A revised and improved summary of all the reading material from week 1 to week 7 for the course Advanced Clinical Neuropsychology of the Master in 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
A major issue for clinical neuropsychologists – is 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
Data Needed – Advancement of NP
For clinical NP – to advance as a profession – there are two types of ‘data’ or ‘evidence’
needed:
Data (1) – Outcome Studies
The 1st type of data – comes from well-designed, evidence-based – outcome studies
- Which demonstrate the efficacy and cost-effectiveness of our procedures and
interventions
Data (2) – Demonstrating Value of Clinical Judgement
The 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 via a mentoring model
- So that they can understand – and communicate – this info to providers
Loss of Economic Footing – Consequences
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
As a result – some patients in need of NP services – would NOT obtain them – which would
lead to:
(1) Postponement – of proper diagnosis
(2) Lack – of proper treatment interventions
(3) Negative outcomes – that could have been avoided – if NP assessment was part of the
clinical and diagnostic workup
There is an expanding trend of NPs – to do more ‘medical-legal’ work – to survive
economically
NP began as a clinical science – thus, in order for the field to grow:
- Clinical NPs – need to remain active in providing both (1) patient care – and (2)
conducting research relevant to the field
PROFESSIONAL IDENTITY OF NEUROPSYCHOLOGISTS
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”
NPs have flourished – because they have been able to relate their discipline – to a growing
database of neurosciences
This technical knowledge – is indispensable to NP work
- But it is 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:
(1) Helps reduce patients’ suffering
(2) Allows the referring physician to recognize that the NP contributions have improved
patient care
Value of Neuropsychological Work
The value of NP work – is judged by four individuals:
- The patient – a relevant family member – the referral source – and the payer for the
services provided by NPs
Outcome Studies
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
- It is highly likely – that patients and their families – will NOT return to the NPs – or
follow NP recommendations
The goals – of outcome studies – include:
, (1) Demonstrating efficacy and cost-effectiveness of NP work
(2) Developing – and training – NPs to be scientist-practitioners
- Who are able to blend NP science – with patient and family needs and
concerns
Patient satisfaction – is directly related to the perception – that the clinical
neuropsychologist:
- Took adequate time – to carefully listen to his/her concerns
- Acted on those concerns – in a way that helped the patient
SCOPE OF PRACTICE OF CLINICAL NEUROPSYCHOLOGISTS
Scope of Clinical NP Practice
Clinical NPs – are 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 NP
disturbances – in different patient populations
- And, in trying to remediate – or otherwise reverse – the effects of NP
disturbances
When disturbances cannot be remediated – a major focus of clinical NP – becomes to:
- Help the person and family to adjust – to the permanent NP disturbances –
and return to a productive lifestyle
Outcome Studies
Provide objective evaluation – of NP diagnostic and interventional skills
Such studies – demonstrate the efficacy of NP – and the costs related to those benefits
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