CHHS17/294

Canberra Hospital and Health Services

Operational Procedure
Psychological Tests: Use, Storage, and Access (MHJHADS)
Contents

Contents.....................................................................................................................................1
Purpose......................................................................................................................................2
Scope..........................................................................................................................................2
Section 1 – Background..............................................................................................................3
Section 2 – Use of Psychological Tests.......................................................................................4
Section 3 – Storage of Test Data.................................................................................................7
Section 4 – Storage of Psychological Tests.................................................................................9
Implementation........................................................................................................................10
Related Policies, Procedures, Guidelines and Legislation........................................................11
Definition of Terms...................................................................................................................11
Search Terms............................................................................................................................12
Attachments.............................................................................................................................12
Attachment A: Templates of Forms for MAJICeR.................................................................14
Attachment B: Sample Information and Consent Forms for Psychological Assessment.....17
Attachment C: Sample Test Data Sheet................................................................................22
Attachment D: Psychological Testing Procedure Flowchart for Psychologists.....................27

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Purpose
The purpose of this procedure is to protect the integrity of psychological tests and test data
in line with the Australian Psychological Society Code of Ethics (2007) and the Ethical
Guidelines for Psychological Assessment and the Use of Psychological Tests (2014). This is to
ensure appropriate qualified use and interpretation for people under the National Standards
for Mental Health Services (2010) standard 10.4.1 and 10.4.2 (Assessment and Review). This
procedure also provides psychologists a standardised process for the documentation of
psychological assessment and storage of psychology test data in MHJHADS.

Psychological tests in Mental Health, Justice Health and Alcohol and Drug Services
(MHJHADS) are accessed and used by appropriately qualified psychologists and are securely
stored and disposed of. Psychologists are health practitioners registered with the Psychology
Board of Australia (AHPRA). A psychological test in this procedure refers to a test that is
restricted to psychologists under commercial test licensing agreements, including manuals,
inventories, equipment, and original test record forms.

MHJHADS has adopted the use of the Australian Psychological Society Code of Ethics and
Ethical Guidelines for Psychological Assessment and the Use of Psychological Tests and as
such, all psychologists in MHJHADS are expected to have read and to comply with the
standards in those documents. This document should also be read in conjunction with the
MHJHADS Mental Health Services Neuropsychology Referral and Administrative Process
Procedure.

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Scope

This procedure applies to all psychologists (including provisional psychologists and

psychology students) and Team Managers of psychologists in MHJHADS.

All MHJHADS psychologists and their Team Managers are responsible for appropriate use
and storage of psychological tests and test data in line with this procedure.

Non-psychologists who are credentialed to use specialised assessment tools are not in scope
for this procedure. However, it is expected that any use of specialised assessment tools
adheres to the best practice principles of appropriate use and storage of the assessment
tool, documentation of the results/interpretation of the assessment, and providing timely
feedback to the person.

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Section 1 – Background

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Under the Australian Psychological Society Code of Ethics (hereafter referred to as The Code)
and the Ethical Guidelines for Psychological Assessment and the Use of Psychological Tests
(hereafter referred to as The Guideline), psychologists have a responsibility to secure
psychological tests from unqualified professionals and the public and to safeguard the
confidentiality of psychological assessment data.

Psychological tests “are characterised by standardised administration and scoring, the use of
a manual and usually the availability of population norms to assist interpretation. A
psychological test is a set of items that has accepted levels of reliability and validity, and
allows measurement of some attribute of an individual, for example, intelligence, aptitudes,
or personality traits” (The Guideline, p. 126).

Psychological testing covers a number of different areas, including:

 Achievement testing,
 Adaptive behaviour assessments,
 Aptitude testing,
 Cognitive testing,
 Forensic psychological testing,
 Mental health assessment,
 Neuropsychological testing, and
 Personality assessment.

Commonly used psychological tests in MHJHADS that require appropriate security and
safeguarding include, but are not limited to, the following tests:
 WAIS-IV – Wechsler Adult Intelligence Scale Fourth Edition
 WISC- VA&NZ – Wechsler Intelligence Scale for Children – 5th Edition Australian and
New Zealand
 WMS-IV – Wechsler Memory Scale Fourth Edition
 WPPSI III – Wechsler Preschool and Primary Scale of Intelligence (and WPPSI-IV
A&NZ
Standardised Edition)
 SB5 – Stanford–Binet Intelligence Scales Fifth Edition
 KAIT – Kaufman Adolescent and Adult Intelligence Test
 WASI – Wechsler Abbreviated Scale of Intelligence (and WASI II, no Australian
norms)
 WJ III COG – Woodcock-Johnson Test of Cognitive Abilities III
 WRAML2 – Wide Range Assessment of Memory and Learning Second Edition
 SDS – Self Directed Search (and 2nd Australian Edition 2012, Form R)
 Strong – Strong Interest Inventory
 PAI – Personality Assessment Inventory
 NEO-PI-R – NEO Personality Inventory Revised
 MMPI-2 – Minnesota Multiphasic Personality Inventory-2
 16PF 5th Ed – Sixteen Personality Factor Questionnaire Fifth Edition
 BDI – Beck Depression Inventory (and BDI-II)
 WIAT-III – Wechsler Individual Achievement Test- 3rd Edition
 ABAS – Adaptive Behaviour Assessment System
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Psychologists who are unsure of whether a test and/or test data requires to be secured will
seek advice from the Team Manager of Mental Health Services (MHS) Neuropsychology
(hereafter referred to as the Senior Neuropsychologist) or representative MHS
Neuropsychology team member.

