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Division of Clinical Neuropsychology
Newsletter
American Psychological Association
Volume II, No. 2
Executive Board, Division 40
President: Thomas J. Boll
President Elect: Lawrence Hartlage
Past President: Nelson Butters
Secretary: Gerald Goldstein
Treasurer: Raymond Dean
Members at Large:Kenneth Adams, Byron Rourke, Charles Matthews
Council Representative: Manfred Meier
Election Results
Manfred Meier is the new President-elect of Division 40. Linas Bieliauskas
was elected to the position of Member-at-large for 1985-1987.
APA Convention August 24-28
Program for the Division 40 1984 APA national convention is summarized
on pages 2-3 of the Newsletter.
The Division of Clinical Neuropsychology is concentrating its activities
on Sunday, July 28. On that day, the presidential address, business meeting,
social hour and a large number of presentations will occur.
The Division Program Committee included Linas Bieliauskas (chairman),
Kathy Haaland, Polly Henninger, Harvey Levin, and Robert S. Wilson.
The program will include six symposia. Topics include ethnic minority
issues in neuropsychology (chaired by Leslie Hicks), neuropsychological
contribution in neurosurgy (Harvey Levin, chair), lateralization of function
in affective disorders (Harold Sackeim, chair), lateral eye movement research
(Merrill Hiscock, chair), lead exposure in adult workers (Walter Penk,
chair) and effect of diffuse brain injury in children (chaired by Jack
Fletcher).
Paper sessions will focus on developmental issues in neuropsychology,
issues in lateralization of func-tion, psychopathology in neurological
disorders, and a research sampler.
A poster session will be featured in which a variety of clinical and
experimental topics will be addressed.
Invited addresses will be presented by Herbert Weingartner (How does
memory fail?) and by Karl Pribram on the far frontal cortex.
Thomas Boll will delineate developing issues in neuropsychology in
his presidential address.
Computer Task Force
Division 40 APA Task Force on Computer Technology in the field of neuropsychology
will hold its initial planning meeting at the APA convention on Sunday,
August 26, 4-6 p.m.
Chaired by Charles Matthews, Task Force members now include Jeffrey
Barth, Gregory Brown, Rosa-mund Gianutsos, Jordan Grafman, J. Preston Harley,
Robert T. Kurlychek, Daniel L. Schacter, and James M. Schear.
Convention Facilities for Disabled Attendees
The Board of Convention Affairs would like each person with a disability
who is planning to attend the convention to identify himself or herself
and to provide information on how we can make the convention more readily
accessible for his or her attendance. APA will provide a van with a lift
as transportation for persons confined to wheelchairs, interpreters for
deaf individuals, and escorts/readers for persons with visual impairments.
Westrongly urge individuals who would like assistance in facilitating their
attendance at the convention to register in advance for the convention
on the APA Advance Registration and Housing Form which will appear in the
April through June issues of the American Psychologist. A note which outlines
a person's specific needs should accompany the Advance Registration and
Housing Form. This is especially important for persons who are deaf and
require interpreting services.
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Newsletter 40
Calender of Events
Thursday, Aug. 23 l:OO-5:00
Newfoundland Room, Royal York Committee Meeting:
Task Force on Education, Accreditation and Credentialing
in Clinical Neuropsychology
Chair: Manfred J. Meier
1:00-1:50 Dominion South, Sheraton Centre
Invited Address: Karl Pribram
The Far Frontal Cortex: Executive of the Brain
Chair: Arthur L. Benton
Friday, August 24 9:00-10:50 Wellington Room, Harbour Castle
Executive Committee Meeting
Chair: Thomas J. Boll
2:00-2:50 Windsor Room, Sheraton Centre
Paper Session: Psychopathology in Neurological Disorders
Chair: Allan Yozawltz
Saturday, August 25 9:00-l 0:50 City Hall Grille, Sheraton Centre
Paper Session:
Developmental Issues in Neuropsychology
Chair: Steve Mattis
3:00-3:50 Manitoba Room, Royal York
Presidential Address: Thomas Boll Developing Issues in Clinical Neuropsychology
Chair: Nelson Butters
l:OO-2:50 City Hall Grille, Sheraton Centre
Symposium:
Neurobehavioral Effects of Diffuse Brain Insult in Children
Chair: Jack M. Fletcher
4:00-4:50 Manitoba Room, Royal York
Business Meeting
Chair: Thomas Boll
5:00 p.m.
