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Division of Clinical Neuropsychology
Newsletter 40
American Psychological Association
Volume 17, Number 1 Winter/Spring 1999
DIVISION 40 OFFICERS AND COMMITTEE CHAIRS
PRESIDENT: Cecil R. Reynolds, PhD
PRESIDENT-ELECT: Gordon J. Chelune, Ph.D.
PAST-PRESIDENT: Linas Bieliauskas, PhD
SECRETARY: Ann C. Marcotte, PhD
TREASURER: Wilfred G. Van Gorp, PhD
MEMBERS-AT-LARGE:
Richard Berg. PhD.
Lloyd Crioe. Ph.D.
C. Munro Cullum, PhD
COUNCIL REPRESENTATIVES:
Theadore Blau, PhD, Kerry Hamsher, PhD Thomas J. Boll, PhD, Antonio
Puente, PhD
COMMITTEE CHAIRS (STANDING COMMITTEES)
FELLOWS: Stan Berent, PhD
MEMBERSHIP: William B. Meneese, PhD
ELECTIONS: Linas Bieliauskas, PhD
PROGRAM: Glenn Smith, PhD Joseph H. Ricker. Ph.D.
COMMITTEE HEADS (AD HOC COMMITTEES/TASK FORCES):
SCIENCE ADVISORY: Russell Bauer, PhD
EDUCATION ADVISORY: Kerry Hamsher, PhD
PRACTICE ADVISORY: Joseph D. Eubanks, PhD
PUBLIC INTEREST ADVISORY:
ETHICS: Barbara C. Wilson, PhD Bruce Becker, PhD
MINORITY AFFAIRS: Duane E. Dede. PhD
NEWSLETTER: John DeLuca, PhD
TRAINING PROGRAMS DATA BANK: Lloyd Cripe, PhD
AWARDS COMMITTEE: Ida Sue Baron. PhD
CPT CODE: Antonio Puente, PhD
ASHA/DIV.4O TASK FORCE LIASON: Jill Fischer, PhD
"INCIDENT TO” TASK FORCE: Linas Bieliauskas, Ph.D.
POLICY/PROCEDURES MANUAL COMMITTEE: Darlene G. Nemeth,
PhD
LIAISONS TO APA COMM. ON GAY, LESBIAN & BISEXUAL
CONCERNS: Kristine M. Herfkens, PhD Roger L. Mapou,
PhD
LIAISON TO APA COMM. ON WOMEN IN PSYCHOLOGY: Paula
Shear, PhD
REP. TO THE INTERDIVISIONAL COUNCIL: Ann C. Marcotte,
PhD
Eileen Fennell, PhD
DIVISION 40 ARCHIVIST: Darlyne Nemeth, PhD
www.div40 Webmaster: Lloyd Cripe, Ph.D.
President's Message:
On Mangled Care and Other Matters
The managed care industry has had a substantial impact
on the practice of clinical neuropsychologists in hospital and clinic settings
but even more profoundly in the individual clinical practice. Indeed, the
prevalence of the PPO and HMO concepts seem to be driving neuropsychologists
into large clinics, hospitals, and government operated settings at a substantial
pace. Several members of the Division have raised a number of issues with
regard to the propriety of certain managed care practices that have considerable
impact on the clinical freedom of neuropsychologists to act in the best
interest of their patients and quite simply, to do their job.
Many of you, myself included, have had the experience
of contacting a managed care company to obtain precertification for neuropsychological
testing of a referred patient for purposes of diagnosis, treatment planning,
or treatment monitoring. It is common with many companies to request a
list of specific tests to be used with a patient and the time requested,
bundled for administration, scoring, interpretation, and report writing,
for each test. A faceless reviewer who has had no contact with the patient
then determines which of your proposed tests are medically necessary,”
and the length of time it will take for your patient to be administered
these tests. Commonly, the reviewer does not allow all of the tests requested
nor the time required to do good diagnostic work. Upon objection, the neuropsychologist
is often told to do whatever they think is necessary to do a good job but
the managed care company will only pay for the tests the reviewer has determined
are necessary. This caveat is a de facto denial of appropriate care to
the patient but is used by managed care as their out,” so they can argue
that they do not deny care, they only determine which care they will reimburse.
This creates personal, ethical, professional, and financial conflicts for
the practicing clinician.
The reviewer may or may not be a psychologist, and
if a psychologist, may or may not be a neuropsychologist. This raises a
number of issues that must be addressed head on by our profession, much
as we have addressed the incident to” issues and the development of appropriate
billing codes for neuropsychologists and relative work values with HCFA.
If a managed care company reviewer determines which
psychological and/or neuropsychological tests are appropriate to be
Continued on page 7
[Page 2]
From the Editor
Our Winter-Spring issue of Newsletter 40 presents
a memorial tribute to Drs. Charles Matthews and Aaron Smith, two Neuropsychologists
who have made very significant contributions to our field. We are pleased
to present this tribute from the Division 40 membership. We are pleased
to continue to present our regular columns as well such as minutes from
the Executive Meetings and Announcements. Our Presidents Message is important
to us all. The Clinical Corner presents a unique application of Neuropsychology
into the US space program. The Science Scene provides very important information
on funding opportunities for research. The Division 40 Education Committee
provides an summary of its latest actvities, which are extensive.
We hope you enjoy this issue of your Newsletter.
We encourage you to contact your elected officials and other representatives
of the Division, and don't forget to visit regularly with the division
40 website.
John DeLuca, Ph.D.
Editor
On Mangled Care and Other Matters 1
From The Editor: 2
Science Scene 2
Memorial Tribute
Charles G Matthews 3
Clinical Corner
Neuropsychology in Space 4
Memorial Tribute
Aaron Smith 5
From the Education Committee
of Division 40 6
Message from APA President 6
Division 40 Scholarship and Award Winners 7
Division 40 Executive Committee Meeting Minutes 16
Annual Business Meeting Division 40 20
Russell M. Bauer, Ph.D., University of Florida
SAC Activities
The Science Advisory Committee (SAC) has been working
on a number of new initiatives designed to support and foster science activities
and awareness among Division 40 members. One such initiative is designed
to attract new and exciting neuropsychology and cognitive neuroscience
research to the Division 40 APA program. Toward this end, the SAC announces
two new student awards in addition to those already given by Division 40.
Each award carries with it a $250 stipend designed to help with costs associated
with attending the meeting. These awards will be given for the first time
in Boston in 1999. The first award is for a student-initiated paper that
reflects excellence in the field of clinical neuropsychology. Papers that
utilize neuropsychological methods to study clinical problems will be considered
for this award. The second award is for a paper that reflects excellence
in cognitive neuroscience. Papers that utilize neuropsychological or neuroscience
methods (psychological experiments, functional imaging, psychophysiology,
evoked potentials, etc.) to elucidate cognitive processes in a nonapplied
context will be considered for this award. The SAC will select award recipients
from those student papers submitted to the 1999 Division 40 program.
The second goal is to increase science visibility
in the Division 40 program by sponsoring a scientific symposium at the
APA meeting that would have broad interest to APA members. The committee
is currently in the process of arranging a symposium focusing on Functional
Imaging Applications that will feature prominent neuropsychologists engaged
in imaging work from several centers across the US. For the 2000 conference,
we are considering a symposium on Developmental Neuropsychology. Further
ideas on how to emphasize Division 40's investment in science are welcome.
Continued on page 8
[Page 3]
Newsletter 40
Memorial Tribute
Charles G Matthews
TRIBUTUM ET MONUMENTUM AD CHARLES (CHUCK) G. MATTHEWS
Convenimus ut doctori et litterato summo cum ordine, medico summo cum acumine, homini summa cum integritate, valere iubeamus et illum honoremus. Quietus at sapiens dux erat. Eloquentia magnifica et facetiis docuit, quae perpetuo animo summisso et misericordia solum aequatae sunt. Erat homo quotidianus rarae facultatis, qui libere effecit ut alii comprobationem et potestatem sentirent. Exemplum eius vitas innumeras tetigit, et in nostris aspirationibus habitat. Eum et legatum eius salutamus!
We have come to pay tribute and bid farewell to a
teacher and scholar of the highest caliber, a clinician of unsurpassed
talent, a man of utmost integrity. He was a quiet yet wise leader. He taught
with superb eloquence and wit, that were equaled only by his unending humility
and compassion. He was a common man with uncommon gifts, given freely to
make others feel recognized and empowered. His example has touched countlesslives,
and lives on in our aspirations. We salute him and his legacy.
The foregoing words were read at Chuck's funeral.
The Latin was thought appropriate to commemorate Chuck's professional preparation
in a Benedictine seminary. He spent 4 years at St. John's Preparatory School
in Minnesota being steeped in the translation of Caesar and Cicero among
others. He was quite adept at conjuring up a Latin phrase to capture the
essence of the moment, a talent which both impressed and intimidated attorneys.
I came to enjoy the salutations of his letters which routinely were in
Latin and invariably sent me to my Latin-to-English dictionary.
Something about the monastic life obviously attracted
him. I suspect it was the scholarly study of the classics in an environment
conducive to reflection. Time for reflection was very important to him.
Later in life he would complain that the hectic pace of academic medicine
simply left too little time to ponder and reflect on important issues and
developments in our profession. His days in the seminary also provided
him with avocabulary of rich religious terms for characterizing patients
and circumstances, e.g., reciting the litany of symptoms (somatoform tendencies),
owing to one's personal creed (delusions), undergoing the inquisition (deposition),
turning to the sacred doctrines (rules of test interpretation), and respecting
one's superiors (department chair and hospital administrators).
