Psychological Evaluations: A Tool to Help Gain Insight To Your Child’s Challenges And Strengths, With Dr. Alison Lafollette
Host: Brenda Zane, brenda@brendazane.com
Guest: Dr. Alison LaFollette, Life Elevated Psychological Services
Free ebook: “HINDSIGHT: 3 Things I Wish I Knew When My Son Was Addicted to Drugs, by Brenda Zane. Download here.
Want my weekly email for support during this challenging time? Click here to request it.
Are you a dad who needs some support? Membership for The Woods Community is now available here.
Podcast support from:
This episode is sponsored by The Woods Community.
The Woods Community is an online space for men to find tools, resources, and personal connections when trying to help a child or other loved one with substance misuse and mental health challenges.
We offer skills that help improve communication and rebuild broken relationships in a confidential and supportive digital environment — not connected to any social media.
Learn more and join us as a Founding Member at members.thewoodscommunity.org
about this episode:
For many parents, having their teen or young adult child undergo psychological evaluation can feel incredibly stressful. They worry that even talking to their son or daughter about the process can make it seem like they think their child is broken or maybe even that they're crazy. My guest today is Dr. Alison LaFollette, a psychologist based in Salt Lake City with over a decade of experience conducting psychological and neuropsychological assessments. Given her extensive education and experience, she has a lot to share with us about how evaluations can benefit families with young people who struggle with substances and mental health.
episode resources:
Hopestream podcast episode 79 with Virginia Holleman on insurance for behavioral healthcare coverage
-
One of the bittersweet things about doing this podcast is finding out all the stuff I did not know when my family was going through the difficult years with my son. I often find myself thinking if only I had known.
When I'm talking to these different experts. And today's conversation is one of those. I got to meet Dr. Allison LaFollette at a conference. And after talking to her for a while, I realized I had to have her join me here so that you could learn the information that she shared with me. What I love about today's episode is it's going to give you one more tool that could provide guidance on what types of resources your son or daughter would benefit from if they're struggling with mental health and or substance use.
I remember when I was in this feeling like I was just bumping around in a dark closet when it came to getting insight as to why my son was acting out, why he was so angry, why he was choosing a high risk lifestyle and using drugs. It was a complete black hole to me, which was part of the torture of the situation.
Not knowing what I didn't know. However, what you'll hear today is that there are ways that you can get a peek at what's going on and into your son or daughters brain a little bit, not literally, but through the use of psychological testing. Once we got my son into wilderness therapy, he did have a psych eval done, but I hadn't ever heard of it.
And I definitely didn't know it was something that we could have done preemptively before we made decisions about treatment. My guest today is Dr. Allison LaFollette, who is a licensed psychologist based out of Salt Lake City, Utah. She has over a decade of experience conducting psychological and neuropsychological assessments. She's practiced in community mental health, university counseling centers, veterans administrations and psychiatric inpatient units, which has provided her a very large breadth of experience and for the last seven years, she's conducted neuropsychological and psychological assessments in residential treatment programs, therapeutic boarding schools, young adult transitional and wilderness therapy programs.
She provides these assessments to clients age who are age ten and older, and she is licensed and not just Utah, but Oregon and New Mexico. And she can also provide assessment services on a temporary basis in 31 other states. Her areas of expertise include autism spectrum disorders and social pragmatic communication disorders, or NLD, cognitive, academic and executive functioning evaluations, developmental trauma and post-traumatic stress disorders, A.D.D. and ADHD.
Anxiety and depressive disorders. Personality disorders. Schizophrenia spectrum and other psychotic disorders. Obsessive compulsive and related disorders. Substance use disorders and school and college accommodations. That is not a complete list. I don't know what is. This is such a rich conversation that I'm sure is going to be extremely enlightening and might give you one more option in your journey.
There's more information on Dr. Lafayette's website. Life elevated psychological dot com and for Allison's contact information, you can go to the show notes which are always up Brendazane.com/podcast. and I won't hold things up any longer so please enjoy this conversation now with Dr. Allison LaFollette. Enjoy.
00;05;09;00 - 00;05;22;13
Brenda
This is my second welcome to Allison to Hope's room, because the first welcome I was so excited to chat with her that I actually forgot to hit record. So, Allison, welcome again. Thank you.
00;05;22;13 - 00;05;26;18
Alison
Thank you. As many times as you want to welcome me, I'm here for it.
00;05;26;19 - 00;05;54;05
Brenda
Yes. Okay, well, we'll try not to do it again. So what I wanted to do is just have Allison give us some background on how she became interested in psychology and then ended up doing evaluations with with young people because it's such a unique career path, I think. So how did you become interested in psychology and and then more specifically, how you ended up doing what you're doing today?
00;05;55;12 - 00;06;34;13
Alison
I've had a very linear path in pursuing psychology. My interest really started in high school and an AP psychology class where I just loved learning about it. I was reading chapters that weren't assigned by the teacher, which was very abnormal for me. I normally didn't read anything during high school, and so then I got a bachelors in psychology at a liberal arts college, and that exposed me to a lot of different realms of psychology and I ended up really liking kind of the social psychology discipline, which is why people kind of tick and why we respond to the environment and the way that we do.
