Clinical Clinical Neuropsychology: Neuropsychology: A Window to Understanding Brain and A Window to Understanding Brain and Behavior Relationships Behavior Relationships Flagler College Flagler College March 9, 2004 March 9, 2004 Antonio E. Puente Antonio E. Puente Department of Psychology Department of Psychology University of North Carolina at Wilmington University of North Carolina at Wilmington Wilmington, North Carolina 28403 Wilmington, North Carolina 28403 www.uncw.edu/people/puente www.uncw.edu/people/puente www.clinicalneuropsychology.us www.clinicalneuropsychology.us [email protected][email protected]
43
Embed
Clinical Neuropsychology: A Window to Understanding Brain and Behavior Relationships Flagler College March 9, 2004 Antonio E. Puente Department of Psychology.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Clinical Neuropsychology:Clinical Neuropsychology:A Window to Understanding Brain and Behavior A Window to Understanding Brain and Behavior
American Psychological AssociationAmerican Psychological Association Others (e.g., APS, FPA, SEPA)Others (e.g., APS, FPA, SEPA)
APA MembershipAPA MembershipYear Doctorate Masters Bachelors
1970 1505 457 2975 218319077 14602
1980 1921 1333 4096 5812 15440 26653
1990 1566 2245 3377 7353 15336 38616
2000 1405 2905 3552 10913 17402 56600
APA Membership by DivisionAPA Membership by Division
Approximately 150,000 membersApproximately 150,000 members Approximately 50 different divisionsApproximately 50 different divisions Top three divisions are:Top three divisions are:
Clinical Psychology Clinical Psychology Clinical NeuropsychologyClinical Neuropsychology Independent PracticeIndependent Practice
What is Clinical What is Clinical Neuropsychology?Neuropsychology?
Study and practrice of the Study and practrice of the relationship between brain (nervous relationship between brain (nervous system?) and behavior, especially in system?) and behavior, especially in neurological patientsneurological patients
Approximately 4-5,000 (out of Approximately 4-5,000 (out of 150,000)150,000)
Doctorate with post-doctorate Doctorate with post-doctorate training is minimum requirementtraining is minimum requirement
OutlineOutline
IntroductionIntroduction Brief Overview of Twenty Five YearsBrief Overview of Twenty Five Years Current StatusCurrent Status Projections for the FutureProjections for the Future
History: OrganizationalHistory: Organizational
American Psychological Association (American Psychological Association (APAAPA))Division of Clinical Neuropsychology (Division of Clinical Neuropsychology (4040))
National Academy of Neuropsychology (National Academy of Neuropsychology (NANNAN)) International Neuropsychological Society (International Neuropsychological Society (INSINS)) Other issues/groups;Other issues/groups;
APA’s First Specialty (1996)APA’s First Specialty (1996) Board Certification (e.g., ABPN vs ABCN)Board Certification (e.g., ABPN vs ABCN) Licensure (e.g., Louisiana)Licensure (e.g., Louisiana) Sub-specialty Groups (e.g., Forensics, Sports, Sub-specialty Groups (e.g., Forensics, Sports,
Founding of NAN and Division 40 - Founding of NAN and Division 40 - 19801980 Demographic PatternsDemographic Patterns
Primarily Male to now Primarily Male to now Mostly MaleMostly Male Primarily Academic to Primarily Academic to Primarily ClinicalPrimarily Clinical
Institutional SettingsInstitutional Settings AcademicAcademic Departments of Psychology Departments of Psychology Medical SchoolMedical School Neuropsychology Services Neuropsychology Services Community/Rehabilitation HospitalCommunity/Rehabilitation Hospital Services Services Private PracticePrivate Practice
RehabilitationRehabilitation Cognitive RehabilitationCognitive Rehabilitation Medical Compliance and beyond (H & B CPT Codes)Medical Compliance and beyond (H & B CPT Codes)
ForensicForensic Social Security DisabilitySocial Security Disability Worker’s CompensationWorker’s Compensation Personal InjuryPersonal Injury Death PenaltyDeath Penalty
Current Status: Review of the Current Status: Review of the SurveysSurveys
Brief History of SurveysBrief History of Surveys Hartlage; othersHartlage; others DeLuca & PutnamDeLuca & Putnam
Weekly Professional Activities Weekly Professional Activities by Organizationby Organization
01020304050607080
Clinical Pract.
Teach. Research($)
Res. (No $)
Non-ClinAdmin.