The thoughts of the Latin passage are hardly original.
Indeed, meritorious comments about his integrity, wit, eloquence, humility
and compassion permeated the presentations of virtually every commentator
at both his funeral and the tribute made to him at the APA meeting in San
Francisco. Ironically, while others readily recognized these virtuous qualities
in Chuck, he did not appreciate them. For example, while his eloquence
in public presentations was legendary, and even assumed, he of all people
was insecure and never confident of how a speech would be received. He
often labored in his preparations, and
Continued on page 10
[Page 4]
Newsletter 40
Clinical Corner
NEUROPSYCHOLOGY IN SPACE
Robert L. Kane', Christopher Flynn2, Rodney Vanderploeg3, Paul Retzlaffd, Jeffery Moore5, Steven Vander Arks, Daniel Ekzuians, Dennis Reeves7, Tim Elsmors, & Kathy Winter9
VA Maryland Health Care System, University of Maryland, Georgetown University, 2 NASA Johnson Space Center, 3Tampa VA Medical Center, University of Northern Colorado, 5Robert E. Mitchell Center for Prisoner of War Studies, Pensacola, FL, 6Wyle Laboratories, Houston, TX, 7 San Diego Naval Medical Center, aActivity Research Services, San Diego, 9Naval Computer and Telecommunications Station, Pensacola, FL
When the space shuttle Endeavour took off from Cape
Canaveral, January 22nd, it launched a new era for neuropsychology. For
the first time, a tool to perform cognitive evaluations in space became
an official part of Medical Operations at Johnson Space Center. Endeavour
carried on board a new tool to monitor crew health. The tool is called
the Space-flight Cognitive Assessment Tool (SCAT). The SCAT is a series
of computerized cognitive exercises designed to assess aspects of attention,
response speed, and memory. Its purpose is to provide crewmembers and flight
surgeons objective data to help assess an astronaut's mental functioning
should an accident or injury occur while in space. In the future, the SCAT
might also be used to look at the effects of sleep disruption or other
circumstances that could interfere with a crew member's efficiency.
The impetus for developing the SCAT was the realization
that as missions in space become longer in duration, accidents can happen
the same way they do on earth. Potential dangers include toxic exposures
and decompression incidents along with the possibility of injury or illness.
The S-CAT was designed to assess and monitor neurocognitive functioning.
It is a clinical assessment tool designed for repeated assessments. It
is presented as a standard part of a crewmember's routine medical check-up
while in space. In addition, it can be used as mission events and circumstances
dictate.
The SCAT was based on existing technology modified
to meet NASA's needs and specifications. The core of the SCAT is made up
of selected tests from the Automated Neuropsychological Assessment Metrics
(ANAM) test system. ANAM was developed by the Department of Defense. It
is a library of tests that can be modified and configured into different
batteries for different clinical and research needs. Other tests were added
to the SCAT to bolster assessment of memory and distributed attention.
The SCAT contains two distinct test batteries, both repeatable. One was
designed for brief repeated measures assessment and monitoring. The other
as a follow-up battery should a flight surgeon or crewmember feel the need
for further assessment.
The SCAT was flight tested on this last Shuttle-Mir
mission. Future plans include using S-CAT as a medical evaluation tool
on the International Space Station. As it is evaluated and refined, it
is likely that the SCAT would be part of any mission to Mars. The SCAT
is also being used in ground-based simulations of long-duration missions.
It was recently part of the operational medicine assessment package used
in a 90 simulated mission conducted in the NASA Lunar Mars Integrated Life
Support System Test Facility at Johnson Space Center.
The SCAT is a result of the contributions and cooperation
of several government and non-government agencies. NASA is the lead agency.
However, work being done with computerized assessment at the Baltimore
VA Medical Center, Georgetown University, the San Diego Naval Medical Center,
and the National Rehabilitation Hospital contributed substantially to the
design of the SCAT. As noted, the basic software for the SCAT, while modified
to meet NASA needs and specifications, was developed by the Department
of Defense for studies related to chemical defense and countermeasures
against chemical weapons. These measures were then adapted for clinical
purposes. In addition to being a new tool to monitor the health of space-crews,
the S-CAT could become an important example of technology transfer and
inter-agency cooperation. It is also an acknowledgement of the contributions
made to patient assessment by neuropsychologists and an example of how
neuropsychology can be used in non-traditional settings.
[Page 5]
Newsletter 40
Memorial Tribute
Aaron Smith
In Memoriam - Aaron Smith, Ph.D.
Aaron Smith died on June 13, 1998 after a brief bout
with pancreatic cancer. In true form he was a young 82 year old, still
seeing patients and preparing and editing research papers. In addition
to compiling an extraordinary list of publications, Aaron was a past president
of the International Neuropsychological Society, Fellow of the American
Psychological Association, Charter Member and Diplomate of the American
Board of Clinical Neuropsychology, Editor of the International Journal
of Neuroscience and Professor Emeritus of the University of Michigan.
Some may remember Aaron from past INS meetings as
the tall, serious man in the back row with the booming voice, asking pointed
questions that made you squirm in your seat in empathy for the presenter.
Others may remember him as the professor they went out to dinner with and
enjoyed a fascinating discussion of Russian literature, music, wine, food,
or current events. Others may have approached him with apprehension, but
were surprised when he took a genuine interest in their research, then
gave them several valuable suggestions, and off the top of his head, a
list of helpful references.
Aaron Smith was born in New York City in 1916, a
child of the depression. His widowed mother struggled to raise five children
in a two room flat on the lower east side. Aaron sometimes spoke of the
benefits of poverty, and clearly this reflected his own personal experience.
Aaron's first ambition was to be an author. He wrote several short plays
which were produced off-broadway by the East Side Dramatic Group which
he founded in the late 1930s. His work prompted an invitation to move to
Hollywood to write for the movie industry. Instead, he went to Brazil where
he worked as a tutor and
played semi-pro basketball. At 6' 4” he was known
in Rio as the Gigante Americano.”He also traveled throughout South America,
working on a crew that built airports.
During World War II, Aaron was part of the D-Day
invasion force, assigned to towing concrete piers across the English Channel.
After the war, he became a radio operator for TWA. This job permitted him
to travel the world while completing his psychology training at City College
of New York. When he took a class with Kurt Goldstein, Aaron quickly realized
that neuropsychology was to become his full-time all-consuming passion
and life's work. Aaron liked to tell of how he once approached Goldstein
wondering why a patient with a lesion localized in a particular area of
the brain did not show the symptoms described in his neurology textbook.
Goldstein replied Aaron, if the patient doesn't agree with the book, throw
the book away. The patient can never be wrong.”
Aaron completed his Ph.D. at Yeshiva University.
His dissertation described factors contributing tolongterm cognitive declines
in frontal lobotomy patients. In an atmosphere of euphoria over this new
treatment for schizophrenia, his report was an unwelcome cautionary note
in what is now recognized as an unfortunate chapter in the history of science.
In 1961, after completing a Post-Doctoral internship
with Ritchie Russell at Oxford University, Aaron published the first article
in a United States scientific journal demonstrating the utility and validity
of Post-Continued on page 13
[Page 6]
From The Education Committee of Division 40
In an effort to augment the role Division 40 may play in its contribution to the development of education and training in clinical neuropsychology through its Education Advisory Committee (EAC), a luncheon was held at the APA meeting in San Francisco this past August, 1998. Included were the presidents or representatives of the three educational organizations viz., the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN), the Association for Internship Training in Clinical Neuropsychology (AITCN), and the Association for Doctoral Education in Clinical Neuropsychology (ADECN). Hereafter the EAC shall continue to provide a forum for communication, coordination, and cooperation among ADECN, AITCN, APPCN, and the EAC of Division 40.
Our guest at this luncheon was Michael Patton, Ph.D., Chair of the APA Committee on Accreditation (CoA). Concerns were raised in regard to the cost of accreditation ($2K for the application year, $3K for the site visit, and a $2K annual maintenance fee thereafter),and the CoA's exclusionary rule prohibiting applications for accreditation by residency programs with less than 2 residents. A bilaterally fruitful discussion was held. Among other things, we learned that the fee structure for accreditation will be revisited by APA in the year 2000.
Also at the APA meeting in San Francisco, the EAC held its first social event for all students with interests in clinical neuropsychology. The EAC expects to continue this event on an annual basis, holding it from 6:00 to 8:00 p.m. on the Saturday of the annual APA meeting. The EAC hopes to obtain the participation of at least one faculty and one student representative (and alumni if possible) from every doctoral, internship, and residency program participating in these educational organizations.
The goal of this event is to provide an informal social context so as to allow students at all levels of education and training an opportunity to meet faculty Newsletter 40 6 and students from doctoral, internship and residency programs in clinical neuropsychology. Whether this serves to meet their compatriots in other programs to compare notes, or to explore programs at higher levels of education and training through these programs' faculty or students, or to catch up on the goings on in the programs from which they have graduated, the EAC hopes this event will have a salutary effect on the interests of students and faculty and contribute to a general esprit de corps.
This social event was a modest success at the APA meeting in August.The EAC learned a great deal about problems we need to overcome in the future in our preparations and in disseminating the invitational material.
