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Model of Psychological Intervention in Dementia Care Polly Shepard , Psy.D . Corby Bubp , Ph.D. Clinical Neuropsychology/Psychology. Psychiatric Assessment. Marital/Family Therapy. Learning Disability Assessment. Individual Therapy. Neuropsychological Assessment. PPS. Career
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Model of Psychological Intervention in Dementia Care Polly Shepard, Psy.D. Corby Bubp, Ph.D. Clinical Neuropsychology/Psychology
Psychiatric Assessment Marital/Family Therapy Learning Disability Assessment Individual Therapy Neuropsychological Assessment PPS Career Counseling Biofeedback Therapy Parent Coordination Custody Evaluation Competency Evaluation
The Memory Clinic of Indianapolis • Provide compensatory strategies and recommendations for home and school • Identify potential barriers for decision making in daily living (e.g. independent living, driving, financial decision making, etc.) • Provide assessment, consultation, and testimony for issues related to competency and brain-related impairments.
The Memory Clinic of Indianapolis • Pediatric and Adult Neuropsychological Evaluations • Psychoeducational Evaluations • To determine Learning Disorders and AD/HD • Evaluate cognitive strengths and weaknesses in chronic medical diagnoses • Pre-and post-concussion/TBI evaluations • School readiness/private school admission evaluations • Distinguish neurological vs. emotional/psychiatric syndromes
What is a Neuropsychologist? • Neuropsychology = study of brain-behavior relationships • Educational requirements • Ph.D./Psy.D. in Psychology with emphasis in neuropsychology • Doctoral level internship with 50% devotion to neuropsychology • 2 year fellowship/residency in neuropsychology • Board certification in Clinical Neuropsychology by the American Board of Professional Psychology (ABPP)
Referral Triggers • Prior Psych Diagnosis • Psychotropic/Sedative use • Behavioral Issues • MDS Trigger • Staff-patient interaction • Non-compliance with Treatment • Substance/Medication abuse • Cognitive/Behavioral change
Treatment and Interventions • Counseling/therapy • Supportive/emotional • Cognitive behavioral
Treatment and Interventions • Behavioral-based Interventions • Wandering • Sleep management • Hallucinations • Physical/Verbal abusive behaviors
Treatment and Interventions • Cognitive Rehabilitation • ACTIVE • Impact • Tailored intervention • Cogmed
Diagnostics • Screen/Full Neuropsych Assessment • Testing instruments designed to evaluate: • Cognitive (IQ, Memory, Attention, Problem Solving, Insight, Executive Functioning, Language, Motor Skills, Judgment, Speed of Thought, etc.) • Emotional (Depression, Anxiety, Post Traumatic Stress Disorder, Manic episodes, etc.) • Personality (Impulsivity, Recklessness, Lack of Motivation, Apathy, Withdrawal, etc.)
Diagnostics • Diagnostics guide recommendations for: • Differential diagnosis (Dementia/Delirium/Depression) • Treatment planning • Ability to handle finances (bills, checkbook, plan, vulnerable to scam artists) • Ability to make medical/legal/financial decisions • Ability to drive (Poor reaction time, spatial neglect, mentally plan for driving in high traffic conditions) • Medication effectiveness (tracking cognitive/emotional/behavioral)
Memory: Word List Learning Delayed Recall Trial 1 Trial 2 Trial 3 1. Butter 1. Butter 1. Butter 1. 2. Arm 2. Arm 2. Arm 2. 10. Engine 10. Engine 10. Engine 10. Recognition Recall 1. Target 20. Distractor
Memory Performance in Normals and Patients with Mild Dementia
Consultation • Environmental/Physical design of facility • Behavioral management strategies for staff • Stress management • Prevention of staff burnout • Research-based program design
Limitations • Medical culture • Environmental logistics • Insurance/reimbursement • Communication/Language • Training opportunities
Questions • What do facilities want from us • How can we better address limitations • What is the best way to educate facilities about psych/neuropsych services