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Section 2 – Use of Psychological Tests

Psychologists in MHJHADS who are appropriately trained and/or under the supervision of an
appropriately trained psychologist are encouraged to utilise psychological tests when it is
identified that the assessment, treatment or care of a person may benefit from testing.
Psychologists are expected to work collaboratively with the multidisciplinary team, other
psychologists, including their clinical supervisor and/or the Senior Neuropsychologist or
representative MHS Neuropsychology team member, to identify the appropriateness of
testing for a person.

Scope of Practice and Clinical Supervision

Psychologists are to be aware of their limitations and work within the scope of their practice
for psychological testing and assessment.

Psychologists are encouraged to receive clinical supervision on psychological testing via a

senior psychologist, their clinical supervisor and/or the Senior Neuropsychologist if they are
conducting psychological assessments.

Referral Question
Prior to conducting testing, psychologists must be able to identify and confirm a clear and
appropriate referral question, which will assist in determining if testing is required and if so,
which tests are to be used. Psychologists are encouraged to contact a senior psychologist,
their clinical supervisor and/or the Senior Neuropsychologist if they require assistance in
formulating a referral question and/or identification of appropriate tests.

It is the responsibility of the psychologist to clearly document the final referral question
using the Psychological Testing Referral Question for Psychologists form in MAJICeR, tagging
the form as ‘psychology’ (refer to Attachment A). Evidence of a referral question is required,
irrespective of whether the referral for psychological testing is to be undertaken by the same
psychologist, referred elsewhere, or testing deemed inappropriate.

Notification to MHS Neuropsychology

Psychologists do not require the prior approval of the Senior Neuropsychologist to complete
a psychological assessment. However, to assist with quality control and provision of clinical
supervision (if required), MHS Neuropsychology are to be informed of psychological
assessments via MAJICeR message for noting. This is not required for the use of routine

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psychological tests (e.g. the BDI) or cognitive screening instruments (e.g. NUCOG, ACE-III).

Consent
Psychologists are to ensure prior to the use of psychological tests that appropriate informed
consent has been obtained from the person and/or their guardian, carer or nominated
person. Written consent is not usually required for more routine psychological tests (e.g. the
BDI) but should be considered when a full psychological report is anticipated (e.g. to provide
a diagnostic psychological report and/or following the use of tests such as the PAI). Examples
of samples of information and consent forms can be found in Attachment B and adapted
based on needs of the person and program area. Psychologists are to scan and upload the
consent form onto MAJICeR using the title Psychological Testing Consent Form (tagging the
document as ‘psychology’) and then enter the required consent information under the
‘Consent’ tab.

Psychologists will refer to the ACT Health Consent and Treatment Policy for further
information on supported decision making and obtaining consent from a person with a
mental disorder or mental illness and with children and young people.

Psychological Reports
Psychologists that undertake psychological testing with people are required to provide an
interpretation report (i.e. a psychological report). Routine tests do not require a full
psychological report but do require interpretation.

The sole use of computer generated reports without taking into account all other relevant
data (such as the person’s history and any observations made) for the psychological report is
not acceptable. Psychologists are to use their clinical expertise to integrate diverse
information and to provide a valid opinion to the person, the treating team, guardian, carer
and nominated person (where applicable).

Psychological reports will follow a standardised structure, which may be amended

dependent on the referral question and assessment method used. This standard template
will be available as a MAJICeR form (refer to Attachment A). A full psychological report may
include but is not limited to the following information:
 Name
 Date of Birth
 Date of Assessment
 Age at Testing
 Reason for Referral
 Disclaimer on limits to report (see sub-section on Documentation below)
 Assessment Method
 Background
o Presentation (including cultural factors)
o Early Childhood
o Education and Vocational History
o Social History

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o Medical History
o Mental Health History
o Drug and Alcohol History
o Family Members/Carers/Nominated Person Observations
 Psychological Assessment
o Description of tests
o Mental State Examination/Presentation at Testing
o Results
 Summary and Conclusions
o Diagnosis and/or Formulation
o Treatment Recommendations
 Details of psychologist, including qualifications
 Disclaimer on where test data is stored (see sub-section on Documentation
below).