The EAC will continue its initiatives in interfacing with various components of the APA Education Directorate. The EAC also will be developing materials for posting on the Division 40 web site.
Kerry Hamsher, Ph.D., Chair
Division 40 Education Advisory Committee
Message from APA President
Dr. Richard M. Suinn
Dr. Suinn has declared an interest cancer as a major initiative as part of his Presidency of APA. He is requesting that members of various APA Divisions to submit articles on cancer research with a special emphasis on the topic area of each Division. As such, the editors of the Division 40 Newsletter are soliciting articles on cancer research in neuropsychology from the Division 40 membership to be published in the next issue of our Newsletter. Dr. Suinn is hoping to have enough such articles to form a bound volume for dissemination. Please submit your article no later than April 15, 1999 to Dr. DeLuca for review. Only 1 article will be selected for publication.
[Page 7]
On Mangled Care and Other Matters
Continued from page 1
administered to a particular patient for the purposes of diagnosis,treatment
planning, or treatment monitoring, does this mean the reviewer is practicing
psychology? Certainly from a common sense standpoint, such decisions are
in fact the practice of psychology. From the standpoint of state licensing
laws, the issue is unclear in many cases. Reviewers may also be ina different
state than the neuropsychologist and the patient. This further complicates
the issue of governing law. I have asked the Chair of the Division 40 Practice
Advisory Committee, Dr. Dan Eubanks, to call upon the resources of his
committee and to work jointly with the APA practice directorate to develop
a written discussion of the problems related to this practice and whether
it indeed constitutes the practice of psychology and under what conditions.
We must develop thoughtful, reasoned analyses of these issues in order
to provide appropriate patient care while being financially viable as a
profession at the same time.
If the reviewer is a psychologist, other issues
come to the fore. A nonpsychologist is not bound by the ethical principles
of the profession or the rules of practice in the state in which they are
licensed. A licensed psychologist however has additional and higher levels
of responsibility to the profession in making such judgments. Consider
some of the following issues. Is it appropriate for a psychologist who
has not seen or interviewed a patient and has not reviewed the patient's
records and history to determine what psychological or neuropsychological
tests are necessary for proper diagnosis and treatment planning with a
specific patient? I have personally encountered psychologists who conduct
reviews for managed care companies who were clearly not neuropsychologists
yet were passing judgment on the appropriateness of specific neuropsychological
tests. In one recent such review, the psychologist noted that he was denying
my request for certain neuropsychological tests because he was not familiar
with them and was not sure what they measured but did not think they measured
what I intended to use them for (these obscure tests included the Trail
Making Test, Seashore Rhythm Newsletter 40 Test, and the Speech Sounds
Perception Test). I have heard similar stories from other members of our
Division. An additional question then becomes whether it is ethical or
otherwise appropriate for a psychologist without competence in neuropsychology
to determine the appropriateness of specific neuropsychological tests for
a particular referral. This seems obviously problematic if the psychologist
is unfamiliar with the tests being requested. Certain of the ethical principles
of psychologists and the rules of practice in several states would seem
to dictate that a psychologist must in fact see a patient to make such
determinations and that, a psychologist without competence in neuropsychology,
would be practicing outside their area of expertise in passing judgment
on the appropriateness of neuropsychological tests.
Continued on page 9
ROBERT A. and PHYLLIS LEVITT AWARD:
Marlene Behrmann from Carnegie Mellon University has won the the Levitt
award. Dr. Behrmann has been involved in basic research and has contributed
to clinical practice by her studies on visual imagery, attention and neglect,
and rehabilitation of language and reading disorders. She has extended
and refined her computational theory of attention and unilateral neglect.
Her multifaceted contributions to neuropsychology contributed to her selection
as this year's winner of the Levitt Early Career Award.
HENRY HEACAEN SCHOLARSHIP: Melissa Lamar is the winner of this scholarship. Melissa attends Drexel University in Philadelphia, in Clinical Neuropsychology.
MANFRED MEIER SCHOLARSHIP: Tim Conway is the winner of this scholarship. Tim attends the University of Florida at Gainesville, in the Department of Clinical and Health Psychology, with Neuropsychology as his specialty area.
[Page 8]
Newsletter 40
Science Scene
Continued from page 2
Science News
Funding Opportunities. Although the past several years have been
difficult, indications are that NIH funding of behavioral science, neuropsychology,
and cognitive neuroscience is improving. The 1999 President's Budget for
NIH represents an 8.4% increase over FY 1998, and the picture may be even
better for FY 2000, where budget estimates call for a further increase
around 15%. All of this means that the pendulum is swinging back toward
a favorable picture as far as federally-funded research and research training
is concerned. In addition to individual research projects (ROl), NIH has
several grant mechanisms that might be of interest to Division 40 members.
These include the Small Grants Program (designed to fund smaller-scale
demonstration projects that may represent an initial foray into a research
area for a particular investigator), the Academic Research Enhancement
Award (designed to enhance research activities and training at institutions
that do not have substantial NIH funding), and Career Development Awards
for individual investigators. The National Research Service Award is a
primary NIH mechanism for individual pre- and post-doctoral training support.
The level of support within pre- and post-doctoral NRSA awards is slated
to increase 25% in FY 1999, bringing the annual predoctoral stipend to
$14,600 and the postdoctoral stipend to $26,200. The NRSA is an increasingly
attractive mechanism for funding research training in neuropsychology and
cognitive neuroscience because of the favorable budget climate and because
training of future biomedical and behavioral researchers is a primary NIH
priority. Small Business Innovation Research and Small Business Technology
Transfer awards are also available and will increase by nearly 9% over
FY 1998. This all should encourage Division 40 members who have not sought
NIH support for their research activities to consider doing so. While obtaining
such support remains highly competitive, it is no longer the bleak long
shot” it once was. Further information on the range of funding opportunities
can be obtained from the NIH website at: www.nih.gov/grants/nding/funding.htm.
NIH Reorganization. Readers should also know
about major changes in the organization and functioning of study sections
(peer review groups) at NIH. Basically, three previously separate institutes
(National Institutes of Mental Health, Drug Abuse, and Alcohol Abuse and
Alcoholism) have been integrated into NIH, resulting in a reorganization
of the structure of peer review committees that review grant proposals.
The initial focus was on reorganizing review of neuroscience applications,
with later focus on behavioral and social sciences. Reorganization of neuroscience
review led to the establishment of new study sections on Cellular Neurobiology
(5 study sections), Developmental Neuroscience (3), Cognitive Neuroscience
(2), Integrative and Functional Neuroscience (5) and Brain Disorders/Clinical
Neuroscience (7). Study sections are organized around substantive scientific
areas rather than specific funding mechanism (e.g., training vs. research).
The NIH Center for Scientific Review (formerly the
Division of Research Grants) will be substantially reorganized beginning
with the review of grants submitted for the February 1999 deadline. The
reorganization of behavioral and social science applications is now nearly
complete. Essentially, there are seven Basic Behavioral Science (BBS) study
sections, and eight study sections covering Risk, Health, and Social Sciences
(RHSS). The BBS study sections focus on affect/emotion, language, cognition/perception,
adult onset psychopathology, developmental disorders, and motor function.
The RHSS study sections focus on social-emotional development,intervention
research, behavioral health, psychological aspects of mental health, physical
health, and drug/alcohol abuse, socioenvironmental factors, population
studies, health services research, and technological/methodological advancements.
Specific details about these committees is available on the NIH website
at www.drg.nih.gov/review/bssreorg.htm. The SAC currently has the following
members: Russell M. Bauer, Chair (rbauer@hp.ufl.edu), Richard Kaplan (kanlan@psychiatry.uchc.edu),
Jane Continued on page 9
[Page 9]
On Mangled Care and Other Matters
Continued from page 7
I have asked Dr. Bruce Becker, Chair of the Division
40 Ethics Committee, to develop a written discussion of these issues and
to render opinions about the ethics associated with such actions and to
coordinate with the APA ethics committee in addressing these matters of
concern.
These are not just matters of professional turf
or some obscure rule designed to enhance our profession internally .These
are matters of direct concern to the quality of patient care and the ability
of neuropsychologists to practice independently. The review and precertificatinon
of diagnostic procedures, particularly being reviewed and approved on a
test by test basis smacks of long distance supervision .As a profession,
we cannot afford to sit idly by while our ability to serve our patients
as we see fit is superceded by long distance telephone reviews of appropriate
psychological and neuropsychological testing.
Division 40 has been successful in bringing its
resources to bear on a variety of issues that continue to be of concern
to us. In conjunction with the leadership of the APA practice directorate,
past president Dr. Linas Bielauskas, has continued to monitor issues surrounding
the incident to ” reimbursement policies. Progress continues to occur on
this front .HCFA has been responsive to the concerns of the Division as
well and Dr. Tony Puente has been heavily involved in the CPT coding issues
and the establishment of relative value for our work also in conjunctio
nwith the APA practic e directorate. Constant vigilance and a proactive
stance are necessary on all fronts.
To become increasingly proactive in support of our
profession and our membership, I will be proposing, along with president
elect, Dr. Gordon Chelune, the development of Division 40 supported literature
reviews to assess the empirical support for practice in clinical neuropsychology.
