Training in Neurorehabilitation Psychology: Defining Competencies, Requisite Skill Sets, and a Proposed Developmental Pathway.

Psychologists have been applying neurorehabilitation models of care for many years. These practitioners come from different training backgrounds and use a variety of titles to refer to themselves despite considerable overlap in practice patterns, professional identification, and salary. Titles like 'neurorehabilitation psychologist' and 'rehabilitation neuropsychologist' are sometimes used by practitioners in the field to indicate their specialty area, but are not formally recognized by the American Psychological Association, the American Board of Professional Psychology, or by training councils in clinical neuropsychology (CN) or rehabilitation psychology (RP). Neither the CN or RP specialties alone fully address or define the competencies, skill sets, and clinical experiences required to provide high quality, comprehensive neurorehabilitation psychology services across settings. Therefore, irrespective of practice setting, we believe that both clinical neuropsychologists and rehabilitation psychologists should ideally have mastery of specific, overlapping competencies and a philosophical approach to care that we call neurorehabilitation psychology in this paper. Trainees and early career professionals who aspire to practice in this arena are often pressured to prioritize either CN or RP pathways over the other, with anxiety about perceived and real potential for falling short in their training goals. In the absence of an explicit training path or formal guidelines, these professionals emerge only after the opportunity, privilege, or frank luck of working with specific mentors or in exceptional patient care settings that lend themselves to obtaining integrated competencies in neurorehabilitation psychology. This paper reflects the efforts of 7 practitioners to preliminarily define the practice and philosophies of neurorehabilitation psychology, the skill sets and competencies deemed essential for best practice, and essential training pathway elements. We propose competencies designed to maximize the integrity of training and provide clear guideposts for professional development.

Barriers to finding psychology postdoctoral training opportunities in intensive care settings.

PURPOSE/OBJECTIVE: U.S. health organizations, including Division 22 of the American Psychological Association, the Society for Critical Care Medicine, and the American Thoracic Society advocate for psychological treatment that improves long-term outcomes in critical illness survivors. However, limited information exists with regard to psychology training opportunities in intensive care settings. We aim to identify and describe (a) existing psychology programs with training in intensive care settings and (b) barriers to finding these training opportunities. RESEARCH METHOD/DESIGN: Using aspects of the Arksey and O'Malley Framework and Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews reporting checklist as guides, two independent reviewers searched the Association of Psychology Postdoctoral and Internship Centers (APPIC) Directory and Universal Psychology Postdoctoral Directory (UPPD) to identify programs with training experiences in intensive care settings. RESULTS: Searching the APPIC Directory did not reliably or accurately identify training opportunities in intensive care settings. Thus, only programs identified in the more reliable UPPD search were considered for inclusion. After duplicates were removed, searches using the UPPD yielded 31 programs for review. Of those, 22 programs met inclusion, offering heterogeneous training in intensive care settings. CONCLUSIONS/IMPLICATIONS: These results suggest few opportunities exist for psychology training in intensive care settings and available opportunities are difficult to identify using standard search methods. The identified challenges also emphasize the need for advanced search features for training opportunities within APPIC/UPPD and/or a list of programs offering these training opportunities. Our results highlight the importance of program descriptions that accurately and comprehensively reflect training opportunities-particularly relating to opportunities in intensive care settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Survey of internship training in rehabilitation psychology: 2019.