Psychologists should be mindful that psychological assessment information is used only for
the purposes for which it was first collected and for which consent was obtained from the
person being assessed (i.e. the referral question).

Routine Tests
Routine tests do not require a full psychological report, but do require interpretation.
Psychologists will provide a brief interpretation using the Psychological Report form in
MAJICeR (removing the non-applicable headings), tagging the form as ‘psychology’ (refer to
Attachment A).

Test Data
Psychologists will not provide the raw scores of tests to untrained professionals or to the
public. As such, clinical file notes and/or psychological reports will provide qualitative
descriptors rather than test data.

The summary Data Sheet is to be stored with the test forms (refer to section 3 on Storage of
Test Data) and not to be attached with the clinical record and/or psychological reports. It is
prefaced with the following “These data are strictly confidential and should only be
interpreted by a registered psychologist. They should not be released to any other persons
because they have the potential to cause harm through misuse or misinterpretation.” A
sample of a Data Sheet can be found in Attachment C. Note that this is only a sample data
sheet; psychologists are to modify the Data Sheet to include all psychological tests
administered, relevant scores, and statistical analyses.

Feedback
Psychologists who have conducted psychological testing (including routine tests such as
symptom inventories) are required to communicate the results by oral or written feedback
(refer to documentation subsection below) to the individual person and/or to the guardian,
carer or nominated person.

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Psychologists will use their clinical judgement in determining what feedback is provided to
people and/or guardians, carers or nominated persons. The feedback session is to be clearly
documented in MAJICeR using the Psychological Testing Feedback Session form, tagging the
document as ‘psychology’ (refer to Attachment A). In circumstances when feedback has not
been possible or appropriate (e.g. the person declines or is not available), this should be
documented using the aforementioned form in MAJICeR.

Documentation
1. Psychologists without an area of practice endorsement in clinical neuropsychology
(exception of clinical neuropsychology registrars) will not use the title
Neuropsychological Report or Neuropsychological Assessment, and will instead title all
psychological reports in MAJICeR as Psychological Report.
2. Provisional psychologists that complete psychological reports must print the report, have
the report counter-signed by a psychologist supervisor before scanning and uploading
the report onto MAJICeR (using the title Psychological Report) and/or prior to
distribution (tagging the document as ‘psychology’).
3. All psychological reports must state the following at the beginning of the psychological
report: “This report has been prepared for clinical purposes and is not intended or
sufficient for medico-legal use. Due to the confidential and personally sensitive nature of
the information contained herein, this report is not to be provided to third parties,
including the client/family, and all requests made by third parties to access this report
require formal processing by the MHJHADS Release of Information Officer (ph: 6205 4806
or 6205 5142).”
4. All psychological reports must identify where the test data is stored at the end of the
report following the details of testing psychologist, for example “the test data is stored in
the Psychology Test Cabinet at City Mental Health Team and not in the MHJHADS clinical
record.” Refer to section 3 on Storage of Test Data.
5. The full report is only made available to MHJHADS clinical staff via MAJICeR. Where
clinically relevant and appropriate to do so, a psychologist may choose to release the full
report (instead of the summary report) to non-MHJHADS clinical staff and external
providers. A person who has undertaken testing (including their guardian, carer or
nominated person, if applicable) will receive a summary of the results and the
conclusions from psychological assessment by the author of the report. Consent to share
the summary of the results and conclusions or the full report to non-MHJHADS clinical
staff or external providers, including General Practitioners, must be obtained in writing
by the person before distribution by the author.

A flowchart outlining the steps psychologists need to follow is available in Attachment D.

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Section 3 – Storage of Test Data

Psychology File

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Completed record forms from psychological tests are to be stored on a separate paper file to
both the person’s MAJICeR and paper based clinical record (if applicable) by the psychologist
responsible for testing. The file should be clearly identified with the person’s first and last
name, date of birth, and clinical record number (obtained from MAJICeR) and marked as
‘Confidential’. The file remains an official ACT Health record but will be stored in the team’s
psychology test cabinet, filed by year. The location of the psychology file must be identified
both within the Psychological Report and on MAJICeR via the ‘Physical Files’ tab.

The psychology file should contain the following:

 A print-out of the person’s client registration form from MAJICeR,
 A copy of the psychological report,
 The summary of test data, and
 Completed test record forms.

The documents forming the psychology file should be filed promptly and not left in a place
where they may be subject to casual inspection.

A flowchart outlining the steps psychologists need to follow is available in Attachment D.

Release of Psychology Files/Psychology Test Data

Requests for information contained specifically in psychology files (i.e. test data) must be
made via the MHJHADS Release of Information Officer (ph: (02) 6205 4806 or
(02) 6205 5142), who will consult with the Senior Neuropsychologist or the Discipline
Principal of Psychology regarding the appropriate release of test data.