As a clinical profession that prides itself on its scientific basis, it
only makes sense that its representative, Division 40, would promote the
clear documentation and collation of the scientific literature that supports
the clinical utility of what we do. The specific nature and form of this
task will be discussed at the Newsletter 40 upcoming Division 40 midyear
Board meeting held in conjunction with the INS convention in Boston in
February .Whatever form the executive Board chooses, we will all benefit
as will our patients from the careful documentation of the scientific basis
of specific practices in clinical neuropsychology. We will then be prepared
to meet the challenges of managed care and others who would deny proper
patient care solely on the basis of profit motive and fiscal restraint.
As your President, I urge each Division member to
contact me or other of your elected representatives with issues and concerns
about the practice of clinical neuropsychology and its development as a
profession. The activities of the Division need to be driven by the needs
of its membership and the needs of the profession. Your Board is composed
of a solid
mix of clinical practitioners, academics involved in the training
of neuropsychologists, and researchers in our discipline. We are nevertheless
few in number and do not have the perspective of our broad array of membership.
Your involvement in the activities of the Division is necessary to the
work of the Division but also to your ability to provide appropriate patient
care and ultimately to your ability to practice your profession independently.
Do let us know of your concerns and please do participate with your time,
thoughts, and efforts when called upon to do so by the leadership you have
chosen for your Division.
Cecil R. Reynolds, PhD, ABPN, ABPP.
President, APA Division of Clinica l Neuropsychology.
Science Scene
Continued from page 8
Paulsen (jane-paulsen@uiowa.edu) , Joe Trac y (trac v @ auhs.eud), Max Trenerry (trenerrv.max@mavo.edu ) and Mike Westerveld (westerm@email.msn.com) . The role of the SAC is to support and enhance science activities within Division 40. Division members should call upon any of us if we can be of help.
[Page 10]
Newsletter 40
Charles G Matthews
Continued from page 3
ruminated about the delivery of an address, to the point of seeking
counsel. I recall that he worked himself into a particular frenzy in thinking
about his presidential address to theInternational Neuropsychological Society
in 1991. He asked me to review an early draft of his thoughts. Once I deciphered
his handwriting, I recall marveling at the precision of his choice of words,
a precision that most of us aspire to achieve in final polished versions,
much less in preliminary exercises. The speech is now legendary. Those
who worked with him on a daily basis were able to witness his eloquence
even in his most informal and ill-prepared moments.
While Chuck was many things to many people, it is
hard to imagine him more excited and enthused than when he was teaching
and interacting with students. I never knew him to pass up an opportunity
give a colloquium or be with students. Indeed, my most precious memory
of Chuck was my first encounter with him. I was a lowly graduate student
attending an INS convention in Minneapolis. Shortly after asking him what
was probably an inane question, I found myself sitting in a bar with him
on the top floor of the convention hotel, sipping a drink, and musing over
matters of testing philosophies, delivering psychological service to the
reservations of South Dakota, and coping with the personal creeds ” of
one's superiors ” in the seminary.
Pax vobiscum, Carolus!
Tomas Hammeke
"Charlie, Charles, Chuck ”
Charles G. Matthews, Ph.D.
March 30, 1930 -- April 19, 1998
Charlie Charlie was a fun guy. His classmate at
St. John 's thought of him as quite the character. ” The friendships that
were forged there lasted a lifetime and to these good men he was always
Charlie. ” Charlie 's uncanny perceptiveness, substantial intelligence,
and subtle wit were appreciated by all. The St. John 's faculty knew him
to be a student that you wanted in your class. Charlie enjoyed learning
and he valued what he learned, though he also enjoyed proclaiming that
his liberal arts education had prepared him for life at the cutting edge
of the 18th century. ”Charlie never took himself too seriously.
Charles
Madison, Wisconsin, the center of Charles ' universe,
is populated with people who loved him and whom Charles loved. Charles,
you see, was Geri 's devoted husband, Anne Margaret 's proud father, and
an army of people 's dearest friend. Whenever the opportunity presented
itself for Charles to talk about his girls ” and their accomplishments,
his usual professorial demeanor transformed into the proud glow of a doting
father and husband. No matter how much physical pain Charles endured, a
smile always lightened his face when he was asked about his girls. Charles
was only slightly less proud of his many other children. He was the biological
father of just one child, but the professional father of many.
Chuck
We knew him as Chuck.
Chuck was a teacher, a healer, a mentor, a colleague
,and a friend. His profession was neuropsychology, but Chuck taught lessons
that molded students ' souls. At least once (that I know of), late in his
life Chuck grudgingly acknowledged that he had, in fact, done some good
work. ” He wasn't referring to his many scientific o r professional accomplishments,
to the esteem in which he is held by his many friends, or to the awards
that place dhim at the center of neuropsychology 's inner circle. Chuck
measured himself by the successes of his students and the accomplishments
of his friends. He probably never appreciated it (and if he had, he would
never admit it) but all of Chuck 's friends were, in one way or another,
his students. To the day he died, Chuck 's life was a lesson on living.
His daily deeds were both his lessons and his gifts.
Chuck cared about others. At his funeral we learned
about the file of poems that he kept in his office desk. He incorporated
these poems into beautiful letters of condolence that he so carefully
[Page 11]
and lovingly prepared to ease the pain of his friends when they had
lost a loved one. Chuck even tried to ease the pain that he knew Geri,
Anne Margaret, and the U.W. neuropsychology staff would bear when it came
time for his own funeral. He wrote, Use these for me,” on this poetry file.
Chuck cared for us even after he was gone.
Arthritis was Chuck's cross and pain was his constant
companion. These twin evils disfigured, bent, and badly beat him. He was
in a constant but quiet battle, day in and day out, for as long as most
of us knew him. He rarely complained and he frequently ignored his own
distress to attend to others' problems. Chuck probably never realized how
his very private and very painful battle affected those of us who watched.
In our eyes he continually grew in both stature and strength. It has been
said that God only gives us crosses that we can bear. If that's true, then
God saw Chuck as an incredibly strong man.
It wasn't easy for Chuck to use his strength, but
if he had to he would. At his INS presidential address he dared to chide
our profession for its failings. He reminded those of us who are privileged
that our riches carry a responsibility to others. Sometimes his hesitancy
to be forceful had a down side. He used the occasion of accepting the NAN
Distinguished Neuropsychologist Award to warn us to resist the forces that
work to dummy down” our profession. The poetry of his words belied the
intensity of his concern. Chuck worried about us and for us. He wanted
the best for us and for those we serve. To this end he taught that professional
competence was earned, not purchased or bestowed. He believed in honest
work, rigorous standards, fair tests, and principled behavior. He had little
tolerance for substandard professional preparation, workshop mediocrity,
andpseudo-academic institutes - and even less regard for those who organize,
promote, and profit from them.
Chuck wasn't perfect. He enjoyed a drink, especially
with Homer, and he was a bit of a gossip. My fondest personal memory is
having him to myself for three or four hours each time that we drove together
to and from the twice-yearly ABCN oral exams late in his life. During these
drives Chuck spoke forcefully and candidly about the issues and the people
that shape our profession. As his health failed and travel became impossible,
I could always expect a call from Chuck after a professional gathering.
So much of his life was neuropsychology, and it was so difficult for him
to be kept from it.
So what will be Chuck's legacy?
His legacy is us and our profession. We are better
because of Chuck. It is Tess, Austin, Jeanne, Phyllis, Bruce, and all of
the other people who staffed Chuck's Lab” for so many years. It is his
students: Jordan, Kathy, Suryea, Preston, Jim, and so many others. It is
his professional contemporaries and dear friends: Manny, Homer, Edith,
Hal, Art,
It is the people of the organizations for which
he worked so long and so hard: Kerry, Linas, Tom, Bob, . . . .
Chuck lives on in us all. We must now live up to
the standard that he set.
"Requiescat in pace,” my friend.
Robert J. Ivnik, Ph.D.
Postdoctoral Fellow, 1976-1977
Charles G. Matthews Neuropsychology Laboratory
A Personal Reminiscence
Since Chuck Matthews' death in mid-April of this
year, I have tried to bring into focus different aspects of a relationship
that extended over 40 years. Our relationship spanned my adult years, enriched
my life, and energizes me still through the shared experiences that lie
happily in memory, arising at my beck and call. A selective recounting
of some of my more vivid memories involving Chuck follows. The selectivity
is reinforced by a note I received from Chuck following the gathering a
few years ago of his colleagues and students who testified to his contributions
to neuropsychology. I did not participate actively by giving testimony,
and shortly after I returned to Boston, I received a note from Chuck thanking
me for my discreet silence which he claimed as an important basis for our
long and close friendship.
Chuck and I shared a number of demographics, some
important, some not. We shared 1930 as our
[Page 12]
birth year, and we both earned doctorates in clinical psychology in
the mid-1950's at Purdue University. Our introduction to neuropsychology
was shepherded and shaped by Ralph Reitan, and both of us were happy to
acknowledge the career-long debt owed him. The demographics of birth and
training are not more important, however, than the impact of childhood
and adolescent experiences of growing up in rural western communities in
the 30's and 40's. The distance as the spirit travels between my home in
western Kansas and Chuck's home in South Dakota is very small. The culture
of those communities values common sense, plain speech, and a lack of artifice
in emotional expression. It is a serious approach to life but one leavened,
at least in Chuck's case, by dry humor and an often self-deprecating wit.
Chuck's seriousness of purpose and his wit were both evident throughout
his living and dying. We often worked together as observers for candidates
undergoing the Board examinations in neuropsychology. The role of the observer
is to evaluate the examiners while keeping an active eye on the candidate.
