CLINICAL NEUROPSYCHOLOGY IN DEVELOPING COUNTRIES: THE SOUTH AFRICAN EXPERIENCE

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CLINICAL NEUROPSYCHOLOGY IN DEVELOPING COUNTRIES
THE SOUTH AFRICAN EXPERIENCE

• Ann Watts
• Univ of KwaZulu-Natal Univ of Zululand
• ICTP-2008

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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

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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.

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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.

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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.

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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

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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)

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Tiered system of delivery

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

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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

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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

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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

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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

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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

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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

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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

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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