Under the Australian Psychological Society Ethical Guidelines for Psychological Assessment
and the Use of Psychological Tests (2014), testing documents may be deemed exempt
documents on the grounds that disclosure would be contrary to the public interest, where
disclosure would:
a) Invalidate the utility of the test or tests in the practice of psychology;
b) Impair the ability of psychologists to perform their duties properly;
c) Constitute a breach of the contractual arrangements under which psychologists are
supplied with test materials.

In the event the psychology file is to be released, it will only be released to a psychologist
who holds general registration with the Psychology Board of Australia (or equivalent in the
case of international request).

This information on release of psychology test data will be made available as a document
under the ‘Information’ tab in MAJICeR (refer to Attachment A).

Disposal of Psychology Files

The nominated psychologist will be responsible for an annual audit of paper based
psychology files and disposing of these in accordance with the Health Records (Privacy and

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Access) Act 1997. The disposal of a psychology file must be documented in the person’s
MAJICeR file by the nominated psychologist.

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Section 4 – Storage of Psychological Tests

Psychology Test Cabinet

Restricted psychological tests are to be stored in a secure, lockable cabinet. The key to the
test cabinet should remain with the most senior psychologist in the team (refer to sub
section Nominated Psychologist below), who is responsible for overseeing test security,
maintenance, and lending.

When in use, psychology tests should not left in a place where they may be subject to casual
inspection.

Nominated Psychologist
The most senior psychologist in each team where there is a psychology test cabinet is
responsible for the securing and maintenance of test materials. Where there are multiple
senior psychologists in a team, the nominated psychologist will be determined in
collaboration with the Senior Neuropsychologist and/or Team Manager. If a given team does
not actively employ a registered psychologist, the Team Manager will be responsible for
ensuring the cabinet is secure until such time as a psychologist is employed.

The nominated psychologist is responsible for:

 Ensuring the test cabinet remains locked and secure,
 Ensuring restricted psychological tests are only used and or lent to appropriately
qualified persons,
 Establishing whether the request to borrow and use a test is valid and
appropriate,
 Ordering new tests and record forms as required to keep the test/s updated and
in working order (with permission from the Team Manager or financial delegate),
 Disposing of old tests under advice from the Senior Neuropsychologist,
 Informing Team Managers about inter-team lending and borrowing of test
materials,
 Providing oversight of the register of tests and tracking the lending of test
materials via the register,
 Reporting any breaches of security to their Team Manager and the Senior
Neuropsychologist and/or the Discipline Principal of Psychology, and
 Delegating the responsibility to another appropriately qualified psychologist in
their absence and/or in the case of permanently leaving the service, and informing the
Team Manager and Senior Neuropsychologist of this arrangement.

Register of Tests

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A register of available tests will be kept for each test cabinet and managed by the nominated
psychologist with oversight provided by the Senior Neuropsychologist. The register will also
track borrowed test materials to other teams. The spreadsheet will be kept in the share
drive with nominated psychologists provided access to the following location via the ACT
Health IAM Service Portal:
Q:\MH\Director of Allied Health\Psychology\Testing\Register

Ordering of Psychological Tests

Each team and/or program area is responsible for the payment and re-ordering of
psychological tests and test protocols for their team. Under test licensing agreements,
ordering of protected tests and forms can only be done by a psychologist with general
registration (i.e. provisional psychologists cannot order tests), following permission by the
Team Manager or financial delegate.

If a psychologist would like to order a test not previously owned by the team, this is to be
discussed with the Senior Neuropsychologist prior to ordering the test (with permission of
the Team Manager or financial delegate). This is to ensure the test falls within the remit of
testing undertaken by MHJHADS and to discuss test purchasing options in the case of single
use testing.

Copyright
Where psychological tests are restricted, psychologists are to ensure original test materials
(inclusive of manuals, test forms, answer sheets and other forms) are used. Photocopies of
these materials are a breach of copyright and are to be avoided.

Disposal of Tests
The Senior Neuropsychologist will provide advice and directives to psychologists as required
regarding updates to psychological tests and any requirements to dispose of out of date
tests.

Tests (including manuals) that are to be disposed can be done so via the confidential waste
bin. Manuals that are bound are to be separated from the bind before disposal in
confidential waste. Test materials that cannot be disposed of in confidential waste (i.e. block
design test material) can be disposed of by returning them to the publisher/supplier of the
test, or, in exceptional circumstances, placing these in closed bags in general waste.
Psychologists are to ensure the means of disposing of a test does not compromise the
restricted nature of the content.

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Implementation

This procedure is to be overseen and implemented by the Discipline Principal of Psychology

and the Senior Neuropsychologist and championed by senior psychologists, clinical

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supervisors and Team Managers. Expectations will be communicated at MHJHADS

Psychologists’ Meetings and by email.