Room 3, Royal York
Social Hour
Sunday, August 26 9:00-950
Sheraton Room, Sheraton Centre
Poster Session: Experimental and Clinical Studies in Neuropsychology
Chair: Mark Shatr
Monday, August 27 lO:OO-11:50 Wentworth Room, Sheraton Centre
Paper Session: Program Committee's Sampler of Neuro-psychology Research
Chair: Linas A. Bieliauskas
11:00-l 1:50 Civic Room, Sheraton Centre
Invited Address: Herbert Weingartner
How Does Memory Fail?
Chair: David C. Garron
11:00-l 1:50 Peppermill Room, Harbour Castle
Symposium: Clinical Neuropsychology and Ethnic Minorities
Chair: Leslie Hicks
2:00-3:50 Dominion North, Sheraton Centre
Symposium: Neuropsychological Contributions to Neurosurgery
Chair: Harvey S. Levin
Sunday, August 26 12:00-12:50 Wentworth Room, Sheraton Centre
Paper Session: Issues in Lateralization of Function
Chair: Robert S. Wilson
9:00-l 0:50 Huron Room, Sheraton Centre Symposium: La teraliza tion of Function in Affective Disorders Chair: Harold A. Sackelm
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Monday, August 27 l:OO-2:50
Kenora Room, Sheraton Centre
Symposium: Current Status of Lateral Eye Movement Research
Chair: Merrill Hiscock
3:00-3:50 Pier 9, Harbour Castle
Symposium: Forensic Implications and Neuropsychoiogical Assessment
Chair: Walter E. Penk
Newsletter 40 is the official newsletter of the Division of Clinical
Neuropsychology (Division 40) of the American Psychological Association.
It is published biannually.
Staff:
Roberta Firnhaber White, Editor
Mark B. Moss, Associate Editor
Boston University Medical Center
Department of Neurology
720 Harrison Ave., Suite 707
Boston, MA 02118
Report of the Division 40/INS
Joint Task Force on Education, Accreditation, and Credentialing
A. Introduction and Historical Background
The International Neuropsychological Society was orig-inally established as a forum for those psychologists whose neuropsychological interests, professional and scientific, were not represented collectively by any existing APA Division. Following its modest origin in 1966, the INS has grown to a current membership of almost 1500 and a growth rate of 10-15% per year. While the INS was formed largely by psychologists, it has evolved into an interdisciplinary organization which consists predominantly of clinical, experimental/physiological, cognitive and developmental psychologists, but also includes behavioral neurologists, audiologists, speech pathologists, psycholinguists, special educators, neurosurgeons, psychiatrists and physiatrists. A majority of INS members are also APA members holding various divisional relationships within APA including divisions 3,6,12,13,20,22,24, 28 and, most recently, 40.
The establishment of Division 40, the Division of Clinical Neuropsychology, was determined largely by the fact that INS had moved in an interdisciplinary direction and was not suited to deal with all the professional and scientific issues of individual disciplines. This is especially true in the area of professional role functioning where questions of role definition, boundaries, ethics, and educational standards become a primary concern. Therefore, the INS welcomes the opportunity to share responsibility for professional matters with the APA through Division 40. The INS encourages a collaborative relationship with Division 40 and other interested divisions of APA for the purpose of defining thespecialty of clinical neuropsychology and for establishing the necessary educational, accreditation and credentialing mechanisms for assuring the continued vitality and growth of this specialty.
To help stimulate discussion and planning, INS members organized symposia on professional issues and educational directions in clinical neuropsychology at INS and APA meetings. Also enlisted in these early efforts were members of Divisions 6, 12, 20, and 22. With the establishment of Division 40, clarification of roles and articula-tion of educational and professional standards will now be pursued through a Joint INS/Division 40 Task Force on Education, Accreditation and Credentialing. Task Force recommendations are submitted to the INS board of gov-ernors and to the executive committee of Division 40 for consideration.
Expansion of scientific and professional activities in clin-ical neuropsychology can be attributed to the rich mixture of experimental and clinical interests that has characterized this specialty. A distinguishing feature of the professionalization of neuropsychology is the increased participation of experimental physiological and cognitive psychologists in applied research and in professional activity. Their contributions reflect the changing values
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among experimental and physiological psychologists about the significance
and relevance of applied work to our understanding of brain-behavior relationships.
