clinical neuropsychology in developing countries: the south african experience ann watts univ of...

CLINICAL NEUROPSYCHOLOGY IN CLINICAL NEUROPSYCHOLOGY IN DEVELOPING COUNTRIES: THE DEVELOPING COUNTRIES: THE SOUTH AFRICAN EXPERIENCESOUTH AFRICAN EXPERIENCE

Ann WattsAnn WattsUniv of KwaZulu-Natal; Univ of ZululandUniv of KwaZulu-Natal; Univ of Zululand

ICTP-2008ICTP-2008

Status of Clinical Neuropsychology in Status of Clinical Neuropsychology in Developed Countries Developed Countries

Over the past 60 years, clinical neuropsychology Over the past 60 years, clinical neuropsychology has developed into a distinct specialtyhas developed into a distinct specialtyCreation of training standards & qualifications for Creation of training standards & qualifications for clinical practice (e.g. US, UK).clinical practice (e.g. US, UK).Clinical neuropsychology integrated into the Clinical neuropsychology integrated into the healthcare system. The result is improved care healthcare system. The result is improved care & clinical outcomes for patients with & clinical outcomes for patients with neuropsychological diseasesneuropsychological diseases

Status of Clinical Neuropsychology Status of Clinical Neuropsychology in Developing Countriesin Developing Countries

In developing countries high incidence of In developing countries high incidence of brain damage.brain damage.

Limited access to healthcare facilities.Limited access to healthcare facilities.

Number of psychologists relative to Number of psychologists relative to population low so specialization rare.population low so specialization rare.

Training standards & qualifications for Training standards & qualifications for clinical practice not delineated.clinical practice not delineated.

Dearth of formal training programs.Dearth of formal training programs.

Challenges for the Development of Challenges for the Development of Clinical Neuropsychology in South Clinical Neuropsychology in South

AfricaAfrica

Multi-lingual & multi-cultural society in a rapid Multi-lingual & multi-cultural society in a rapid state of transition.state of transition.Inequalities in educational & health status.Inequalities in educational & health status.

If neuropsychological services do exist they are:If neuropsychological services do exist they are:Urban-based Urban-based Assessment dominated.Assessment dominated.Acute rehabilitation facilities may be available.Acute rehabilitation facilities may be available.Post-acute rehabilitation facilities lacking.Post-acute rehabilitation facilities lacking.

TRC Recommendations on the TRC Recommendations on the Health Sector: Mental HealthHealth Sector: Mental Health

Services be accessible to all, with Services be accessible to all, with particular emphasis on rural areasparticular emphasis on rural areas

Focus of services shift from one-on-one Focus of services shift from one-on-one therapy to become community basedtherapy to become community based

Different care & therapy models be Different care & therapy models be explored & instituted, particularly explored & instituted, particularly traditional & indigenous modes of traditional & indigenous modes of treatment.treatment.

TRC Recommendations on the TRC Recommendations on the Health Sector: Mental HealthHealth Sector: Mental Health

Community counselors & family members Community counselors & family members be involved in care provision.be involved in care provision.

Psychometric tests that are culturally Psychometric tests that are culturally appropriate in all aspects be developed appropriate in all aspects be developed and appliedand applied

Services have a developmental focusServices have a developmental focus

Challenges for the Development of Challenges for the Development of Clinical Neuropsychology in South Clinical Neuropsychology in South

AfricaAfricaNeuropsychological services need to be:Neuropsychological services need to be:

-- affordableaffordable

-- accessible (devolution of skills)accessible (devolution of skills)

-- appropriate (development of appropriate (development of culturally culturally appropriate assessment & appropriate assessment & intervention intervention procedures)procedures)

Tiered system of deliveryTiered system of delivery

Specialist neuropsychologistSpecialist neuropsychologist

Psychologist (Masters level)Psychologist (Masters level)

Registered councilor (4 year degree)Registered councilor (4 year degree)

Mental health assistant (2 year diploma)Mental health assistant (2 year diploma)

Primary healthcare workerPrimary healthcare worker

Current Limited Training for Current Limited Training for PsychologistsPsychologists

Clinical, counseling & educational Clinical, counseling & educational psychology masters students receive psychology masters students receive basic instruction in neuropsychological basic instruction in neuropsychological assessment & intervention.assessment & intervention.