00;06;34;24 - 00;07;05;06
Alison
And so I pursued a master's in counseling at Marquette University. And again, during my time there, I love my learning, I love my classmates. I loved my practicum, which is where I started seeing clients under supervision. And still I felt like I wanted to learn more. So I decided to take on a Ph.D. and counseling psychology, which is very closely related to clinical psychology, but more strengths based focus is kind of the split in those disciplines.
00;07;05;06 - 00;07;33;04
Alison
Historically and during that Ph.D., I continue to earn more through my coursework, but I continue to see more and more clients in a variety of settings. So I had a practicum in community mental health. I had a practicum out of university counseling center, and then I took on an assessment practicum at the Veterans Administration in Topeka, Kansas, working part time with a psychologist and the other part time with a neuropsychologist.
00;07;33;04 - 00;08;04;08
Alison
And that was really my first exposure to assessment or evaluation and using the different types of tools that I'll talk more about today and how they really provide a lot more data and insight into what is going on with clients. And so from there, my interest specifically in evaluation and assessment was really piqued, but I still wasn't done with my Ph.D. because, as I'm sure you know, or your listeners know, they take a long time, a lifetime.
00;08;04;08 - 00;08;28;07
Alison
Yeah, they take forever. So don't do it unless you really want to. So then I then I needed to go on an intern ship, which is basically where you're seeing clients full time under supervision. So I did my 20 hours at another university counseling center, and then I did a post-doc, which is after you finish your Ph.D., but you still want more supervised experience.
00;08;28;07 - 00;09;11;27
Alison
Seriously? Yeah, it just goes on forever. And then so I did my postdoc at the University of Utah Neuropsychiatric Institute, which is now called, I believe, Huntsman Institute, which is a psychiatric inpatient. So I did that. And at the time of finishing that, there weren't really any jobs that I was interested in that I was looking for. So then I was a professor at a liberal arts college in Utah called Westminster College, and I was able to teach masters and counseling students and upper level psychology undergrad students, and then became introduced to this whole world of wilderness therapy and therapeutic boarding schools and residential treatment and was able to kind of fall back into doing
00;09;11;27 - 00;09;23;10
Alison
assessments in those settings, which is again, something that I wanted to get back to doing. So that's kind of the short synopsis of the last 15 years of my life. I would say, Wow.
00;09;24;00 - 00;09;26;25
Brenda
That sounds like a lot of work.
00;09;27;05 - 00;09;28;15
Alison
A lot of school.
00;09;29;04 - 00;09;34;20
Brenda
Tells me, Yeah, like you said, like you don't do that if you're just sort of haphazardly interested in something.
00;09;34;21 - 00;09;43;09
Alison
So no, it's not something you are able to casually pursue. You're pretty much your whole life is wrapped up around that educational pursuit.
00;09;43;17 - 00;10;06;07
Brenda
Right? Right. Which is so I just think it's fascinating how some people just find that thing and it's like, that is what I want to do. And I love hearing. Yes. Especially in this realm, because it's, you know, you really are. And we'll talk about how this works, but you're really impacting lives in such a profound way at a young age.
00;10;06;07 - 00;10;30;26
Brenda
Right. So this I think this time in life and part of why I do what I do is, you know, we're looking at a window here in a young person's life that can absolutely change their trajectory in life. So I think it's just it's so awesome to hear that there are people who get into this and it's like, this is what I do and I'm going to do it to the utmost degree.
00;10;30;26 - 00;11;00;20
Alison
So yeah, yeah. And, you know, that's just kind of my personality. And so it worked well for her pursuing a Ph.D. And, you know, we we'll talk more about this, I'm sure. But, you know, I really see assessment fitting nicely with kind of the philosophy behind counseling psychology, which is more strengths based and preventative, like how do we figure out what you're good at and where you're struggling so we can help you now before things become acute and severe?
00;11;00;28 - 00;11;30;20
Alison
And so that's what I really like about, you know, doing what I do is I can give parents and their children this picture of, okay, here's what you're really good at, and then here's where you're struggling and here's what I here's what I would recommend for your support for helping you with those weaknesses. So it's not to the point that you're having to be psychiatrically hospitalized or you're pursuing substances and developing a secondary substance use problem to these difficulties.
00;11;31;04 - 00;12;16;12
Brenda
Right. Right. Because a lot of I know for a lot of our kids, they get into substance use and then as they go through that experience, maybe it's several years. There's trauma that happens along the way that wouldn't have happened if if they had kind of gotten pointed in a different direction. So now not only are you dealing with the original reason for the substance use and the substance use from a kind of medical standpoint, now you have these additional layers of violence, you know, things that they see, things that they experience, things that happened to them, their bodies as a result of the substance use that is just now compounding everything that they were
00;12;16;12 - 00;12;39;13
Brenda
starting with. So, yeah, that's why I just love this as an early, early intervention. So why don't you give us just a one on one? So you're like you're talking to somebody like me who had never even heard of a psychological evaluation until my son was in wilderness therapy. What actually is this? And and maybe a little bit about what it's not, that's helpful as well.