Their efforts to identify the psychological processes that interact with
pathophysiological processes to determine the psychological deficits associated
with neurological invol-vement have complemented the traditional clinical
component of the specialty by improving the technology of assessment and
intervention. Interaction between the scientific and professional interests
within the specialty and the increasing roleoverlap among clinical and
experimental neuropsychologists may be a healthy basis for generating research
and improving professional practice. A foundation for more powerful neuropsychological
theories and technologies and for broadening the professional capabilities
of the specialty beyond the traditional diagnostic and assessment roles
into the domain of remediation of function through therapeutic interventions
appears to have been established. Thus, the prospects for a strong specialty
of clinical neuropsychology are based on disciplinary foundations in clinical,
experimental, physiological, cognitive and developmental psychology and
in the clinical neurosciences. This report attempts to identify the salient
roles, educational needs, and credentialing outlook for clinical neuropsychology.
B. Neuropsychological Roles and Functions
1. Practice
A major function of the clinical neuropsychologist is to assess current behavioral disturbances that are associated with central nervous system dysfunction. The first responsibility, whenever possible, is to develop an interdisciplinary data base of historical and current information to permit an accurate perspective of the presenting problem. These data frequently consist of developmental, academic, vocational and medical histories in addition to the specific findings of the psychological and neurological examinations, neuroradiologic and neuroelectrodiagnostic procedures, and laboratory tests. This information, when available, helps: a) to determine the appropriateness of the refferal and b) to direct the course and content of the neuropsychological assessment. A definitive competency in neuropsychological assessment requires the ability to integrate medical, neurological, and behavioral interview data with neuropsychological findings for the purpose of relating behavior to the neurologic status.
Referrals for clinical neuropsychological assessment typically consist of but may not be limited to the following: 1) differential diagnoses between psychogenic and neurogenic syndromes (e.g., depression vs. dementia); 2) differential diagnoses between two or more suspected etiologies of cerebral dysfunction (e.g., neoplasm vs. cerebral vascular disorder); 3) delineation of spared and impaired functions secondary to an episodic event (e.g., cerebrovascular accident, head trauma, infection); 4) establishment of baseline measures to monitor progressive cerebral disease (e.g., neoplasms, demyelinating disease); 5) comparison of pre and post pharmacologic, surgical and behavioral interventions (e.g., drug trials, tissue excision, shunts, vascular repair and language or cognitive therapy); and 6) assessment of cognitive functions for the formulation of rehabilitation strategies.
2. Procedure-Neuropsychological Assessment
Clinical neuropsychologists display considerable diversity in the use of discrete protocols, inventories or procedures. This is predicated on the training and expertise of the individual practitioner. The proliferation of research in brain-behavior relationships encourages the practitioner to modify existing applications and to develop new procedures. Common to all neuropsychological assessments is the focus on a broad spectrum of behaviors which includes: 1) abstract reasoning and categorical thinking; 2) cognitive flexibility and planning; 3) language-communication; 4) learning and memory; 5) sensation/-perception; 6) fine and gross motor functions; 7) initiation and attention; 8) affect and mood and 9) psychosocial adaptation.
The clinical neuropsychologist achieves sophistication in the understanding of central nervous system function that is based upon knowledge of: 1) functional neuroanatomy, disorders of attentional, sensory, perceptual, conceptual, language, memory, voluntary and involuntary motor, and affective processes; 2) clinical diseases, their presentation, findings, course and treatment; 3) CNS effect of systemic disorders; 4) child development and the ontology of neuropsychological processes; 5) expected decrements in neuropsychological processes as a function of normal aging; 6) behavioral psycho-pharmacology; 7) psychophysiological principles underlying behavior pathology; 8) social-cultural status as a co-determinant of behavior; 9) principles of personality assessment and interviewing skills; 10) principles of test construction and validation: and, 11) test administration and interpretation. It is recognized that the degree of sophistication achieved by individual practitioners in any of these areas will be determined by the nature of the clinical setting to which this knowledge base will be applied.
