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Clinical Neuropsychology: A Window to Understanding Brain and Behavior Relationships Sandhills Regional Psychology Conference 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, North Carolina 28403 www. uncw. edu/people/puente www. clinicalneuropsychology. us [email protected] edu

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

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

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

What is Clinical Neuropsychology? n n n Study and practrice of the relationship between What is Clinical Neuropsychology? n n n 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

Outline n n Introduction Brief Overview of Twenty Five Years Current Status Projections for Outline n n Introduction Brief Overview of Twenty Five Years Current Status Projections for the Future

History: Organizational n n American Psychological Association (APA) Division of Clinical Neuropsychology (40) National History: Organizational n n American Psychological Association (APA) Division of Clinical Neuropsychology (40) National Academy of Neuropsychology (NAN) International Neuropsychological Society (INS) Other issues/groups; n n 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)

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

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

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

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

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

Survey Return Rates Actual Return Rate n 1569 returns n 5791 mailed 1569/5791 = Survey Return Rates Actual Return Rate n 1569 returns n 5791 mailed 1569/5791 = 27. 1% Adjusted Return Rate n Or returns, 1406 U. S. , Doctoral, Licensed, Clinicians n Of mailed, 1590 excluded (duplicates, unintended, undelivered) 1406/4201 = 33. 5%

Organizational Membership (All Doctoral Licensed Clinicians) Percent Organizational Membership (All Doctoral Licensed Clinicians) Percent

Gender (All Doctoral Licensed Clinicians vs. Younger Samples) Percent Age: Males = 48. 6 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%

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

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

Work Status (All Doctoral Licensed Clinicians) Percent Work Status (All Doctoral Licensed Clinicians) Percent

Work Setting (All Doctoral Licensed Clinicians) Percent Work Setting (All Doctoral Licensed Clinicians) Percent

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

Board Certification Status (Doctoral Licensed Clinicians) Percent Board Certification Status (Doctoral Licensed Clinicians) Percent

Weekly Professional Activities by Organization Percent Weekly Professional Activities by Organization Percent

Weekly Professional Activities by Organization Percent Weekly Professional Activities by Organization Percent

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

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

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

HOURS/Week Clinical Activity HOURS/Week Clinical Activity

Evaluation Time by Evaluation Goal (Except forensic, those using assistants test more hours (e. 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.

Time-Related Case Activities (All Doctoral Licensed Clinicians) Minutes Hours billed: Private=11. 1 (SD=5. 0); 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

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

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

Knaus, Schatz & Puente (2004) (Demographics: in %) Gender n n Male Female 49. Knaus, Schatz & Puente (2004) (Demographics: in %) Gender n n Male Female 49. 2 50. 8 Highest Degree Earned n n Ph. D. Psy. D. Ed. D. M. D. /Ph. D. Board Certified n n Yes No 80. 0 17. 8 1 29. 1 70. 9

Demographics (cont. ) (in %) Employment Settings n n n Private Practice Medical/Hospital College/University Demographics (cont. ) (in %) Employment Settings n n n Private Practice Medical/Hospital College/University Rehabilitation Other Psychiatric Facility Work Status n n Full-time Part-time Full w/ Part-time Two Part-time 58. 54 45. 12 15. 85 10. 06 3. 69 39. 94 27. 74 17. 99 9. 45

Professional Activities n n n n Report Writing Neuropsychological Assessment Personal History of Patient Professional Activities n n n n Report Writing Neuropsychological Assessment Personal History of Patient Diagnostic Interview (no formal testing) Psychological Assessment Follow-up Assessment (w/ patient or family) Neurobehavioral Examination Treatment Planning w/ other Healthcare Providers Psychotherapy with Patient Clinical Supervision of Students (or Post-Docs) Clinical Research Cognitive Rehabilitation Reviews for Insurance Organizations Other 95. 94 94. 72 93. 94 92. 67 88. 51 85. 36 83. 52 82. 61 75. 39 75. 00 61. 34 51. 67 50. 77 19. 12

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

Professional Activity (in order of prevalence) n n n n Determination of Diagnosis/Deficits Treatment Professional Activity (in order of prevalence) n n n n 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

Overall Summary n n n Personnel Clinical Activities Income/Reimbursement Overall Summary n n n Personnel Clinical Activities Income/Reimbursement

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

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

Potential Overall Trends for Clinical Neuropsychology n n Catching up to Psychiatry Leaving Psychiatry Potential Overall Trends for Clinical Neuropsychology n n Catching up to Psychiatry Leaving Psychiatry Joining Medicine Leaving Medicine Sports n Governmental n Industrial n Legal n

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

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

Defining the Future… l Paradigm = Change Defining the Future… l Paradigm = Change