Would You Become a Neuropsychologist Again
Introduction
Co-ordinate to the brief definition by the American Psychological Clan:
"Clinical Neuropsychology is a specialty field within Clinical Psychology, dedicated to understanding the relationships between brain and behavior, particularly as these relationships can be practical to the diagnosis of brain disorder, assessment of cognitive and behavioral functioning and the pattern of effective treatment."ane
Clinical Neuropsychology in Europe has its roots in psychology, particularly experimental psychology, but also in neurology, psychiatry, and functional anatomy. The early milestones include the first chair of neurology created for Jean-Martin Charcot at the Salpêtrière in Paris France in 1882, the first descriptions of the localization of expressive speech by Paul Broca in 1861 and receptive speech communication by Carl Wernicke in 1874, and the clinico-pathological findings of Alois Alzheimer in 1906 (McHenry, 1969; Eling, 2016; Derouesné and Poirier, 2018). In 1879, Wilhelm Wundt (1832–1920), a physician, physiologist, and the showtime to call himself a psychologist, congenital a laboratory of experimental psychology in Leipzig, Federal republic of germany. This is considered to mark the nascence of psychology as an independent subject. Wundt as well contributed directly to neuropsychology by participating in the give-and-take of the theory of localization of function, and by developing theories of attending and cognitive control (Fahrenberg, 2015). Amidst the get-go to use methods derived from experimental psychology to encephalon injury patients in Europe were Kurt Goldstein (1878–1965), a professor of neurology, and Adhémar Gelb (1887–1936), a psychologist who worked with him at the Institut zur Erforschung der Folgeerscheinungen von Hirnverletzungen (Institute for Research on the Consequences of Brain Injury) in Frankfurt am Main, Germany (Eling, 2016). Following the Second World War, psychologists across Europe were asked to evaluate the effects of penetrating head wounds in returning war veterans, which boosted the development of neuropsychology from experimental science to clinical specialty on a larger scale (Collins, 2016; Hokkanen et al., 2016).
Despite current evidence of the growing necessity for qualified wellness services regarding cognitive, affective, and behavioral consequences of long-term neurological conditions and psychopathological weather, the preparation of specialists in Clinical Neuropsychology throughout the world, and even in Europe, is remarkably uneven. Only a minority of European countries, also in loftier-income regions, provide systematic high-level specialist preparation in Clinical Neuropsychology, equally required for diagnosis and treatment of disorders described in the international classifications of diseases, namely ICD-x and DSM V (Grote and Novitski, 2016; Hessen et al., 2018; Hokkanen et al., 2019). Both in France and in Spain, one of the top perceived barriers to the development of neuropsychology was reported to exist the lack of clinical and academic preparation opportunities (Olabarrieta-Landa et al., 2016; Lopes et al., 2019). A consequence of this is that the general public in European countries receives neuropsychological intendance and treatment by professionals with unequal competencies and abilities to diagnose and treat their clinical conditions. In 2019, European Federation of Psychologists' Association (EFPA) conducted a survey on the routes of specialization on all fields of psychology in Europe and while finding neuropsychology to be one of the most common areas of specialty, it also confirmed the heterogeneity of the existing grooming models (Dias Neto et al., 2020).
In 2015, EFPA established a Continuing Committee on Clinical Neuropsychology to analyze the situation of the field of Clinical Neuropsychology in Europe and to make recommendations on how the specialization training in neuropsychology can and/or should be developed in the time to come.
The aims of the present paper are iii-fold: (1) To talk over gimmicky Clinical Neuropsychology, and to depict the professional state of affairs of the field in Europe, (2) To draw the current specialization training models based on information collected by the EFPA Standing Commission on Clinical Neuropsychology, and contrasting it with the electric current EuroPsy Specialist Certificate model available for other areas in psychology, and (3) To make recommendations regarding benchmarking the training standards and competencies. We propose that the EuroPsy Specialist Document model could play a disquisitional role in ensuring the safety and intendance of the patients across Europe.
