Telepractice and the EVT

The telepractice information in this document is intended to support professionals in making

informed, well-reasoned decisions around remote assessment. This information is not intended to
be comprehensive regarding all considerations for assessment via telepractice. It should not be
interpreted as a requirement or recommendation to conduct assessment via telepractice.

Professionals should remain mindful to:

• Follow professional best practice recommendations and respective ethical codes

• Follow telepractice regulations and legal requirements from federal, state and local authorities,
licensing boards, professional liability insurance providers, and payors

• Develop competence with assessment via telepractice through activities such as practicing,
studying, consulting with other professionals, and engaging in professional development.

Professionals should use their clinical judgment to determine if assessment via telepractice is
appropriate for a particular examinee, referral question, and situation. There are circumstances
where assessment via telepractice is not feasible and/or is contraindicated. Documentation of all
considerations, procedures, and conclusions remains a professional responsibility.

Several professional organizations and experts have provided guidance on telepractice assessment
(American Psychological Association Services [APA Services], 2020; Association of State and
Provincial Psychology Boards [ASPPB], 2013; Grosch et al., 2011; Inter Organizational Practice
Committee [IOPC], 2020; Stolwyk et al., 2020) to assist professionals in decision making and ethical
and legal practice issues. The American Speech-Language-Hearing Association (ASHA) Practice Portal
includes guidance and resources specific to speech-language pathologists, audiologists, and other
qualified professionals (www.asha.org/practice-portal/).

The Expressive Vocabulary Test (EVT; Williams, 1997, 2007, 2019) can be administered in a
telepractice context by using digital tools from Q-global®, Pearson’s secure online-testing and
scoring platform, or by Q-interactive®, Pearson’s secure digital administration system using two
iPads. Specifically, Q-global digital assets (e.g., stimulus books) can be shown to the examinee in
another location via the screen-sharing features of teleconferencing software. Details regarding Q-
global and how it is used are provided on the Q-global product page.

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A spectrum of options is available for administering this assessment via telepractice; however, it is
important to consider the fact that the normative data were collected via face-to-face assessment.
Telepractice is a deviation from the standardized administration, and the methods and approaches
to administering it via telepractice should be supported by research and practice guidelines when
appropriate.

Professionals engaging in telepractice assessment may train facilitators to work with them on a
regular basis. If such a facilitator is well trained and in a professional role (i.e., a professional
facilitator), they can present materials and adjust audiovisual equipment. This approach may yield
scores that are available in face-to face assessment mode. If a professional facilitator is not used, it
may impact the workflow of the session and the approach to deriving scores.

In times when physical distancing is necessary (such as the COVID-19 pandemic), using a
professional facilitator may not be safe or feasible. If testing must occur under these conditions, it is
possible that the examinee may participate without the help of an on-site facilitator. In the case of
the EVT, it is possible that the examinee may participate with or without the help of an on-site
facilitator. If the examiner determines that no facilitator is required, the examinee can assist with
technological and administrative tasks during testing and should be oriented to these
responsibilities before, and again at the beginning of, the session. An initial virtual meeting should
occur in advance of the testing session to address numerous issues specific to testing via
telepractice. This initial virtual meeting is described in the administrative and technological tasks
portion of the Examiner Considerations section and referred to in various sections of this document.
The examiner should consider best practice guidelines, the referral question, and the examinee’s
condition, as well as telepractice equivalence study conditions, to determine if this is possible and
appropriate. Independent examinee participation may not be possible or appropriate, for example,
for examinees with low cognitive ability or with low levels of technological literacy and experience.

If the examiner determines that the examinee cannot participate independently, and testing must
occur under physical distancing constraints, the only facilitator available may be someone in the
examinee’s home (e.g., a parent, guardian, or caregiver). If the on-site facilitator is not in a
professional role (i.e., nonprofessional facilitator), they can assist with technological and
administrative tasks during testing and should be oriented to these responsibilities in the initial
virtual meeting and again at the beginning of the session.

Professional and nonprofessional facilitators typically do not remain in the room with the examinee
throughout the testing session. The examiner should plan to minimize (as much as possible) the
need for the facilitator to remain in the room. In rare cases when the facilitator must remain in the
room, they should do so passively and unobtrusively; they should merely monitor and address the
examinee’s practical needs, as well as any technological or administrative issues as necessary. The
facilitator’s role should be defined clearly by the examiner. The facilitator should only perform those
functions the examiner approves and deems necessary. In any case, if a facilitator is necessary, it is
preferred that the facilitator remain accessible.

