The document discusses strategies for increasing efficiency and flexibility in a psychology practice. It summarizes the author's journey of returning to private practice from the business world and feeling overwhelmed by the lack of structures. The author then details various workflows and tools implemented over several years to streamline processes such as client booking and management, assessment planning and administration, scoring, and remote access. These include using a cloud-based CRM, digitizing materials, and a do-it-yourself cloud scoring system. The strategies allowed for significant increases in clients and decreases in evening/weekend work.

1. Fostering Efficiency and Flexibility in
Your Psychology Practice
Your Psychology Practice
... or ... How to caffeinate your workflow without getting the shakes

2. Michael Decaire, M.A., C.Psych.Assoc.
Credentials/Background
Member of the College of Psychologists of Ontario
Practice in Clinical Psychology (Child; Adolescent; Adult)
Specializing in psycho-diagnostics: learning/attention disorders; full spectrum
AXIS-I/II disorders
Private Practice (Hamilton/Toronto) & Hospital (Lindsay/Virtual)
Former clinical consultant with PsychCorp Canada

3. Michael Decaire, M.A., C.Psych.Assoc.
Disclosures
Business: FLEX Psychometrics
Special Interest Group Work: Ontario Association of Psychological Associates
(President); Coalition of Regulated Health Professional Associations (Board
Member); College of Psychologists of Ontario (Task Force Work)
Honoraria: Purdue Pharma

4. Workflow Analysis
A different world. Several years in the test
development and publishing world
provided a unique environment of
workflow efficiencies and quality control
mechanisms.
Big Surprise. The psychometric experts
spent a lot of time measuring themselves.
Overwhelming? 1000+ clients; 100+ client
contacts a day; 80%+ of the month out of
the office/town.
Self-evaluation, focused strategies, and support
mechanisms kept it together.

5. Returning to the real world...
I returned full-time to the clinical world
in search of a more balanced and less
pressured work life.
Reality. Leaving the business world also
meant leaving structures that I had in
place to manage information and to get
things done - well.
Overwhelmed! My first year back saw no
vacation, many evenings of scoring and
report writing, and literally dozens of 7
day work weeks.

6. Workflow Analysis
The reality of the situation was that I
had lost all my structure and was
working from A to Z in one not so fluid
step.
I needed to realize that I was still in the
business world. All that had changed
was what business I was in.
Turns out I was well prepared to reverse
this trend by combing big-business
principles and psychology strategies.

7. Self-Evaluation
What am I being asked to do?
What steps are there to reach this goal?
Am I combining more than one step at a time?
How much time is each step taking me?
Am I the best person to be doing this step?
Where am I feeling overwhelmed?

8. Before the solution - the results..
Year Two
33% increase in clients
500% decrease in evening/weekend work
Took a vacation
Year Four
90% increase in clients
Evenings and weekends down to a handful
6 weeks off for vacations and conferences
Year Five (so far)
Maintaining same client load
Two weekends worked so far
Down to four days a week
Away 4 weeks so far ...

9. Examining The Process: A to Z
Let’s walk through my current workflow.
Remember that this has been the culmination of a
four year process of self-assessment,
development, and a bit of trial-and-error
Trying to adjust all of this at once would have
undoubtedly failed.
Everyone’s workflows (and brains) are different
so some of this may not fit with you, your client
base, or your environment.
Is there one thing here that could make a change
for you tomorrow?

10. Assessment Workflow
Intake and booking the client
Planning the assessment
The assessment
Scoring
Interpretation
Report Writing
Feedback

11. Booking & Client Management
If you start off disorganized you are not likely
to become increasingly streamlined or focused
as you move through the assessment process.
The reality is that many of us don’t integrate
the administrative and clinical aspects of our
work in a way that promotes fluid and flexible
movement towards are end goals.
We spend a lot of time with logistical busy
work, when we should be spending time being
clinicians (and office managers).
We asked ourselves if there was a better way?