00;12;40;03 - 00;12;52;27
Alison
Yeah. Yeah. Well, I'll start by, you know, another question you had asked me to think about. Brenda was, you know, kind of like myths about psychological testing. So I think that's actually a good place to start with answering this question.
00;12;53;00 - 00;12;53;15
Brenda
Okay, cool.
00;12;53;17 - 00;13;23;14
Alison
So some people think that there is a test or the test that will definitively tell us yes or no. My child has X and x can be ADHD or autism or depression, right? That once I gave your child this one magical test, it will definitively tell us 100% that your child has autism or ADHD or depression or bipolar or whatever you know you're wondering about.
00;13;23;14 - 00;13;52;23
Alison
And that is not true. Tests that we give are norm referenced or standardized, which means they're given the same way every single time. And we compare your child to other children that are approximately the same age and with the same gender identity and controlling for things like ethnicity that will tell us kind of how they perform compared to their peers and with different tests that we give.
00;13;52;23 - 00;14;15;03
Alison
It also will tell us that they have these types of symptoms, but it won't definitively tell us where those symptoms come from. So I want to start there because I think a lot of times when parents are asking about testing, they're asking why does my child have X? Right? And they want to know that right. And I want to be able to tell them that.
00;14;15;03 - 00;14;43;28
Alison
But it's not going to be through just giving them one specific test that's going to be part of it, that's going to give me information about their symptoms. But it's also psychologic testing beyond kind of these standardized tests in other pieces that are really important are the interviews that we have with the clients, the interviews that we have with their parents, the interviews that we do with either their current therapist or previous therapist or information that we gather from their teachers.
00;14;44;06 - 00;15;08;27
Alison
So there's a lot of information we want to gather from interviews in terms of kind of their developmental history, their academic history, their social history. So that's a piece. So interviews is the norm. Reference tests, behavioral observations are really important as well, Like how is the client presenting when they are with me doing the testing, How are their interpersonal skills?
00;15;08;27 - 00;15;34;22
Alison
How are they dealing with frustration that comes about from the testing? How are they communicate? And so those behavioral observations are really important as well. And then there are also things like reviews of school records or medical records or if there have been previous assessments, those are all part of what would go into a broad psychological testing. We're not hooking people up to anything.
00;15;34;22 - 00;15;56;25
Alison
So I think that's, you know, important to know, we're not medical doctors, so I'm not invasively looking at somebody whose brain, I'm not scanning it. I'm not doing MRI. That's a totally different realm of testing. So I think that's important to know. Like kids are like, well, how are you going to figure this out? It's like, I'm not going to hook you up to anything, but I'm going to ask you a lot of questions.
00;15;57;19 - 00;16;03;12
Brenda
I love that. I love that. I could just see you show up with a probe thing.
00;16;03;15 - 00;16;29;20
Alison
There you go. Yeah, exactly. That's and I think that's sometimes right. What the kids are expecting. It's like, No, Oh, no, no. Like, I'm going to actually, like, ask you to do things in this testing that demonstrate to me, like, your capacity or your strengths or your weakness. So there's going to be hands on things that they are going to be doing as part of the testing often and sometimes there's also self-report measures where the clients can say yes or no.
00;16;29;20 - 00;16;50;02
Alison
I feel this way because some clients are really nervous about talking to a psychologist and somebody that they don't know. And so sometimes, you know, having something in a written format where again, we can use that as a starting point for our interview or they're answering these questions in private and then we can come back to them and say like, Hey, tell me more about why you endorse this this way.
00;16;50;09 - 00;16;53;23
Alison
Those are all kind of different helpful methods that we try to use.
00;16;53;23 - 00;17;18;19
Brenda
Okay, that's super helpful. So what I'm hearing is as you're doing these tests, which are noninvasive, what you're looking at is sort of a constellation of conditions, symptoms, things that you're observing, the ways that they're answering questions. And all of that's going to come together in in some sort of a report that's going to say this is what this looks like.
00;17;18;19 - 00;17;40;10
Brenda
And it's not like you can you know, we love the drug test because we can have our kids pee in a cup and then it's like, okay, you are using cocaine, but it's not like that. I am assuming. So there's there's nothing like that. So that's really good just to clear up sort of exactly what it is, because that's that's, I think, a little bit of a mystery.
00;17;40;17 - 00;17;50;20
Brenda
And then who's qualified to do this? Like, is it doctors only like you, like your Ph.D.? Is it? So just talk to us about who who's qualified to do this.
00;17;52;04 - 00;18;20;06
Alison
Yeah, there's kind of three specialties that are qualified to conduct psychological testing. So one would be school psychologist, which I am not, and school psychologist. Really, their training is about operating within a traditional school environment. And so the testing that they're going to give is going to be more learning and academic focus. They're really not trained and giving psychological measures or assessing substance use or assessing memory.
00;18;20;07 - 00;19;11;07
Alison
They're don't receive that type of training kind of through their education. So that's group one, Group two or people like myself, clinical psychologist or counseling psychologists, we're trained to assess for a variety of intellectual, emotional, academic, social, behavioral, psychological problems. And then the third, which is kind of a specialty within clinical psychology, is neuro psychologists. And so neuropsychologists are basically people like me who have Ph.Ds, and then they do two more years on top of that, specializing in looking at neuropsychological conditions or neurodegenerative conditions that can be things like Trump, brain injury, seizures, dementia.