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Conducting Telepractice Assessment
Conducting a valid assessment in a telepractice service delivery model requires an understanding of
the interplay of a number of complex issues. In addition to the general information on Pearson’s
telepractice page, examiners should address five factors (Eichstadt et al., 2013) when planning to
administer and score assessments via telepractice:

1. Telepractice Environment & Equipment

Assessment Materials & Procedures

Examinee Considerations

Examiner Considerations

Other Considerations

1. Telepractice Environment & Equipment

Computers and Connectivity

Two computers with audio and video capability and stable internet connectivity—one for the
examiner and one for the examinee—are required. A web camera, microphone, and speakers or
headphones are required for both the examiner and the examinee. A second computer screen or
split-screen format on a large computer monitor for the examiner is helpful to allow a view of a
Pearson-delivered digital manual or administration directions, but the examiner can also use the
paper format manual or administration directions. The second computer screen or large screen also
tends to make sharing test content more straightforward for the examiner.

Image/Screen Size

When items with visual stimuli are presented, the digital image of the visual stimuli on the
examinee’s screen should be at least 9.7” measured diagonally, similar to an iPad® or iPad Air®.
Some teleconferencing software shrink the size of images, the image size should be verified in the
initial virtual meeting. It is recommended that computer screens used for teleconference
assessment be at least 15” measured diagonally. Smaller screens, such as those of iPad minis, small
tablet PCs, and smartphones, are not allowed for examinee-facing content, as these have not been
examined empirically and may affect stimulus presentation, examinee response, and validity of the
test results. Similarly, presenting stimuli on extremely large screens has not been examined, so the
same precaution applies. At the beginning of the testing session, the examiner may ask for a
peripheral camera or device (as described later in this section) to be aimed at the examinee’s screen
to ensure that the examinee’s screen is displaying images in the correct aspect ratio and not
stretching or obscuring the stimuli image.

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Audio Considerations

High-quality audio capabilities are required during the administration. An over the head, two-ear,
stereo headset with attached boom microphone is recommended for both the examiner and
examinee. Headphones with a microphone may be used if a headset is not available.

The examiner should test the audio for both the examiner and examinee in the initial virtual
meeting and at the beginning of the testing session to ensure a high-quality audio environment is
present. Testing the audio should include an informal conversation before the administration where
the examiner is listening for any clicks, pops, or breaks in the audio signal that distort or interrupt
the voice of the examinee. The examiner should also ask if there are any interruptions or distortions
in the audio signal on the examinee’s end. Any connectivity lapses, distractions, or intrusions that
occurred during testing should be reported.

Audiovisual Distractions

As with any testing session, the examiner should do everything possible to make sure the
examinee’s environment is free from audio and visual distractions. If the examiner is unfamiliar with
the examinee’s planned physical location, a visual tour of the intended testing room should be given
during the initial virtual meeting. The examiner can then provide a list of issues to address to
transform the environment into one suitable for testing. For example, remove distracting items,
silence all electronics, and close doors. The examiner should confirm that these issues have been
addressed at the time of testing. If possible, the examinee should be positioned facing away from
the door to ensure the examiner can verify through the examinee’s camera that the door remains
shut and can monitor any interruptions. The examiner should confirm that all other applications on
the computer, laptop, or peripheral device are closed, the keyboard is moved aside or covered after
the session is connected, and alerts and notifications are silenced on the peripheral device. Radios,
televisions, other cellular phones, fax machines, smart speakers, printers, and equipment that emit
noise must be silenced and/or removed from the room.

Lighting

Good overhead and facial lighting should be established for the examiner and examinee. Blinds or
shades should be closed to reduce sun glare on faces and the computer screens.

Teleconferencing Software

Teleconferencing software is required. Screen-sharing capability is required if anything other than

items with verbal stimuli and responses are administered.

Video

High-quality video (HD preferred) is required during the administration. Make sure the full faces of
the examiner and the examinee are seen using each respective web camera. The teleconferencing
software should allow all relevant visual stimuli to be fully visible to the examinee when providing
instruction or completing items; the view of the examiner should not impede the examinee’s view of
visual test stimuli.