The Office of Clinical Neuropsychology in Major Health Disorders
In because the role of Clinical Neuropsychologists within the society, it is important to understand the various work areas of the practitioners in the field. The prevalence and health impact of brain disorders e.g., traumatic brain injury (TBI), stroke, epilepsy, motor neuron illness etc., are substantial. A study conducted in 2003 by the European Brain Council found that disorders of the encephalon were the largest contributor to the total morbidity brunt in Europe, accounting for 35% of all disease burden (Olesen and Leonardi, 2003). The economic costs of disorders affecting the encephalon are large, constituting 24% of the full straight healthcare expenditure in Europe in 2010 (Gustavsson et al., 2011; Olesen et al., 2012). Notably, this study expands beyond the typical neurological disorders and acknowledges the affect of for example psychotic disorders, feet disorders, mood disorders, and neurodevelopmental disorders in childhood and adolescence (Olesen et al., 2012). The World Health Organization in their report estimated that while the neurological disorders they considered in 2005 globally contributed to 92 million disability-adjusted life years (DALYs), the burden is projected to increase to 103 meg in 2030 which is approximately a 12% increment (Globe Health System, 2006).
The cognitive, affective, and behavioral disturbances related to brain disorders are a significant cause of disability, have a negative influence on functional outcomes, impact personal, professional, and social lives and significantly impair the quality of life of those affected and their family members (come across Feigin et al., 2019). With the increasing prevalence of these disorders (World Health Arrangement, 2006; Feigin et al., 2019), the demand for health professionals with expertise both in cess and treatment of these patients has also increased. Among those working in this field, the extensive training and core competencies of Clinical Neuropsychologists brand them well suited to reply to the need (Lezak et al., 2012; Hessen et al., 2018).
Clinical Neuropsychologists tin can help obtain important data for diagnostic criteria in order to differentiate between various clinical phenotypes of mental, neurological, or neurodevelopmental disorders, too as evaluate their functional outcomes. In many countries, neuropsychological cess has a role in quantifying and understanding deficits or impairments for the purpose of inability insurance and other legal implications. Neuropsychological assessment tin can besides pinpoint the type of intervention needed, suggest the required amount of relevant rehabilitation or therapies, and evaluate the progress and efficacy of rehabilitation with objective measures of mental functioning (Lezak et al., 2012). This information is vital in evaluating the abilities of returning to work and maintenance or improvement of independence in daily life and social activities. A recent disquisitional review plant show of the incremental value of neuropsychological cess e.thou., in the care of persons with mild cognitive harm/dementia, TBI, stroke, epilepsy, multiple sclerosis, and attention deficit hyperactivity disorder (ADHD; Donders, 2020). Based on the review, participation in neuropsychological evaluations was also associated with toll savings.
Similarly, Clinical Neuropsychologists can provide the rehabilitation services to, for case, survivors of stroke, TBI, other forms of acquired brain injury or to those suffering from developmental deficits, such as dyslexia or autism. There are numerous studies indicating the prove-based efficacy of neuropsychological interventions, such as those reviewed by Rohling et al. (2009), Cicerone et al. (2011, 2019), van Heugten et al. (2012), and Langenbahn et al. (2013). Moreover, Clinical Neuropsychologists can contribute to public health by educating people on how to best improve and maintain brain health during the entire lifespan, and they tin also increase public awareness about neurocognitive or neuroaffective disorders and brain-behavior relationships.
Qualified assessment of neuropsychological part is at present a requirement both for a diagnosis and for identifying potential functional disabilities due to dissimilar conditions affecting the brain. For example, current consensus requires identifying specific patterns of neuropsychological deficits in order to diagnose mild cerebral impairment in early on stages of possible neurodegenerative diseases like Alzheimer'southward disease (Albert et al., 2011) or Parkinson's disease (Litvan et al., 2011). Importantly, neuropsychological assessment has proven valuable in the diagnosis and prediction of outcomes in elderly individuals who are at chance for MCI and/or progression to dementia in a higher place and beyond neuroimaging or biomarkers (Donders, 2020).
With respect to multiple sclerosis, cerebral symptoms were described in the start known article that addressed its clinical and pathological characteristics, written by Jean Martin Charcot (1877). In more than contempo years, two studies by Rao and colleagues (Rao et al., 1991a,b) revealed that cognitive and behavioral symptoms both were frequent and among the most disabling symptoms in many persons with multiple sclerosis. Further enquiry has confirmed that neuropsychological symptoms may be the most disabling symptoms reported in multiple sclerosis (Stuifbergen et al., 2012) and thus of import to detect and address. The increment value of neuropsychological variables has been found specially in predicting outcomes afterwards multiple sclerosis (Donders, 2020).
