Evidence‐Documenting Reports as a Plan‐B in Urgent/Complex Cases of Psychological Practice

A rare psychologist can be an expert in all areas of psychological practices. After recognising this fact, regulatory Colleges in many Western countries have segregated licenses into subspecialties, such as Child, Geriatric, Educational, Addiction, Military, Clinical, Organisational, or Neuropsychology. The negative outcome of such segregated licensing has emerged as a shortage of Specialists in Psychology (SP), who have a license to conduct psychological evaluations of specific demographic groups. For example, only Child Psychologists can perform evaluations of children, but there is a long waiting list for a Child Psychologist in many regions. In 2022, the APA reported that only 4% of Psychologists have licenses to work with children and adolescents (Abramson, 2022). This shortage is even more noticeable in cases when the SP should know specific language to understand the client. Limited access to needed SPs by people for whom registered clients requested assistance (let's call them “EDR clients”); Urgency of the cases when a delay in sharing the information would potentially cause the development of psychopathology or other harm to the member(s) of the public. Vulnerability of the EDR clients: children, people with serious medical conditions, veterans, the elderly, loners, disabled individuals, refugees escaping violence, and victims of abuse. The large volume of information; multiplicity of relevant incidents; the large volume of documentation. Language barrier and the deficit of SPs speaking the client's language, whereas the EDR-preparing psychologist can speak this language; Complexity of the case due to the entanglement of medical, personal, socioeconomic and professional factors. Such cases are rare, but to ensure inclusivity and quality of care for all members of the public, psychologists should have Plan B-s to handle them. We can base these Plan B-s on the inter-disciplinary cooperation—similar to the permission to assist in medical emergencies for doctors regardless of their sub-specialities. Otherwise, with the recent surge in refugees, veterans and relocations of people avoiding war conflicts, as well as the ageing of populations, a significant number of people are at risk of not having timely evaluation and quality care simply because they can't find SPs speaking their language. The purpose of the EDR format is to serve exclusively in such complex EDR cases and to assist the information transfer from an EDR client in distress to needed services, including the informational assistance of non-clients in the referral to a needed SP. This might reduce the SP's time for psychological assessment, including time for information gathering and summarising facts, translations, file review and optional highlighting of possible correspondence of behaviour to DSM/ICD descriptors (Figure 1). An EDR can be prepared as an extensive attachment to the client-family referrals to SPs. Normally, referral letters mention the concerns or symptoms only briefly. Any parallels between more specific DSM/ICD categories and observed or cited (from reviewed documents) behaviour can be viewed as an attempt to give a diagnosis to non-clients by a non-SP psychologist, violating the conditions of a license. This is not a trivial matter, as there are currently several cases where regulatory Colleges of Psychologists penalise Psychologists for documenting information about non-clients (clients' relatives) in distress who were desperately but unsuccessfully looking for a psychologist. Psychologists who were treating these clients knew the family and their situation well, spoke their language. Still, their hands were tied in helping the clients' relatives since they didn't have SP licenses related to this demographic group. It is important, therefore, to distinguish between the regular format of Psychological Assessment Reports (that constitutes formal evaluation) and the format of EDR (that should be considered only as an informational supplement). Table 1 illustrates the differences between these two formats. As highlighted in Table 1, the EDRs don't have several main components of proper psychological assessment reports: the title (of an Assessment Report), the stated purpose of the diagnosis, structured clinical interview, testing using a psychometric battery, tests results, the derivation of the diagnosis using DSM/ICD codes and possible treatment recommendations. Without these key components, any document should not be considered an assessment report, and the same applies to an EDR. EDR-Psychologists should not feel obligated to gather information for all the sections listed in Table 1. They can prepare only one or more of the indicated sections using the freely disclosed information by various direct or collateral sources. An EDR-Psychologist can also serve as a qualified witness to prepare a section on behavioural observations and/or translations of documents related to the case, provided the EDR-Psychologist is familiar with the relevant language. This is especially helpful when there is a large volume of documentation or a multiplicity of incidents that should be reviewed and summarised in a written form. The goal of the EDR is not to investigate or evaluate the EDR client, but to document available, freely given information in the required language by a licensed psychologist, and to pass it to the attention of SPs or other specialists. Provision of a diagnosis as a controlled act of psychological practice is the subject of many professional liability disputes, in which the parties sometimes equate it with the use of DSM/ICD descriptors. It is essential to clarify that a formal diagnosis in psychological practice is normally based on multiple components of psychological evaluation (Table 1). Any single or even several, but not all, components, especially without the word “diagnosis” in the conclusions, can't be viewed as “diagnosis” even if some DSM/ICD descriptors are mentioned. In the EDR practice, there is no expectation of formal interviews, testing, or the use of DSM/ICD codes and the term “diagnosis.” Descriptions of the EDR (complicating) factors that trigger the preparation of the given EDR (such as urgency due to the risk of development of psychopathology, language barrier, deficit of specialists, serious medical conditions of involved individuals, long waiting lists, large volume of information, rural isolation, vulnerability of the client, potential for radicalisation, potential for suicide). A note that this EDR is not a Psychological Assessment Report but is prepared to assist in the information transfer relevant for the access of the EDR client to needed services, including SPs' evaluations. A note that the communications with an EDR client and collateral sources (including spontaneous uninvited disclosures) should not be considered as structured clinical interviews. Moreover, a rarely discussed principle, “a child has a right to be heard,” should be given more weight in complex/urgent cases. Children can be EDR clients for any psychologist, and their disclosures can be included in EDRs. Children's “right to be heard” without parents' consent when it comes to children's key aspects of life was recognised by the United Nations Convention on the Rights of the Child (CRC), Article 12 of the Convention. The CRC was adopted by the UN in 1989 and entered into force in 1990. France and Australia signed the CRC in 1990, Canada—in 1991, Germany—1992, USA—1995. In total, 196 countries signed this Convention, making it the most ratified human rights treaty in history. If screening tests were used to obtain information about the EDR-client, there should be a clarification that this person was not properly tested; that proper psychological testing requires a psychometric battery and that one test should not be considered as testing for diagnostic purposes. A similar statement should be given if the EDR included behavioural observations by the EDR-Psychologist, explaining that these are impressions of a qualified witness, but this is not a formal psychological assessment. Sometimes the severity of observed symptoms in an EDR client is so high, and/or the described facts explicitly hit the clinical threshold for meeting criteria listed in DSM/ICD. If the DSM/ICD descriptors were used in the EDR, there should be clarification that they are used to structure the observed behaviour according to clinical standards, but the given provisional diagnostic impressions are not equal to a formal diagnosis. If a provisional diagnostic impression was given, it should be noted that no proper psychometric testing and clinical interview with the EDR client were conducted, and so the EDR doesn't issue the final diagnosis. Importantly, the EDR practice would not violate the existing regulatory Acts and licensing for Psychologists, but would add a useful format to their toolbox. The author declares no conflicts of interest. The author has nothing to report.

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