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Peripheral Camera or Device

A standalone peripheral camera can be used to provide a view of the session from another angle or
a live view of the examinee’s progress. Alternately, a separate device (e.g., a smartphone with a
camera or another peripheral device) can be connected to the teleconference and set in a stable
position to show the examinee’s pointing or written responses. The device’s audio should be
silenced and microphone should be muted to prevent feedback. This second camera is helpful but
not needed for EVT because the items require only verbal responses from the examinee.

Screen-Sharing Digital Components

Digital components are shared within the teleconferencing software as specified in Table 1. There
are two ways to view digital components in the Q-global Resource Library: through the pdf viewer in
the browser window or full screen in presentation mode. Always use full screen (i.e., presentation)
mode for digital components viewed by the examinee. This provides the cleanest presentation of
test content without on-screen distractions (e.g., extra toolbars). Refer to Using Your Digital Assets on
Q-global in the Q-global Resource Library for complete directions on how to enter presentation
mode.

2. Assessment Materials & Procedures

Test Item Security

The examiner is responsible for ensuring test item security is maintained, as outlined in the Terms
and Conditions for test use. The examiner should address test security requirements with the
examinee (and facilitator, if applicable) during the informed consent process. The examiner should
make it clear to the examinee/caregivers that the video should not be captured, photos should not
be taken, and stimuli should not be copied or recorded, as this is a copyright violation. The
examinee must agree that they will not record (audio or visual) or take photos or screenshots of any
portion of the test materials or testing session, and not permit anyone to observe the testing
session or be in the testing room (except for a facilitator, when necessary). Any test-related
materials used in the testing session must be returned to the examiner.

Disruptions

The examiner should record any and all atypical events that occur during the testing session. This
may include delayed audio or video, disruptions to connectivity, the examinee being distracted by
external stimuli, and any other anomalies. These can be noted on the record form or in the notes
section on Q-interactive, if applicable, and should be considered during interpretation and described
in the written report. Refer to Other Considerations for guidance on report writing.

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Digital Assets

The examiner should practice using the digital assets until the use of the materials is as smooth as
an in-person administration. It is not recommended that the examiner display items from paper
stimulus books on a camera. Refer to Using Your Digital Assets on Q-global in the Q-global Resource
Library for complete directions.

Gesturing

When gesturing to the stimulus books is necessary, the examiner should display them as digital
assets on-screen and point using the mouse cursor. Refer to Table 1 for specific instructions by
subtest.

Content Considerations

Review Table 1 for the specific telepractice considerations for each subtest to be administered.

Table 1. Specific Telepractice Considerations

Subtest(s) Considerations
• Requires high-quality audio for examinee and examiner
• Examiner shows the visual stimuli and provides a verbal prompt
• Examinee views image on-screen and responds verbally
• Examiner provides a specific stimulus prompt if the examinee’s
response approximates/corresponds to the target response. For
example, if the examinee says “luggages” rather than “luggage,” the
Expressive Vocabulary examiner provides the stimulus prompt of “give me a different form
of that word.”
• If the examinee’s response is a phrase that includes the target word,
then the examiner can score without asking the examinee to respond
with only one word. For example, if the examinee responds with “a
set of luggage” for the target luggage, the examiner can score the
response as 1.

Evaluating Equivalence Evidence

Examiners should review the current research available on equivalence between different modes of
administration before proceeding to use remote administration of a standardized assessment with
normative data collected via in-person assessment. When reviewing the literature, the examiner
should consider the input and output requirements for each task, and the evidence available for
telepractice equivalence for the specific task type. Direct evidence of equivalence for a specific task
may be available because the task was researched in a study with results indicating no significant
difference between telepractice and in-person assessment. Indirect evidence may also be reported
in the literature for a task that is similar in construct and input/output demands to the standardized
assessment being considered for remote administration and may help determine the examiner’s
level of confidence in applying the norms. For instance, a study demonstrating direct evidence for

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the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Picture Naming
subtest also demonstrates valuable indirect evidence for the WISC-V Vocabulary and CLQT+
Confrontation Naming subtests because Picture Naming, Vocabulary, and Confrontation Naming all
require brief spoken directions with pictorial stimuli inputs with open-ended spoken response
outputs. Examiners can have more confidence that the normative scores are valid when tasks have
direct evidence showing equivalency between modes.