12. The New Way... CRM
Amongst my partners we literally
evaluated dozens of cloud (online) and
locally based CRM’s before I settled on
CapsuleCRM (www.capsulecrm.com)
for my client management.
It is an entirely mobile solution that
allows me to manage a client’s entire file
from any computer, tablet, or
smartphone.
It integrates with other free or for-fee
solutions that allow me to expand my
business.
Cloud Solution
Current Cost:
$36/month (3 users)

13. The New Way... CRM
I initially explored this option because I was having difficulty
keeping up with a lot of the small logistical aspects of my
practice:
Documenting all points of contact
Keeping track of to-do’s that were not in my normal
workflow
Keeping track of my team when either of us are off-site
In the end, a good CRM solution solved all of these problems
and added structure to all aspects of my practice.

14. Keeping Track: Contact/Intake
A phone call, email, or
web-inquiry comes in
regarding a potential client
This is added as an
“opportunity” in order to
not fill our client files with
people we’ve never seen
We can assign a step-wise
“track” (workflow) at this
point (e.g., therapy;
psychoed; gifted)
Assign to a specific staff

15. Keeping Track: Workflow
Client either books during the initial call, calls back later, or
does not book.
If they go ahead with the booking, they are converted at the
press of a button to an active client.
Those who do not book are left as opportunities (just non-
active ones)
These are not deleted because we can use the opportunity
vs. converted data to plot our intake conversion rates

16. Keeping Track: Booking
Now that they are a client we
go ahead with collection of
additional information.
The actual client becomes an
“organization” (main client)
which is then tagged with
supplementary “people” (e.g.,
parents).
This keeps the system cleaner
regarding who is the actual
client.

17. Keeping Track: Workflow
Once they become a client the
“workflow”-track tag initiates a series
of to-do and appointment items that
will be completed as part of the
assessment.
Each individual team member is
alerted to their new tasks
Anyone can view the progress of
the case and what the next step is
We can make sure that we’ve
always dotted the i’s and crossed
the t’s.

18. Keeping track: Points of Contact
From either a computer, tablet, or
smartphone I can click on the email
address to open my email client and
send an email that will automatically
be attached to the client file.
I can forward replies back to the
CRM with a push of a button and
they also get attached.
On my phone I can click on the
phone number to initiate a phone
call.

19. Keeping track: Notes and files
All of the teams session notes are
organized in one place, by date, and
identifying who made the entry.
Paper based notes, consent forms,
releases, and other small paperwork
are taken as a photo. This can be
attached as a JPG or as a PDF (e.g.,
JotNot app).
Reports attached as PDF’s and/or
editable formats.
Rest of file scanned (Fujitsu), backed
up, and into shredder.
Productivity boost: Dictate notes from
your computer or smartphone.

20. Keeping Track: Calendar
You can view any or all team
members calendars in either a
traditional format or as a task list.
This can be exported securely to a
diverse range of calendar
applications (e.g., iCal; Outlook;
Google Calendar)
The task list workflow allows you to
see the clients progress regardless of
the team member involved and to
quickly assess what step is next.
To-do’s can be sent as a daily email.

21. All of this is integrated in a single “client file” page

22. When away ...
The majority of this is also available
on my smartphone:
Contact information
Notes and email history
Tasks and calendar entries
Assign new tasks with full
delegation features
Available on and offline

23. Keeping Track: Billing
CRM’s generally don’t have billing
and invoicing integrated in directly
Local (non-cloud) CRM’s generally
pair well with other local invoicing
solutions (e.g., QuickBooks)
Cloud CRM’s often allow you to
integrate your workflow with cloud
invoicing solutions (e.g.,
Freshbooks)

24. Keeping Track: Expanding
CloudCRM’s generally include a
number of additional integration
opportunities that may expand or
streamline your practice:
Estimates and time-tracking
Invoicing and accounting
Mailing lists / Newsletters
Website contact forms
Surveys for collecting client
information
Email automation

25. CRM: Summary
Organizing your client information and workflow from the very start will allow you to stop
spending mental and physical resources keeping track of logistics and instead focus on what
you do best.
Onsite hardware/software combinations (e.g., Microsoft Dynamics CRM; Daylite CRM):
Powerful tools that can usually be adapted to your specific work environment
Hefty set up costs and will usually require initial consultant support
May lock you in to specific technology
Cloud based CRM software (e.g., CapsuleCRM; Salesforce)
Powerful if they can fit your workflow
Mobile access and cross-technology compatible
Less risk of theft

26. Assessment
While assessment (and treatment) is
the first time we can flex our
psychology muscle in an assessment,
there is still a marked difference in
how smoothly this process can go.
Many small and easy to implement
steps can focus your work and
provide information that easily
integrates into your report writing
workflow.
How can we see the forest though
the trees?

