Because I completed my PhD in a school psychology program, I received comprehensive training in completing psychological evaluations within the schools by leading authorities in the field. In my career, I have done assessments in a children’s hospital, public schools, and this clinic. I also trained other clinicians on how to conduct psychological evaluations when I worked at Sam Houston State University.

This experience has shaped my beliefs on what evaluations should look like. After leaving the university and starting this clinic, I discovered some of these should’s are only possible within ideal conditions that rarely occur in real life.

Recently, I had a conversation with a current school psychology student about the differences between school and private practice assessments. It was an interesting conversation, particularly in noticing the reactions the student gave as I explained these differences. This made me think information about evaluations would be helpful for other individuals as well.

School Evaluations

I will start by saying something you may not expect to hear from a psychologist who works in private practice. If done correctly, a school evaluation can be superior to an assessment in an outside clinic. This is why, when we get calls for school-aged children, our first suggestion is to see if the school can provide the assessment. Let me explain the benefits of school evaluations.

Cost and Availability

One of the biggest advantages of a school evaluation is the cost. Schools provide evaluations at no cost to the student, regardless of how extensive the evaluation is. Furthermore, if you don’t agree with the findings, you can request a second opinion for free as well. According to IDEIA 2004, parents have the right to request and receive an Independent Educational Evaluation (IEE) at the school’s expense.

Evaluations done outside the school can get expensive very quickly. The private pay rate for an assessment is usually $1,000 to $4,000 depending on the type of the evaluation. Even at that price, it can be difficult to find someone willing to do it. First, only a limited number of individuals are qualified to provide these services. Second, for those who are qualified, they often make more money by providing other services (e.g., therapy). Third, for the few offices that do provide evaluations, they often have a lengthy waiting list. On the other hand, the law requires schools to provide assessments to students who qualify. The law also establishes timelines the school must follow to ensure evaluations are completed.

Insurance Coverage

For private practice, providing therapy is often easier and cheaper than conducting evaluations. Much of this has to do with billing insurance. Some plans require an authorization before beginning testing. Other plans limit the number of testing hours so much that the provider cannot collect all necessary data. While many plans require a regular copay for each testing appointment, others require a deductible for assessment services. A good assessment should produce a well-written report, but writing time is not billable to insurance. These examples show the complexities of using insurance to cover an assessment and explain why many offices choose not to offer evaluations.

Insurance also does not cover certain evaluations, regardless of plans or coverage. For example, insurance companies only allow assessments for medical diagnoses. They do not allow assessments for educational diagnoses or learning problems. For a suspected learning disability, the only options are to private pay or do a school evaluation.

Dealing with Complications

Have you ever gone to get a repair (e.g., car, plumbing, or electrical) and gotten an estimate, but then found out it will cost more and/or take longer because the problem is bigger than expected? The same thing can and does happen for evaluations.

When this happens in an evaluation, the school is required by law to assess all areas of suspected disability. Although this may require going back to an ARD meeting to approve the extra testing, it is still free for the family. The school covers the cost for all the extra materials, time, and labor.

When dealing with a private clinic, there are no state funds already available to pay for the extra costs. We must meet with the parent/patient to decide what to do when these situations come up. Proceeding with further evaluation may mean obtaining authorization from the insurance company, scheduling additional appointments, and collecting additional payments from the family. Alternatively, we can finish the report without gathering additional information. In that case, we make what diagnostic considerations we can and then give recommendations on how to move forward.

Thoroughness

A school evaluation can be more thorough than a private evaluation. A formal evaluation can include many different elements. An assessment in private practice may include some of these items (e.g., clinical interview and rating scales), but other items are not done as often. This is due to greater difficulty obtaining the necessary information (e.g., interviews with teachers) or because that portion is not covered by insurance (e.g., achievement testing).

There are three areas I feel are easier to obtain in the school than in private practice: different reporters, behavioral observations, and pre-existing data.

Different reporters

In a school setting, it is fairly easy to access a variety of reporters of the child’s behavior. When I worked in the schools, I interviewed principals, multiple teachers, nurses, aides, and even janitors. Imagine the difficulty trying to set this up from outside the school!

Behavioral observations

Probably the most difficult item to replicate in a private evaluation is behavioral observations. When working in the schools, I could observe classes the child is doing well in, classes they are doing poorly in, lunchtime, recess, passing periods, etc. Information from these environments help create a more complete picture of the student, but these are very difficult to obtain as an outside provider.

Pre-existing data

Yes, I can do a records request to try to obtain this from the school myself; however, getting the right data the first time is actually quite difficult. When I was in the schools myself, it was much easier to go directly to the person who had the information to get exactly what I wanted. Accessing these records often requires a game of phone tag, sometimes across weeks.

