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4.1 Consideration should be given to the development of a curriculum for cognitive rehabilitation service providers at major universities, preferably taught by an interdisciplinary faculty. The program offered would include training as outlined in paragraphs three and four of this section. Such a program would be available to individuals from any rehabilitative discipline who would take this curriculum as a sub-specialty of their training.
4.2 Were specific standards for credentialing of cognitive rehabilitation service providers to be developed, such standards should include (a) degree requirements, such as, bachelor s degree in an educational, psychological, or rehabilitative discipline from an accredited college or university, educational and training requirements as outlined in the first paragraph of this section, and requirements for a specified time period (e.g., two years) of supervised practice in cognitive rehabilitation. Such standards would be best developed by an interdisciplinary group of rehabilitation specialists, such as the Interdisciplinary Special Interest Group on Head Injury of the American Congress of Rehabilitation Medicine (Harley, 1990), in conjunction with interdisciplinary groups such as the International Neuropsychological Society and disciplinary groups such as the American Speech and Hearing Association, American Occupational Therapy Association, and Divisions 22 (Rehabilitation Psychology) and 40 (Clinical Neuropsychology) of the American Psychological Association.
4.3 Until such time as training and standards for cognitive rehabilitation are developed, appropriate training and supervision of cognitive rehabilitation providers remains the responsibility of individual rehabilitation centers and providers. Systems for supervision of cognitive rehabilitation services should be developed within rehabilitation centers. It would be appropriate that such supervision would, in part, be within individual disciplines. Overall supervision of the cognitive rehabilitation program and of individual providers and trainees would be best offered through an interdisciplinary group consisting, at a minimum, of a neuropsychologist, speech pathologist, and occupational therapist.
ISSUE 5: ETHICAL STANDARDS FOR SERVICE PROVIDERS
Of the ten guidelines that governed the preparation of the 1995 APA Standards for Educational and Psychological Testing, four are particularly germane to the Guidelines for Computer-Assisted Neuropsychological Rehabilitation and Cognitive Remediation. First, a statement of technical standards for sound professional practice should be presented rather than a social action prescription. Second, a strong ethical imperative should be embodied, though it was recognized that enforcement mechanisms could not be included. Third, all standards would not be uniformly applicable across a wide range of instruments and uses. Fourth, standards should be presented at a level that would enable a wide range of people who work with tests or test results to use the Standards. The Standards for Educational and Psychological Testing document was formulated with the intent of being consistent with the APA Standards for Providers of Psychological Services (1977) and with the APA s Ethical Principles of Psychologists (1981) which are binding on members of APA. The Standards for Educational and Psychological Testing Committee suggested that "those who are not members of APA consider the ethical principles to be advisory in general outline if not in detail" (p. vii). This same suggestion also appears in the Guidelines for Computer-Assisted Neuropsychological Rehabilitation and Cognitive Remediation.
RESOLUTIONS:
5.1 The clinical neuropsychologist in his/her professional relationships with other professional disciplines who may also be employing cognitive remediation procedures will exercise as a starting point ethical principles 2 and 7 from the APA Ethical Principles for Psychologists (1981) namely, the requirement that "the psychologist recognizes the areas of competence of related professionals, making full use of the professional, technical and administrative resources that best serve the needs of consumers" (p. 636).
5.2 As with any clinical technique or tool, cognitive remediation procedures should be used in a responsible manner by responsible, skilled, and knowledgeable clinicians.
5.3 Cognitive remediation programs should be used in the context of a treatment plan with a specific rationale to achieve specific goals for a specific individual having specific problems.
5.4 The clinician prescribing the use of cognitive remediation software programs would necessarily have to be knowledgeable about several areas, including rehabilitation generally, brain-behavior relationships, cognitive science, and learning theory, as well as the specific features of the program including the validity of evidence or lack thereof (see introduction to Issue 4 above).
5.5 Qualified practitioners should either have specific course work that will assist them in understanding neurobehavioral problems and deficits or have formalized training (such as internships, workshops, or directly supervised work experiences) in brain-behavior relationships sufficient to acquire functional understanding of the impact of specific brain injuries on behavior (see 4.1 and 4.2 above).
5.6 There are, at present, no formal mechanisms either to ratify an individual s credentials as a qualified practitioner or to monitor the compliance of an individual with specific ethical standards. There are no formal mechanisms to assure the regular upgrading of such special proficiency skills through continuing education courses. This being the case, it is, ultimately, the responsibility of the individual clinician to determine if he/she is sufficiently qualified. This determination should be made with consideration of both the welfare of the client and the ethical standards of the practitioner s own professional discipline.
ISSUE 6: EPILOGUE
The Division 40 Task Force adopts no specific position at this time
on the question of requiring/adopting certification or licensing criteria
for neuropsychologists who desire to be identified as possessing a special
competency in cognitive remediation techniques. Were such special competencies
deemed to be desirable, possible mechanisms, for implementation are offered
in 4.1 and 4.2 above.
Predictably, given the mandate from the Division 40 Executive
Committee to prepare the present document, the Task Force feels strongly
about the need for the Guidelines offered here. Consequently, the Committee
disagrees with Kramer (1985) who, referring specifically to
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