3. Disposition and Intervention
The patterns of spared and impaired functions, identified through neuropsychological assessments, are compared with known patterns of behavioral dysfunction that are concordant with the expression of documented CNS disease. This permits not only a simple differential deter-mination of the probability of the presence of CNS involvement, but also contributes to an appreciation of the nature, locus, and extent of involvement necessary for any prognostic formulation. Comprehensive neuropsychological assessment provides a baseline of functioning which may be utilized for tracking of natural recovery and/or the evaluation of the efficacy of therapeutic inter-vention( s) (medical, surgical, behavioral).
Delineation of behavioral disabilities within the context of functional cerebral organization achieves a biologically relevant taxonomy that permits long-range rehabilitation and vocational strategies. Clinical neuropsychological assessments may improve theselection of specific
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training tasks based upon the demonstrated cognitive, motor and perceptual assets of the patient. Such procedures may be initiated and implemented by the neuropsychologist or allied health care specialists. Therefore, an important objective of the clinical neuropsychological evaluation is to render a service that ultimately improves adaptive functioning in patients with cerebral dysfunction. The clinical neuropsychologist recommends specific treatment interventions or initiates referrals to other disciplines based on the neuropsychological assessment. The practice of clinical neuropsychology also includes consultation to family members, educators, and employers for improving behavioral adjustment in specific evnironmental settings. The commonality of training that permits clinical neuropsychologists to initiate behavior-ally meaningful recommendations should include work-ing knowledge of: 1) the strengths and limitations of assessment and treatment procedures of neuropsychology and allied professions; 2) skills underlying activities of daily living and work and 3) community resources and ecological constraints.
Clinical neuropsychological intervention encompasses a wide range of applications for remediation of primary disability associated with cerebral dysfunction and secondary disability that may arise as an emotional or otherwise maladaptive consequence of the patient's primary disability. While neuropsychological intervention first attempts to minimize secondary disability, subsequent interventions are intensively focused upon the utilization of the patient's spared functions to subserve adaptive behaviors. Prescriptive strategies have been applied in the treatment of children and adults with a variety of neurologically related syndromes.
4. Special Role Requirements of Child Clinical Neuropsychology
The subspecialty of child clinical neuropsychology shares many of the practices and competencies relevant to adult neuropsychology. However, there are bodies of knowledge, techniques, and resources which arespecific to child clinical neuropsychology. These are dictated by the major issues of child development, central nervous system plasticity and the nature of the referral questions. Although it is certainly useful for an adult clinical neuropsychologist to be cognizant of developmental issues relative to the interpretation of historical data, this is a basic requirement for the practice of child neuropsychology.
One of the salient distinctions between the application of adult and child clinical neuropsychology is the emphasis on description of processes, i.e., function and dysfunction of neuropsychological systems. This is true whether one is concerned with the neonate, the preschool or school-aged child. The focus upon process helps opera-tionally to define the need for specific intervention strategies.
The issue of etiology of neuropsychological dysfunction is less relevant and is rarely addressed directly. That is, many school-age children seen by child clinical neuro-psychologists are referred for developmental problems broadly characterized as brain related in nature (cognitive development, language, motor skills...), rather than those resulting from a known encephalopathic event. In the majority of cases, etiology, if addressed at all, is inferred from historical data.
Another salient feature of child clinical neuropsychology is interdisciplinary assessment. For example, at the neonatal and infant level, assessments typically include, the neonatologist, the pediatric neurologist and frequently, a professional involved in the motor sciences. The disciplines of speech and language and special education must be added to the interdisciplinary list as the patient approaches school age. The neuropsychologist has the responsibility, then, to develop sufficient knowledge of related professions so that the relevant data from those other disciplines can be assessed and utilized in formulating further assessment plans, recommendations and/or direct intervention.
In practice, interventions initiated by the child neuropsychologist flow from the global assessment of the patient as a participant in a psychosocial milieu. As with the assessment itself, the nature of the interventions vary with the age of the child. With the neonate, for example, the major non-medical interventions may be provided by a therapists concerned with oromotor function. The neuropsychologist may assume the counseling role with the family, helping them to understand and to cope with the facts surrounding the impaired CNS status of their child. A more comprehensive role is case management, in which the neuropsychologist may coordinate interdisciplinary referrals, inform parents as to results of evaluations and treatment recommendations. Resources in the community should be identified, and contact with the parents and resource facilities should be maintained. As the assess-ment of the child is interdisciplinary in nature, so must the intervention strategies and the implementation of those strategies be predicated upon interdisciplinary consensus.
