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3.3.15 The publisher should provide for follow-up consultation with the psychologist-author or with another psychologist assuming responsibility for the software, who will be available to consult and respond to inquiries relating to the use of the software. Publishers are urged to take affirmative action to encourage the utilization of this service, and to encourage feedback (not simply endorsements) from users.
3.3.16 Publishers should conform to the relevant guidelines on test development set forth in Standards for Educational and Psychological Testing (1985) and to the relevant sections of the Code of Fair Testing Practices in Education (1988).
3.4 Appropriate levels of professional consultation would be encouraged by labeling software in three classes as follows:
3.4.1 Class A: This program should be used only under the direct and continuous supervision of a qualified professional. Such programs are too difficult and complex for the majority of patients to use without such supervision. Other programs in this category may be simpler, but are designed for more severely handicapped persons. Both types of programs require a trained professional to explain and augment instructions, offer corrections, and provide appropriate reinforcement.
3.4.2 Class B: This program may be used independently by certain patients in a clinical setting with periodic or moderate professional supervision. Such programs allow some better functioning patients who have mastered more basic programs to participate in a more independent fashion in a controlled setting. The therapist is responsible for selecting difficulty level, responding to questions, and integrating computer rehabilitation with other therapies.
3.4.3 Class C: This program may be used independently by better functioning patients in non-clinical settings (e.g., home) with periodic professional supervision. Programs in this category should present instructions, cues, and feedback sufficient to allow relatively advanced patients to practice independently without daily supervision. With adequate consultation, family members may be able to assist. Regular professional consultation is important to permit the trainer to evaluate the appropriateness, progress, and effectiveness of both specific and general aspects of the cognitive rehabilitation program.
ISSUE 4. STANDARDS FOR SERVICE PROVIDERS: TRAINING AND EXPERIENCE
The employment of computer-assisted cognitive remediation procedures
and cognitive rehabilitation is obviously not the sole province of the
neuropsychologist. Guidelines proposed for training and experience must
therefore strive for an appropriate and realistic balance between two major
competing valences. On the one hand is the conceptual and functional premise
of those professionals who hold that any applied clinical activity that
seeks to acquire professional status, whether it be psychotherapy or computer-assisted
cognitive remediation, requires mastery of a coherent, if not unique, body
of scientific knowledge acquired through appropriate educational and training
experiences. On the other hand is the observation of Hawley and Capshaw
(1981) that de-professionalization appears to be gaining momentum throughout
the world of work, particularly in the human services.
Tension between these competing views is not resolved but may
be attenuated by reference to an interdisciplinary process in which specialized
knowledge and skills are not focused in a single "specialist", but are
implemented by a team of care providers. Fordyce (1981) offered the following
distinction between multi-disciplinary and interdisciplinary processes.
Both involve efforts by people from several disciplines, and both require
that these people have at least passing familiarity with the knowledge
and methods of the other disciplines. But interdisciplinary differs from
multi-disciplinary in that the end product of the effort - the outcome
- can only be accomplished by a truly interactive effort and contributions
from the disciplines involved. In a multidisciplinary exercise, two or
more professions may make their respective contributions, but each contribution
stands on its own feet and could emerge without the input of another (p.
51).
A recurrent theme throughout this document has been that the
training, experience, and skill of the service provider is critical to
the effectiveness of computer assisted cognitive rehabilitation. Cognitive
rehabilitation is a service that requires a broad base of knowledge and
skill. Ideally, cognitive rehabilitation service providers would be knowledgeable
about the following: (a) basic relationships between specific brain dysfunction,
cognition, behavior, and emotions; (b) basic research regarding specific
cognitive processes, such as attention, memory, visual-spatial skills,
and higher-order abilities; (c) basic research regarding effectiveness
of cognitive rehabilitation techniques; (d) behavioral principles for effecting
change; (e) instructional methods for teaching individuals with specific
cognitive dysfunction and/or learning disabilities; (f) methods for enhancing
generalization of the effects of cognitive rehabilitation to the patient
s functional abilities and everyday life; (g) basic computer use. Furthermore,
the practitioners should have practical experience in cognitive rehabilitation
with brain-damaged patients.
With a few isolated exceptions (Frangicetto, 1989), no formal
training programs for providers of cognitive rehabilitation exist. No standards
for, or system of, credentialing cognitive rehabilitation service providers
exist (Kreutzer & Boake, 1987). Into this vacuum, individuals from
a number of disciplines have entered to offer cognitive rehabilitation
services: psychologists and neuropsychologists, speech pathologists, occupational
therapists, and learning disability specialists. Each of these disciplinary
groups comes to the enterprise of cognitive rehabilitation with specific
knowledge and skill relevant to cognitive rehabilitation as well as with
specific deficiencies. As mentioned previously, neuropsychologists are
expert in understanding relationships between specific brain dysfunction,
cognition, behavior, and emotions, but typically have no systematic training
in methods to rehabilitate cognitive deficiencies. Speech pathologists
have training in rehabilitating certain cognitive impairments within the
language domain. Similarly, learning disability specialists are focused
in their training to work with individuals, typically children and not
adults, with specific problems that in some cases are similar to the problems
of brain-damaged patients and in other cases are not. The training that
occupational therapists receive in rehabilitation typically focuses on
the development of functional skills, with significantly less emphasis
on understanding underlying cognitive, emotional, and behavioral processes.
Thus, cognitive rehabilitation is not solely within the purview
of any one discipline. Neuropsychology and other disciplines possess a
base of knowledge and skill that is relevant to cognitive rehabilitation.
These considerations lead to the following recommendations.
RESOLUTIONS:
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