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

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

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.

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.

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.

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

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)

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

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

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

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

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

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

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

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

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