PURPOSE/OBJECTIVE: The purpose of this study was to obtain information about psychology internship training programs involving work with individuals with disabilities receiving rehabilitation services in the United States and Canada. RESEARCH METHOD/DESIGN: The Association of Psychology Postdoctoral and Internship Centers (APPIC) directory was used to identify 426 training programs that listed supervised experience in rehabilitation psychology, and these programs were sent a survey assessing characteristics of their internship. There were 227 program directors who responded (53%), and 114 of them reported that their internship involved working with disabled persons receiving rehabilitation services. RESULTS: The majority of training programs were at a hospital or subacute rehabilitation facility (Veteran Affairs and non-Veteran Affairs), and 41% of the programs were housed within an independent psychology department. Sixteen programs (15%) had faculty who were board certified by the American Board of Rehabilitation Psychology (ABRP). CONCLUSIONS/IMPLICATIONS: Interns were exposed to a broad range of conditions, such as brain injuries, orthopedic, and spinal cord injuries, as well as comorbid psychiatric and substance use disorders. Interns were also provided various levels of training in ABRP competencies across programs. Opportunities to improve training with rehabilitation populations at the internship level include increasing didactics related to rehabilitation psychology and increasing opportunities to work with ABRP faculty. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A survey of postdoctoral training in rehabilitation psychology in the United States and Canada: 2019.

PURPOSE/OBJECTIVE: Survey psychology postdoctoral training programs involving patients with disability receiving rehabilitation services, and compare with similar data from 2007. RESEARCH METHOD/DESIGN: Public data sources identified 297 potential postdoctoral training programs. Of these, 100 programs (34%) provided services for patients with disability in rehabilitation settings, and 92% returned a survey (n = 92). RESULTS: Programs reported having a primary rehabilitation involvement (42%), a secondary involvement (26%), or an optional involvement (23%). Programs were based in university settings (27%), VA/DoD settings (35%), or private/public health care settings (38%). A total of 433 faculty and 308 residents were involved in these programs. Fifty percent (50%) of programs had faculty with American Board of Rehabilitation Psychology (ABRP) certification, while 62% of programs had faculty with American Board of Clinical Neuropsychology (ABCN) certification. On average, programs formally taught 58% of the ABRP competencies. CONCLUSIONS: Compared to 2007, there has been a 200% increase in the number of training programs with rehabilitation involvement. However, there has been an overall decrease in the variety of populations with which residents work, and an overall decrease in the number of ABRP competencies that are formally taught, so that training has become more focused on specific populations and specific competencies to the exclusion of others. Many rehabilitation patients and teams receive services from psychologists whose professional concentration is not primarily in rehabilitation psychology, and many psychology residents involved with rehabilitation populations do not receive comprehensive training in rehabilitation psychology. There is an opportunity for rehabilitation psychologists to collaborate with these programs to enhance competent services to persons with disability. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

American Academy of Clinical Neuropsychology consensus conference statement on uniform labeling of performance test scores.

Objectives: Descriptive labels of performance test scores are a critical component of communicating outcomes of neuropsychological and psychological evaluations. Yet, no universally accepted system exists for assigning qualitative descriptors to scores in specific ranges. In addition, the definition and use of the term "impairment" lacks specificity and consensus. Consequently, test score labels and the denotation of impairment are inconsistently applied by clinicians, creating confusion among consumers of neuropsychological services, including referral sources, trainees, colleagues, and the judicial system. To reduce this confusion, experts in clinical and forensic neuropsychological and psychological assessment convened in a consensus conference at the 2018 Annual Meeting of the American Academy of Clinical Neuropsychology (AACN). The goals of the consensus conference were to recommend (1) a system of qualitative labels to describe results from performance-based tests with normal and non-normal distributions and (2) a definition of impairment and its application in individual case determinations. Results: The goals of the consensus conference were met resulting in specific recommendations for the application of uniform labels for performance tests and for the definition of impairment, which are described in this paper. In addition, included in this consensus statement is a description of the conference process and the rationales for these recommendations. Conclusions/Importance: This consensus conference is the first formal attempt by the professional neuropsychological community to make recommendations for uniform performance test score labels and to advance a consistent definition of impairment. Using uniform descriptors and terms will reduce confusion and enhance report comprehensibility by the consumers of our reports as well as our trainees and colleagues.

A survey of psychology practice in critical-care settings.

