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Clinical Neuropsychology: A Window to Understanding Brain and Behavior Relationships

Clinical Neuropsychology: A Window to Understanding Brain and Behavior Relationships. Sandhills Regional Psychology Conference UNCW March 20, 2004 Antonio E. Puente Department of Psychology University of North Carolina at Wilmington Wilmington, North Carolina 28403

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Clinical Neuropsychology: A Window to Understanding Brain and Behavior Relationships

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  1. Clinical Neuropsychology:A Window to Understanding Brain and Behavior Relationships Sandhills Regional Psychology Conference UNCW March 20, 2004 Antonio E. Puente Department of Psychology University of North Carolina at Wilmington Wilmington, North Carolina 28403 www.uncw.edu/people/puente www.clinicalneuropsychology.us puente@uncw.edu

  2. What is Psychology? • The Story of Psyche • The Definition of Skinner • The Organization of Psychology • Personnel • Ph.D., Psy.D., Ed.D • Professional Activity • Academic • Applied • (nr, clinical, school, counseling, health, industrial, forensic) • Organizations • American Psychological Association • Others (e.g., APS, NCPA, SEPA)

  3. Year Doctorate Masters Bachelors 1970 1505 457 2975 2183 19077 14602 1980 1921 1333 4096 5812 15440 26653 1990 1566 2245 3377 7353 15336 38616 2000 1405 2905 3552 10913 17402 56600 APA Membership

  4. APA Membership by Division • Approximately 150,000 members • Approximately 53 different divisions • Top three divisions (#s) are: • Clinical Psychology • Clinical Neuropsychology • Independent Practice

  5. What is Clinical Neuropsychology? • Study and practrice of the relationship between brain (nervous system?) and behavior, especially in neurological patients • Approximately 4-5,000 (out of 150,000) • Doctorate with post-doctorate training is minimum requirement

  6. Outline • Introduction • Brief Overview of Twenty Five Years • Current Status • Projections for the Future

  7. History: Organizational • American Psychological Association (APA) Division of Clinical Neuropsychology (40) • National Academy of Neuropsychology (NAN) • International Neuropsychological Society (INS) • Other issues/groups; • APA’s First Specialty (1996) • Board Certification (e.g., ABPN vs ABCN) • Licensure (e.g., Louisiana) • Sub-specialty Groups (e.g., Forensics, Sports, Pediatrics, Hispanic)

  8. History: Informational • Publications • Books (Goldstein, 1974) • Journals (ACN, JCEN, TCN, Neuropsychology, NR) • Online • Trends • Assessment (1970s-…) • Rehabilitation (1990s-…) • Forensic (1995-…) • Other Sub-specialties (2000-…)

  9. History: Personnel • Overall Trends • Growth Patterns • Founding of NAN and Division 40 - 1980 • Demographic Patterns • Primarily Male to now Mostly Male • Primarily Academic to Primarily Clinical • Institutional Settings • Academic Departments of Psychology • Medical School Neuropsychology Services • Community/Rehabilitation Hospital Services • Private Practice

  10. History: Clinical Activities • Assessment • Individual Tests (Wecshler Intellingence Scales) • Fixed Battery (Halstead-Reitan Vs. Luria-Nebraska) • Flexible Approach (Boston) • Rehabilitation • Cognitive Rehabilitation • Medical Compliance and beyond (H & B CPT Codes) • Forensic • Social Security Disability • Worker’s Compensation • Personal Injury • Death Penalty

  11. Current Status: Review of the Surveys • Brief History of Surveys • Hartlage; others • DeLuca & Putnam • Current Survey Methodology • Sweet & Peck (and others; 2002) • Knauss, Schatz, & Puente (2004)

  12. Survey of Clinical Neuropsychology • National Academy of Neuropsychology • Division of Clinical Neuropsychology of the APA • Primary Surveyors: Jerry Sweet & Ted Peck • Date: 2001-2002

  13. Actual Return Rate 1569 returns 5791 mailed 1569/5791 = 27.1% Adjusted Return Rate Or returns, 1406 U.S., Doctoral, Licensed, Clinicians Of mailed, 1590 excluded (duplicates, unintended, undelivered) 1406/4201 = 33.5% Survey Return Rates

  14. Organizational Membership(All Doctoral Licensed Clinicians) Percent

  15. Gender (All Doctoral Licensed Clinicians vs. Younger Samples) Percent Age: Males = 48.6 (n=866) Females = 45.5 (n=524) Years Since Licensed: Males = 14.6 (n=855); Females = 10.1 (n=508) ---------------------------------- Among licensed <10 years: (n=525) Males = 48.6% Females = 51.4% Among licensed <5 years: (n=216) Males = 36.6% Females = 63.4%