27. Assessment
I looked at how we could streamline, focus,
and improve each major step:
Assessment Planning
Client-Parent interviews
Structured Observations
Diagnostic Verifications
Digital Administration

28. Keeping Organized
Similar to most of you, I keep a list of
potential tests that I can use as a
checklist of “to-do” and “completed”
items for myself and my
psychometric team.
I generally label this by the session
number, whether something is a
wish-list, and whether something is
to be done through a prescriptive
approach (e.g., if this - then that)
With a few exceptions, each area is
broken down in a manner similar to
how the report will be divided.

29. Parent Interview
Parent interviews are developed to
match the manner in which I report
on these in my background:
Birth, Developmental, and
Medical History
Behavioural, Social, and
Emotional Development
Academic History
Assessment and Treatment
History

30. Observation Sheets
My goal was to be able to write reports off-site with literally no paper on hand.
A missing element was when I came across outlier data that I could not easily
explain during my interpretation and report writing without referring back to
notes within the original record form.
Borrowing a great idea (now abandoned) from the WIAT-II record form, I created
a series of “observation” checklist sheets to be used by my psychometrists and
myself during each assessment.
Currently we are using this on paper and scanning to PDF - but we will all be
moving to an iPad/iPen (an alternative stylus from Cregle) shortly.

31. Observation Sheets

32. Diagnostic Interviews
Much of my graduate research and my early clinical career was in forensics
That environment demanded that diagnostic decisions be made on the basis of
quantifiable criteria and not just statistical elevations on surveys and general
perception that a person has a disorder or not
While I left forensics behind, this approach always stuck with me and seems to
have inadvertently led to a great deal of referrals from physicians and
psychiatrists in my area (which at first surprised me outside of LD cases)

33. Diagnostic Interviews
I spent a lot of time speaking to these referrals (and I continue to do this) to
determine what exactly they wanted from psychology, given that they are just as
capable of making most of these diagnoses
Looking for a fine tuned assessment that will sort out diagnoses in
logistically complex cases (e.g., comorbidity vs. differential diagnosis)
Want a step-wise evidence based approach to diagnosis that they can stand
behind for the purpose of disability applications and program referral

34. Diagnostic Interviews
Providing a criteria driven approach
to diagnosis used to mean that I had
to lug around the DSM
I did use the SCID, which I continue
to use in many cases, but several
disorders were almost entirely
ignored (e.g., GAD).
DSM-IV on iPad/iPhone was a
logistical nightmare
My DIY Solution: PDF’s of diagnostic
criteria stored on my iPad (can be
filled out right on the device with a
stylus or Cregle iPen)

35. Digital Expansion
The DSM project made me think about how I can digitize other aspects of my
assessment process:
How can I have more of my toolkit on-hand when I need them
How can I do this without breaking the assessment flow
Where do I risk compromising standardized administration procedures
What can I do that does not violate copyright/fair-use laws in my region

36. Digital Expansion
A long history of damaged audio
CD’s and now useless cassettes
meant my first step was to make
electronic copies of my audio-
stimuli for tests like CTOPP, TEA-
Ch/TEA, & SCAN-A/C-SCAN
These can be managed through an
MP3 player or computer or across
all platforms through cloud services
like Dropbox
Now no matter where I am (or what
I forgot) I have easy access to my
audio stimuli

37. Digital Expansion
Digitizing visual stimuli like figure drawing and projective activities has been
tempting, but do bring up potential standardization concerns (e.g., Can the sizing be
done correctly? Does the medium impact attention?).
The test publishers have increasingly promised computer and tablet based products
so the future may be increasingly expansive in this regard
While there may be little else that can be done from a stimuli perspective (I’m open
to ideas!), these devices can also be used to record oral responses or to take photos of
non-permanent stimuli (e.g., the dry-erase activities on the Test of Everyday
Attention; Behavioural Assessment of Dysexecutive Syndrome).