PURPOSE/OBJECTIVE: The aims of this survey study were to (a) examine the frequency of health-service psychology involvement in intensive and critical-care settings; (b) characterize the distinguishing features of these providers; and (c) examine unique or distinguishing features of the hospital setting in which these providers are offering services. RESEARCH METHOD/DESIGN: χ2 analyses were conducted for group comparisons of health-service psychologists: (a) providing services in critical care versus those with no or limited critical care activity and (b) involved in both critical care and rehabilitation versus those only involved in critical care. RESULTS: A total of 175 surveys met inclusion criteria and were included in the analyses. Psychologists who worked in critical-care settings at least monthly were more likely to be at a Level-1, χ2(1, N = 157) = 9.654, p = .002, or pediatric, χ2(1, N = 158) = 7.081, p = .008, trauma center. Psychologists involved with critical care were more likely to provide services on general medical-surgical units, χ2(1, N = 167) = 45.679, p = .000. A higher proportion of rehabilitation-oriented providers provided intensive care, critical care, and neurointensive care services relative to nonrehabilitation providers. CONCLUSION/IMPLICATIONS: The findings indicate that health-service psychologists are involved in critical-care settings and in various roles. A more broad-based survey of hospitals across the United States would be required to identify how frequently health-service psychologists are consulted and what specific services are most effective, valued, or desired in critical-care settings. (PsycINFO Database Record

Supervision in rehabilitation psychology: Application of Beatrice Wright's value-laden beliefs and principles.

Clinical supervision is of critical importance for training subsequent generations of psychologists. Specialty training in rehabilitation psychology requires exposure to specific knowledge, skills, and attitudes related to disability and specialized supervision and mentorship. In the literature to date, minimal guidance exists regarding supervision training and methods specifically for rehabilitation psychologists. This article aims to provoke discussion regarding supervision practice and dissemination of the values fundamental to our specialty. The foundational wisdom of Dr. Beatrice Wright (1983) is applied for the purposes of this endeavor. Examples of clinical supervision scenarios are presented as teaching vignettes to demonstrate ways in which supervisors and mentors can incorporate this content, promote discussion, and apply it to real-world practice.

Guidelines for competency development and measurement in rehabilitation psychology postdoctoral training.

OBJECTIVE: This study describes the results of a multidisciplinary conference (the Baltimore Conference) that met to develop consensus guidelines for competency specification and measurement in postdoctoral training in rehabilitation psychology. METHODS: Forty-six conference participants were chosen to include representatives of rehabilitation psychology training and practice communities, representatives of psychology accreditation and certification bodies, persons involved in medical education practice and research, and consumers of training programs (students). RESULTS: Consensus education and training guidelines were developed that specify the key competencies in rehabilitation psychology postdoctoral training, and structured observation checklists were developed for their measurement. DISCUSSION: This study continues the development of more than 50 years of thinking about education and training in rehabilitation psychology and builds on the existing work to further advance the development of guidelines in this area. The conference developed aspirational guidelines for competency specification and measurement in rehabilitation psychology postdoctoral training (i.e., for studying the outcomes of these training programs). Structured observation of trainee competencies allows examination of actual training outcomes in relation to intended outcomes and provides a methodology for studying how program outcomes are related to program structures and processes so that program improvement can occur. Best practices in applying program evaluation research methods to the study of professional training programs are discussed.

Guidelines for postdoctoral training in rehabilitation psychology.