C. Education for Clinical and Research Competencies
Most clinical neuropsychologists characteristically attain their competencies on an ad hoc, unsystematic basis, either through non-accredited postdoctoral training programs or workshop experiences or through research in neurological settings. Therefore, the current educational preparation and procedures for validating professional role competencies of practicing neuropsychologists are neither uniform nor standardized. Formal educational and credentialing criteria for neuropsychological practice have yet to be developed and implemented. There is a need to identify specific guidelines, models, and criteria for establishing adequate predoctoral, internship, post-doctoral, and continuing education programs in clinical neuropsychology. These programs should generate neuropsychological competencies that can subsequently be validated independently by state and national board review procedures. Educational planning should address the desirability of competency-determined approaches to curriculum design and validation. A competency-based approach for establishing professional competencies would also help clarify the status of Clinical Neuro-
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psychology as a specialty in accord with the criteria for specialty
status being developed within APA.
The Task Force has identified five models by means of which definitive
training in clinical neuropsychology might be obtained. All models require
extensive and combined preparation in psychology and the neurological sciences
and the availability of the resources of a department of psychology and
of appropriate departments and units of a medical school.
Model 1: Subspecialty Emphasis in a Traditional Applied Curriculum
This approach calls for the incorporation of neuro-psychological knowledge and clinical competency development within a traditional applied psychology curriculum such as a clinical or counseling psychology program. The product of such programs is expected to be a general-ist whose refinement of competencies in neuropsychology is likely to require postdoctoral training following a general clinical internship. Such generalists would be expected to be competent in research and service roles. Full competency attainment in clinical neuropsychology would be expected only after one-two years of postdoctoral study in an organized and structured postdoctoral program. The degree to which neuropsychology content and supervised clinical experience has been incorporated into traditional applied program curricula varies widely across existing programs. Although this is the prevalent model for the training of clinical neuropshychologists at this time, the Task Force recommends the development of other educational options as a means of ensuring the continued quality and growth of the specialty.
Model 2: Interdepartmental Supporting Program in Clinical Neuropsychology and Neurosciences
Most graduate programs in psychology require a minor or equivalent interdepartmental supporting program outside the major department. This model utilizes the availa-ble time in the curriculum for extradepartmental preparation and provides the necessary balance of courses and practicum experiences for the development of clinical service and clinical research role competencies. This supporting program should include courses in functional neuroanatomy, clinical neurology (adult and/or pediatric), neurosurgery, rehabilitation medicine, behavioral neurology, and specialized neurologic diagnostic technologies. Elective neurological sciences courses should reflect the primary research and clinical neuropharmacology, neuropathology, and neurolinguistics. Clinical neuropshychological assessment and intervention strategies would be taught either by the department of psychology or by neuropsychology faculty in the medical school in which the supporting program is provided.
Model 3: Integrated Scientist/Practitioner Curriculum in Clinical Neuropsychology
While there have been problems associated with application of the scientist/practitioner model in clinical psychology, there appears to be considerable promise for this model when applied to clinical neuropsychology. In this more circumscribed context, the model would not be expected to yield a generalist but rather would prepare a specialist in clinical neuropsychology with general back-ground in both behavioral and neurological sciences. This model favors the production of highly competent professionals who would function within clearly-defined boundaries of professional role functioning and clinical research. The psychological component of the curriculum should provide a firm basis in cognitive, physiological, abnormal, and life-span developmental psychology. The neurological sciences component should includethe course content of the Model 2 curriculum with electives chosen on the basis fof student needs. Subsequent competencies should include as core those dealing with ethics or research and professional practice, interviewing methods and skills, problem and goal-oriented record keeping, program evaluation, and the design of specific research and clinical projects. The sociology of profes-sionalization, whether in scientific or clinical roles would be covered to help establish the necessary values and role identifications of a professional. Terminal competencies should include application of representative neuropsychological assessment approaches and analysis of individual cognitive processes for diagnosis and rehabilita-tion planning. Intervention competencies should be provided in the area of cognitive remediation, behavior analysis/modification, and psychophysiological applications. Terminal competency refinement should be behaviorally based through the implementation of a research study, appropriate clinical projects, mock board examina-tions, presentation of research findings at professional meetings, and participation in a faculty/student colloquim designed to integrate the scientific and professional role competencies.