00;19;11;15 - 00;19;25;04
Alison
If there's some kind of genetic condition that might cause difficulties, that's kind of where their specialty lies. But there's a lot of overlap in between what a neuropsychologist does and a clinical psychologist does in terms of testing.
00;19;26;03 - 00;19;45;24
Brenda
That's super, super helpful to understand. Yeah, because I think maybe if we've had enough, our child had some sort of evaluation at their high school, at their middle school, we might think, okay, check on that. But it sounds like there's a lot that might be missing from that, especially if there is substance use involved.
00;19;46;19 - 00;20;12;22
Alison
Yeah, if there's substance use involve or you think that your child has autism or depression or anxiety, that's not something that a school psychologist is necessarily going to drill down closely. They really want to know the impact of those things specifically on their capacity for learning and their academic skills. And then their focus is on how can we accommodate those within the school.
00;20;12;22 - 00;20;32;13
Alison
They're not going to speak to this as the type of, you know, psychological treatment your child might need, whether that's individual or group or what evidence based practice or whether they need a higher level of care like residential or therapeutic boarding school. That's really, you know, well with outside their scope of practice for recommendations.
00;20;32;25 - 00;20;42;14
Brenda
Right. Okay. Good to know. My son was in wilderness therapy by the time I learned about this. So I don't know if I was just late to the game or if that's typical, but definitely not.
00;20;42;14 - 00;20;43;03
Alison
Definitely not.
00;20;43;23 - 00;20;51;03
Brenda
In an ideal world, knowing that we don't live in that world. But if we could, when would it be ideal to get this kind of testing done?
00;20;52;17 - 00;21;28;19
Alison
I mean, ideally, the time to get this testing done is before the behavior becomes severe, before the school refusal starts, before significant substance abuse starts, before psychological concerns become the point where you're looking at psychiatric hospitalizations. Yeah, because by then, you know, we're in an acute phase and we can still do testing during an acute phase. And we're going to get a snapshot of what that level of distress looks like and those behaviors and where they're coming from.
00;21;28;19 - 00;21;54;11
Alison
But ideally, if we can do it before we get to that point again, like I was kind of speaking to earlier, hopefully we can circumvent some of those higher level kind of needs for care and we can say like, okay, wow, if we can put these specific things in place now, maybe we don't have to get to that level of where we need wilderness or residential treatment or a therapeutic boarding school or young adult transition.
00;21;54;20 - 00;22;16;19
Alison
We can say like, okay, yes, things are starting to escalate or creep up and here's where we're at now. You know, we don't want to get to this place. So here's our recommendations for care and wraparound supports and family therapy. And again, all those kind of recommendations that we make as part of this evaluation, that's in the ideal world, of course.
00;22;17;02 - 00;22;37;17
Brenda
Right. Right. But I think that's critical to know, because a lot of times what I hear from parents is like they have a little bit of a wait and see strategy in place and I think that can be good as long as while you're waiting and seeing you're doing some of these things which can help inform what you're, you know, what you're doing.
00;22;37;17 - 00;22;54;09
Brenda
And I really liked what you said about strengths based because I'm thinking of how do I pitch this to my kid, right? Like, how do I tell my 14 year old, Hey, I have this awesome idea for today, Let's go meet.
00;22;54;09 - 00;22;55;28
Alison
With Dr. Gillette.
00;22;55;28 - 00;23;18;29
Brenda
And do this testing so that when you talked about the strengths based with that made me think is you could present it as and I'm sure you do. Hey we want to take and take a look at what you're really good at and see where we can get you dialed in there. And then let's take a look at some of the places that maybe you're not so good at and what we can do to steer those in a better direction.
00;23;19;01 - 00;23;23;00
Brenda
Is that kind of how you would pitch this to a young person?
00;23;23;06 - 00;23;45;18
Alison
Yes, that's exactly how I pitch it when I meet with them. Like my a lot of kids, when you pitch evaluations to them, their ideas, you're just trying to figure out what's wrong with me, Right? I don't actually have that interest. Like, I want to know why something is a struggle to you, but you certainly have areas of strength that we could be tapping into in a better way.
00;23;45;28 - 00;24;00;27
Alison
You know, and tapping into those strengths is going to help with your self-confidence and your self-esteem. And it's going to help you socially and it's going to help you, you know, in your day to day life. So I want to know what you're good at. I don't necessarily just want to know what's wrong with you. And I don't think anything is necessarily wrong with you.
00;24;00;27 - 00;24;22;10
Alison
There are reasons that, you know, you have these symptoms that have presented over time. So how can I help you? Is really my my end goal and kind of how I talk about it with with kids. And do you know, the other thing I let them know is most of the tasks that I ask them to do when I'm doing an evaluation, each little task is only going to take 5 to 10 minutes.