Epilepsy, one of the virtually ofttimes diagnosed neurological conditions, is defined by the International League Against Epilepsy and the International Bureau for Epilepsy as "a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological, and social consequences of this status" (Fisher et al., 2005). This definition does non only crave the occurrence of epileptic seizures, but also the assessment of its impact on cognitive and psychological functions (McCagh et al., 2009).
Traumatic brain injury is another major wellness condition where Clinical Neuropsychologists have been playing a disquisitional role in inquiry, assessment, treatment, and rehabilitation over the last several decades (Yeates et al., 2017). Moreover, neuropsychological assessment, quite often, provides the just objective functional measure of mild traumatic brain injury, which represents the vast majority of traumatic encephalon injury cases. Thus, neuropsychological cess ensures the best understanding of the cerebral, melancholia, and behavioral consequences of mild traumatic brain injury (Zink, 2001), allotting neuropsychology a primal part in planning rehabilitation and treatment post-obit TBI. Neuropsychological test variables add uniquely to the prediction of outcomes after TBI, in both children and adults (Donders, 2020).
Among neurodevelopmental disorders, ADHD affects people across the lifespan with a prevalence rate of iii–five% in childhood, 1.iv–3.six% in adulthood, and two.eight–iv.2% in persons over 60 years of age (Kooij et al., 2019). In the Usa, eleven% of all children of 4–17 years have ever had a diagnosis for ADHD (Visser et al., 2014). For those afflicted, neuropsychological cess provides a precise description of the cognitive problems and offers specific information for individualized treatment planning (Lange et al., 2014). Early neuropsychological assessment may also be of incremental benefit in the prediction of the development of ADHD and the associated outcomes (Donders, 2020). ADHD has risen to be the most mutual condition seen by Nordic neuropsychologists (Norup et al., 2017); among the French neuropsychologists, ADHD and learning disabilities were at the peak third and fourth place in diagnostic groups of clients for assessment and rehabilitation (Lopes et al., 2019).
In addition to neurological and neurodevelopmental disorders, neuropsychological dysfunctions also appear as core features of some psychiatric disorders. For example, schizophrenia is associated with moderate to astringent deficits across several cerebral domains, including attending, working memory, verbal learning and retentivity, and executive functions (Elvevag and Goldberg, 2000; Kremen et al., 2000; Sheffield et al., 2018). Similar findings are besides axiomatic in depressive psychosis. Studies have consistently establish that these deficits in the example of schizophrenia pre-date the onset of frank psychosis and are stable throughout the form of the illness in most patients (Sheffield et al., 2018). With the recognition that neuropsychological deficits are consistently the best predictor of functional outcomes beyond outcome domains and patient samples, the focus on cognition has increased dramatically (Bowie and Harvey, 2006). Acknowledging the importance of neuropsychological functioning in schizophrenia, the DSM-five (American Psychiatric Association, 2010) recommends obtaining a formal neuropsychological cess in individuals with psychosis (Elvevag and Goldberg, 2000; Kremen et al., 2000; Bowie and Harvey, 2006).
Clinical Neuropsychology as a Specialist Profession
The development of professional person Clinical Neuropsychology has mainly taken place in loftier income regions of European countries, Australia, and North America, with well-adult health care systems. This is reflected both by the number of scientific publications that come up from these areas of the world and by the growth of Clinical Neuropsychology in comparison to other psychological disciplines. One clear example of this is evident in the United States, where the Partitioning of Clinical Neuropsychology at present is the largest of 55 divisions of the American Psychological Clan.ii In addition, the board certification in Clinical Neuropsychology has grown faster over the last few years than whatsoever of the other 13 specialties nether the umbrella of the American Lath of Professional Psychology, including Clinical Psychology (Hessen et al., 2018).
After the Second Globe State of war, professional development in European countries progressed but not linearly. As stated by Collins (2016), "dissever neuropsychology adult when psychologists could offering techniques they could call their own, most notably psychometric tests, when psychology itself became an established bookish discipline and fix of professional practices, when psychologists began to occupy posts that brought them into regular contact with brain-damaged patients, and when psychologists began to develop models that were adequate for explaining both normal and disordered function." In the United Kingdom, these steps were taken in the 2d half and especially in the last quarter of the twentieth century (Collins, 2016). In Germany, progress was hindered by the National Socialism regime and the forced emigration of notable researchers, such as Kurt Goldstein and Hans-Lukas Teuber, who took refuge in the Us (Eling, 2016). In several European countries, the move from research labs to clinical applications, and from the rehabilitation of war veterans to wider civilian health care has taken its time (Boller et al., 2016; Collins, 2016; Eling, 2016; Hokkanen et al., 2016).
