CLINICAL NEUROPSYCHOLOGY IN DEVELOPING COUNTRIES: THE SOUTH AFRICAN EXPERIENCE

1. CLINICAL NEUROPSYCHOLOGY IN DEVELOPING COUNTRIES: THE SOUTH AFRICAN EXPERIENCE Ann Watts Univ of KwaZulu-Natal; Univ of Zululand ICTP-2008

2. Status of Clinical Neuropsychology in Developed Countries • Over the past 60 years, clinical neuropsychology has developed into a distinct specialty • Creation of training standards & qualifications for clinical practice (e.g. US, UK). • Clinical neuropsychology integrated into the healthcare system. The result is improved care & clinical outcomes for patients with neuropsychological diseases

3. Status of Clinical Neuropsychology in Developing Countries • In developing countries high incidence of brain damage. • Limited access to healthcare facilities. • Number of psychologists relative to population low so specialization rare. • Training standards & qualifications for clinical practice not delineated. • Dearth of formal training programs.

4. Challenges for the Development of Clinical Neuropsychology in South Africa • Multi-lingual & multi-cultural society in a rapid state of transition. • Inequalities in educational & health status. If neuropsychological services do exist they are: • Urban-based • Assessment dominated. • Acute rehabilitation facilities may be available. • Post-acute rehabilitation facilities lacking.

5. TRC Recommendations on the Health Sector: Mental Health • Services be accessible to all, with particular emphasis on rural areas • Focus of services shift from one-on-one therapy to become community based • Different care & therapy models be explored & instituted, particularly traditional & indigenous modes of treatment.

6. TRC Recommendations on the Health Sector: Mental Health • Community counselors & family members be involved in care provision. • Psychometric tests that are culturally appropriate in all aspects be developed and applied • Services have a developmental focus

7. Challenges for the Development of Clinical Neuropsychology in South Africa • Neuropsychological services need to be: - affordable - accessible (devolution of skills) - appropriate (development of culturally appropriate assessment & intervention procedures)

8. Tiered system of delivery • Specialist neuropsychologist • Psychologist (Masters level) • Registered councilor (4 year degree) • Mental health assistant (2 year diploma) • Primary healthcare worker

9. Current Limited Training for Psychologists • Clinical, counseling & educational psychology masters students receive basic instruction in neuropsychological assessment & intervention. • At University of KwaZulu- Natal comprises 10 seminars

10. Recommended Curriculum for Professional Training in Clinical Neuropsychology • Post-lisencing, usually in clinical field • Masters level degree • Usually at least 2 years post-training clinical experience that includes a special interest in clinical neuropsychology • Course work: full-time over 1 year or part-time over 2 years

11. Curriculum of Course Work Module A. Neurosciences & Human Neuropsycholgy • Neuroanatomy, clinical neurology, neuroradiology, pharmacology & psychiatry for clinical neuropsychologists • Neuropsychology of perceptual, cognitive and executive processes • Neuropsychology of development and developmental disorders • Neuropsychology of ageing and the dementias • Research design for neuropsychology

12. Curriculum of Course Work Module B. Specific Clinical Neuropsychology Training • Neuropsychological assessment techniques: theoretical & practical instruction • Neuropsychological rehabilitation: theory & practice • Indigenous knowledge & culture • Ethics for neuropsychologists • Practicum: Assessment & intervention (children and/or adults) in a supervised assessment facility

13. Curriculum of Course Work Module C. Optional Seminars • Optional attendance at seminars offered by the departments of Neurology, Neurosurgery, Radiology, Anatomy & Pharmacology. D. Research dissertation

14. Clinical Neuropsychology Internship • 1 year; 2 years in exceptional circumstances • Preferably hospital based, but as dearth of internship sites in South Africa can be conducted in private practice setting, provided that practice exposes intern to didactic & experiential requirements

15. Clinical Neuropsychology Internship 1. Didactic training • Neurological diagnosis • Consultation to neurological, neurosurgical, psychiatric, pediatric & general medical services (including ward rounds, seminars, etc) • Consultation to patients & referral sources • Neuropsychological assessment, interpretation of test results, & report writing • Neuropsychological rehabilitation

16. Clinical Neuropsychology Internship 2. Experiential Training • Neuropsychological examination & evaluation of clients with actual & suspected neurological diseases & disorders, as well as psychiatric, pediatric & general medical disorders • Participation in clinical activities with Neurologists & Neurosurgeons (e.g. ward rounds) • Direct consultation to patients regarding neuropsychological issues • Consultation to referral & treating professions