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Related Policies, Procedures, Guidelines and Legislation

Policies
 ACT Public Service Code of Conduct
 ACT Health Consent and Treatment Policy
 ACT Health Privacy and Confidentiality Policy

Procedures
 ACT Health Clinical Records Management Manual
 MHJHADS Clinical Supervision for Allied Health Procedure
 MHJHADS Mental Health Services Neuropsychology Referral and Administrative Process

Guidelines
 Australian Psychological Society Code of Ethics (2007)
 Australian Psychological Society Ethical Guidelines for Psychological Assessment and the
Use of Psychological Tests (2014)
 Australian Psychological Society Ethical Guidelines on Record Keeping (2004)
 Australian Psychological Society Managing Legal Requests for Disclosure of Test Data and
Test Materials (2015)
 National Standards for Mental Health Services (2010)
 National Safety and Quality Health Services Standards (2013)
 Standards of Practice for ACT Allied Health Professionals (2016)

Legislation
 Carers Recognition Act 2010
 Children and Young People Act 2008
 Health Practitioner Regulation National Law (ACT) Act 2010
 Health Records (Privacy and Access) Act 1997
 Human Rights Act 2004
 Mental Health Act 2015
 Privacy Act 1988

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Definition of Terms

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MAJICeR – Mental Health, Alcohol and Drug, Justice Health Integrated Care eRecord. The
electronic clinical record used in MHJHADS.

People – the terms ‘person’ or ‘people’ have been used as a generic term which applies to
people accessing MHJHADS who may otherwise be known as clients, patients and
consumers.

Psychologists – health practitioners registered with the Psychology Board of Australia

(AHPRA). This is inclusive of psychologists that hold provisional or general registration.

Psychological Assessment – an assessment conducted by a psychologist to gather

information about how people think, feel, behave and react. Psychological assessments
include a range of ways for gathering information and may include interview, observation,
consultation with other professionals, and formal psychological testing.

Psychological Tests – all test materials that are restricted to psychologists under test
licensing agreements, including manuals, inventories, equipment, and original test record
forms.

Psychological Testing – involves the administration, scoring and interpreting of psychological

tests.

Supported Decision Making – a person with mental disorder or mental illness must always
be given the opportunity to make decisions about their treatment, care or support to the
best of their ability and always be supported to contribute to decisions about their
treatment, care or support to the best of their ability.

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Search Terms

MHJHADS, MAJICeR, psychology, psychological tests, psychologist, neuropsychology, testing,

psychological assessment.

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Attachments

 Attachment A: Templates of Forms in MAJICeR

o Psychological Testing Referral Question for Psychologists
o Psychological Report
o Psychological Testing Feedback Session
o Information Sheet for Release of Psychology Test Data
 Attachment B: Sample Information and Consent Forms for Psychological Assessment
o Psychometric Assessment Information Sheet
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o Cognitive Assessment Information Sheet (Adult)

o Cognitive Assessment Information Sheet (Child or Adolescent)
o Psychometric/Cognitive Assessment Consent Form (Adult)
o Psychometric/Cognitive Assessment Consent Form (Child or Adolescent)
 Attachment C: Sample Test Data Sheet
 Attachment D: Psychological Testing Procedure Flowchart for Psychologists

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Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services
specifically for its own use. Use of this document and any reliance on the information contained
therein by any third party is at his or her own risk and Health Directorate assumes no responsibility
whatsoever.

Policy Team ONLY to complete the following:

Date Amended Section Amended Divisional Approval Final Approval
01/12/17 Entire review Tina Bracher, ED CHHS Policy
MHJHADS Committee

This document supersedes the following:

Document Number Document Name
No Doc Number Psychological Tests: Use, Storage and Access
No Doc Number Storage and Use of Psychological Tests

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Attachment A: Templates of Forms for MAJICeR

MAJICeR Psychological Testing Referral Question for Psychologists

This form is only to be completed by the psychologist to document the final referral question.
Members of the treating team seeking to refer a person for psychological testing are to
document the request in the MDTR file note and discuss their request with the psychologist.

Referral Question:

Recommendation (drop-down box):

- Psychological testing to be completed within community team
- Referral for psychological testing with MHS Neuropsychology team
- Psychological testing not recommended

If psychological testing to be completed within community team:

- Tests to be used:
- Notification to MHS Neuropsychology completed (drop-down box)?
o Yes
o No

If psychological testing not recommended, please provide rationale for this:

MAJICeR Psychological Report

Note: These are sample headings only [exception: disclaimers and where test data is stored].
A full psychological report may include but is not limited to the following information.
Psychologists are to adapt the information sheet to suit the needs of the testing participant
and/or the MHJHADS program area.