We did this each day and at night, over a shared flask of Irish whisky,
we delighted in evaluating the examiners by seeing whether or not we could
answer their questions satisfactorily. Although we were usually able to
give ourselves passing grades, there were instances for each of us when
we could not, events that we happily attributed to the examiner's narrow
frame of reference and arcane interests. With candidates, Chuck was always
at his reassuring best, a valuable and necessary trait since his mien was
typically that of an undertaker. A vivid example comes to mind. The brief
break between oral examinations allows one only to pencil a few notes while
running to and from the bathroom. Chuck and I were busily peeing away the
morning coffee when he asked me if I had looked over the roster of candidates
and did I see any special problems arising. No sooner had he formed his
question than a young man exploded out of the closeted stall, announcing
that he was a candidate and that he wanted to make his presence known to
us since he suspected that we might be giving him a special ethics examination.
Even Chuck had difficulty suppressing a grin as he commended the man for
his vigilance and soberly assured him that Newsletter 40 we had been standing
shoulder to shoulder in places very much like that one for more years than
the candidate had been alive, but that we had never yet used the bathroom
break as part of some larger entrapment design. His calm demeanor defused
the candidate's paranoia and allowed me to catch a much needed breath.
Chuck went through his protracted dying with the
same honesty that he brought to living, battling his terminal illness for
many months. He was angry and depressed at the prospect of his own premature
death, noting with irony that his professional employment and his health
ended together. He did what he could to stave off the health crisis and
to continue to function in useful ways as long as possible. But he made
no attempt, at least with me, to hide his true feelings, something that
requires real fortitude of spirit,even when the spirit is strengthened
by a devoted family and by deep religious faith.
There is a lingering sadness still that attaches
itself to Chuck's death. But there is also, for me and for his other close
friends, the legacy of great memories. It is now October, a month memorialized
in a favorite poem of Chuck's, that signifies the special bond he had with
so many of us. It is a poem that Chuck viewed as life affirming and love
affirming. I give it back to him now in his honor.
Homer B. C. Reed, Jr.
Now Blue October
by Robert Nathan
Now blue October, smoky in the sun,
Must end the long, sweet summer of the heart.
The last brief visit the birds is done;
They sing the autumn songs before they part.
Listen how lovely-there's the thrush we heard
When June was small with roses, and the bending
Blossom of branches covered nest and bird,
Singing the summer in, summer unending-
Give me your hand once more before the night;
See how the meadows darken with the frost,
How fades the green that was the summer's light.
Beauty is only altered, never lost,
And love, before the cold November rain,
Will make its summer in the heart again.
[Page 13]
Aaron Smith
Continued from page 5
Traumatic Amnesia as an index of severity of head injury. In 1962, Aaron
published "Ambiguities in concepts and studies of brain damage and organicity",
in which he pointed out that the frequently conflicting findings reported
in studies of apparently similar groups of brain damaged patients reflected
failures to control for specific factors determining outcome of brain damage
such as age, locus, nature of the lesion (evolving or resolving, intrinsic
or extrinsic), momentum, diaschisis and time. Aaron was surprised by the
large number and international scope of reprint requests for this paper.
The article also prompted a request from Dr. Ray Dennerll to conduct a
neuropsychology interest group at an upcoming APA meeting. Instead, Aaron
suggested, and Dr. Dennerll agreed, to jointly begin writing colleagues
in the U.S. and around the world inviting them to join in the organization
and establishment of an International Neuropsychological Society. Aaron
subsequently edited and published the INS bulletin for many years with
the help of his assistant, Margaret Benkert.
Aaron's longitudinal studies of 64 children with
either right or left hemispherectomy demonstrated the remarkable capacities
of a single right or left hemisphere to reorganize and mediate both verbal
and non-verbal cognitive functions. He also reported findings of remarkably
intact language capacities in 2 adults with the longest survival after
left hemispherectomy. Both patients showed normal articulation, persisting
basic verbal comprehension, a remarkably intact receptive vocabulary, and
the capacity to sing along with music. On occasion these two patients were
able to produce complete grammatic sentences. Dr. Joe Bogen was intrigued
by Aaron's work, and travelled to Omaha, Nebraska to examine one of these
patients. When he concluded his interview, Bogen turned to Aaron and said,
"You S.O.B., do you realize what you've done to 20 years of neurological
training?" Aaron later collaborated with Dr. Bogen in a longitudinal study
demonstrating the role of the corpus callosum in cerebral reorganization.
Despite residual language capacities following removal
of the left hemisphere, the two adult hemispherectomy patients were nevertheless
clearly aphasic. Conversely, his series of adult right hemispherectomy
patients all showed persisting marked impairments of visuospatial abilities.
This reciprocal syndrome, however, was not seen when the operation was
carried out in childhood. Aaron repeatedly emphasized that the two most
important factors determining outcome in hemispherectomy are condition
of the resideual hemisphere and age at operation.
Aaron is probably best known for the Symbol Digit
Modalities Test. He developed this test by inverting the Digit Symbol task.
Thus, the Sumbol Digit involves matching a series of symbols with a key,
and writing the number indicated by the key under the each symbol. There
is no organized search pattern as with the numerically ordered Digit Symbol
key. This added search demand may partly explain why the Symbol Digit has
been reported to be more sensitive than the Digit Symbol to the presence
of organic cerebral dysfunction. Also unlike the Digit Symbol, the Symbol
Digit provides for both written and oral administrations, permitting comparisons
of the status of oral vs. written output modalities. Aaron applied the
same rationale in selecting tests for the Michigan Neuropsychological Battery.
By testing the same function through different modalities (as well as testing
different functions through the same modalities), this battery allows for
differentiations of deficits in "lower" sensory input and motor output
modalities required to carry out the tests from deficits in "higher" cognitive
functions that the tests were designed to measure.
Aaron established a Neuropsychological Laboratory
at the University of Michigan in 1967, where he continued his clinical
work, research and teaching. Aaron fostered a Socratic approach by encouraging
students to ask questions. A natural raconteur, answers rolled off his
tongue like polished prose. He reflected questions back to students and
when queries exceeded the limits of his understanding he would unhesitatingly
reply "I can give you a clear and definite answer: I don't know." He illustrated
his view of the dynamic nature of brain disease by pointing out how a focal
[Page 14]
Newsletter 40
lesion in one part of the brain can disrupt otherwise healthy neural
tissue in the opposite hemisphere. To bring the point home he concluded
that brain damage, like a love affair, has a beginning, a middle and an
end, is typically in flux and rarely, if ever static. He confided to his
classes that he was a student like them, but only a little farther along
in the learning process. He shared his recognition of the importance of
cherishing mistakes and learning from them, noting that its hard to learn
anything new when you are right. He never believed anything too strongly,
and was always ready to abandon accepted doctrine in favor of a better
concept or approach.
Aaron often told his patients when they first arrived
that they had come home.” He would conduct a relaxed and extended interview,
quickly establishing rapport and setting the patient at ease while recording
observations and developing a detailed history. After perhaps an hour he
would begin testing. His examination was not an impersonal,rote administration.
Instead, Aaron would periodically pause to give support, provide therapeutic
insights and suggest exercises and compensatory strategies. His ability
to empathize with, and quickly focus on and articulate feelings and experiences
that the patient was perhaps only dimly aware of, had a remarkable impact
on those who came under his care. At the end of the assessment, Aaron always
gave the patient his card, and told them they could call him any time.
His patients in return were loyal, grateful and loved him.
Dr. Muriel Lezak recently recalled her first encounter
with Aaron at one of the early INS meetings. I immediately realized he
was the genuine article. He helped confirm that I was on the right track
in my approach to neuropsychology. Aaron was a willing sounding board,
and always responded to my letters by return mail. He had the zeal, the
passion, the courage, and the sense of righteousness of an old Testament
prophet-would there were more like him. His voice-sometimes crying out
in the wilderness-will be missed. Few are left who continue to exhort us
to think straight and do right.”
Ennis Berker, October, 1998
Some Remembrances of Aaron Smith
Dr. Aaron Smith was a neuropsychologist known well
to me as a colleague and an important contributor to the development of
the International Neuropsychological Society (INS), serving as its President
and, more importantly, as its Newsletter Editor in the formative years
of the Society. Aaron's editorship produced a lively newsletter which was
the only printed source of the Society's abstracts and proceedings prior
to the affiliation of the Journal of Clinical Neuropsychology with the
INS in 1984 to become the Journal of Clinical and Experimental Neuropsychology.
Aaron's personality was unabashedly reflected in
the INS Newsletter. Serious essays were trimmed with an endless array of
quotations from psychologists, physicians, and other sources. That the
Newsletter reflected exclusively Aaron's view of neuropsychology and his
personal soapbox seemed not to bother most readers, because most of us
recognized the service he was doing for the society; the INS Newsletter
was clearly a labor of love for Aaron.
But some were brave enough to disagree with his
well-defined views on cerebral dominance, the value of particular tests,
or even the review of a book. They generally got the samecorrective action”
in print that Aaron meted out in person so often in the days when the INS
meetings were small enough to have only one plenary session in session
throughout the meeting. A speaker seeing Aaron rise to ask a question could
never be sure if they were about to receive an avuncular compliment on
their perspicacity or the INS version of the Dan Ackroyd Saturday Night
Live parody of a news program point-counterpoint (Shana, you stupid * !#*
!).
