How, when, and for whom: decisions regarding remote neuropsychological assessment during the 2020 COVID-19 pandemic

Abstract

Neuropsychological assessment provides crucial information about cognitive, behavioral, and socioemotional functioning in medical, educational, legal, and social contexts. During the 2020 COVID-19 pandemic, the Israeli Ministry of Health initially mandated that all psychological assessments be postponed. However, as referrals to time-sensitive, high-need, and high-stakes assessments began to accumulate, it became necessary to consider remote solutions. In the current paper, we describe the considerations that affected the transition to remote activity in a prominent Israeli provider of neuropsychological assessment and rehabilitation services, referring to technological and environmental conditions, cognitive requirements, and tasks, as well as to legal, regulatory, and funding issues. After discussing how assessments should be conducted to maximize feasibility and validity while minimizing risks to clients and clinicians, we propose a preliminary model for deciding whether specific referrals warrant remote administration. The model delineates key factors in decisions regarding remote assessment, emphasizing the distinct roles of the referring clinician and the neuropsychologist who conducts the assessment, and highlighting the need for collaboration between them. The abrupt need for remote assessments during the pandemic required a quick response with little preparation. The lessons learned from this process can be applied in the future, so that the need for remote services can be met with greater certainty and uniformity.

Tele-Neurorehabilitation During the COVID-19 Pandemic: Implications for Practice in Low- and Middle-Income Countries

“…For instance, in Israel, the neuropsychological assessment services were postponed due to the pandemic with many people requiring such services put on a long waiting list. To combat this, the Israel government had developed remote solutions to meet the increasing demand for such services ( 33 ). Though these guidelines keep getting developed in many LMICs, some caveats need to be considered especially when it comes to administering standardized neuropsychological tests.…”

“…There are significant differences between conducting a standardized neuropsychological evaluation in an ideal environment as compared to a virtual environment. Interpretation of the evaluations might differ and may not be the same while this is carried out virtually ( 33 ). Also, the neurorehabilitation team may have to rely substantially on the caregivers and patients to engage in the sessions proactively.…”

Considerations and suggested practices for psychological assessment and intervention when working with older adults with disabilities.

“…For such services, a safety plan also should be developed in advance that delineates resources for the client should suicidal or homicidal ideation, violence, or abuse be disclosed or suspected (Luxton et al, 2016). If a client has a family member or care provider in their home or care setting, it should be determined if and how much support will be required to establish and maintain the connection with the psychologist, assist with any disruptions or problems, and/or maintain confidentiality and privacy if requested by the client (Bloch et al, 2021; Luxton et al, 2016). If neither telepsychology nor the provision of face-to-face services (with appropriate PPE, if warranted) is feasible, a referral to another clinician is likely necessary in these situations.…”

Validation of an Automated Speech Analysis of Cognitive Tasks within a Semiautomated Phone Assessment

“…Recently developed tools, such as videoconference or computer-based NPAs, have already been validated as a good alternative to face-to-face assessments [3]. However, most of these alternative NPA options require an internet connection and a computer to support video or teleconferencing platforms [3][4][5][6]. This may be difficult for the elderly population or those with cognitive impairments, as technical interactions would be required [3][4][5][6].…”

“…However, most of these alternative NPA options require an internet connection and a computer to support video or teleconferencing platforms [3][4][5][6]. This may be difficult for the elderly population or those with cognitive impairments, as technical interactions would be required [3][4][5][6]. Therefore, there is a need for an easy method for remote NPA, such as phone-based testing.…”