00;24;22;10 - 00;24;43;26
Alison
So if they hate it, you know, it'll be over quickly, right? You know, it's not like it's not like school where if you hate math, right, you're going to be in that class for an hour. And it's just math, math, math, math, math. It's like, I'm going to ask you to do 5 minutes of math. Right. And if you can't tolerate that 5 minutes of math, then you hate like that tells me a lot of information.
00;24;43;26 - 00;25;11;20
Alison
You know, if if you're really struggling for that 5 minutes, like, how are you getting going to get through an hour of math at school? So again, that's like observational data that I'm able to gather. But I try to say like, you know, we can take lots of breaks, you know, depending on the age of the student. We can break this into multiple sessions and we can do the tasks in different order, you know, kind of depending on your interest, we can start with something that's easier for them or that they enjoy.
00;25;11;20 - 00;25;33;26
Alison
And I try to gather that type of information from their parents ahead of time so that I can structure it in a way, you know, And sometimes it's helpful just for me to talk with them before we do any testing. You know, maybe it's a week before and they're really worried and they just want to, you know, hear the person that's going to meet with them or see them and be like, Oh, this isn't an evil person who's out to get me right.
00;25;33;26 - 00;25;46;02
Alison
Like, you are building on that like therapeutic relationship as a tester as well.
00;25;46;02 - 00;26;03;18
Brenda
Hi. I'm taking a quick break because I want to let you know about the private online community I created and host for moms who have kids misusing drugs or alcohol. It's where I hang out between the episodes, so I wanted to share a little bit about it. This place is called The Stream, and it isn't a Facebook group.
00;26;03;18 - 00;26;29;20
Brenda
It's completely private away from all social media sites where you start to take care of yourself. Because through all of this, who is taking care of you? The stream is a place where we teach the craft, approach and skills to help you have better conversations and relationships, and we help you get as physically, mentally and spiritually healthy as possible so that you can be even stronger for your son or daughter.
00;26;29;20 - 00;26;56;07
Brenda
You can join us free for two weeks to see if it's the right kind of support for you and learn more about all the benefits that you get as a member at the Stream community dot com and I'll see you there. Now let's get back to the conversation. I'm going to ask the question that every single person who's listening is thinking right now.
00;26;56;12 - 00;27;16;06
Brenda
You guys don't know that I'm a mind reader, but I am because I know what you're thinking. And what you're thinking is, Yeah, but my kid is smoking weed all the time. Oh, yeah. And I've been told, or I could imagine that I couldn't do this because they're under the influence of something most of the time and everything is going to be skewed.
00;27;16;20 - 00;27;19;02
Brenda
So please answer this question for us.
00;27;19;02 - 00;27;48;17
Alison
I'd love to. I'd love to. Yeah, there are different there are certainly different philosophies of this. And, you know, I'm part of a group, a Facebook group called the Testing Psychology, which is just testing psychologists who constantly share ideas about things. And so there are certainly philosophies from some psychologists that we would like, you know, your child to be abstinent of all substances for a minimum of six months so we can get a true baseline of their abilities.
00;27;48;17 - 00;28;15;27
Alison
And again, we're talking about ideal world conditions, and that's certainly not the world that most people or their children live in. So, you know, my kind of philosophy is the more sobriety, certainly the better. But if all I can get your child to commit to is 3 hours in the morning of not smoking weed, and I meet with them at eight or 9 a.m. and I say like, hey, we're going to go for 3 hours.
00;28;15;27 - 00;28;36;28
Alison
And I can't control what you do after that, but at least for that 3 hours, I know you're not actively high or actively intoxicated, then that's kind of the best that we can do. And that's something that I as the evaluating psychologist, need to take in mind, that there is substance abuse and it is severe. And how does that impact the scores that we're getting?
00;28;37;01 - 00;29;06;11
Alison
We're probably not getting your child's true baseline innate ability, but we are getting a good snapshot of their abilities now, and that's the abilities that they're working with and struggling with and that you're seeing them have trouble access and that's going to direct treatment. We're often not operating in that ideal world where we can get six months of sobriety before starting testing and then your child is continuing to struggle and be in pain and suffer.
00;29;06;11 - 00;29;12;02
Alison
And I don't think ethically that that aligns very well with my my values as a psychologist.
00;29;12;21 - 00;29;24;18
Brenda
Right. And I have yet to meet a young person that would say, Yeah, mom, I'll stay sober for six months so that I can do a psychological evaluation. Like, are you kidding me? Like, what world are that?
00;29;24;22 - 00;29;27;29
Alison
It just doesn't happen.
00;29;27;29 - 00;29;45;12
Brenda
It just doesn't happen. But but I love what you said about, hey, let's be strategic about when we do this, maybe about where we do this. And and I think it's so cool that you're willing to have the conversation ahead of time to say, like, Dude, I'm just show up at your house at seven. We're going to do this, right?
00;29;45;13 - 00;30;01;15
Brenda
Maybe not seven. I'm not signing you up for a 7 a.m. start. You're probably like, Wait, wait, wait, I'm not doing that. But you know what I mean? Like, you're willing to be flexible and say, Let's just figure out what we can do, what can we agree on to make this happen? And then, like you said, I don't know what you're going to do afterwards.
