil and paper, my older clients get less fatigued,” said Bolyard. “They’re also pretty proud of themselves for using the tablet.”
Like Bolyard’s clients, most test takers enjoy taking a test on an iPad. This increased engagement usually means the test taker is putting forth their best effort, which gives clinicians greater confidence in the validity of the results.
- More personalized assessments. Whether they’re using digital or paper assessments, most health professionals put together a battery before they know the client’s full capabilities. With a digital assessment, clinicians can adjust the test easily as they go, rather than stop the process and go to their file drawers to search for another test.
“I might put together a battery for a high-functioning person, but then during testing I realize the person is more impaired than I thought,” Bolyard said. “Since I can see the scores as I’m administering the test, I can edit the test on the spot, and add and delete subtests to help answer the initial questions posed in the referral.”
- Better scoring accuracy. Even the most experienced psychiatrists can make a mistake when scoring a battery of tests. They are adding, transferring numbers and converting scores as part of coming up with diagnostic hypotheses. Bolyard said that because of the digital scoring, she’s now much more confident about her results. “All the scores are summarized on a single page,” she said. “There’s so much less room for error.”
- Time savings. It’s obvious that a digital testing resource can save time through streamlining the testing process, scoring tests automatically, and eliminating the need to organize and pull paper test materials prior to an assessment session. Bolyard estimates that the total testing process from preparation through scoring may have taken close to ten hours per client in the past. Now, it can take as little as five hours. Besides saving her hours of paperwork, the time savings is important for her clients.
“I work in a rural area, and I’m only one of two neuropsychologists in the area,” she said. “I can fit in more clients a week now, so more people can get help locally. Before, if clients needed an evaluation they’d either have to wait several months for an appointment or travel 100 miles to the nearest town.”
Bolyard still uses several paper-and-pencil tests, mainly for subtests that are particular to her clients and aren’t yet available on Q-interactive. However, for the most part, she advises anyone considering digital assessment to try it out.
“I’m not tech savvy, and I know many people aren’t ready to move testing to an all-digital format,” she said. “But there are so many advantages. Not just money savings and time savings, but the ability to serve my clients better. Because they’re engaged and because I can alter the course of testing during the evaluation, I know that I’m getting a more accurate picture of their abilities. I have much more confidence that based on the tests, they’ll be able to get the treatment they need.”
* not her real name
Dustin Wahlstrom, Ph.D., is the product owner for the Q-interactive project at Pearson. He has a Ph.D. in clinical psychology from the University of Minnesota and completed his clinical internship at Children’s Hospital of Minnesota. He joined Pearson in 2009 and was a research director for the WPPSI-IV and WISC-V prior to working on Q-interactive.