Private Evaluations

Despite all the advantages of school evaluations, there are some reasons why going to an outside clinic may be a good idea. Some psychological practices exist primarily for providing evaluations.

Speed

After requesting testing to determine eligibility for special education services, the school has 15 school days to respond, 45 school days to complete the testing, and then 30 calendar days to complete the report and hold the ARD meeting (Texas Education Agency, 2023). Adding in the weekends, it could take up to 114 days for the school to complete the report. This also assumes the time periods do not cross a lengthy school break (e.g., spring break).

Realistically speaking, testing to determine eligibility for special education services can take an entire semester to complete, assuming the school actually follows these timelines. For example, Austin ISD recently lost a highly publicized lawsuit for reportedly failing to evaluate more than 2,000 students, including 800 initial evaluations and 1,600 re-evaluations (Disability Rights Texas, 2021).

For a private clinic, especially an office close to home, there often is a waiting list. Besides this, the time to complete the evaluation and obtain the report may take as little as 2 to 4 weeks.

Specialization

Schools are limited in what assessments they can provide. For example, while schools can collect data related to a student’s attention and hyperactivity, a medical doctor must give a formal diagnosis of ADHD. Based on that, the student may qualify for school accommodations. Testing in the school has an educational focus, and the goal of testing is to determine the student’s eligibility for services in the school. Usually, a student must be struggling in school in some way to be approved for a school evaluation in the first place.

Furthermore, the types and specialization of evaluations are limited in a school setting. Schools rarely do neuropsychological evaluations, and they do not conduct forensic evaluations. Schools only provide testing for individuals under the age of 22 who do not yet have a high school diploma.

Better trained individuals

If you do a school evaluation, you get the evaluator the school picks. Many professionals called School Psychologists do not have doctoral degrees. They have a specialist degree. While I have seen some very good results from specialist-level school psychologists, the level of training is not equivalent to a doctoral degree. Having graduated from a doctoral program myself and having taught in a specialist program, I can say with some authority that the clinical training is much more extensive for the doctorate. Formal training is not the only factor in determining who will provide a quality evaluation, but it is something to consider.

Going to an outside provider allows you more choice to find someone with more specialized training in a specific area. This may be particularly true in overlapping fields, such as neuropsychology.

Less bias

Schools have large incentives to avoid diagnosing individuals. Schools are required to provide adequate services to any individual they find with a qualifying disability. They must do so regardless of their resources. Therefore, the more people they identify with disabilities, the higher the cost and the greater the work for the school.

This gets more complicated when considering how schools have tried to meet state standards in less than appropriate ways. For example, as late as 2018, schools could be penalized by the state if they identified more than 8.5% of students as needing special education services (NPR ED, 2018). You can imagine how this could work out by statistically forcing your school to have the right percentage of students eligible for special education services.

After a federal investigation, this policy ended. Results Driven Accountability (RDA) became the new policy. RDA assesses disproportionality in identification rates for special education based on race or ethnicity (Texas Education Agency, 2024). In theory, this sounds like a good thing. In practice, it may not be. I personally was pressured by school administrators to say no on an eligibility decision due to concerns about the district’s disproportionality rates. Thankfully, the school eventually said yes for this student, but it was not a fun experience for me.

An assessment by an outside clinic is generally free from these concerns. This is one of the reasons I started my own practice. Reasonably speaking, I can say whatever I want! I have the freedom to say exactly what I feel is appropriate in terms of diagnosis and treatment recommendations without any pressure from school administrators.

Evaluations: Conclusion

Receiving a psychological evaluation is an important step for obtaining needed services, treatment planning, and medication management. I realize this can be a confusing process, but we can help you figure out what service is best for you. Contact us to see what services we can provide or to receive assistance in finding an appropriate provider. We can even provide help understanding a report from an evaluation you already received. I hope it was helpful to learn some of the advantages and disadvantages of school and private evaluations, and that, should you need one, you can find the best fit for your needs.

Post written by Dr. Gordon D. Lamb, Licensed Psychologist and Clinical Director

Please note posts are educational in nature and are not intended to replace psychological services when needed.

References

Disability Rights Texas. (2021). Lawsuit says Austin violates federal law, fails to evaluate more than 2,000 students. https://disabilityrightstx.org/en/press_release/austin-isd-failure-to-evaluate-for-special-ed/

NPR ED. (2018). Department of Education finds Texas violated education law. https://www.npr.org/sections/ed/2018/01/11/577400134/texas-violates-federal-law-education-department-finds

Texas Education Agency. (2023). Special education initial referral timeline. https://spedsupport.tea.texas.gov/sites/default/files/2023-08/special-education-initial-referral-timeline.pdf

Texas Education Agency. (2024). Texas significant disproportionality crosswalk. https://tea.texas.gov/academics/special-student-populations/review-and-support/significant-disproportionality-crosswalk.pdf