00;30;01;15 - 00;30;18;04
Brenda
That's none of my business. But and when you said the word baseline, it would it made me think of is, yes, their sober baseline is one thing. Yeah. But but even as parents like we haven't seen that sober baseline in so long, we don't even know. So this actually is baseline right.
00;30;18;04 - 00;30;45;23
Alison
Like Yeah. And this is is a starting point. Right. And you know we do the evaluation and we see like oh wow, they're really struggling cognitively. It's like, okay, well baby, some of that is due to the substance use. And if they do eventually become sober for a prolonged period of time, we can always redo it. And then if there are improvements, you know, cognitively speaking, we can say, well, part of that is probably because you're sober now and that's a good thing.
00;30;45;23 - 00;31;02;25
Alison
And we can kind of see the impact now that that had on your brain. So we can always retest at a later point and time. But, you know, any type of data that we have is going to help inform treatment. And, you know, the caveats for that data look different, right? Like there are also other compounding factors, right?
00;31;02;25 - 00;31;23;05
Alison
Like is your child eating regularly? Are they getting regular sleep? You know, there are other kind of things like that that we have to think about as psychologists. And yeah, it's nice if we don't have to worry about those. It just makes the data a little cleaner, so to speak. But that's again, not always reasonable. And let's just figure out what's going on.
00;31;24;11 - 00;31;38;03
Brenda
Just from a practical standpoint, what does this look like? Like, are you in the wilderness? Are you like sitting out on the rocks with them? Or just maybe give us a snapshot of from a practical standpoint, what is what does this look like?
00;31;39;06 - 00;32;10;04
Alison
Yeah. So from a practical standpoint, it really depends on the kind of studying there. And so I'll I'll throw in a few different settings for you. So one setting is that I have gone to the homes of the clients that I am evaluating to meet with them in their home and do the testing in a private space within the home, because sometimes it's just so hard to get the clients to leave the house to do the assessment that again, I'm trying to decrease the barriers to getting the evaluation done.
00;32;10;04 - 00;32;30;05
Alison
So sometimes I'm going into the parents homes and if they're not comfortable with me going into their home and I'm traveling to do an evaluation, I can always rent an office space. But some parents are like, Wow, great. Thank you. Like, that makes my life so much simpler, right? And the parent doesn't need to be there. They can go up, you know, they can do their remote work.
00;32;30;05 - 00;32;50;26
Alison
I don't need them to be around. They can just kind of know that their child is there and their child can go back to their room and take a break and, you know, be on their phone and then come back out and meet with me. So that's one setting. You know, certainly in wilderness. Yes. I'm driving out to where the group is and the woods and the mountains and the desert.
00;32;51;18 - 00;33;14;09
Alison
During COVID, we weren't allowed really by programs to test in our vehicles. So, yes, I was sitting out in the snow and on rock, and that created some challenges. But, you know, now that we're kind of in the state that we're in with the pandemic, I'm doing testing in my vehicle. And there are, you know, electronic versions of assessments that I bring out to me.
00;33;14;09 - 00;33;35;25
Alison
So I'm not bringing book loads of paper assessments with me into the woods. And then in wilderness, I usually bring them snacks because I know what they eat out there, and that gives me a lot of buy in when I show up with donuts and chocolate milk. Oh, they'll pretty much that. They'll pretty much sit in my jeep for as many hours as I need because they're warm, they're dried, they have their own stash of donuts and chocolate milk.
00;33;35;25 - 00;33;41;29
Alison
I can get a lot of really good testing and wilderness with with a little bit of help from snacks.
00;33;42;04 - 00;33;46;15
Brenda
I should only imagine. It's like, wow, this is the best day ever.
00;33;46;29 - 00;33;58;11
Alison
Totally. Totally. And then, you know, they write their letters to their parents and they're like, Alison brought me donuts, and testing was great. I loved it. And the parents are like, Cool, That was better than I thought it was going to go.
00;33;58;11 - 00;34;17;29
Brenda
Right? Right. No, I love hearing that because I know so many parents. When we envision our kids in wilderness, it's so hard, first of all, to think about them being there. And then when you're like, Oh, now he's going to have to go through this big, horrible test and he's going to think that we think he's crazy, right?
00;34;17;29 - 00;34;45;28
Brenda
And you just you kind of like it eats at you as a parent thinking how horrible this is going to be. And so I just love that picture and description that you gave us of this being something that is probably a wonderful break in the routine, something different. I'm actually like doing something, you know, cognitively that I haven't been doing for a while and I'm getting to know donuts and have like, Hello, that sounds pretty awesome.
00;34;46;01 - 00;35;11;14
Alison
Yeah. And it ends up, you know, it's it's more common than not for a lot of students to go through testing during wilderness based on my experience. And so it also becomes more normative doing it out there because they've seen they've seen lots of vehicles come up to the group, they've seen their peers from the group go into vehicles to do testing, and then their peers come back and they're like, Oh, what did your tester bring you to eat?
00;35;11;14 - 00;35;34;07
Alison
Like they brought me bagels or, you know, and so, like, I have a reputation. They'll be like, Oh yeah, you're the donut lady. And I'm like, Yeah, that's me. Like, No, they know, like, and it's just like a normalized part of the process being out there. It's not, oh, like I'm the only one that this is happening to because there's something really defective with me, which is, I think, how it can feel.