NAN D40 Both Unknown
Percent
Weekly Professional Activities Weekly Professional Activities by Organizationby Organization
01020304050607080
Supervision Forensic
NAN D40 Both Unknown
Percent
Percentages of Percentages of Reimbursement SourcesReimbursement Sources
(For All Doctoral Licensed Clinicians)(For All Doctoral Licensed Clinicians)
0
5
10
15
20
25
30
Managed Care
Medi- care
IndemnityInsur
Self Pay
CHAMPUS Public Aid
Indigent Forensic
Correlates of IncomeCorrelates of Income
Years licensed .27**Years licensed .27** Work Setting Work Setting -.25-.25**** % Forensic .24**% Forensic .24** Gender Gender -.21-.21**** % Self Pay .19**% Self Pay .19** Age .18**Age .18**
Hrs Hrs billed/Eval .13**billed/Eval .13**
% Public Aid % Public Aid -.12-.12**** % Medicare % Medicare -.09-.09** % Man. Care % Man. Care -.09-.09** % Indemnity .07% Indemnity .07 % Indigent % Indigent -.04-.04
*=.05 **=.01 *=.05 **=.01 Negative correlations in red.Negative correlations in red.““Work Setting” above limited to Private and InstitutionWork Setting” above limited to Private and Institution
All All nns between 775 and 1185s between 775 and 1185
Income by Work SettingIncome by Work Setting(Doctoral Licensed Clinicians Working Full (Doctoral Licensed Clinicians Working Full
DX Interv Nbeh Ex Npsy Test Psy TestF/ Up Ass. TX (BD) TX (No BD) CogRehTx plan Superv
Evaluation Time by Evaluation Evaluation Time by Evaluation GoalGoal
6.3
4.4
4.2
4.8
9.3
0 2 4 6 8 10
Determ DX (n=1022) (1-16)
TX Plan (n=914) (.5-12)
Pre/ Post (n=566) (1-10)
Baseline (n=784) (1-10)
Forensic (n=790) (1-20)
(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.
Time-Related Case ActivitiesTime-Related Case Activities(All Doctoral Licensed Clinicians)(All Doctoral Licensed Clinicians)
319
260
050
100150200250300350
IntakeInterview
Rec Rev
Test Admin
Scoring *
Interp/ Rep
Feedback
Cons Ref So
Private Institution
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
Minutes
Use of Testing AssistantsUse of Testing Assistants(All Doctoral Licensed Clinicians)(All Doctoral Licensed Clinicians)
51.2 48.8
0
10
20
30
40
50
60
Yes (n=692)
No (n=660)
Percent
Use Of Testing Assistants By Use Of Testing Assistants By Work SettingWork Setting
Work StatusWork Status Full-timeFull-time 39.9439.94 Part-timePart-time 27.7427.74 Full w/ Part-timeFull w/ Part-time 17.9917.99 Two Part-timeTwo Part-time 9.45 9.45
Professional ActivitiesProfessional Activities
Report WritingReport Writing 95.9495.94 Neuropsychological AssessmentNeuropsychological Assessment 94.7294.72 Personal History of PatientPersonal History of Patient 93.9493.94 Diagnostic Interview (no formal testing)Diagnostic Interview (no formal testing) 92.6792.67 Psychological AssessmentPsychological Assessment 88.5188.51 Follow-up Assessment (w/ patient or family)Follow-up Assessment (w/ patient or family) 85.3685.36 Neurobehavioral ExaminationNeurobehavioral Examination 83.5283.52 Treatment Planning w/ other Healthcare ProvidersTreatment Planning w/ other Healthcare Providers82.6182.61 Psychotherapy with PatientPsychotherapy with Patient 75.3975.39 Clinical Supervision of students (or Post-Docs)Clinical Supervision of students (or Post-Docs) 75.0075.00 Clinical ResearchClinical Research 61.3461.34 Cognitive RehabilitationCognitive Rehabilitation 51.6751.67 Reviews for Insurance OrganizationsReviews for Insurance Organizations 50.7750.77 OtherOther 19.1219.12
Referral SourcesReferral Sources(in order of prevalence)(in order of prevalence)
NeurologyNeurology Other Medical SpecialistsOther Medical Specialists Physiatry Physiatry General MedicineGeneral Medicine OtherOther PsychiatryPsychiatry Pediatric MedicinePediatric Medicine Other Mental Health SpecialistsOther Mental Health Specialists Forensic/LawForensic/Law NeurosurgeryNeurosurgery
Professional ActivityProfessional Activity(in order of prevalence)(in order of prevalence)
Determination of DiagnosisDetermination of Diagnosis Determination of Effects of DeficitsDetermination of Effects of Deficits Treatment PlanningTreatment Planning Documentation of Baseline FunctioningDocumentation of Baseline Functioning Educational Evaluation/IEPEducational Evaluation/IEP Forensic ActivitiesForensic Activities (civil & criminal) (civil & criminal) Disability/Workers CompensationDisability/Workers Compensation Monitoring Cognitive RecoveryMonitoring Cognitive Recovery Pre/Post Medical ProcedurePre/Post Medical Procedure Independent Medical ExaminationsIndependent Medical Examinations
Catching up to PsychiatryCatching up to Psychiatry Leaving PsychiatryLeaving Psychiatry Joining MedicineJoining Medicine Leaving MedicineLeaving Medicine