The evolution of the professional person expertise in Norway can serve as one case. In 1987, the specialty of Clinical Neuropsychology was separated from the general specialty in Clinical Psychology. At that time, the service provided by neuropsychology was insignificant and with hardly any impact on public health care. Today, the service provided by specialists in Clinical Neuropsychology has become a requirement in the diagnostic processes equally well as in treatment planning and implementation, within all relevant aspects of specialist health care (Hessen et al., 2016). Thus, positions for specialists in Clinical Neuropsychology exist within major hospital departments, namely, in child and adult psychiatry, pediatrics, neurology, rehabilitation, and geriatric health care. Clinical Neuropsychology has emerged and established itself equally a new required health service over the last xxx years.
A different example of the development of Clinical Neuropsychology comes from France. Although the history of French neuropsychology is long, kickoff with Broca in 1861, its development from being part of neurology to its recognition as an democratic discipline has been slow (Derouesné and Poirier, 2018). The beginning primary's degree specializing in neuropsychology was opened in 1992, yet an association aimed at promoting professional neuropsychology in France (Organisation Française des Psychologues spécialisés en Neuropsychologie – the Arrangement of French Neuropsychologists) was only created in 2014 (Lopes et al., 2019). Additionally, the allocation of public funding in French republic still tends to put psychologists at a disadvantage in relation to other professions working in the field (Derouesné and Poirier, 2018).
Estimated Numbers of Practitioners in Europe
Estimating the electric current number of practitioners across Europe is challenging. Legal regulations usually do not exist, and the definition of a Clinical Neuropsychologist varies from country to country (Hokkanen et al., 2019). A survey conducted past the EFPA Standing Committee on Clinical Neuropsychology consisting of information provided by representatives of national psychological associations and/or neuropsychological societies in Europe suggested a full number of active practitioners within Clinical Neuropsychology in Europe beingness 13,367 (Hokkanen et al., 2019). Relative to the population in Europe, information technology amounts to i practitioner for 53,494 individuals. In that location is a great deal of variation between countries, however, ranging from i per 10,455 inhabitants in Kingdom of denmark to 1 per ane,995,250 in Turkey (Hokkanen et al., 2019). The numbers presented do non indicate that all practitioners have equal teaching, training, competencies, and task descriptions. No other like studies from beyond Europe tin be found for comparison. Prior estimates in individual European countries included in a global survey accept suggested ane per xix,231 for Finland and 1 per 32,000 for Espana (Grote and Novitski, 2016). The ratio of Neuropsychologists to Clinical Psychologists in the global survey of 14 countries suggested a mean ratio of one:29 (Grote and Novitski, 2016).
Another way of estimating the number of Clinical Neuropsychologists comes from looking at the size of the membership in national neuropsychological societies in Europe. There are 23 societies that are members of the Federation of the European Societies of Neuropsychology (FESN). Some have less than l individual members, many between 200 and 400 members, some over 1,500. Many of the societies take members representing unlike educational backgrounds such as physicians and speech therapists, in add-on to psychologists. Membership is often not restricted to those with specialization grooming and the numbers may therefore also reverberate the general interest in neuropsychology among students and other practitioners. Some countries too accept several societies representing different geographical regions, unlike languages, or different professional focus and goals. Some include members working in bookish or inquiry settings, in improver to clinical practitioners. Equally a result, the estimates on the numbers of practitioners differ. For instance, the estimated number of neuropsychologists in France (five,000) refers to the number of graduates with a Primary'due south degree in Neuropsychology reported past the French National Association of Neuropsychologists (Hokkanen et al., 2019; Lopes et al., 2019). At the same time, the number of members of the Société de Neuropsychologie de Langue Française (French Speaking Neuropsychological Society) who are also members of the FESN, is 220. In a recent report from France, the number or members in the Organization Française des Psychologues Spécialisés en Neuropsychologie (Organization of French Neuropsychologists) is 500, and the number of those who self-identified as psychologists or other wellness professionals working in the field of neuropsychology responding to the survey was 800 (Lopes et al., 2019).
Specialist Pedagogy Options and Implications
Equally stated in the previous section, the piece of work area of Clinical Neuropsychology is wide and diversifying, involving a high number of different etiologies and handling strategies. The required competencies reflect this fact. The development of the profession in the field is at different stages in different countries, as seen in the few examples above.
