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Book Review   |    
Psychological Assessment in Managed Care
John David Ball,, Ph.D.
Psychiatric Services 1998; doi:
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by Chris E. Stout; New York City, John Wiley & Sons, 1997, 276 pages, $45

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Chris Stout holds a doctoral degree in psychology and a master's degree in business administration and is a high-ranking managed care executive; thus he is well suited to have written this book. In it he details a cost-conscious, business-minded perspective on practice issues for testing specialists. Busy practicing psychologists and psychology students are particularly apt to find the book informative and helpful. Other mental health professionals will likely scan much of the material because they will be more interested in the managed care discussions than in details of psychological testing.

The book is an interesting, current, light reference text to be read casually once and then kept nearby for its links to other materials. Dr. Stout is among the first to address explicitly the impact of managed care on psychological testing. Because, as he points out, 90 percent of psychologists are involved in testing, the title alone will sell many copies. Dr. Stout avoids any extended discussion of the many controversies over managed care curtailments and simply begins with the assumption that restricted care is the new reality. He speaks realistically about the new constraints managed care imposes and the new opportunities it presents.

While I was positively impressed by much of this book, I found flaws that prospective readers should anticipate. Early chapters are informative but superficial. Chapter 1 presents an assortment of interesting facts and ideas, but it is neither a signpost for where the book is going nor a thorough integration of managed care and testing themes. An early misspelling— "Wexler" instead of "Wechsler" Adult Intelligence Scale—is an unfortunate error. Only by reading further does the reader realize that the author is not as naive as this error makes him appear. However, the book gives the impression of being written quickly. Dr. Stout seems to arbitrarily select tests to highlight. He rarely says enough about any instrument for the discerning psychologist to decide whether or not to use it. Of particular concern, he never cautions the reader about the importance of psychometric properties of test instruments. Individually designed survey questionnaires and clinician rating forms are not distinguished from sophisticated tests backed by decades of research attesting to their reliability and validity.

Neuropsychological testing is generally given short shrift. A section on malingering fails to discuss the different types of malingering that clinicians encounter. Thus the tests discussed in this section are of more use to courtroom attorneys facing head-injury plaintiffs than to medical colleagues sorting through pain patients' self-determined needs for medical interventions.

These examples illustrate a pattern in which Dr. Stout initiates topics that hold great promise but then provides only sketchy information. Psychological Assessment in Managed Careis intended as a broad overview rather than an in-depth treatment of complicated issues. It is written in the fast, easy style of many business books, although the author's extensive knowledge of testing and managed care becomes readily evident.

Specific strong points include a discussion of treatment outcome measurement, an excellent chapter on risk management for testing psychologists, an interesting array of annotated research references addressing medical offset from psychological treatment, and a guidebook chapter on issues specific to automated assessment. Good discussions about the risks and benefits of computer-assisted testing are found throughout the text and are concentrated in the last chapter. References to software developers and a broadened discussion of practice-management software make this material a very practical inclusion.

Happily, throughout the book Dr. Stout reminds all mental health professionals and managed care leaders that psychological assessment is a critical aspect of behavioral health care. Psychologists who implement his ideas will help ensure that psychological testing has a promising future.

Dr. Ball is professor of psychiatry and behavioral sciences at Eastern Virginia Medical School and neuropsychology coordinator at Eastern State Hospital in Williamsburg.

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