I was recently engaged by court order to provide second opinion telehealth consultation through direct computer-mediated observation of the clinical interview sessions.
My online office at doxy.me/drchildress is HIPAA secure. The on-site professional logs into my online office at the start of the interview session and I observe the interview through my computer-mediated involvement.
Following my involvement in the clinical interview sessions through telehealth, I provide a second-opinion consultation report on the diagnostic and treatment-related issues evident in the clinical interviews.
The primary diagnostic report is written by the local-area licensed mental health professional who conducted the on-site interviews. I am a second opinion consultant. An additional third opinion consultant from the other party-parent is fine.
When possible child abuse is a considered diagnosis, the returned diagnosis needs to be accurate 100% of the time. The consequences of misdiagnosing child abuse are too devastating for the child.
It is the responsibility of the doctors to return an accurate diagnosis 100% of the time. Telehealth consultation can help that happen.
Court Orders
Here are recent court orders for my involvement through telehealth in an active assessment of the attachment pathology surrounding divorce. These orders allow the parent-litigant to appoint a second-opinion telehealth consultant to the assessment.
One parent-litigant selected me as their second-opinion consultant to the assessment. The other parent-litigant can select an additional third-opinion consultant if they desire.
From Court Order: “Respondent’s Second Opinion: Respondent (name) will be responsible for obtaining and paying for a second opinion. The psychologist providing the second opinion shall attend all clinical sessions via telehealth. Both parties shall have access to the findings of the second opinion.”
From Court Order: “Furthermore, professionals providing the second and third opinions are authorized to attend all clinical sessions/interviews, either in person or via telehealth, as appropriate. These professionals are also authorized and encouraged to consult directly with Dr. Xyz (or the primary psychiatrist/psychologist) to ensure a comprehensive and collaborative approach to the assessment and diagnosis process.”
Professional Consultation
Professional consultation is encouraged because it improves the quality of healthcare services delivered to the patients.
The National Academies of Sciences, Engineering, and Medicine discuss the role of second opinion consultation in diagnosis:
From Improving Diagnosis in Health Care:
“Clinicians may refer to or consult with other clinicians (formally or informally) to seek additional expertise about a patient’s health problem. The consult may help to confirm or reject the working diagnosis or may provide information on potential treatment options. If a patient’s health problem is outside a clinician’s area of expertise, he or she can refer the patient to a clinician who holds more suitable expertise. Clinicians can also recommend that the patient seek a second opinion from another clinician to verify their impressions of an uncertain diagnosis or if they believe that this would be helpful to the patient.”
Improving Diagnosis in Healthcare (2015). National Academies of Sciences, Engineering, and Medicine; Institute of Medicine; Board on Health Care Services; Committee on Diagnostic Error in Health Care; Erin P. Balogh, Bryan T. Miller, and John R. Ball, Editor
Ethical Obligations for Consultation
The ethics code for the American Psychological Association encourages all psychologists to cooperate with other professionals to serve their clients/patients effectively and appropriately.
Standard 3.09 Cooperation with Other Professionals
When indicated and professionally appropriate, psychologists cooperate with other professionals in order to serve their clients/patients effectively and appropriately.
Standard 2.01 Boundaries of Competence encourages consultation to meet ethical obligations for competence.
2.01 Boundaries of Competence
(a) Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience.(c) Psychologists planning to provide services, teach, or conduct research involving populations, areas, techniques, or technologies new to them undertake relevant education, training, supervised experience, consultation, or study
(d) When psychologists are asked to provide services to individuals for whom appropriate mental health services are not available and for which psychologists have not obtained the competence necessary, psychologists with closely related prior training or experience may provide such services in order to ensure that services are not denied if they make a reasonable effort to obtain the competence required by using relevant research, training, consultation, or study.
The domains of professional competence that are potentially “new to them” are:
- Diagnostic assessment of possible delusional thought disorders
- Diagnostic assessment of possible factitious disorder
- Diagnostic assessment of attachment pathology
- Diagnostic assessment of family systems pathology
- Diagnostic assessment of child abuse and complex trauma
- Diagnostic assessment of court-involved custody conflict
Dr. Childress is competent in all six domains of this required specialized knowledge as supported by my vitae education, training, and experience.
There are multiple ways to involve the consultation of Dr. Childress in a matter.
When possible, my preferred involvement is through direct telehealth consultation to an active assessment conducted by a local-area licensed mental health professional.
Craig Childress, Psy.D.
Clinical Psychologist, CA PSY 18857
Dr. Childress Consulting 