00;35;34;07 - 00;35;54;12
Alison
It's like, Oh yeah, I know. Like half my group or more has gone through testing while they've been out here and this is just part of what happens. I think it's more normalized in that setting. You know, we do it in wilderness and then we can also go do it in the program. You know, if there's a therapeutic boarding school or residential treatment, again, I'm going to the program.
00;35;54;12 - 00;36;15;04
Alison
I'm trying to be as least disruptive to the therapeutic process as possible. So I'm coordinating with the program around, you know, do they have family therapy that happens a certain day of the week. Are there excursions that the program is doing Certain days a week? We want to make sure they don't miss out on. Are there more typical days that it would be helpful for me to come?
00;36;15;14 - 00;36;37;07
Alison
But again, I'm going to the program. I'm trying to, you know, not take as much time away from their therapeutic process as possible, which is often a worry I hear from parents as well, like, oh, we don't want them missing this thing. And it's like, Yeah, me neither. I don't want them missing this thing and I want you to have this information so that they're getting the most utility out of the program as I can.
00;36;37;21 - 00;37;05;19
Brenda
Absolutely. So that was actually going to be my next question is, so now that we have this information and let's let's talk about a scenario where this because I'm so hopeful that this is going to be something that more people do is let's say this is pre any sort of, you know, treatment. So pre wilderness, pre hospitalization is the parent who is saying, you know, there's enough going on that.
00;37;05;19 - 00;37;20;14
Brenda
I want to get some more insight. How does this testing inform and what would a parent do? Is this something that you take to an educational consultant? Do you share this with a treatment program? Like what am I going to do with this information now that I have it?
00;37;20;14 - 00;37;41;18
Alison
Yeah. So I think the first kind of piece that comes up for me to know when you're asking, what do I do with this information, is that this information really is owned by the parents and owned by the family. I can't share that information with anybody unless the parent specifically gives me a release of information to share this information.
00;37;41;18 - 00;37;45;28
Alison
And so I want to start there because that's also a privacy concern that parents have like.
00;37;46;10 - 00;37;46;22
Brenda
Their.
00;37;47;00 - 00;38;08;18
Alison
15 to 25 pages long. And so they do have a lot of personal information about them. And so these reports, you know, these evaluations or assessments would be something that you would share with an educational consultant. You would be able to say like, hey, you know, my child really struggling in school. I'm not sure this is the best educational fit for them.
00;38;08;27 - 00;38;35;27
Alison
Based on your reading of this report, what kind of settings or specific schools or boarding schools or therapeutic placements could you recommend for my child based on your reading of this evaluation? And again, educational consultants are super familiar with these types of assessments and evaluations and they love them because they provide a lot of contextual information for the types of decisions that the educational consultant needs to make.
00;38;36;07 - 00;39;05;12
Alison
So certainly something you should share with an educational consultant, something you should share with a psychiatrist. If your child is having any kind of psychiatric medication, because it might adjust kind of how your psychiatrist is viewing your child and their medication regimen, it may be something that you share with your child's school, you know, if they're really struggling in school and to get to school to attend and school to do their homework.
00;39;05;12 - 00;39;29;22
Alison
And there are psychological reasons why they're having difficulties with that, they might be eligible for some kind of 504 plan or IEP plan. And often the school wants to do their own additional evaluation as well. But this again, gives them kind of more information about why they might be having the issues they're having with your student or with your child at the school.
00;39;30;04 - 00;39;57;01
Alison
And then certainly if your child already has some kind of individual therapist that they're seeing, you know, individual therapists certainly can make diagnoses. It just takes them a lot longer to do that because their you know, their goal with the limited time they have with your child is not to find the differential diagnosis between ADHD and depression. It's what symptoms do they have, how are they presenting and how can I help them?
00;39;57;01 - 00;40;24;11
Alison
And they often don't have kind of the time, you know, to really dig deep. And so we're doing that deep dive for them that, you know, it might take them a year to kind of get the same type of information that we're able to get you and the psychological evaluation and a couple of weeks. And so we make recommendations for these are the types of evidence based therapies and treatments that your child should be receiving with these diagnoses so that they can get better quicker.
00;40;24;28 - 00;40;38;12
Brenda
Okay, that makes a ton of sense. So that's super helpful. I'm going to ask a question that you probably I don't know if you'll be able to answer next. I imagine it varies by state, by state, in plan, by plan. But are these typically covered by insurance?
00;40;39;12 - 00;41;08;01
Alison
Yes and no. And I'll tell you kind of why. So in every kind of has their specific rules for what they think psychological testing should look like and what tools are covered and what tools are not covered, and how many hours are covered and how many hours are not covered. And then they have specific reimbursement rates for the psychologists.
00;41;08;01 - 00;41;55;27
Alison
Right. For the testing that the psychologist is doing. And so, yes, certain types of testing can be covered by insurance companies, but that's going to vary really specifically based on your plan. And then there's going to be kind of an upward limit to kind of how many hours and insurance company is going to approve for testing. And so it can be really tricky to get kind of a really comprehensive evaluation using insurance because it's going to limit the amount of time the psychologist is going to spend with your student because they know or your child's right, they know that they're only going to be reimbursed for, let's say, 8 hours, 8 hours.