In reviewing the literature of telepractice–in-person and digital–traditional investigations,

professionals should also be mindful of the age range and population (e.g., clinical group) of the
research study to consider relevancy for the examinee. Greater caution is recommended when only
indirect evidence of equivalency is available for a task, or when equivalence has not been
established for a particular examinee’s age range and clinical condition. However, it can be
informative to consider any such available evidence when considering impact of remote
administration on results and interpretation. Pearson Clinical Assessment is tracking and
aggregating the relevant equivalence evidence for our assessments, including the age range,
population, direct evidence, and indirect evidence (see Evidence for Remote Assessment).

Research has compared results obtained in telepractice and in-person administration modes.
While equivalence data on similar measures are relevant, practitioners should be mindful that more
research is needed to establish equivalence in the youngest ages on the EVT. It is important to
consider the conditions under which equivalence studies of telepractice and in-person assessment
modes were conducted and attempt to reproduce these as closely as possible if testing via
telepractice. Typical telepractice studies that support telepractice and in-person equivalence involve
the examiner becoming very familiar with the teleconference platform by using it for its intended
purpose for several hours and administering tests (even those that are familiar in in-person mode)
multiple times to practice examinees (e.g., professional colleagues).

Telepractice involves the use of technology in assessment as well as viewing on-screen stimuli. For
these reasons, studies that investigate assessment in digital versus traditional formats are also
relevant. Investigations have produced evidence of equivalence when administered and scored via
digital or traditional formats to examinees without clinical conditions (e.g., Drozdick et al., 2016). It is
important to note that digital studies are relevant but are not always conducted remotely or via
video conference. However, equivalence has been demonstrated for examinees with or without
clinical conditions in remote studies (e.g., Dekhtyar et al., 2020; Sutherland et al., 2017).

Table 2 lists the input and output requirements of each task. The abbreviations in the Input and
Output column correspond to the various input and output requirements of each task, and a key
appears at the bottom of the table. For example, brief spoken directions as an input requirement is
abbreviated as BSD.

Table 2. Input and Output Requirements

Task Inputa Outputb
Expressive Vocabulary BSD, PS, SS BSR

Note. aInput abbreviations are: BSD = Brief spoken directions, PS = Pictorial stimuli, SS = Spoken stimuli
b
Output abbreviation is: BSR = Brief spoken response

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3. Examinee Considerations
Appropriateness

The examiner should first ensure that a telepractice administration is appropriate for the examinee
and for the purpose of the assessment. Clinical judgment, best practice guidance for telepractice,
information from professional organizations and other professional entities (e.g., licensing boards,
legal resources, professional liability insurance providers, payors), consultation with other
knowledgeable professionals, existing research, and any available federal or state regulations
should be considered in the decision-making process. Consideration should be given to whether the
necessary administrative and technological tasks involved in a telepractice session can be
accomplished without influencing results.

Preparedness

Before initiating test administration, the examiner should ensure that the examinee is well-rested,
able, prepared, and ready to appropriately and fully participate in the testing session.

Facilitator Role

If using a facilitator, the role of the facilitator must be explained to the examinee so participation
and actions are understood.

Headset

It may not be appropriate or feasible for some examinees to use a headset due to behavior,
positioning, physical needs, or tactile sensitivities, or if a headset is not available. Clinical judgment
on the appropriate use of a headset in these situations should be used. If a headset is not utilized,
the examiner’s and examinee’s microphones and speakers should be turned up to a comfortable
volume.

Mouse

On some teleconferencing software, the examiner can pass control of the mouse to allow the
examinee to point to indicate responses; this is an option if it is within the capabilities of the
examinee. However, best practice guidelines provide cautions about this. For example, the IOPC
guidelines suggest examiners be alert throughout administration, resume control of the screen once
the task is finished, and never leave the computer unattended while the examinee has control over
the examiner’s computer (IOPC, 2020).

4. Examiner Considerations
Practice

During the telepractice setup, and before administering to any actual examinee, the examiner
should rehearse the mechanics and workflow of every item in the entire test using the selected

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teleconferencing software so that the examiner is familiar with the administration procedures. For
example, a colleague could be used as a practice examinee.