OBJECTIVE: This article describes the methods and results of a national conference that was held to (1) develop consensus guidelines about the structure and process of rehabilitation psychology postdoctoral training programs and (2) create a Council of Rehabilitation Psychology Postdoctoral Training Programs to promote training programs' abilities to implement the guidelines and to formally recognize programs in compliance with the guidelines. METHODS: Forty-six conference participants were chosen to include important stakeholders in rehabilitation psychology, representatives of rehabilitation psychology training and practice communities, representatives of psychology accreditation and certification bodies, and persons involved in medical education practice and research. RESULTS: Consensus guidelines were developed for rehabilitation psychology postdoctoral training program structure and process and for establishing the Council of Rehabilitation Psychology Postdoctoral Training Programs. DISCUSSION: The Conference developed aspirational guidelines for postdoctoral education and training programs in applied rehabilitation psychology and established a Council of Rehabilitation Psychology Postdoctoral Training Programs as a means of promoting their adoption by training programs. These efforts are designed to promote quality, consistency, and excellence in the education and training of rehabilitation psychology practitioners and to promote competence in their practice. It is hoped that these efforts will stimulate discussion, assist in the development of improved teaching and evaluation methods, lead to interesting research questions, and generally facilitate the continued systematic development of the profession of rehabilitation psychology.

Investing in our future: unrealized opportunities for funding graduate psychology training.

PURPOSE: Changes in the health care environment have brought challenges and opportunities to the field of psychology. Practitioners have been successful in modifying service models to absorb losses of financial support for behavioral health care, due to managed care and public policy changes, while simultaneously managing the growing need for these services. However, in this reactive mode of responding to evolutions in the health care system, the field of psychology has at times lost sight of the long-term vision required to promote psychology's inclusion in the health care system of the future. In particular, a focus on training psychologists and ensuring the availability of funding to support these activities must be a priority in planning for the future. This article provides an overview of federal programs that currently offer funding for psychology training, as well as other opportunities for federal funding that have been unrealized. Details regarding advocacy efforts that were required to secure available sources of funding are given, followed by consideration of strategies for taking advantage of existing resources and prioritizing advocacy for additional funding. CONCLUSION: Funding for psychology training provides an avenue for increasing the number of well-trained psychologists who can serve patients' mental and behavioral health needs and thereby improve health outcomes. Moreover, capitalizing on available funding opportunities for psychology training and promoting efforts to expand these opportunities will help ensure that the field of psychology is positioned to remain an important contributor to the health care system of the future.

Providing effective supervision in clinical neuropsychology.

A specialty like clinical neuropsychology is shaped by its selection of trainees, educational standards, expected competencies, and the structure of its training programs. The development of individual competency in this specialty is dependent to a considerable degree on the provision of competent supervision to its trainees. In clinical neuropsychology, as in other areas of professional health-service psychology, supervision is the most frequently used method for teaching a variety of skills, including assessment, report writing, differential diagnosis, and treatment. Although much has been written about the provision of quality supervision in clinical and counseling psychology, very little published guidance is available regarding the teaching and provision of supervision in clinical neuropsychology. The primary focus of this article is to provide a framework and guidance for the development of suggested competency standards for training of neuropsychological supervisors, particularly at the residency level. In this paper we outline important components of supervision for neuropsychology trainees and suggest ways in which clinicians can prepare for supervisory roles. Similar to Falender and Shafranske (2004), we propose a competency-based approach to supervision that advocates for a science-informed, formalized, and objective process that clearly delineates the competencies required for good supervisory practice. As much as possible, supervisory competencies are related to foundational and functional competencies in professional psychology, as well as recent legislative initiatives mandating training in supervision. It is our hope that this article will foster further discussion regarding this complex topic, and eventually enhance training in clinical neuropsychology.

Index, summary, and subtest discrepancy scores on the WAIS-III in postacute traumatic brain injury patients.

WAIS-III profile interpretation typically involves the analysis of disparities between summary and subtest scores. Determination of clinically meaningful differences has been guided by published rates of discrepancies based upon the normative sample. However, noting that a particular profile discrepancy is uncommon among normals only represents one step in the interpretive process. Rates of such pairwise differences have yet to be published for clinical samples. In order to begin filling this void in the literature, we present frequencies of composite and subtest differences from a postacute traumatic brain injury sample. The practical utility of these tables, in conjunction with the normative tables, is demonstrated.