At University of KwaZulu- Natal comprises At University of KwaZulu- Natal comprises 10 seminars10 seminars

Recommended Curriculum for Recommended Curriculum for Professional Training in Clinical Professional Training in Clinical

NeuropsychologyNeuropsychology

Post-lisencing, usually in clinical fieldPost-lisencing, usually in clinical field

Masters level degreeMasters level degree

Usually at least 2 years post-training Usually at least 2 years post-training clinical experience that includes a special clinical experience that includes a special interest in clinical neuropsychologyinterest in clinical neuropsychology

Course work: full-time over 1 year or part-Course work: full-time over 1 year or part-time over 2 yearstime over 2 years

Curriculum of Course Work ModuleCurriculum of Course Work Module

A. A. Neurosciences & Human NeuropsycholgyNeurosciences & Human NeuropsycholgyNeuroanatomy, clinical neurology, Neuroanatomy, clinical neurology, neuroradiology, pharmacology & psychiatry for neuroradiology, pharmacology & psychiatry for clinical neuropsychologistsclinical neuropsychologistsNeuropsychology of perceptual, cognitive and Neuropsychology of perceptual, cognitive and executive processesexecutive processesNeuropsychology of development and Neuropsychology of development and developmental disordersdevelopmental disordersNeuropsychology of ageing and the dementiasNeuropsychology of ageing and the dementiasResearch design for neuropsychologyResearch design for neuropsychology


B. B. Specific Clinical Neuropsychology TrainingSpecific Clinical Neuropsychology TrainingNeuropsychological assessment techniques: Neuropsychological assessment techniques: theoretical & practical instructiontheoretical & practical instructionNeuropsychological rehabilitation: theory & Neuropsychological rehabilitation: theory & practicepracticeIndigenous knowledge & cultureIndigenous knowledge & cultureEthics for neuropsychologistsEthics for neuropsychologistsPracticum: Assessment & intervention (children Practicum: Assessment & intervention (children and/or adults) in a supervised assessment and/or adults) in a supervised assessment facilityfacility


C. C. Optional SeminarsOptional Seminars

Optional attendance at seminars offered Optional attendance at seminars offered by the departments of Neurology, by the departments of Neurology, Neurosurgery, Radiology, Anatomy & Neurosurgery, Radiology, Anatomy & Pharmacology.Pharmacology.

D. D. Research dissertation

Clinical Neuropsychology Clinical Neuropsychology InternshipInternship

1 year; 2 years in exceptional 1 year; 2 years in exceptional circumstancescircumstances

Preferably hospital based, but as dearth of Preferably hospital based, but as dearth of internship sites in South Africa can be internship sites in South Africa can be conducted in private practice setting, conducted in private practice setting, provided that practice exposes intern to provided that practice exposes intern to didactic & experiential requirements didactic & experiential requirements


1. 1. Didactic trainingDidactic training

Neurological diagnosisNeurological diagnosis

Consultation to neurological, neurosurgical, Consultation to neurological, neurosurgical, psychiatric, pediatric & general medical psychiatric, pediatric & general medical services (including ward rounds, seminars, etc)services (including ward rounds, seminars, etc)

Consultation to patients & referral sourcesConsultation to patients & referral sources

Neuropsychological assessment, interpretation Neuropsychological assessment, interpretation of test results, & report writingof test results, & report writing

Neuropsychological rehabilitation Neuropsychological rehabilitation


2. 2. Experiential TrainingExperiential TrainingNeuropsychological examination & evaluation of Neuropsychological examination & evaluation of clients with actual & suspected neurological clients with actual & suspected neurological diseases & disorders, as well as psychiatric, diseases & disorders, as well as psychiatric, pediatric & general medical disorderspediatric & general medical disordersParticipation in clinical activities with Participation in clinical activities with Neurologists & Neurosurgeons (e.g. ward Neurologists & Neurosurgeons (e.g. ward rounds)rounds)Direct consultation to patients regarding Direct consultation to patients regarding neuropsychological issuesneuropsychological issuesConsultation to referral & treating professions Consultation to referral & treating professions

clinical neuropsychology in developing countries: the south african experience ann watts univ of...

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