Standardized Procedures

The examiner must follow the administration procedures of in-person administration as much as
possible. For example, if a spoken stimulus cannot be said more than once in in-person
administration, the examiner must not say it more than once in a telepractice administration unless
a technical difficulty precluded the examinee from hearing the stimulus.

Real-Time Troubleshooting

In order to conduct a smooth telepractice session, audiovisual needs and materials must be
managed appropriately. The initial virtual meeting involves the examiner, examinee, and/or the
facilitator (if used), and is the opportunity for the examiner to provide information about the
audiovisual needs and materials. During the initial virtual meeting, the examiner should provide
training in troubleshooting audiovisual needs that arise during the testing session, including camera
angle, lighting, and audio checks. The examiner should provide verbal feedback to guide camera
adjustment, checking the on-screen video shown by the peripheral camera/device to provide
information about how to reposition it until the proper view is shown. The examiner should
emphasize that no materials should be opened until the examiner provides instructions to do so, if
applicable. The examiner should also expect to provide verbal guidance about these issues during
the testing session. Refer to the Telepractice Environment & Equipment section and to Table 1 for
specific subtest telepractice considerations.

Collaborating With Facilitators

If used, the facilitator is to assist with administrative and technological tasks and not to manage
rapport, engagement, or attention during the testing session. The examiner should direct them not
to interfere with the examinee’s performance or responses. Any other roles and responsibilities for
which an examiner needs support, such as behavior management, should be outlined and trained
before the beginning of the testing session. The examiner is responsible for documenting all
behaviors of the facilitator during test administration and taking these into consideration when
reporting scores and performance.

5. Other Considerations
There are special considerations for written reports describing testing that takes place via
telepractice. The professional completing the written report should state in the report that the test
was administered via telepractice, and briefly describe the method of telepractice used. The
professional should also make a clinical judgment, similar to an in-person session, about whether or
not the examiner was able to obtain the examinee’s best performance. Clinical decisions should be
explained in the report, including comments on the factors that led to the decision to conduct
testing via telepractice and to report all (or not to report suspect) scores. In addition, it is
recommended that the report include a record of any and all atypical events during the testing
session (e.g., delayed video or audio, disruptions to connectivity, extraneous noises such as phone

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ringing or loud dog barking, person or animal unexpectedly walking into room, the examinee
responding to other external stimuli). List and describe these anomalies as is typical for reporting
behavioral observations in the written report, as well as any observed or perceived impact on the
testing sessions and/or results, and consider these in the interpretation of results.

An example of a written report might include:

“The EVT was administered via remote telepractice using digital stimulus materials on Pearson’s Q-
global system, and a facilitator monitored the administration on-site using a printed response
booklet during the live video connection using the [name of telepractice system, e.g., Zoom]
platform. The remote testing environment appeared free of distractions, adequate rapport was
established with the examinee via video/audio, and the examinee appeared appropriately
engaged in the task throughout the session. No significant technological problems or distractions
were noted during administration. Modifications to the standardization procedure included: [list].
The EVT, or similar tasks, have received initial validation in several samples for remote telepractice
and digital format administration, and the results are considered a valid description of the
examinee’s skills and abilities.”

Notes may be recorded about any testing issues on the record form or in the notes section on Q-
interactive.

Conclusion
This test was not standardized in a telepractice mode, and this should be taken into consideration
when utilizing this test via telepractice and interpreting results. For example, the examiner should
consider relying on convergence of multiple data sources and/or being tentative about conclusions.
Provided that the examiner has thoroughly considered and addressed the factors and the specific
considerations as listed above, the examiner should be prepared to observe and comment about
the reliable and valid delivery of the test via telepractice. Materials may be used via telepractice
without additional permission from Pearson in the following published contexts:

• EVT manuals and digital stimulus books via Q-global

• EVT via Q-interactive (requires advanced technology skills and mirroring software)

• EVT via a Pearson-licensed telepractice provider/platform

Any other use of this test via telepractice is not currently recommended. This includes, but is not
limited to, scanning the paper stimulus books, digitizing the paper record forms, holding the
stimulus books physically up in the camera’s viewing area, or uploading a manual onto a shared
drive or site.

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References
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assessment during the COVID-19 crisis. (2020).
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