  16. Type of Doctoral Degree(All Doctoral Licensed Clinicians) Percent

  17. Field of Doctoral Degree(All Doctoral Licensed Clinicians) Percent

  18. Work Status(All Doctoral Licensed Clinicians) Percent

  19. Work Setting(All Doctoral Licensed Clinicians) Percent

  20. Gender Within Work Setting(Doctoral Licensed Clinicians) Percent

  21. Board Certification Status(Doctoral Licensed Clinicians) Percent

  22. Weekly Professional Activities by Organization Percent

  23. Weekly Professional Activities by Organization Percent

  24. Percentages of Reimbursement Sources(For All Doctoral Licensed Clinicians)

  25. Years licensed .27** Work Setting -.25** % Forensic .24** Gender -.21** % Self Pay .19** Age .18** Hrs billed/Eval .13** % Public Aid -.12** % Medicare -.09* % Man. Care -.09* % Indemnity .07 % Indigent -.04 Correlates of Income *=.05 **=.01 Negative correlations in red. “Work Setting” above limited to Private and Institution All ns between 775 and 1185

  26. Income by Work Setting(Doctoral Licensed Clinicians Working Full Time or Full Time+)

  27. HOURS/Week Clinical Activity

  28. Evaluation Time by Evaluation Goal (Except forensic, those using assistants test more hours (e.g., for determination of diagnosis, 6.6 hrs vs. 5.8 hrs, p=.017.) However, hours billed are similar.

  29. Time-Related Case Activities(All Doctoral Licensed Clinicians) Minutes Hours billed: Private=11.1 (SD=5.0); Institution=8.2 (SD=3.3) * Only scoring is not significant between groups; covarying amount of forensic practice did not eradicate group differences

  30. Use of Testing Assistants(All Doctoral Licensed Clinicians) Percent

  31. Use Of Testing Assistants By Work Setting Percent Using Assistants (n=1349)

  32. Knaus, Schatz & Puente (2004)(Demographics: in %) Gender • Male 49.2 • Female 50.8 Highest Degree Earned • Ph.D. 80.0 • Psy.D. 17.8 • Ed.D. 1.8 • M.D./Ph.D. 1 Board Certified • Yes 29.1 • No 70.9

  33. Demographics (cont.)(in %) Employment Settings • Private Practice 58.54 • Medical/Hospital 45.12 • College/University 15.85 • Rehabilitation 15.85 • Other 10.06 • Psychiatric Facility 3.69 Work Status • Full-time 39.94 • Part-time 27.74 • Full w/ Part-time 17.99 • Two Part-time 9.45

  34. Professional Activities • Report Writing 95.94 • Neuropsychological Assessment 94.72 • Personal History of Patient 93.94 • Diagnostic Interview (no formal testing) 92.67 • Psychological Assessment 88.51 • Follow-up Assessment (w/ patient or family) 85.36 • Neurobehavioral Examination 83.52 • Treatment Planning w/ other Healthcare Providers 82.61 • Psychotherapy with Patient 75.39 • Clinical Supervision of Students (or Post-Docs) 75.00 • Clinical Research 61.34 • Cognitive Rehabilitation 51.67 • Reviews for Insurance Organizations 50.77 • Other 19.12

  35. Referral Sources(in order of prevalence) • Neurology • Other Medical Specialists • Physiatry • General Medicine • Other • Psychiatry • Pediatric Medicine • Other Mental Health Specialists • Forensic/Law • Neurosurgery

  36. Professional Activity(in order of prevalence) • Determination of Diagnosis/Deficits • Treatment Planning • Documentation of Baseline Functioning • Educational Evaluation/IEP • Forensic Activities (civil; criminal; disability/workers comp) • Monitoring Cognitive Recovery • Pre/Post Medical Procedure • Independent Medical Examinations

  37. Overall Summary • Personnel • Clinical Activities • Income/Reimbursement

  38. Examples of Research & Applications (AEP) • Applications • Diagnoses and Rehabilitation of Brain Injury and Disease • Death Penalty • Research • Coronary Artery Bypass Surgery • Cultural Neuropsychology • Roger Sperry/Consciousness

  39. Immediate Predictions for the Practice of Neuropsychology Income Professional Activities Recognition Paradigms

  40. Potential Overall Trendsfor Clinical Neuropsychology • Catching up to Psychiatry • Leaving Psychiatry • Joining Medicine • Leaving Medicine • Sports • Governmental • Industrial • Legal

  41. Future Problems • Empirical Data Base • Limited Understanding of Culture • Personnel Issues • Value to Society

  42. Summary • Continued Growth • Especially in the Professional Domains • Expansion Beyond Mental Health, to Health, to Other Areas • Vibrant, Unpredictable, Exciting

  43. Defining the Future… • Paradigm = Change

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