Name:
Date of Birth:
Date of Assessment:
Age at Testing:
Reason for Referral:

Disclaimer: This report has been prepared for clinical purposes and is not intended or
sufficient for medico-legal use. Due to the confidential and personally sensitive nature of the
information contained herein, this report is not to be provided to third parties, including the
client/family, and all requests made by third parties to access this report require formal
processing by the MHJHADS Release of Information Officer (ph: 6205 4806 or 6205 5142)

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Assessment Method:
Background:
- Presentation (including cultural factors)
- Early Childhood
- Education and Vocational History
- Social History
- Medical History
- Mental Health History
- Drug and Alcohol History
- Family Members/Carers/Nominated Person Observations
Psychological Assessment:
- Description of tests
- Mental State Examination/Presentation at Testing
- Results
Summary and Conclusions:
- Diagnosis and/or Formulation
- Treatment Recommendations
Details of testing psychologist, including qualifications:

The test data is stored in ___________________________ and not in the MHJHADS clinical
record.

MAJICeR Psychological Testing Feedback Session

Individuals provided with feedback:

Type of feedback provided (drop-down box):

- Oral
- Written
- Both Oral and Written

Summary of feedback session:

Reason why feedback not provided:

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MAJICeR Information Sheet for Release of Psychology Test Data

Under the Australian Psychological Society Code of Ethics and the Ethical Guidelines for
Psychological Assessment and the Use of Psychological Tests, psychologists have a
responsibility to secure psychological assessment/test data from unqualified professionals
and the public and to safeguard the confidentiality of psychological assessment data.
Psychological test data should only be interpreted by a psychologist registered with the
Psychology Board of Australia. They should not be released to any other persons because
they have the potential to cause harm through misuse or misinterpretation.

As such, psychology test data is stored separately to MAJICeR as per the aforementioned
ethical guidelines.

Requests for information contained in psychology files must be made via the MHJHADS
Release of Information Officer (ph: (02) 6205 4806 or (02) 6205 5142), who will consult with
the Senior Neuropsychologist or the Discipline Principal of Psychology regarding the
appropriate release of test data.

Under the Australian Psychological Society Ethical Guidelines for Psychological Assessment
and the Use of Psychological Tests (2014), testing documents may be deemed exempt
documents on the grounds that disclosure would be contrary to the public interest, where
disclosure would:
a) Invalidate the utility of the test or tests in the practice of psychology;
b) Impair the ability of psychologists to perform their duties properly;
c) Constitute a breach of the contractual arrangements under which psychologists are
supplied with test materials.

In the event the psychology file is to be released, it will only be released to a psychologist
with general registration with the Psychology Board of Australia (or equivalent in the case of
international request).

Guidelines:
 Australian Psychological Society Ethical Guidelines on Record Keeping (2004)
 Australian Psychological Society Code of Ethics (2007)
 Australian Psychological Society Ethical Guidelines for Psychological Assessment and the
Use of Psychological Tests (2014)
 Australian Psychological Society Managing Legal Requests for Disclosure of Test Data and
Test Materials (2015)

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Attachment B: Sample Information and Consent Forms for Psychological Assessment

Note: This is a sample information sheet. Psychologists are to adapt the information sheet to
suit the needs of the testing participant and/or the MHJHADS program area.

Psychometric Assessment: Information Sheet

What is a psychometric assessment?

A psychometric assessment aims to assess psychological functioning which may include
psychological difficulties and personality traits. A psychometric assessment is used to more
objectively detect areas of strength and difficulty and identify their impact on a person’s life.
The information gained from the assessment is used to help with diagnosis, understanding
of personal strengths and weaknesses, and identifying best treatment.

What is the process?

A psychologist with training and experience can carry out psychometric assessments. The
assessment involves an interview and completion of standardised questionnaires or other
psychological assessment tools. You will be asked to provide information about your
medical and psychiatric history, education, employment and social relationships.

The psychologist will write a report based on the interview and questionnaire. The report
will include a summary of the findings and specific recommendations, and a copy will be
made available to your psychiatrist, case manager and other relevant health care
professionals. You will receive feedback from the psychologist, where you will be free to
ask questions and discuss the recommendations.

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Note: This is a sample information sheet. Psychologists are to adapt the information sheet to
suit the needs of the testing participant and/or the MHJHADS program area.

Cognitive Assessment: Information Sheet (Adult)

What is a Cognitive assessment?

A cognitive assessment aims to objectively assess a range of thinking abilities via
standardized tests of cognition and interview with a psychologist. These thinking abilities
might include intellectual functioning and academic skills. The information gained from the
assessment is used to help with diagnosis, understanding of personal strengths and
weaknesses, and identifying best treatment or compensatory approaches. In addition, the
information can be useful to guide decision making about important areas of life, like
independent living or returning to work or study.

What is the process?