Current Training Models
In Europe, a dandy deal of variability currently exists among countries with respect to the models of preparation to go a Clinical Neuropsychologist. Based on the survey conducted past the EFPA Standing Committee on Clinical Neuropsychology (Hokkanen et al., 2019) there are training models based on master's programs, continuing pedagogy courses, doctoral programs, and post-doctoral specialization. Tabular array 1 lists training models in European countries as described in the 2017 survey.
Table 1. Features in the specialization and training of Clinical Neuropsychologists in Europe (full number of responding countries was 30) based on the data in Hokkanen et al. (2019).
In the United states of america, specialist education and training in Clinical Neuropsychology has been defined in The Houston Conference on Specialty Pedagogy and Training in Clinical Neuropsychology policy statement (Hannay et al., 1998). The statement is grounded on the view that the training of the specialist in Clinical Neuropsychology must be based on the scientist-practitioner model (Belar and Perry, 1992), and it may lead to a primarily do, primarily bookish, or a combined career. Inside the Houston model, the specialization in Clinical Neuropsychology begins at the doctoral level including an internship period and continues in a postal service-doctoral residency or fellowship training program (Hannay et al., 1998).
In Europe, Doctoral level teaching for Clinical Neuropsychologists is a requirement only in the Uk and Ireland. In these countries, practicing Clinical Psychology also requires a doctorate. Psychology education in the United kingdom of great britain and northern ireland, nevertheless, does not follow the 3-cycle Bologna model3 where a minimum of a iii-twelvemonth bachelor's caste is followed by a 2-year master's degree before entering doctoral preparation is possible. In the United Kingdom, doctoral training tin begin after the bachelor'south caste. Also, a clinically oriented Dr. of Psychology (D Clin Psychol) is available in the United Kingdom in addition to the more than enquiry-intensive Doctor of Philosophy (PhD) degree. Similar dual doctorate routes are available also in Australia and the United states, but generally in Europe only a PhD is available. Within the specialist instruction in Clinical Neuropsychology, the requirements related to research skills vary in the seven countries reviewed in Hessen et al. (2018): In addition to Commonwealth of australia and the United states, Italy also requires a dissertation, only in Italy, this does not lead to a doctorate. In the United kingdom, an empirical research study is required that contributes to a doctorate. In Finland, kingdom of the netherlands, and Kingdom of norway, students produce one or two scientific papers as part of their specialist education, either in the form of systematic literature reviews or empirical studies, published or not (Hessen et al., 2018).
Competencies in Clinical Neuropsychology
The competency approach became prominent in medical training in early 2000 (Leung, 2002; Williams et al., 2010) with various international initiatives promoting competency-based training and assessment (due east.chiliad., The European Union of Medical Specialists). Core competencies for professional practice were also specified internationally for psychology past the ways of the International Declaration of Core Competences in Professional Psychology.four In Europe, the full general competencies necessary for practicing psychology were farther developed within the EuroPsy model (Lunt et al., 2015).
Competencies for each specialist surface area of psychology need to be separately identified, however. In response to this need, cadre competencies for entry-level Clinical Neuropsychologists have been delineated in the The states (Rey-Casserly et al., 2012) and approved by the American Board of Professional Psychology/American Lath of Clinical Neuropsychology and the Council of Specialties in Professional Psychology (COSPP).5 Practicum guidelines and methodology for competency-based evaluation of Clinical Neuropsychology trainees were also established (Nelson et al., 2015). Besides, in the United Kingdom a competency framework in Clinical Neuropsychology was published by the British Psychological Lodge (Division of Neuropsychology, 2012).
The framework of COSPP delineates the competencies necessary for inbound the professional person practice in health care (the so-called entry-level competencies). They are divided into foundational competencies (knowledge-based elements necessary across all of the neuropsychologist's functional domains), functional competencies (knowledge- and skill-based elements describing particular aspects of practice), and additional competencies (relevant in specific advanced areas of do). Each competency area is described in terms of several individual subcompetencies that are necessary for a successful practice.
