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
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
