By Colten Larsen, Psy.D.
While completing psychological evaluations over video is not a new concept, the COVID-19 pandemic forced many clinicians to alter their practices in order to meet the needs of the public. And even with in-person evaluations starting back up again, many clinicians have continued to offer virtual services. This is even true within the forensic realm. In general, research has suggested that videoconferencing does not significantly alter the validity of forensic evaluations (Luxton & Niemi, 2020). Literature also demonstrates that video psychological and psychiatric services are at least comparable to traditional in-person services (Batastini et al., 2016; Chakrabarti, 2015). Further, not only has research shown that videoconference evaluations help reduce costs and speed up the process, and the literature has also shown that it does not significantly impact rapport building (Sharp et al., 2011). Moreover, although there is skepticism surrounding the use of video evaluations with individuals experiencing psychosis; overall, there has not been any significant evidence in research to suggest a negative impact on the quality of services (Luxton et al., 2019). In fact, some literature has demonstrated a positive effect for people with psychosis and virtual services as these individuals may find it more comfortable and less anxiety-provoking given the perceived distance between the person and clinician. Further, while it is important to consider the impact of videoconferencing on those with technology-related delusions and whether or not a virtual appointment is appropriate, an individual’s reaction to the technology in the evaluation may actually provide useful clinical information. That is, an individual’s delusional reaction to a videoconferencing evaluation could actually support diagnostic criteria that often impact functioning, such as competency to stand trial abilities (Luxton et al., 2019).
While remote evaluations appear to be generally acceptable in the literature, if appropriate for the individual being evaluated, there are some limitations that should be taken into consideration (Luxton & Lexcen, 2018). First, it is important to consider the general practice differences between forensic psychology and clinical psychology. That is, clinical psychological services typically do not have possible, life-altering consequences if the results are inaccurate; however, errors in forensic services could result in potential issues with fairness and due process. For example, a person who is actually competent to stand trial could be found incompetent, prolonging their legal process. However, this concern could also be said for in person evaluations when completed by an inexperienced clinician. Second, videoconferencing evaluations present with observational limitations that are not found in in-person evaluations. For example, olfactory (i.e., smell and odor) impressions of someone with poor hygiene are associated with psychosis and a limited view of psychomotor movements seen in some mental health and neurocognitive disorders. Third, virtual evaluations could impact the integrity of some psychological assessment measures, as the majority have only been standardized for in-person administration. In cases where personality or cognitive assessments, for example, are needed for the evaluation, clinicians should use caution, practice good clinical judgment, and follow test-makers' recommendations for virtual administration, if available. As mentioned above, despite some limitations, the use of videoconferencing for evaluations is generally comparable to in-person evaluations. In cases where videoconferencing is utilized, it is important for evaluators to be transparent and notify report readers of the nature of the evaluation. The report should include an explanation as to why videoconferencing was utilized, the features of the technology used and possible impact on the assessment, and efforts made to ensure confidentiality and security.
References
Luxton, D. D., & Niemi, J. (2020). Implementation and evaluation of videoconferencing for forensic competency evaluation. Telemedicine and e-Health, 26(7), 929-934.
Batastini, A. B., King, C. M., Morgan, R. D., & McDaniel, B. (2016). Telepsychological services with Criminal Justice and substance abuse clients: A systematic review and meta-analysis. Psychological Services, 13(1), 20–30. https://doi.org/10.1037/ser0000042
Chakrabarti, S. (2015). Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches. World Journal of Psychiatry, 5(3), 286. https://doi.org/10.5498/wjp.v5.i3.286
Luxton, D. D., & Lexcen, F. J. (2018). Forensic competency evaluations via videoconferencing: A feasibility review and best practice recommendations. Professional Psychology: Research and Practice, 49(2), 124–131. https://doi.org/10.1037/pro0000179
Luxton, D. D., Lexcen, F. J., & McIntyre, K. A. (2019). Forensic competency assessment with Digital Technologies. Current Psychiatry Reports, 21(7). https://doi.org/10.1007/s11920-019-1037-9
Sharp, I. R., Kobak, K. A., & Osman, D. A. (2011). The use of videoconferencing with patients with psychosis: A review of the literature. Annals of General Psychiatry, 10(1), 14. https://doi.org/10.1186/1744-859x-10-14
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