In the Assessment domain, examples of the knowledge-based subcompetencies (total of 10) include the knowledge of the neuropsychology of beliefs (involving information processing theories, cognitive/affective neuroscience, social neuroscience, cultural neuroscience, and behavioral neurology); the knowledge of patterns of behavioral, cerebral, and emotional impairments associated with neurological and related diseases and conditions that affect brain construction and functioning; the knowledge of patterns of behavioral, cerebral, and emotional impairments associated with psychiatric disorders; and the noesis of theories and methods of measurement and psychometrics relevant to cognitive abilities, social and emotional functioning, and encephalon-behavior relationships. Examples of skill-based subcompetencies in the Cess domain (total of nine) include the ability to analyze and clarify referral questions based on the context, professional roles, and the patient/examinee presentation; the ability to get together information key to addressing the referral question, including interview(s), targeted behavioral observations, and review of records; the ability to appropriately select tests, measures, and other information sources consequent with best evidence and specific context of cess, including assessment of performance and symptom validity, if relevant; the ability to translate assessment results, with germination of an integrated conceptualization that draws from all relevant information sources (e.one thousand., interview, test results, behavioral observations, and records); and the power to demonstrate written communication skills in the product of integrated neuropsychological assessment reports.
Similarly, the Intervention domain includes five cognition-based and seven practical competencies, and the Consultation domain includes three knowledge-based, seven applied competencies. The boosted competency domains include research, teaching and supervision, management-administration, and advocacy, each with their own knowledge-based and practical subcompetencies. Meet the COSPP frameworkvi for the full list.
Recently, these entry-level competencies were evaluated in a global comparison between individual grooming programs in Australia, Finland, Italia, Netherlands, Norway, United Kingdom, and United States, and the understanding for the required competencies was quite high (Hessen et al., 2018). The assessment domain was covered very similarly in all countries included, but small-scale variation existed in the corporeality of focus on the fields of neurochemistry, neuropsychopharmacology, and neuroendocrinology, and also on the amount of accent on addressing issues related to specific populations (Hessen et al., 2018). Within the intervention domain, both the knowledge base and the application are, with few exceptions, covered similarly.
EuroPsy Specialist Certificate Model
The European EuroPsy modelseven offers a framework that can be used in developing basic and specialist teaching and training. The general aims of EuroPsy are (1) protection of consumers and citizens in Europe by providing quality assurance and protection against unqualified and ethically questionable practice, (ii) promotion of the availability of adequate psychological services across Europe by creating transparency and raising standards, and (three) promoting the mobility of psychologists (and clients) in Europe (Lunt et al., 2015).
Twenty-four countries in Europe accept adopted the EuroPsy Basic Certificate, which includes half-dozen years of professional pedagogy in Psychology (5 years academic and one-yr supervised practice), declaration of upstanding beliefs, and an obligation for continuing professional development. The full general competencies of psychologists are too outlined within the framework. The workload is described in terms of the European Credit Transfer and Accumulation System (ECTS) where ane academic year is equivalent of 60 ECTS. Despite differences in defining the verbal curriculum and requirements for psychology practitioners, all EFPA member associations agree on the full general construction and competencies it involves (Lunt et al., 2015). Chiefly, the EuroPsy is a European qualification that complements but does not override national standards.
The EuroPsy Specialist Document builds upon the basic document and is currently offered in Psychotherapy and Work and Organizational Psychology (Lunt et al., 2015; Dias Neto et al., 2020). The requirements for the basic EuroPsy document demand to be met in order to apply for the Specialist Certificate, but it is possible to apply for both certificates at the aforementioned time. Tabular array 2 describes the current requirements in the ii bachelor specialist areas, both involving 90 ECTS of preparation and 3 years of supervised practice. European countries vary in the degree to which they accept developed specialization.8 The EuroPsy Specialist Document in Psychotherapy is currently bachelor in Finland, Russia, Espana, and Turkey. The EuroPsy Specialist Certificate in Work and Organizational Psychology is bachelor in Finland, Norway, and Kingdom of spain.
Tabular array 2. Description of the requirements in the currently available specialist certificates within the EuroPsy framework, Psychotherapy and Work and Organizational Psychology.
The implementation of the certificate system is outlined in the EuroPsy Regulations.nine Inside EFPA, in that location is a European Application Committee (EAC) for the basic certificate and a European Specialist Awarding committee (SEAC) for the specialist certificates. The authority to award the certificates has been delegated to national level, to National Awarding committees (NACs) and Specialist National Awarding committees (S-NACs) in countries that have adopted the EuroPsy model. The EAC and the SEACs supervise the proper implementation of the regulations, ensure that the national bodies are interpreting the European standards in a similar fashion, and coordinate the piece of work of the NACs and S-NACS in many ways. The national committees written report to and submit all their procedures for approving to the European level committees. This ensures the compliance with the common standards.
