Frequently Asked Questions about the BCAT
Regarding the Patient Population:
- Is the BCAT valid for someone with a diagnosis of Intellectual Disability (ID) or Down’s Syndrome (DS)?
As the BCAT assesses cognitive domains, it can be applied to persons with ID and DS. However, one should be cautious in making definitive statements about cognitive in these circumstances.
- Is the BCAT valid for people who speak non-English languages?
The BCAT has been validated in English, and some other languages. Therefore, it can be used with the assistance of a bilingual speaker or by using a translated version (again, with the assistance of a bilingual speaker), but one should be cautious about interpretations.
- What techniques can be used for people who people who speak non-English languages?
The tool may be administered with an interpreter. We recommend using translated versions of the BCAT.
- How do I score the test for someone who does not understand the instructions based on a language barrier?
Before scoring, the administrator should feel confident that patient responses are accurately recorded. The tool may be administered with an interpreter and we recommend using translated versions of the BCAT.
- Is the test valid for someone with a Traumatic Brain Injury (TBI)?
The BCAT was originally validated on samples of adults age 60 and older, and not on a TBI sample per se. However, as the tools (BCAT and other tests in the BCAT Test System) assess cognitive and mood deficits, especially attentional capacity, memory, and executive functions, it can be very helpful for measuring these domains in TBI patients. We recommend emphasizing the Memory Factor (CMF) and the Executive Factor (ECFF) scores for making interpretations about cognitive functioning.
- What do I do if a patient has hearing deficits?
First confirm that the patient has hearing deficits. Attempt to administer the tool in a quiet and/or private space. If the person cannot appropriately hear either due to hearing loss or outside noises, do not administer the tool at that time.
- What do I do if a patient has visual deficits?
We recommend two options for patients with severe visual deficits. First, determine if the patient can see the enlarged images that we provide on our website. If the patient cannot see them, then choose one of the following methods. A provider can choose to administer the BCAT-Short Form (BCAT-SF) since there are no visual items. If the provider chooses to administer the entire BCAT, focus on the Memory Factor score and the Executive Factor score. These provide valuable information about cognitive functioning. However, with this method, the administrator cannot stage level of cognitive impairment.
- Can you use the Short Form on someone who has a diagnosis of dementia of the Alzheimer’s Type?
Yes, the BCAT-SF can be used to assess any person’s current cognitive functioning including dementia in general, and specific types such as Alzheimer’s disease.
- How would I determine which patients to administer the BCAT versus the BCAT-SF?
Generally, this depends on the information you are seeking and how the information will be used. For clinicians, administering the full BCAT is recommended. This is because from a diagnostic and treatment perspective, one gets the most information to optimize treatment. However for non-clinicians who may be using the tools for residential placement or for a rapid cognitive baseline, the short version may be appropriate. Specific reasons for using the BCAT-SF are:
- Time is very limited
- Patient cannot stay engaged longer than 5 minutes
- Provider needs an immediate assessment and will circle back to complete the full BCAT at a later date.
- A full BCAT was administered recently, and the clinician wants to make a comparison of status (We do have a cross-walk table for comparing BCAT and BCAT-SF results).
Regarding the Administration of the BCAT:
- How long does it take to become proficient at administering the BCAT and other tests?
This varies depending on a number of factors, especially experience with administering tests or evaluation tools. Generally, trained administrators report feeling proficient after administering at least 10 BCATs. You should notice that the completion time drops quickly as proficiency increases.
- What do I do if the patient refuses to complete testing?
A provider can review the items answered to get an idea of how the patient may have done. However, conclusions about cognitive functioning will be limited if a patient does not complete the test.
- How do I score the Set Shifting if a person "skips" a letter or number in the series?
If the patient skips two or more correct pairings, the patient would not receive any adjustments in the scoring. Her maximum score would be determined by when she made her first error (See first example below). However, if she skips just one correct pairing and completes the pairings, her maximum score will be 10-1 = 9 (See second example below). This converts to an item score of 2.
Example (2 errors): 1-A, 2-B, 3-C, 4-E, 5-F, 6-H, 7-I—This patient would score “0” since there were only 3 correct pairs in the sequential order.
Example (1 error): 1-A, 2-B, 3-C, 4-D, 5-E, 6-F, 7-H, 8-I, 9-J, 10-K—This patient made one mistake, but kept the pattern through the remainder of the pairs. Therefore, the provider will take the 10-K as the last correct answer, but will subtract one from the total number of correct pairs (9). The score for the BCAT would be “2” in that particular item.
- What if a person draws the two five-sided figures with a very small intersection?
Give one point if the patient makes two 5-sided figures. Give a second point if the figures intersect such that the “common” space is smaller than the other design spaces.