Model 4: Coordinated Graduate Curriculum with Consecutive PhD and PsyD Components
Model IV has not been applied nor is it likely to be applied in the foreseeable future. Analysis of the model, however, may be of use in educational planning since it highlights some distinctions which may become obscure in other models. The Model IV Coordinated Graduate Curriculum calls for the differentiation of the scientist and profes-sional competency domains into separate curricular designs. While distinct, the designs overlap sufficiently so that the student could pursue both degrees simultaneously. This curriculum would permit the development of researchers in neuropshychology without specific clinical competencies through pursuit of the PhD component of the combined curriculum. Thus, the PhD component calls for deliberate research training, proceeding from a strong didactic foundation in behavioral and neurological science. The training should include experimental as well as clinical-study design exercises and core competency development in the areas of grants preparation and man-agement, interviewing, program evaluation, ethics of research with human subjects, and the sociology of pro-fessionalization. If a student then elects the PsyD option, an additional two years of intensive clinical preparation would then be pursued. Such preparation would include the applied elements of the Model III curriculum but would also include, in addition to assessment and inter-
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vention skill development, supervised experience in consultation to schools, the courts, extended care facilities, social security and vocational agencies, and rehabilitation units. In addition, the PsyD component would provide opportunity for skill development in the areas of consumer education, individual and family support systems, education of other health professionals, and in serving hospital and community information services. While relatively ambitious, the Model IV program entails no more postbaccalaureate educational preparation than that required of the medical specialties with which clinical neuropsychologists relate as professional peers. At the very least, Model IV underscores the need to establish programs at the levels of elaboration involved in Models II and III.
Model 5: Clinical Neuropsychology Track of an Integrated Neuroscience8 PhD Program
This model involves a more direct relationship between various neurosciences departments in a medical school and a department of psychology. The increasing priority of neurosciences activities within health sciences centers may favor the future development of an interdisciplinary PhD program in the neurosciences with specialty options in one or another discipline. A consortium of departments would provide a core neurosciences curriculum from which specialized tracks can flow. The major advantage of such a program would be the availability of an interdisciplinary neurosciences faculty and a coordinated basic behavioral and neurological sciences curriculum. Such a curriculum would bring faculty and students of these various disciplines together to define and explore problems jointly. The student would obtain the usual extensive preparation in psychology but would then embark on a core curriculum in the neurosciences before entering the research and clinical competency development phases of the clinical neuropsychology track. The neurosciences curriculum would be more intensive than that provided in Models II or IV so that some undergraduate preparation in basic biological and psychological sciences would be necessary to pursue such an ambitious program. Nevertheless, it is necessary to consider such options as they would most likely produce the advanced scientific personnel necessary to ensure the continued vitality and growth of clinical neuropsychology.
D. External Credentialing and Licensure In the absence of formal accredited educational programs, the Task Force recommends:
1. The entry level credentials for the practice of clinical neuropsychology shall be predicated on a license to practice at the independent professional level in the state or province in which the practitioner resides.
2. In addition, 1600 hours of clinical neuropsychological experience, supervised by a clinical neuropsychologist at the pre- or postdoctoral level, shall be required.
3. Persons receiving a doctoral degree in psychology before 1961 may substitute4800 hours of postdoctoral experiences in a neuropsychological setting, involving a minimum of 2400 hours of direct clinical service, for paragraph 2 above.
Thus, a modified clinical psychology internship, when preceded by appropriate practicum experiences and didactic coursework, might besufficient for meeting the requirements of the entry level. Appropriate internship and post-doctoral program content could be derived directly from the terminal competency phase requirements of Model III or Model IV. To insure adequancy, uniformity, and rele-vance of these comptencies, they should be defined in objective behavioral terms before external board review procedures are introduced, if feasible. While there has been much discussion about the significance of new competency-based educational technologies for curricu-lum development, graduate programs in psychology have not introduced such technologies in curriculum development. TheTask Force concludes that the application of such technologies is both timely and necessary for the continued growth of the specialty and for the establishment of uniform criteria for evaluating individual competencies.