Not many neuropsychologists know how hard Aaron
worked to promote neuropsychology. At the University of Michigan, Aaron
was Professor Emeritus of Communication and Education and he worked tirelessly
as a voice in the academic wilderness in the 60's and 70's to attract students
to the study of neuropsychology at a time when psychoanalytic psychology
held sway in the clinical area of the Department of Psychology here. But
[Page 15]
Newsletter 40
attract them he did, often having to offer his seminar-based course
in evenings through a graduate extension mechanism. He truly helped to
pave the way for the lively neuropsychology community that we enjoy in
Ann Arbor now.
As single-minded and ready to verbally mud wrestle
colleagues as Aaron was, he was unfailingly kind and devoted to the teaching
of students. On a number of occasions I asked if he would be willing to
impart to my students his unique knowledge of the effects of lobotomy he
gained through his intimate familiarity with the Columbia-Greystone project,
or to provide his appreciation of the value of Central European behavioral
neurology in the late nineteenth century. In every case I learned later
from the students that Aaron quite simply dropped what he had planned to
do and spent hours regaling them and answering questions with grace and
real enthusiasm.
Aaron was one of a kind. I strongly suspect that
when called upon to justify his life in return for admission to an ultimate
reward, Aaron probably will attempt to persuade the heavenly gatekeeper
that their data on him desperately needs his editorial revision to get
it right. Ken Adams, Ph.D.
[Page 16]
Newsletter 40
DIVISION 40 EXECUTIVE COMMITTEE MEETING MINUTES
August 13, 1998
Pacific Conference Suite A
San Francisco Marriott, San Francisco, CA
Present: Baron, Bauer, Becker, Berent, Berg, Bieliauskas, Boll, Bondi, Cripe, Cullum, Morgan for DeLuca, Eubanks, Fennell, Fischer, Goldstein, Hamsher, Mapou,Marcotte, Meneese, Nemeth, Puente, Reynolds, Smith, Van Gorp.
Invited Guests: Chelune, Blau.
Absent: DeLuca, Artiola, Dede, Herfkens, Shear.
1. The meeting was called to order by Dr. Bieliauskas at 3:02 pm.
2. Minutes of the Executive Committee (EC) meeting held on February 4, 1998 were reviewed and approved with the following revision. For item 14: Task Force on Incident To” Issues, Dr. Puente suggested that two sentences in the first paragraph be deleted as they are somewhat misleading. This suggestion was approved by the EC. The first paragraph of item 14 as approved now reads:
14. Task Force on Incident To ” Issues: Dr. Bieliauskas reviewed the incident to” issue as it relates to the use of technicians in neuropsychological practice. Presently, many neuropsychologists employ technicians and bill for their services as incident to ” their own services. In hospital settings, particularly those receiving federal monies, institutions have been accused of double dipping” for these bundled services as the services of these support staff members are assumed under the federal monies. This applies to both inpatient and outpatient hospital-based services. In some instances, institutions have had to pay back large sums of money to the government for such alleged practices. A new threat is that Medicare has recently begun auditing institutions for billing compliance; it is possible that not only the institution but individual providers may be held liable for any cases of non-compliance.
3. Treasurer's Report: Dr. Van Gorp presented the Treasurer's Report for the fiscal year 1998 to date. As of July 10, 1998, Division 40 had total assets of $191,423.44. Expenses for 1998 through July 10, 1998 totaled $25,444.24. Dr. Van Gorp reminded the EC that most Divisional expenses are incurred after the August meeting. Dr. Van Gorp then presented the proposed 1999 budget, including revised budgets for the three of the four focus areas (Science, Practice, and Public Interest; no information was received from the Education Advisory Committee to draft a new budget), and travel funds for the Past-President and President-Elect. Dr. Marcotte also expressed concern that the Secretary's Office proposed budget increase for 1998 may not be adequate to cover expenses, as a line item increase in the budget does not reflect the growing membership numbers nor increased costs associated with printing and mailing. The EC voted to approve the proposed 1998 budget, with Dr. Van Gorp to develop a revised budget for the Secretary's Office and for the Education Advisory Committee.The approved budget totals $65,315.00.
4. Council Representatives' Report: Drs. Goldstein, Puente and Boll made the following report. APA is experiencing some financial problems. Council has voted for a balanced budget with no increase in dues, so APA is expected to have to cut the funding on some activities for this upcoming year. Practice Divisions will be assessed a special assessment of $20.00 on the dues statements to fund Practice Directorate advocacy and marketing efforts on behalf of all licensed health care providers. The Task Force on the use of the term clinical” in specialty designations has recommended that currently recognized specialties be allowed to continue to use the title (e.g., Clinical Neuropsychology”), but no newly recognized specialties will be allowed to use clinical” in describing the specialty. In lieu of clinical”, the term,health service provider in psychology” is being advocated. APA has modified its guidelines for Divisions publishing policy
[Page 17]
statements. Such statements by divisions are acceptable if they do not impose guidelines or standards on psychology. Divisions are allowed to makes such guidelines or policy statements if in any published/disseminated materials it is explicitly stated that the guidelines do not reflect APA policy. Divisions continue to be encouraged to submit such guidelines to APA for review and approval.
5. Newsletter: Dr. Morgan, Associate Editor of Newsletter 40 reported for Dr. DeLuca, who was unable to attend the meeting. The Summer/Fall edition of the Newsletter 40 was send to members in time for use at the Convention. The edition was the largest to date, with 28 pages. Drs. Puente and Eubanks submitted articles for the edition. Dr. Morgan encouraged all committee chairs and council representatives to submit articles to provide updates to the membership on divisional activities. The next edition will feature articles highlighting the careers of Dr. Charles Matthews and Aaron Smith. The deadline for submissions to be included in the next edition of Newsletter 40 is November 1, 1998.
Dr. Bieliauskas reported to the EC that Dr. DeLuca has been appointed to a second three-year term as Editor. An advisory committee to the Newsletter has been developed (Cecil Reynolds, Chair, members: Ida Sue Baron, Ann Marcotte, Kathleen Welch) to help the Editors continue to enhance and improve the Newsletter.
6. Membership: Dr. Meneese presented the names of 4 17 applicants to the EC for membership in Division 40 (167 Members, 15 Associate Members, 235 Student Affiliates).The EC voted to accept all of the applicants. As of January, 1999, Division 40 voting membership (Fellows, members, associate members) will total 4,324. Division 40 is now the 4th largest Division within APA.
7. Nominations: Dr. Fennel1 reported the results of the Division 40 election. Gordon Chelune was elected President-Elect. Joining Dr. Antonio Puente in the APA Council Representatives as of January, 1999 will be Drs. Theodore Blau, Thomas Boll, and Kerry Hamsher. Council Representatives serve three year terms. Dr. Lloyd Cripe was elected as Member Newsletter 40 at Large to the Division 40 EC. Dr. Fennel1 noted that election results, including vote tallies, have been posted on the division webpage (www.div40.org) for members to review.
8. Fellows: Dr. Berent announced that the Fellows Committee received 25 inquiries this year from members about applying for Fellow status. Nine members completed applications by the deadline. All of the applicants received approval form the Division, and their names were placed on the agenda of the APA Council of Representatives for vote. This vote will be held on Sunday, August 15, and Dr. Berent hopes to be able to announce the names of the newly approved Fellows at the Division 40 Business Meeting.
The EC discussed ways to better recognize Division Fellows. Suggestions included brief biographical sketches to be published in Newsletter 40. The EC also agreed that Fellows should receive a certificate from the Division, in addition to the certificate awarded by APA (several other Divisions currently follow this practice).Dr. Berent was requested to develop such a certificate, which should be awarded not only to the newly appointed fellows, but also to all previously elected Division 40 Fellows. Dr. Berent was also asked to write a letter of congratulations to each new Fellow on behalf of the Division. Dr. Berent has been appointed to serve a second three-year term as Chair of the Fellows Committee.
9. Program: Drs. Bondi and Smith reported that the Division 40 Program is underway, with four full days of programming scheduled during the APA convention. Drs. Stuart Zola and Eileen Martin will be delivering invited addresses. This year's student award recipient is Brian C. Schweinburg, a graduate student in the UCSD/SDSU joint doctoral program. The program will also feature a conversation hour on the Houston Conference. This year's Social Hour is being held in collaboration with Divisions 22 (Rehabilitation) and 38 (Behavioral Medicine), and is sponsored in part by The Psychological Corporation and Psychological Resources Inc. Dr. Joseph Ricker has been appointed the 1999
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Newsletter 40
Program Committee Co-Chair. Dr. Smith reminds all members that the 1999 submission deadline is December 2, 1998. Members interested in serving on the Program Committee are invited to speak to Dr. Smith.
10. Awards Committee: Dr. Baron reported that 1998 recipient of the Robert and Phyllis A. Levitt Early Career Award is Dr. Marlene Behrmann. The Benton Lectureship will be delivered on Sunday, August 15, 1998 by Dr. Harold Goodglass. Two student scholarship winners were also announced. This year's recipientof the Henri Hcaen Scholarship is Melissa Lamar. The recipient of the Manfred Meier Scholarship is Tim W. Conway. The Awards Committee members serving with Dr. Baron are Drs. Kathleen Haaland, Diane Howieson and Don Stuss.
11. Ethics: Dr. Becker reported that the committee continues to discuss the issue of third party observers in neuropsychological evaluations. The committee will also review the newly revised standards for the use of humans in research - comments are due back to APA on 9/l/98. Dr. Becker has been re-appointed as chair of the Ethics Committee for a second three-year term.