Challenges in the Common EuroPsy Model
The EuroPsy Specialist Certificate tin be seen equally an instrument for benchmarking common standards in training and competencies. In that location are challenges, all the same, that tin can occur on several levels. One is related to agreeing on the model and the standards. Second is related to the interest in actual employ of the certificates. Third is the assumed touch of the certification system.
Identifying common minimum requirements for a qualification in Clinical Neuropsychology would be helpful for developing national training programs and would reduce the heterogeneity in unlike programs and practices. The standards may appear too high in relation to the electric current situation in some countries, notwithstanding. If the development is nevertheless in progress, the recommendations should be seen as aspirational and not condemnatory. The differing educational models, such as early specialization, too need to be taken into account in defining the requirements (Dias Neto et al., 2020). Another business organization applies to countries with already established high standards. If the unremarkably agreed model includes lower standards, it may create a situation where grooming abroad results in certification that would not have been approved in the home country. This risk needs to be considered. Countries with established regulations and requirements, if higher than the proposed model, will probably want to continue the original requirements in place. Within the EuroPsy Specialist Certification arrangement this is possible, equally this certification does not supercede national standards.
The Specialist Certificate builds upon the bones certificate. The basic EuroPsy are currently offered in 24 European countries, just the application rates vary. In Portugal, nigh of the virtually 19,000 effective members of the Ordem dos Psicólogos Portugueses (Portuguese Psychologists' Association) practical for and obtained the basic EuroPsy. Yet, in France among 70,000 psychologists, less than 150 professionals take obtained the EuroPsy basic certification. It is voluntary, then practitioners will consider the need based on their personal state of affairs. The 1-year supervised clinical exercise required for EuroPsy is non included in the basic grooming in all countries, which means it must be obtained separately. There may be difficulties in finding a job where supervision tin can take identify. In France, young graduates demand time to find their kickoff job, often in office-time and with a brusque stock-still-term contract with depression salaries. There are also financial costs involved in the certificate awarding process that may exist covered by the national association in some countries only left to the practitioners themselves in others. Paying for an optional document may not be a priority. Still, a proposal of a Specialist Certificate involves strategic aims for benchmarking European standards which will be beneficial regardless of the number of practitioners applying for the certificate.
Although the Basic or Specialist Certificates are not mandatory to practice psychology, at that place are relevant incentives to apply for them: (a) in that location is a register/directory of EuroPsy certified psychologists with national listings that tin can be consulted past those seeking the services of qualified psychologists,10 (b) through the EuroPsy, EFPA encourages psychologists to obtain continuing and specialized training, (c) obtaining a Specialist Certificate provides professional enrichment, valorization of training, delineation of specific contexts of practice, and can be a process for rewarding merit and competency (Dias Neto et al., 2020), and (d) the recognition of a specialization at a European level fosters mobility and sharing of noesis between nations (Dias Neto et al., 2020).
The Specialist Certificate and the EuroPsy is believed to accept implications on the system's level (protection of consumers by raising standards) as well equally the individual level (promoting the mobility) of the practitioner (Lunt et al., 2015). In countries with established standards and regulation already in place, the new certification may not offering much incremental value within wellness care. Overall, the picture of psychology specialization, all the same, is still in its infancy (Dias Neto et al., 2020). The best means for both protecting the public in need of neuropsychological services and developing professional practice are still under debate, and certification may not exist the only potential model. For individual health professionals moving across borders, there are considerable language and legal restrictions that may hinder mobility even for the holders of the certificate. For trainees, it might all the same open up new opportunities and promote knowledge transfer.
The impact of common standards on the level of care within society is linked to the licensure policies. A document might not be helpful if the title or the do of Clinical Neuropsychology is non protected by law. In Europe, nigh countries regulate practicing clinical psychology but not neuropsychology (Hokkanen et al., 2019). Afterwards obtaining licensure for clinical psychology, adequate training and competence in other specialist fields of psychology is demonstrated separately and the regime evaluating the qualifications differ (Dias Neto et al., 2020). In the United Kingdom for instance, the Qualification in Clinical Neuropsychology involves a clinical portfolio and an oral examination. This resembles the American Board of Professional Psychology Clinical Neuropsychology certification exams. The qualification, nevertheless, is not legally required for practicing neuropsychology, and the patients seeking services may not be aware of such qualifications. EuroPsy Certificates do non override national laws or regulations, and do non provide licensures to exercise psychology in any item country. They are, however, a common framework to recognize qualifications across Europe. If a European standard for Clinical Neuropsychology education and training existed, it would serve as a tool for advocating the need for split licensure besides for Clinical Neuropsychology in the future. Also, informing the public would be easier.