38. Scoring and Interpretation

39. Scoring
Everyone’s favourite activity!
Some of us may have convinced
ourselves that the time lost during
scoring is an opportunity to be
immersed in the data.
Would we encourage educational
clients to study by simply note-
taking?
Reality is we should get through
scoring as quickly as possible and
focus on interpretation distinctly.

40. Hand Scoring
A test like the CTOPP can take longer to score by hand than a WISC-IV when
using the scoring assistant.
A test like the Beery VMI can take longer to score than it takes to administer.
Unfortunately, the inordinate cost of building scoring software means that
software solutions are unlikely to emerge for many of the tools we use on a day to
day basis.

41. Hand Scoring
While I have not found a way to resolve this issue, one of my partners came up
with an idea to streamline the hand-scoring process.
We photocopied the scoring and norms pages for all manual based tests.
These were filed into a scoring binder that also included any templates (e.g.,
symbol search) and other scoring tools (e.g., ruler and protractor).
This meant less trips, flipping through books, and missing manuals.
Then I timed it - old way: 40 minutes; new way: 30 minutes

42. Hand Scoring
That wasn’t good enough for me, so I
decided to go digital
Revisited Dropbox
Placed all my norm pages in one
folder, synced across my work
and home computers, my
iPad/Android tablets, and my
smartphone
This means I can look up scoring
data anywhere and at anytime.
No more return trips to the office!

43. Computer Based Scoring
Scoring assistants can be a huge time saver when they are available.
Surprisingly, these have been quite difficult to sell in the past
Technophobia
The “interpret as I score” argument
Complaints regarding cost

44. Computer Based Scoring
Much of this software is also locked into one ecosystem (e.g., windows PC)
You have to be on-site or use a laptop that can’t be easily shared amongst off-site
staff.
Some companies have moved towards online scoring options, but these can bring
browser limitations (no tablets) and may have a cost per use despite having all-
you-can-score solutions available for on-site use

45. Computer Based Scoring
While I’m a long time user of scoring software and have seen substantial gains in
my workflow and what scores are available to me as a result
I’m not willing to have multiple copies of the same program just so I can score
off-site once and a while
I’m not willing to pay a per-use fee for something I already own unlimited
access rights to.
Came up with my own do it yourself cloud scoring solution

46. DIY Cloud Scoring System
Ingredients:
A low end windows computer
($300)
Local backup hard drive ($50)
Secure online backup service
(free)
A LogMeIn account (free)
LogMeIn Tablet/Smartphone
apps (free)

47. DIY Cloud Scoring System
This allows you to login whenever
you want and wherever you are. I
can login with my iPad/ Mac/ Pc or
in a pinch my iPhone and control my
scoring assistants back at the office

48. DIY Cloud Scoring System
The system has worked amazingly well for us and we’ve now implemented
“Cloud” scoring computers across each of my practices.
I’ve scored from different offices, coffee shops, a pub, bed, my car, and even in the
Caribbean.
The downsides are minor but include the inability to have multiple users on the
software at the same time and the inability to print at your location without the
pro version of LogMeIn.
Printing limitations were easily resolved by adding a “pdf printer” that saves
the files to a dropbox folder that then auto-syncs with each of our personal
devices.

49. Interpretation

50. Interpretation
I used to sit there with all the data around me and try to formulate the ins-and-
outs of a clients clinical profile.
Information overload. This used to work when first preceptorship advocated for
WISC and WRAT.
Those days are over. Now I have such a diverse test list that I was forced to use a
smaller font for my title page.
In keeping with my previous format-for-the-report approach to parent interviews
and assessment design, I created interpretation sheets that follow my assessment
plan and tie directly into my reporting workflow

52. Report Writing

53. The Forbidden Word:
Templates
Templating certainly has become a negative word and is usually thought to mean
poorly written reports.
It did not help that a significant number of end-users started using software
driven interpretive writers back in the mid to late 90’s.
We’ve all seen bad templated reports that convey data and definitions but don’t
tell you a story
Templates fail if they are used in place of clinical judgement (report writers), a
focused description of the current client beyond the scores, and are inflexible to
different referral concerns.