- How do you score the Clock if the numbers are in right places but not legible?
The provider should use his/her judgment as to whether or not the patient attempted to correctly form the numbers.
- How often can I repeat the testing?
Testing can be repeated as often as clinically necessary, but should be done at least 72 hours apart. We also recommend using Alternate versions of the BCAT that are available on the website.
7. When is it appropriate to repeat the test?
There are several scenarios where repeating testing is indicated. If you believe that medical or mood issues have influenced test scores, than repeating testing once those issues are resolved is often helpful. Repeating testing after a course of treatment (e.g., Brain Rehabilitation, Working Memory Exercises, speech therapy, occupational therapy) to determine cognitive improvement may be important. To track progression of cognitive changes, the BCAT (and other BCAT tests) may be repeated. This could be quarterly, semi-annually, or annually.
8. What if they want to stop the test half way through - do I have to start over again or can the patient finish the test later?
To score the test items, the patient should complete the tests in one session. If the patient or provider must stop in the middle of any one test, the provider should start it again during another session.
9. What do I do to "move a patient" along if they clearly don't know the answer to one of the questions?
If the patient doesn’t know the answers, but is struggling to try to find the correct answer, the provider could interrupt the “thought process” and say, “I have another item for you” and move on to the next item.
The provider should use their judgment too in knowing when to stop a particular item. Example: Letter list—if the patient misses one of the “C’s”, then stop the list and move on to the next item. Set Shifting—If the patient makes two mistakes stop the patient and move on.
Regarding the Application of BCAT Results:
- How do the BCAT scores compare to the Allen Cognitive?
In some respects this is an “apples to oranges” comparison. More direct comparisons can be made between the BCAT and the Global Deterioration Scale (GDS). We provide a cross-walk table for such comparisons. The BCAT is a broader test than the GDS. As for comparing the BCAT directly to the Allen, the BCAT directly assesses cognitive domains through the administration of cognitive items; whereas the Allen focuses on task performance of items from which inferences to cognition are made.
2. How do we share the results with a family member?
Educating and managing expectations of family members is an important part of the treatment process. Explaining to them what the BCAT is and carefully going over results provides an opportunity to bring family members on board. While the BCAT is a very accurate tool, one should be careful about making diagnoses on the basis of BCAT results alone. It is recommended that cognitive diagnoses be made based on multiple sources of information.
Regarding Technology Issues:
- Does the Website keep the test results for my log in?
For the privacy of all patients and providers, the BCAT website does not maintain any information that was entered. Once the provider navigates away from the page, the information will be deleted.
- Does the Website keep a log of Brain Rehab per patient?
Providers can print a copy of the Brain Rehabilitation outcomes after each round of each interactive module. Again, for the privacy of patients and providers, no data is maintained on the website.
- What if I don't have access to a computer during patient visit time?
For test administration, many providers administer the BCAT Test System as a paper and pencil measure and then return to a computer at a later time to enter the scores and retrieve the test report. It typically takes just a few seconds to enter the scores online and print the reports.
4. Is there technical support available to new users?
Technical questions should be emailed to firstname.lastname@example.org . A member of the BCAT Team will reply within 24 business hours.
5. How will I know if there are any updates to the science of the BCAT Test System?
All licensed users are automatically placed on our email list. (This list is not shared with anyone outside of the BCAT Staff.) All updates scientifically, technically, etc. are announced on a weekly email usually sent on Wednesday mornings.
Regarding the Broader BCAT Approach:
- What do I do if another member of the interdisciplinary team administered the BCAT Tests and I need to do it to ensure my documentation is complete?
Providers can repeat the testing as long as it is at least 72 hours after the previous one was completed, or an alternate version can be administered.
- How do you share scores across departments?
The BCAT can be uploaded to an electronic health record. It can also be printed and brought to care plan meetings, utilization review (“Medicare”) meetings, or discussed at a morning meeting. We recommend an interdisciplinary team format that we call the “RATE” (Resident Assessment and Treatment Enhancement) team meeting as a vehicle for translating BCAT scores to treatment interventions.
- Can you send/share the test results to/with Patient's Physician?
Providers can email, fax, or allow the patient to hand-carry test reports to their physician.
4. Why is training required before purchasing a license?
Because the BCAT Approach is based on empirical data, the BCAT team requires all providers to be appropriately trained to ensure clients are having the materials (tests or brain rehabilitation modules) administered, scored, and interpreted appropriately.
5. Is Test Administration part of billable time?
Many providers use the Tests as part of their initial and/or continued assessment of patients throughout a treatment period. Providers should consult their compliance staff for details.
Should you have additional questions regarding the use and application of the BCAT Approach, please contact us at email@example.com.