Recommendations and Discussion
The statistics on the major health disorders where Clinical Neuropsychology is relevant support the need for expert and competent neuropsychological services within health care. In that location is a clear discrepancy between the number of trained Clinical Neuropsychologists vs. the demand for those services across long term neurological conditions. The European Brain Council chosen for political action, and quantitatively and qualitatively improved didactics at medical schools and other health-related educational programs, including psychological treatments (Gustavsson et al., 2011). The differences in means and timings for acquiring a specialty in psychology take been suggested to weaken the profession of psychology (Dias Neto et al., 2020). The instruction and grooming in Clinical Neuropsychology need to rise to the challenge.
The general framework of specialist education and training in Clinical Neuropsychology tin can be based on a few grounding values. In their newspaper on the training models of Clinical Neuropsychologists in Europe, the Standing Commission on Clinical Neuropsychology described four principles that could potentially exist used as bases in establishing the mutual requirements for specialist education and training (Hokkanen et al., 2019). These are: (1) Commencing the Specialist teaching in Clinical Neuropsychology should exist preceded past at least 5 years of higher education in psychology culminating in a master's degree (or equivalent) and a minimum of 1-year clinical practice, (2) The cadre elements of the specialist instruction should include theoretical written report, practical training with supervision, and enquiry experience, (3) The theoretical studies, whether in the form of a programme or a combination of split up courses, should be accredited by a national authority, and (4) The length, depth, and latitude of the different elements inside the specialist instruction must be sufficient to allow for the aggregating of the avant-garde competencies necessary for successful entry into the profession. Achieving these competencies typically requires several years of specialization in Clinical Neuropsychology. As these principles are in accordance with the EuroPsy model and the existing Specialist Certifications, two recommendations are in order.
Recommendation 1: Commence the process to develop a EuroPsy Specialist Certificate in Clinical Neuropsychology.
Recommendation ii: Review the competency areas in the European framework in order to detect a common basis for the learning objectives.
The number of countries currently offering EuroPsy Specialist Certificates in other areas of psychology is gradually increasing. While progress may exist slow, the overall development of these fields has been greatly enhanced by the communication amid professionals beyond Europe. Similar evolution is welcome and urgent in Clinical Neuropsychology also. For countries with existing high standards for the teaching and training in Clinical Neuropsychology, a mutual framework volition offering further consolidation of the field without losing their national regulatory power and ensure that incoming Clinical Neuropsychologists are better prepared. For countries in which Clinical Neuropsychology is still developing, the framework will provide aspirational standards in education and professional person practice. This will help to bridge the differences among European countries regarding training and required competencies for Clinical Neuropsychologists, and ultimately pave the manner for universal higher quality practices in the delivery of Clinical Neuropsychological services across Europe for the benefit of the patients.
Author Contributions
LH wrote the start draft of the manuscript and finalized it for submission. FB, AP, MC, MK, NV, EK, SM, SL, GB, BP, and EH had intellectual contributions to the content. All agreed to the submitted version of the publication. All authors contributed to the article and approved the submitted version.
Funding
The work has been supported by Berufsverband Deutscher Psychologen, The Experimental section of the Italian Psychological Clan, the Finnish Psychological Association, the Cyprus Psychologists' Association, the Hellenic Psychologists' Association, the Norwegian Psychological Association, Ordem dos Psicólogos Portugueses, the Professional Association of Austrian Psychologists, the Russian Psychological Lodge, and the Swedish Psychological Association. The open access publication has been supported by the University of Helsinki, Finland.
Disharmonize of Interest
The authors declare that the enquiry was conducted in the absence of whatsoever commercial or financial relationships that could be construed as a potential disharmonize of interest.
Acknowledgments
The authors wish to thank all members of the Standing Committee on Clinical Neuropsychology of the European Federation of Psychologists' Association.
Footnotes
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Source: https://www.frontiersin.org/articles/10.3389/fpsyg.2020.559134/full
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