12. Science Advisory: Dr. Bauer reported that Science Advisory Committee continues to work collaboratively with the Program committee to increase and enhance the scientific presentations at the APA Convention. Beginning at the 1999 APA Convention, the Science Advisory Committee will present two new student research awards . One will be for excellence in clinical neuropsychological research, for a submission that applies methods and concepts of neuropsychology to the study of clinical phenomenon. The second will be for research in the area of cognitive neuroscience, for a submission in which the primary emphasis is to elucidate a neurocognitive ability or mechanism in a non-clinical setting.The Science Advisory Committee has already begun work on coordinating and sponsoring a symposium on merging technologies and/or the empirical basis of assessment for the 1999 Convention. The Committee also has plans to continue submitting the Science Corner” column to 18 Newsletter 40. Dr. Reynolds raised the suggestion that this Committee undertake a review of the proposed guidelines for psychological testing which will be voted on by council to offer opinions on behalf on clinical neuropsychology. Dr. Bauer indicated that his committee would undertake this project.
13. Education Advisory: Dr. Hamsher reported that the Education Advisory Committee (EAC) met on February 5, 1998. The EAC is pursuing a presence on the Division's webpage for posting information germane to education and training, and possibly to be a public area where questions could be raised and responses listed. The EAC also continues to work on enhancing inter-organizational cooperation amongst the three major educational associations for clinical neuropsychology (Association for Postdoctoral Programs in Clinical Neuropsychology, Association for Internship Training in Clinical Neuropsychology, and the Association for Doctoral Education in Clinical Neuropsychology). The EAC is also sponsoring a Social Hour on Saturday, August 15, 1998 at the APA convention for students to meet with representatives from Neuropsychology Training Programs.
14. Dr. Jill Reich, from the APA Education Directorate then visited with the EC, and presented a brief report on recent activities of the Directorate. The 1999 APA convention will feature a mini-convention on the impact of technology on education. The Directorate is looking for Divisions to donate programming hours and also to let members know if they have any ideas to contribute to contact her office. The Education Directorate has also been working on getting psychologists recognized in the General Medical Education (GME) Legislation Act.
15. Public Interest Advisory: No report.
16. Practice Advisory: Dr. Eubanks reported that the Practice Advisory Committee is working towards placing a neuropsychologist on each state's Medicare Committee, with the goal of obtaining representation for neuropsychology issues. The Committee is also investigating the use of
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Newsletter 40
technicians in different states, and state requirements. Dr. Eubanks contributed a column to the last edition of Newsletter 40 to apprise members of the work of this committee. Members of this committee are also working with the Presidential Task Force on Incident To”.
17. The EC was then visited by Marilyn Richmond, Randy Phellps and Laurie Badanes Prather from the APA Practice Directorate, who provided a detailed report on the Practice Directorate's recent efforts to modify HCFA regulations pertaining to the reimbursement of neuropsychological services. In July, 1998, HCFA published new reimbursement guidelines, which called for approximately a 50% reduction in reimbursement for neuropsychological assessment. These psychological and neuropsychological codes also have no relative work value associated with them. APA filed a complaint with HCFA regarding the reduction in reimbursement for neuropsychological services. Members of the APA Practice Directorate met with representatives from HCFA on July 20, 1998. HCFA has agreed that the methodology used to determine the reimbursement rates for psychological assessment was flawed, and that they would be adjusting the rate in the future.
The Practice Directorate has also been active in gaining inclusion of psychology as an allied health profession eligible for Medicare GME. Dr. Richmond reported to the Division 40 EC that she had just learned that the proposal to include psychologists in Medicare GME has been approved. concerns about the incident to” and the HCFA reimbursement issues being pushed at the same time, adding that the inclusion of psychology in the GME formula may help the incident to” issue.
18. Task Force on Incident To” Issues: Dr. Bieliauskas reported that this Task Force, in conjunction with the APA Practice Directorate, is continuing to work with HCFA policy makers on the incident to” issue. A letter has been drafted by the APA Practice Directorate from Senator John Breaux (the senator in charge of appropriations for HCFA) to HCFA, asking if psychologists can document that services from technicians are not bundled under their hospital coverage under Part A, they continue to be allowed to bill for technical services. Comments from Sen. Breaux's office are still pending. Dr. Richmond from the Practice Directorate expressed
19. CPT Code Task Force: Dr. Puente reported that CPT codes will be undergoing revisions in 2002. He also provided guidelines for the use of the 1998 CPT codes as well as documentation guidelines.
20. Interdivisional Health Care Committee: Drs. Marcotte and Fennel1 will be attending the IHC meeting this evening. The IHC is working on gaining exposure for candidates for APA offices and committees from the affiliated IHC Divisions: Divisions 12 (section 5), 22, 38 and 40. The IHC is also working on developing CPT codes for the delivery of psychological/behavioral medicine services in health care settings. The APA Practice Directorate is assisting in this project.
21. Program Listings/Div40 webpage: Dr. Cripe announced that the Training Program data base has been updated and will be appearing in the next edition of The Clinical Neurousvchologist. The webpage listings of programs will be updated in the next few weeks.
Dr. Cripe will be revising and reorganizing the webpage for easier use. He also plans on adding an announcement notice to which members can subscribe. This free service will send members a notice whenever announcements on the webpage have been updated. This will enable the division to disseminate information to members in a fast and efficient manner. Dr. Cripe also suggested that the Newsletter 40 be posted in its entirety on the webpage for readers. He will require funds to purchase a scanner; Dr. Cripe is to present Dr. Van Gorp with estimates, and this will then be reviewed by him and Dr. Reynolds. Finally, Standard Operating Procedures are being developed for www.div40.org by Dr. Cripe, with assistance from Drs. Munroe and Marcotte.
22. Bylaws/Policy & Procedures Manual: Dr. Nemeth presented the latest version of the Division's Policy and Procedure Manual. She has been charged
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by the EC to complete the manual by the February mid-winter meeting. The only section remaining to be completed is a listing of resolutions and policy decisions.
23. Division 40 Archivist: Dr. Nemeth led a discussion leading to an EC decision on the site of the Division 40 Archives. Tow sites were discussed, and the EC voted to approve Louisiana State University in Baton Rouge, LA as the official site. The Division 40 Archives will be housed in the Louisiana and Lower Mississippi Valley Collections, Special Collections, Hill Memorial Library, LSU. Dr. Bieliauskas will sign the agreement letter. Members are encouraged to contact Dr. Nemeth if they have materials that should be housed in the Archives.
24. Minority Affairs: Dr. Dede was unable to file a report as flight delays prevented him from arriving in time for the meeting.Dr. Patricia Perez-Arce has resigned as Co-Chair of this committee.
25. Division 40 Representative to the APA Committee on Gay, Lesbian and Bisexual Concerns (CGLBC): Dr. Mapou reported that he reviewed the minutes of the spring meeting of this APA committee, and found no issues of direct relevance to neuropsychologists per se. There were issues of interest to neuropsychologists interested in gay, lesbian and bisexual issues; he encourage members interested in these issues to contact Clinton Anderson, the officer for this APA committee (e-mail: canderson@apa.org). A notice about the role of the Division 40 CGLBC liaisons was placed in the Division 44 Newsletter. Drs. Mapou nor Herkfens have not received any requests from the division membership to address specific concerns with the CGLBC.
26. Division 40 Representative to the APA Committee on Women: Dr. Marcotte reported for Dr. Shear. The Committee has continued to have no activity in the past year.
27. International Liaison: Dr. Lidia Artiola has been appointed as the Division 40 liaison to the APA Committee on International Affairs.
28. ASHA/Division 40 Task Force: Dr. Fischer reported the Task Force is engaged in several projects. One project is to develop a brochure on referral and /collaborative approaches” describing the two disciplines, training requirements of each, discipline specific and collaborative approaches to assessment and intervention and appropriate methods for evaluating assessment procedures and interventions. The brochure will be targeted for referral audiences.The group will meet in February 1999 to review progress on this project. They will need to decide how to disseminate it, and may turn to the organizations for financial assistance. The Task Force is also working on a manuscript on interdisciplinary approaches to cognitive rehabilitation.
29. Houston Conference: Dr. Bieliauskas reported that APA has received inquiries from members about possible legal impropriety in the Division 40 EC's decision in February, 1997 to contribute funds to the Houston Conference. This matter was investigated by APA Legal Council Mr. James McHugh. It was Mr. McHugh's opinion that deciding to provide funds to such a conference was not a legal question but a matter of policy judgement.
30. Report of the Task Force on Education, Training and Credentialing:
Dr. Bieliauskas reminded members that in 1995, the Division 40 EC accepted
as a working document the Report of the Task Force on Education, Training
and Credentialing. In the section on the Definition of a Clinical Neuropsychologist,
however, the 1995 Division 40 EC voted to specify the American Board of
Professional Psychology (ABPP) as the credentialing board to be included
in the definition. Members of Division 40 and the National Academy of Neuropsychology
(NAN) have met during the past three years to try to resolve differences,
but significant differences remain, particularly over the board issue.