A psychologist with training and experience in cognitive assessment can carry out the
assessment. The assessment involves an interview and cognitive tasks. The interview is
held over a one to two hour period. During this time, the psychologist will want to listen to
any concerns you may have about your thinking abilities. You will be asked to provide
information about your medical and psychiatric history, education, employment and social
relationships. You can ask someone to attend the interview with you (e.g. partner, family
member, carer), as speaking to someone who knows you well can also be helpful. It might
also be necessary for the psychologist to review medical records and previous educational
assessments.

If appropriate, following the interview, the psychologist will ask you to complete a set of
tasks that measure specific areas of thinking ability. The tasks are completed with the
psychologist over a series of sessions to ensure you do not become tired. The psychologist
will write a report based on the interview and task performance. The report will include a
summary of the findings and specific recommendations, and a copy will be made available
to your psychiatrist, case manager and other relevant health care professionals. You will
receive feedback from the psychologist, where you will be free to ask questions and discuss
the recommendations.

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Note: This is a sample information sheet. Psychologists are to adapt the information sheet to
suit the needs of the testing participant and/or the MHJHADS program area.

Cognitive Assessment: Information Sheet (Child or Adolescent)

What is a cognitive assessment?

A cognitive assessment aims to objectively assess a range of thinking abilities via
standardized tests of cognition and interview with a psychologist. These thinking abilities
might include short-term memory, attention, visuo-spatial functions, language, planning,
reasoning, intellectual functioning and academic skills. Children and adolescents can
experience difficulties with cognitive abilities as a result of a number of factors including a
genetic condition, brain injury or disease, a specific learning disorder, mental illness or
medical illness. A cognitive assessment is used to objectively detect areas of strength and
difficulty and identify the impact that these changes might have on family and social
relationships, education and achievement, and mood and behaviour.

The information gained from the assessment is used to help with diagnosis, understanding
of personal strengths and weaknesses, and identifying best treatment or compensatory
approaches. In addition, the information can be used to guide decisions about important
areas of life, like education programs, independent living or vocational training.

What is the process?

A psychologist with training in cognitive assessment can carry out assessments. The
assessment involves an interview and cognitive tasks. The interview is usually held over a
one to two hour period. During this time, the psychologist will want to listen to any
concerns about your child or adolescent’s thinking abilities. You will be asked to provide
information about their medical and psychiatric history, education, social functioning and
family relationships. It might also be necessary for the psychologist to review their
developmental, medical and educational records, as well as speak to their teacher and GP.

If appropriate, following the interview, the psychologist will ask your child/adolescent to
complete a set of tasks that measure specific areas of cognitive ability. The tasks are
completed with the psychologist over a series of sessions (up to two hours at a time) to
ensure that they do not become tired. The psychologist will write a report based on the
interview and task performance. The report will include a summary of the findings and
recommendations, and a copy will be made available to your child’s psychiatrist, case
manager and other relevant health care professionals. You will receive feedback from the
psychologist, where you will be free to ask questions and discuss the recommendations.

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Note: This is a sample consent form. Psychologists are to adapt the consent form to suit the
needs of the testing participant and/or the MHJHADS program area.

Psychometric or Cognitive Assessment: Consent Form (Adult)

I _________________________________________(Name), __________________ (DOB) of

__________________________________________________________________ (Address)
consent to receiving a psychometric or cognitive assessment.

I have read and understood the information sheet regarding psychometric or cognitive
assessment and I have had the opportunity to ask questions and have them answered to my
satisfaction.

I understand that the information gathered in the psychometric or cognitive assessment will
be used to assist with decisions about my continued health care. The assessment will be
conducted by a registered Psychology Board of Australia psychologist in accordance with the
Australian Psychological Society Code of Ethics.

I am aware that the testing information will be kept in a secure location and that the
information will be kept confidential within Mental Health, Justice Health and Alcohol and
Drug Services, ACT Health unless required to be released for specific reasons in accordance
with the Health Records (Privacy and Access) Act 1997. Exemptions may apply to the release
of specific psychological testing material and data.

I understand that my participation is voluntary and I am able to withdraw my consent at any

time without negative consequence to my health care treatment.

Signed: _______________________ Date: _________________

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Note: This is a sample information sheet. Psychologists are to adapt the information sheet to
suit the needs of the testing participant and/or the MHJHADS program area.

Psychometric or Cognitive Assessment: Consent Form (Child or Adolescent)

I ______________________________________ (parent/guardian), consent to my child

___________________________________ (child’s name) ___________ (DOB) of
______________________________________________________________ (address)
receiving a psychometric or cognitive assessment.

I have read and understood the information sheet regarding psychometric or cognitive
assessment and I have had the opportunity to ask questions and have them answered to my
satisfaction.

I understand that the information gathered in the psychometric or cognitive assessment will
be used to assist with decisions about my child’s continued health care. The assessment will
be conducted by a registered Psychology Board of Australia psychologist in accordance with
the Australian Psychological Society Code of Ethics.