54. The Forbidden Word:
Templates
At the same time why would you
spend time:
Redefining working memory for
the hundredth time
Formatting sections, fonts, and
headers
There is many cases where we do not
need to reinvent the wheel and we
can spent our report writing time on
areas of clinical importance.

55. Step One: Templates
My Templates
Formatting
Logistical introductions (e.g., what percentiles are)
Find-and-Replace key words
Domain definitions and introductions
This lets me to focus on the clients clinical profile

56. Step One: Templates

57. Step Two: Text Expansion
Even things that change from one client to the next don’t need to
be reinvented once you have worded it well.
How many different ways can you say a developmental history
was normal?
Text expansion software (e.g., Text Expander for Mac; Breevy
for Windows)
It can turn a phrase like “..‘s health unremark” and turn it into
“Jon’s medical history remained unremarkable, with no
significant history of hospitalization, surgery, medication use,
concussion, fracture, or hearing/vision loss.”

58. Text Expansion:
without - 3 minutes
with - 78 seconds (including a mess up)
with - 78 seconds (including a mess up)
with - 78 seconds (including a mess up)
QuickTime™ and a
H.264 decompressor
are needed to see this picture.

59. Time can be saved everywhere
QuickTime™ and a
H.264 decompressor
are needed to see this picture.

60. Step Two: Text Expansion
The trick with text completion is to introduce only a few short cuts at a time (or
you won’t remember them).
I started with having “..” auto insert the clients name and “pp” to insert the word
percentile.
“..” saved me from typing a clients name on average 142 times in my first ten
reports.
Taken the average length of the name from those clients it saved me 1988
keystrokes.
For Ms. Smithinovski (not her real name but similar in length, syllables, and
my inability to spell it) this saved me between 12 to 20 minutes!

61. Step Two: Text Expansion
This has became such second nature that I am actually unable to type
percentile in full without applying conscious effort to do so.
I next moved to expanding composites and subtest names (e.g., VCI turns into
Verbal Comprehension Index; “ SS,” turns into “ Symbol Search,”
Next full blurbs: “health unremark” to “medical history remained
unremarkable, with no significant history of hospitalization, surgery,
medication use, concussion, fracture, or hearing/vision loss.”
In total I’m seeing on Average at least an hour time savings as a result. Over a
month of report writing this single and cheap (<$30) “tweak” has provided me
a day off a month.

62. The Future of Reporting
Imagine a parent interview that auto generates the background history, but
prompts you for input in areas that were atypical
Imagine a quick prompt screen that auto generated all of your test data into tables
Imagine an adaptive recommendation list builder that creates research driven
recommendations based on your specific clients profile
What is the clients gender?
What is the clients grade range?
What is the nature of the clients disability?
What areas needs specific supports?
Is the client in a private school setting?

63. What do referrers think?
I’ve maintained a survey-group of parents, physicians, teachers, special educators,
peers, and allied health professionals that I run each significant change by.
They’ve universally agreed that these reports are clearer, cleaner, and better
meeting the needs of a diverse support network.
Not every change we’ve tried has led to improvements. You’re just not hearing
about those ones!

64. Feedback
This has been the biggest struggle to streamline
Primarily because of diversity of diagnoses and varied client/parent needs,
knowledge, and comprehension levels.
Tried having a checklist of measure domains to anchor but held things up even
longer
Lately simply asking what level of detail/coverage they want helps
Next step is to produce Dx specific information sheets

65. Questions?
I’ve just used up two hours of your time ... I assure you there is information in
here that will make you gain that time back 10 fold.
Presentation available online at: www.flexpsychometrics.ca
Email: michael.decaire@gmail.com