00;41;55;27 - 00;42;31;02
Alison
It's not a lot of time. So they're going to say, I can meet with your student in person for 2 hours. I can speak with you for one hour and then I have 3 hours to write up the testing. I have an hour to do feedback with you. And then maybe I have 2 hours of leeway there. So it doesn't encourage a greater exploration of the problem because the psychologist knows if I exceed those hours, I'm not going to be reimbursed by the insurance company.
00;42;31;07 - 00;42;32;02
Alison
Does that make sense?
00;42;32;06 - 00;42;35;22
Brenda
Got it. Yes, it's infuriating, but I totally get it.
00;42;35;27 - 00;43;01;18
Alison
Yes. Yes. And so I get this question a lot from parents because I operate on a private pay basis. I don't take insurance. And, you know, they'll they'll be like, well, can't you take insurance? And the other thing is, if I were to take one specific type of insurance, I always have to use that insurance says rules, and I always have to see the clients that have that insurance.
00;43;01;18 - 00;43;25;20
Alison
I can't turn away an insurance based client for a private pay client. And so then I have limited myself to only those types of clients or families who have that one specific insurance type. And that's why you will often have like insurance based psychologists, you know, in larger cities like Seattle or Portland or the Bay Area who take insurance.
00;43;25;20 - 00;43;48;02
Alison
But they're going to be booked out for probably a year or 18 months, which kind of goes back to your question of like, when should I be thinking about this? Right, Right. If you're if you're waiting till the you're in an acute situation and you really need this and you're going to use insurance, you're probably looking at a six to 12 to 18 month waitlist.
00;43;48;11 - 00;44;21;18
Alison
So that, again, is not going to be helpful to you. So I don't want to operate within the confines of insurance. And again, I understand that why those exist and I understand psychologists who want to operate that way. But I am really interested and being able to spend all the time I need with the client and with the family to really get a true sense and not be limited to, oh, I can only use these test because these tests are going to give me the most money at the end of the day for reimbursement from an insurance company.
00;44;21;18 - 00;44;35;01
Alison
And for me, that's not kind of how I like to approach assessment. I like to say, what does this client need? What is going to give me the best sense of what's going on? And when you're operating in a private pay kind of realm, you have the luxury to do that.
00;44;35;20 - 00;44;56;26
Brenda
So there if you're listening, there's an episode. Her name is Virginia Holliman. I don't know the number. I will put it in the show notes, though, and I do have an entire episode about insurance. So if you are interested in that, it's not about specifically psychological evaluations, but it is in general about mental health and substance use treatment, insurance coverage.
00;44;56;26 - 00;44;58;20
Brenda
So I will put that in the show notes.
00;44;58;26 - 00;45;01;23
Alison
I'm glad you have that. And I don't have to speak more about that.
00;45;01;23 - 00;45;19;09
Brenda
No, you don't won't torture you with that. Two quick questions. One is, so when you get the report done and you share it with the parents, what about the the young person? Are you sharing it with them? And should they read it? Like as a parent, should I encourage my child to read it? Is it going to freak them out?
00;45;19;09 - 00;45;21;06
Brenda
Like what? What's the recommendation there?
00;45;21;29 - 00;45;42;27
Alison
Yeah, after the report is done, you as a parent should get a copy of that and then generally you're going to have a feedback or review session with a psychologist where you can answer questions about the report and you can have those answered. But in terms of the child who's doing the evaluation, there are a couple different kind of approaches.
00;45;43;10 - 00;46;03;14
Alison
First, I would recommend that they not read the entire report, you know, especially if they're a teenager. It's a lot to take in. You know, it's a lot for parents to take. And when they receive it, I try to tell my parents like, hey, this is probably going to be overwhelming for even you to read this because it's a lot contained.
00;46;03;14 - 00;46;28;28
Alison
And there's it's hard to kind of see everything that you've been through summarized in writing and to kind of feel those emotions. And so typically don't recommend giving the full report to adolescents with young adults. Possibly. But I like to have a conversation, you know, with the client that's gone through the testing first and say, you know, these are what I noticed as your strengths and weaknesses in the testing.
00;46;28;28 - 00;46;55;25
Alison
And here are some of my recommendations. I've started doing actually like a one or 1 to 2 page kind of summary sheets for late adolescence or young adults to kind of help with that conversation and so that they do have something in writing. And I've had a lot of good feedback from parents and clinicians on them being able to share that with their child in terms of, yeah, these were things you were really strong at and really good at.
00;46;55;25 - 00;47;32;14
Alison
And here's things that I think are liabilities for you kind of psychologically speaking. And then if they're in treatment and they have, you know, an individual therapist or a treatment team, then that's something that I usually encourage the individual therapist to talk about with the client because they have that longstanding therapeutic relationship with your child to where they can talk about the tough thing and they can talk about how it's been impacting their work, right, with working with your child and what it means for their work going forward.