Dr. Bieliauskas noted that since the acceptance of this document as a working
document in 1995, the Houston Conference was convened, and a new set of
aspirational guidelines for education, training and credentialing has been
developed, and endorsed by the Division 40 EC. At this juncture, an offer
has been extended by The
Continued on page 23
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ANNUAL BUSINESS MEETING DIVISION 40 - DIVISION OF CLINICAL NEUROPSYCHOLOGY
AUGUST 17, 1997
HYATT REGENCY CHICAGO HOTEL, CHICAGO, ILLINOIS
1. The Business Meeting of Division 40 was called to order by President Linas Bieliauskas at 4:05pm. Division members were asked to review the minutes of the 1997 Business Meeting in the Winter 1998 Edition of the Newsletter 40.
2. Treasurer's Report: Dr. Wilfred Van Gorp reviewed the Division's financial status, and informed members that there will be no increase in Division 40 dues for 1999. Expenses from January 1, 1998 through July 10, 1998 were $25,444.24, well within the year's budget of $67,904.00. The Division's current assets are $191,423.44. The 1999 budget was approved at the Executive Committee, and budgets $65,315.00 for Divisional expenses. The Executive Committee (EC), however, has asked Drs. Van Gorp and Marcotte to work together to revise the 1999 budget for the office of the Secretary in light of growing membership and cost increases for postage and printing. The budget for the Educational Advisory Committee will also need to be reviewed once a proposed budget is received.
3. Elections: Dr. Fennel1 reported on the results of the recent Division 40 election, Dr. Gordon Chelune was elected President-Elect for 19981999, and will serve as President of the Division in 1999-2000. Dr. Lloyd Cripe was elected to a three year term as Member at Large of the Executive Committee. Drs. Thomas Boll, Theodore Blau and Kerry Hamsher will join current representative Antonio Puente as Division 40 representatives to the APA Council; their terms will begin in January, 1999. The results of the Divisional elections have been posted on the Division 40 web page, and include tally results. Members are encouraged to consult www.div40.org for a more detailed elections report.
4. Council Representatives' Report: Drs. Goldstein and Puente reported that APA is experiencing some financial problems. Practice Divisions, including Division 40 members, will be assessed a $20.00 fee to assist the Practice Directorate in advocacy and marketing efforts. Council has voted to not approve any new specialties using the term clinical” in the specialty name. Clinical Neuropsychology, as an already established specialty, will be allowed to retain the clinical title. Dr. Bieliauskas presented with Dr. Goldstein with a plaque on behalf of the Division, thanking him for his six years of service as Division 40 Representative to APA Council.
5. Fellows: Dr. Stan Berent, Chair of the Fellows Committee announced that the names of eight Division 40 members put before the APA Council for Fellow status within APA were approved; the new Division 40 Fellows are: Drs..Laurence Binder, C. Munro Cullum, Pamela Keenan, Elisabeth Koss, Ann Marcotte, Darlyne Nemeth, Stephen Rao, and Brenda Townes. Dr. Peter Donovick, a Fellow in another Division of APA was also accepted as a Fellow of Division 40. Dr. Berent encouraged members to consider self-nomination for Fellow status. Applications from women and minority members of the Division are strongly encouraged. Applications are due December 15, 1998. Members should contact Dr. Berent if they have any questions. He has been re-appointed as Chair of the Fellows Committee for a three-year term.
6. Membership: Dr. Bieliauskas reported on behalf of Dr. Meneese,Chair of the Membership committee. At the August EC meeting, the names of 417 applicants for Division 40 membership (15 Associate members, 167 Members, 235 Student Affiliates) were approved.
7. Program: Dr. Bondi reported that 19 1 submissions were received this year. Abstracts of accepted papers, posters and symposia appeared in The Clinical Neuropsvchologist. He reminded members that the Social Hour following the Business Meeting is being jointly held with Divisions 22 and 38, and has been generously
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underwritten by The Psychological Corporation and Psychological Resources, Inc. The Call for Papers will appear in next month's APA Monitor. Dr. Glenn Smith will serve as Program Chair next year, assisted by Co-Chair, Dr. Joseph Ricker. Any members interested in working on this Committee are encouraged to send his/her vita to Dr. Smith. Dr. Bieliauskas thanked Dr. Bondi on behalf of the Division for his excellent work during his term as Chair of this Committee, and presented him with a plaque of appreciation.
8. Awards: Dr. Ida Sue Baron announced that Dr. Marlene Behrmann was the recipient of this year's Levitt Award. Dr. Harold Goodglass was also recognized as this year's Benton Lectureship recipient. The recipients of two student scholarships, Henri Hecaen Scholarship and the Manfred Meier Scholarship, administered through APF with Division 40 assisting in the recipients,were announced. This year's recipients are Timothy Conway and Melissa Lamar. Congratulations were conveyed to all of the recipients.
9. Training Programs listing/Division 40 Web Page: Dr. Lloyd Cripe reported that an updated Training Programs Listing will be published in the next edition of The Clinical Neuropsvchologist._The databank listing of these programs can also be found on the web page at www.div40.org, and has been recently updated. Dr. Cripe has also enhanced the web page with an announcement change notice that members can subscribe to for free. It will send you an e-mail message to inform you of when a change in the listed announcements has been made. This will help the Division to rapidly provide members with information.
10. Presidential Update: Dr. Bieliauskas next provided the membership with a review of recent projects and events:
A memorial service was held on August 13, 1998 to honor the memory of former Division 40 President, Dr. Charles Matthews.
The Presidential Task Force on Incident to” has been working in close association with the APA Practice Directorate on this issue, which pertains to reimbursement for technician services. Jim Quillin of this Task Force has contacted the office of Senator Breaux of Louisiana (who co-chairs the Committee responsible for HCFA funding) for assistance with this issue. The Senator's office is reviewing the issues and a response is pending.
HCFA also revised their reimbursement guidelines in July, 1998, and psychological and neuropsychological services were ear marked for very significant reductions in reimbursement. The Practice Directorate has met with HCFA, and HCFA has agreed that the methodology upon which this decision was based was in error. HCFA is reviewing the proposed reimbursement rates. Another issue that has been addressed is the exclusion of psychology to date from GME; the APA Practice Directorate reported to the Division 40 EC that they have been successful in their efforts to have psychology included in the GME. The Division 40 Practice Advisory Committee, working in conjunction with the Task Force, has also begun work on placing a neuropsychologist on state Medicare panels; Dr. Eubanks is spearheading this effort.
Dr. Tony Puente reported at the Division EC meeting that CPT codes will be rewritten in 2002. He will be actively involved in this project.
Dr. Bieliauskas also announced that the official Division 40 Archives site will be at Louisiana State University. Dr. Darlyne Nemeth will be working closely with the Archives Curator in gathering appropriate materials to be placed in the collection. Dr. Nemeth has requested that any member, particularly former Division officers, Committee and Task Force Chairs with materials they believe should be included in the Archives contact her. She can be reached by e-mail at DGNemeth@aol.com.
A Policy and Procedures manual has been developed, and continues to be revised.
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10. Dr. Bieliauskas then turned the podium over to Dr. Cecil Reynolds, the 1998- 1999 President of Division 40. Dr. Reynolds presented Dr. Bieliauskas with a plaque, and on behalf of the Division 40 membership, thanked him for his outstanding leadership this past year as Division President.
11. There being no other business, the meeting was adjourned at 4:50pm.
Respectfully Submitted,
Ann C. Marcotte, Ph.D.
Secretary, Division 40
Executive Committee Meeting Minutes
Continued from page 20
Clinical Neuropsychologist to publish the 1995 Task Force report. The document would have to be reviewed by the APA Legal Office prior to its publication.
A motion was then made to reconsider the 1995 Task Force Report; the motioned passed. The history of the document was reviewed. A motion was next made that the inclusion of ABPP as the credentialing board delineated in the definition of a clinical neuropsychologist be deleted, with the document return to the original wording of the Task Force. The motion did not carry. A subsequent motion was made the revised document accepted in 1995 as a working document now be formally accepted as a final document. The motion was accepted (8 votes for, 2 abstentions). A motion was next made that this document be archived with no further action; the motion carried.
3 1. Dr. Bieliauskas informed EC members that APA has created a Task Force on the integration of science and practice. The Task Force is soliciting ideas from divisions. Dr. Rus Bauer from the Science Advisory Committee and Dr. Dan Eubanks from the Practice Advisory Committee were asked to work together on this project.
32. Dr. Bieliauskas also reviewed an offer from lobbyists to assist the Division in our efforts pertaining to HCFA reimbursement, incident to” and GME. At this juncture, the Division is pleased with the efforts underway by APA to address critical practice issues for neuropsychologists and no lobbyists will be engaged.
33. The EC will next meet on February 10, 1999 in conjunction with the Annual Meeting of the International Neuropsychological Society in Boston, Massachusetts. Dr. Marcotte will work with the INS office on arrangements. There being no other business, the meeting was adjourned at 6:08pm.
Respectfully Submitted,
Ann C. Marcotte, Ph.D.
Secretary, Division 40
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Newsletter 40 is the official publication of Division 40. The Editor is John DeLuca, and the Associate Editor is Joel Morgan. Dr. DeLuca's address is Neuropsychology and Neuroscience Laboratory, Kessler Medical Rehabilitation Research and Education Corporation, 1199 Pleasant Valley Way, West Orange, NJ 07052. Dr. Morgan's address is Neuropsychology Service, VA Medical Center, 385 Tremont Ave., East Orange, NJ 07019. Division 40's Website is: www.div40.org. Webmaster is Dr. Lloyd Cripe.
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