Summary of Advanced Clinical Neuropsychology

Week 1: Introduction and Brain Damage as a Family
Affair

ADVANCING THE PROFESSION OF CLINICAL
NEUROPSYCHOLOGY WITH APPROPRIATE OUTCOME
STUDIES AND DEMONSTRATED CLINICAL SKILLS

Introduction:

1. Major issue for clinical neuropsychologists => getting
financially reimbursed for the services they provide
- Gate-keepers of financial reimbursement => often have
professional and economic reasons for why they will or will not
pay for NP services
2. Clinical NP to advance as a profession => two types of “data” or
“evidence” are needed:
- 1st type of data => comes from well-designed, evidence-based
outcome studies:
 Which demonstrate the efficacy and cost-effectiveness of
our procedures and interventions
- 2nd type of data => involves individual practicing clinicians
having to demonstrate clearly to the referring physicians the
value of their clinical judgement in patient care
 Neuropsychologists => possess unique clinical and
professional skills
 Can add meaningful info to case conceptualization and
impact patient care => can make a real difference for
physicians
 These skills and the profession’s ability to add info to case
conceptualization => need to be clearly taught to residents
through a mentoring model
 So that they can understand and communicate this info
to providers

, 3. If these two sources of “evidence” are not taken seriously => NP
will lose economic footing
- Two-fold end result:
 Clients or patients => will be seen only on a “fee for
service” basis; not everyone can afford it
 Result => some patients in need of NP services would
not obtain them which would lead to:
 Postponement of proper diagnosis
 Lack of proper treatment interventions
 Negative outcomes that could have been avoided
(= if NP assessment was part of the clinical and
diagnostic workup)
 Expanding trend of neuropsychologists to do more
“medical-legal” work to survive economically
 NP began as a clinical science => therefore, in order for
the field to grow:
 Clinical NPs need to remain active in providing
both patient care and conducting research
relevant to the field

Professional Identity of Neuropsychologists:

1. Harold Goodglass (1994) => noted that “clinical application of NP is
as close as or closer to its scientific roots than any other specialty
within psychology”
- Neuropsychologists have flourished => because they have been
able to relate their discipline to a growing database in the
neurosciences
 This technical knowledge => indispensable to NP work
 But => an insufficient condition for the successful
practice of clinical NP
 Must be good at taking this integrated info and
presenting it in a way that:
 Helps reduce patients’ suffering

,  And, allows the referring physician to recognize
that the NP contributions have improved patient
care
2. Value of NP work => judged by four individuals:
- The patient, a relevant family member, the referral source, and
the payor for the services provided by NPs
- Outcome studies => can demonstrate that NP tests are
reliable and valid instruments for helping answer diagnostic
questions
 But => if knowledge is applied in a way that is insensitive
to patient’s experience when receiving NP services
 Highly likely that patients and their families will not
return to the NPs or follow NPs recommendations
- Goals:
 Demonstrate efficacy and cost-effectiveness of NP work
 And, develop and train NPs to be scientist-practitioners:
 Who are able to blend NP science with patient and
family needs and concerns
- Patient satisfaction => directly related to the perception that the
clinical neuropsychologist:
 Took adequate time to carefully listen to his/her concerns
 And, then acted on those concerns in a way that helped the
patient

Scope of Practice of Clinical Neuropsychologists:

1. Scope of clinical NPs practice => very broad
- Clinical NPs => actively involved in the examination and
assessment of individuals from infancy through the elderly years
 Progressively more interested in applying this info => to
successful management of neuropsychological
disturbances in different patient populations
 And, trying to remediate or reverse the effects on NP
disturbances

,  When disturbances cannot be successfully remediated
=> major focus on clinical NPs becomes to:
 Help the person and family to adjust to the
permanent NP disturbances and return to a
productive lifestyle
2. Outcome studies => provide objective evaluation of NP diagnostic
and interventional skills
- Such studies => demonstrate the efficacy of NP and costs
related to those benefits
- Vital => collaborative work with healthcare economists and
professional managers of health maintenance (cost containment)
organizations
3. In practice => clinical NPs must demonstrate to physicians:
- The logic behind what they say concerning a patient
- And, how their knowledge contributes to patient care
- Result:
 Avoiding marginalization of NP departments in medical
centers
 NPs must share a similar language and terminology as
physicians => BUT, never lose their identity as
psychologists; or, their insight as to the underlying
nature of the psychological disturbance of a patient
 Must articulate in a clear and concise way => (1) what
is “wrong” with the patient, (2) indicate what the next
practical steps are in caring for that patient

Focused Goals:

1. Focused goals of the paper:
- Clarify for NPs the 2 types of data needed for the field of NP to
flourish
- Describe types of outcome studies that continue to form the
foundation of the scientific basis for NP practice