It is anticipated that the application of new training mod-els will facilitate the flow of qualified clinical neuropsychologists. The success of these models will depend upon the effectiveness with which competency-based training modules can be developed. These modules will require that the current and evolving competencies of clinical neuropsychologists be defined in performance terms. Competencies are characteristically derived from the knowledge, skills, and attitudes involved in the performance of professional roles. These competencies can be stated in observable and measureable behavioral terms and made public in the sense that the behaviors to be mastered are known to the faculty and the students. Individual differences and abilities are of secondary interest insofar as the attainment of a competency is evaluated in criterion-referenced terms; that is to say, in reference to definable performance standards and without reference to gross differences among the learners. In attaining a competency, instruction is self-paced in the sequence of learning from prerequisite to terminal behaviors which define the competency. Organizational units or modules of instruction are needed to facilitate mastery of neuropsychological competencies. The effectiveness of these modules could then be verified by external review and examination in board examinations and related competency validation procedures. The Task Force recommends that efforts be made to relate modular construction in curriculum design to a performance-based board examination. Responsibility for the examination could then be assumed by state boards of psychology, the American Board of Professional Psychology as an added specialty or to a new American Board of Clinical Neuropsychology as an independent mechanism much like the new Ameri-can Board of Forensic Psychology.
E. Future Planning and Development In an exploration of competency definition and evaluation, the Task Force held a workshop before the San
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Francisco INS meeting in February of 1980. Dr. Thomas Cyrs was invited to preside over this workshop as a con-sultant to the Task Force. While the introduction of competency-based approaches in the analysis and verification of professioal behavior is a complex and difficult issue, the Task Force concluded that the approach warranted serious consideration and that the INS, in partner-ship with Division 40 of APA, submit a proposal to NIMH for developing a competency-based curriculum in Clinical Neuropsychology. The scope of this project should include specification of the conceptual and empirical basis of the curriculum and a set of performance evaluations with demonstrable validity for predicting compet-ency under operationally defined conditions. To achieve the necessary congruence between curriculum design and performance evaluation, it will be necessary to identify a series of questions which can then be translated into problem-solving exercises that constitute an operational definition of the competency. These competency state-ments could then be ordered in accord with their importance and value as perceived by a panel of neuropsychologists, such as the INS Task Force, and any relevant accrediting bodies. The role-relatedness of the competency could be determined by review of practices in selected sites where performance analyses would be conducted with the assistance of an educational methodologist serving as a consultant and staff resource to the panel. Results of these analyses could then be compared to comptency statements to provide confirmation of competencies and, thereby, to establish the empirical basis for competency identification and determination within the curriculum.
Among the major questions to addressed in such a project are included: Can future performance be predicted from competency assessment during training? What predictable competencies are assured, if not guaranteed, by the curriculum? How can the competency be isolated for purposes of external verification through licensure mechanisms and board examinations?
The project would hopefully lead to the identification and definition of neuropsychological competencies and their translation into terms which can form the basis of competency-attainment modules. The curriculum would be expected to establish a minimum acceptable competency in each area of application, provide sufficient flexibility in the curriculum to meet individual needs, and prepare the individual for life-long pursuit of competency maintenance and change in accord with the changing accountability criteria that govern professional practice.
INS Task Force on Education, Accreditation & Credentiallng
Mantred Meier, Ph.D., Chair
Linas Bieliauskas, Ph.D.
Lawrence Majovski, Ph.D.
Samuel Brinkman (Student)
Charles Matthews, Ph.D.
Louis Costa, Ph.D.
Steven Mattis, Ph.D.
Eileen Fennell, Ph.D.
Robert Novelly, Ph.D.
Jack Fletcher, Ph.D.
James Reed, Ph.D.
Robert Gates (Student)
Alan Rubens, M.D.
Harold Goodglass. Ph.D.
Paul Satz, Ph.D. H.
Julia Hannay, Ph.D.
Robert Sbordone, Ph.D.
Lawrence Hartlage, Ph.D.
Daniel Sheer, Ph.D.
Kenneth Heilman, M.D.
Aaron Smith, Ph.D.
Haskel Hoine, Ph.D.
Natalie Sollee, Ph.D.
Arthur MacNeill Horton, Jr., Ph.D.
Barbara Wilson, Ph.D.
Edith Kaplan, Ph.D.
Loren Wurzman, Ph.D.
Muriel Lezak, Ph.D.
Allan Yozawitz, Ph.D.
Newsletter 40
Boston University Medical Center
720 Harrison Ave.
Boston, MA 02118
(End of text)