I am aware that the testing information will be kept in a secure location and that the
information will be kept confidential within Mental Health, Justice Health and Alcohol &
Drug Services, ACT Health unless required to be released for specific reasons in accordance
with the Health Records (Privacy and Access) Act 1997. Exemptions may apply to the release
of specific psychological testing material and data.

I understand that my child’s participation is voluntary and I am able to withdraw my consent

at any time without negative consequence to my child’s health care treatment.

Signed: _______________________ Date: __________________

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Attachment C: Sample Test Data Sheet

Note: This is a sample data sheet. Psychologists are to modify the Data Sheet to include all
psychological tests administered, relevant scores, and statistical analyses.

MHJHADS Psychological Testing Data Sheet

PLEASE NOTE: These data are strictly confidential and should only be interpreted by a
registered psychologist. They should not be released to any other persons because they
have the potential to cause harm through misuse or misinterpretation.

Patient ID
Dates of assessment
Age
Handedness
Education

Effort Measures
Measure Raw Score Base Rates Descriptor

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NOTES.

Wechsler Adult Intelligence Scale –IV (The Psychological Corporation)

Subtest Raw Score Sc S %ile Descriptor
Similarities
Vocabulary
Information
Block Design
Matrix Reasoning
Visual Puzzles
Digit Span (, , )
Arithmetic
Symbol Search
Coding
Composite
Index Sum SS %ile Descriptor
Score
VCI
PRI
WMI
PSI
FSIQ
GAI

NOTES: LDSF: , LDSB: , LDSS:

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Significant WAIS-IV Index -level discrepancy comparisons

Index Comparisons Difference Critical Value Base Rate
VCI < PRI
VCI < WMI
VCI > PSI
PRI > PSI
WMI > PSI
FSIQ < GAI
Significant WAIS-IV Subtest -level discrepancy comparisons
Subtest Comparisons Difference Critical Value Base Rate
N/A - - -

*Discrepancy comparisons made using the overall sample and at the .05 significance
level
* Base rates ≤ 10 are considered clinically unusual.

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Wechsler Memory Scale –IV (The Psychological Corporation)

Subtest Raw Score Sc S %ile Descriptor
Logical Memory I
Logical Memory II
LM II Recognition (cum)
Visual Reproduction I
Visual Reproduction II
VR II Recognition (cum)
Designs I
Designs II
DE II Recognition (cum)
Symbol Span
Index Sum SS Index Sc %ile Descriptor
Auditory Memory*
Visual Memory
Immediate Memory
Delayed Memory

NOTES: *AMI substituting CVLT-II for Word Pairs

Significant WMS-IV Index -level discrepancy comparisons

Index Comparisons Score 1 Score 2 Contrast SS
N/A - - -
Significant WMS-IV Subtest -level discrepancy comparisons
Subtest Comparisons Score 1 Score 2 Contrast SS
LM Recognition vs. Delayed
Recall
Ability-Memory Analyses
Comparisons Score 1 Score 2 Contrast SS
GAI vs. AMI
GAI vs. VMI
GAI vs. IMI
GAI vs. DMI
VCI vs. AMI
PRI vs. VMI
WMI vs. AMI

Note. Contrast score values between 6 and 14 indicate that performance on the index
scores do not vary from one another.

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California Verbal Learning Test – Second Edition

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Subtest Raw Z score Descriptor

Trials 1-5 Total (, , , , ) (T)
Short Delay Free Recall Correct
Short Delay Cued Recall Correct
Long Delay Free Recall Correct
Long Delay Cued Recall Correct
Total Intrusions
Total Repetitions
Delayed Recognition Hits
Delayed Recognition False Positives

NOTES:

Verbal Fluency
Index Raw SS Descriptor
1. Letter Fluency (FAS)
2.

Boston Naming Test

Measure Raw Sc Z Score Descripto

r

Spontaneous correct

Notes. Semantic cues: . Phonemic cues:

Depression, Anxiety, Stress Scale (DASS-21)

Measure Raw Sc Descriptor

Depression

Anxiety

Stress

Notes.

Rey Complex Figure (Meyer and Meyer; PAR, 1995)

Raw %ile Descriptor
Copy

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Time to copy
3” delay
30” delay
NOTES:
Recognition:

Delis-Kaplan Executive Function System (DKEFS)

COLOUR-WORD Condition Raw Time Scaled Sc Descriptor

INTERFERENCE

Colour Naming

Word Reading

Inhibition

Inhibition/Switc
h

Errors Raw Cumulative % / SS Descriptor

Colour Naming

Word Reading

Inh/sw uncorr.

Inh/sw total

TRAILS Condition Raw Time Scaled Sc Descriptor

Visual Scanning

Number Sequencing

Letter Sequencing

Switching

Motor Speed

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Attachment D: Psychological Testing Procedure Flowchart for Psychologists

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