Application of a Competency Model to Clinical Neuropsychology

Abstract

Professional competencies in psychology have received significant attention as education and training standards have been increasingly framed in the context of behavioral, knowledge-based, and attitudinal learning outcomes. We first review the development of the specialty of clinical neuropsychology and describe the establishment of educational and training guidelines in the specialty, including their most recent update (Hannay et al., 1998). Competency initiatives in professional psychology over the last decade are then summarized. Specialties in professional psychology have delineated education and training guidelines and are beginning to incorporate competency-based approaches to describe advanced and specialized abilities that build on generic, core, foundational and functional psychology knowledge, skills, and attitudes. Following the model of France et al., (2008), we apply the Assessment of Competency Benchmarks framework to describe specific competencies required for specialty practice in clinical neuropsychology.

Full text

Application of a Competency Model to Clinical Neuropsychology
Celiane Rey–Casserly
Children’s Hospital, Boston, Massachusetts and Harvard
Medical School
Brad L. Roper
Memphis Veterans Affairs Medical Center, Memphis, Tennessee
and University of Tennessee Health Science Center
Russell M. Bauer
University of Florida
Professional competencies in psychology have received significant attention as education and training
standards have been increasingly framed in the context of behavioral, knowledge-based, and attitudinal
learning outcomes. We first review the development of the specialty of clinical neuropsychology and
describe the establishment of educational and training guidelines in the specialty, including their most
recent update (Hannay et al., 1998). Competency initiatives in professional psychology over the last
decade are then summarized. Specialties in professional psychology have delineated education and
training guidelines and are beginning to incorporate competency-based approaches to describe advanced
and specialized abilities that build on generic, core, foundational and functional psychology knowledge,
skills, and attitudes. Following the model of France et al., (2008), we apply the Assessment of
Competency Benchmarks framework to describe specific competencies required for specialty practice in
clinical neuropsychology.
Keywords: clinical neuropsychology, competency, professional psychology specialties
“Neuropsychology” has been used to describe both a field of
scientific inquiry and a specialty practice area within professional
psychology (Adams, 2002; Boake, 2008). Clinical neuropsycholo-
gists assess, diagnose, and provide treatment to individuals who
have developmental or acquired injury/illness involving the central
nervous system and associated organ systems. Such disorders
include genetic abnormalities, congenital problems, traumatic
brain injury, stroke, tumors, central nervous system infections,
neurotoxic exposures, metabolic diseases, neuropsychiatric illness,
and degenerative diseases of the brain. Many medical disorders
(e.g., cardiac, hepatic, or renal disease, cancer, endocrine dysfunc-
tion) or medical treatments (e.g., major organ transplantation,
chemotherapy treatment, polypharmacy) can affect neuropsycho-
logical functioning through complex metabolic channels. Ad-
vances in medical treatment increase longevity at both ends of the
life cycle, with associated neuropsychological consequences. In
geriatrics, increased life expectancy brings an exponential increase
in dementia risk, and the number of older individuals suffering
from degenerative brain disorders is expected to triple by 2050
(Alzheimer’s Association, 2011; Centers for Disease Control &
Prevention, 2011). In pediatrics, medical advances have insured
that children with complex or chronic health conditions that affect
the central nervous system are increasingly surviving into adult-
hood with significant special needs. Consequently, understanding
the behavioral expression of brain dysfunction, a critical role of
neuropsychology, will continue to be needed in the ongoing med-
ical management, rehabilitation, and intervention of a range of
individuals across the life span. Clinical neuropsychological ex-
amination can be required for diagnosis, patient care and planning,
treatment planning and remediation, treatment evaluation, re-
search, and forensic applications (Lezak, Howieson, Loring, Han-
nay, & Fischer, 2004). Neuropsychologists also play a critical role
in educating patients, families, communities, and policymakers
about neurological, psychological, and neuropsychological condi-
tions (Tranel, 2008).
As a field of inquiry, the scientific study of brain–behavior
relationships has roots in the 19th century, as European physicians
Editor’s Note. This article is one of five in this special section on
Professional Competencies in Specialty Practice and Research.—MCR
CELIANE REY–CASSERLY received her PhD from Boston University in
clinical psychology. She is director of the Neuropsychology Program at
Children’s Hospital, Boston and Assistant Professor in Psychology (Psy-
chiatry) at Harvard Medical School. Her major research interests include
neuropsychological outcomes in pediatric disorders, particularly childhood
brain tumors and traumatic brain injury, as well as education and training
in professional psychology.
BRAD L. ROPER received his PhD from the University of Minnesota. He is
director of the Neuropsychology Program at the Memphis Veterans Affairs
Medical Center and Associate Professor in the Departments of Psychiatry
and Neurology at the University of Tennessee Health Science Center.
Research interests include psychometric properties of neuropsychological
tests, symptom-validity testing, personality assessment, and training issues
within clinical neuropsychology.
RUSSELL M. BAUER received his PhD from the Pennsylvania State Univer-
sity. He is Professor and past chair of the Department of Clinical & Health
Psychology at the University of Florida. His major research interests are in
neuropsychological disorders of memory, preclinical detection of demen-
tia, and concussion/traumatic brain injury.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Celiane
Rey–Casserly, PhD, Neuropsychology Program, Children’s Hospital, 300
Longwood Avenue, Boston, MA 02115. E-mail: celiane.rey-casserly@
childrens.harvard.edu
Professional Psychology: Research and Practice © 2012 American Psychological Association
2012, Vol. 43, No. 5, 422–431 0735-7028/12/$12.00 DOI: 10.1037/a0028721
422

described behavioral syndromes and their associated brain pathol-
ogy (Geschwind, 1965a, 1965b; Halstead, 1947; Meier, 1992).
Beginning in the 1940s and 1950s and continuing today, neuro-
psychologists have been among the world leaders in the study of
brain–behavior relationships. The relative insensitivity of intelli-
gence tests to brain injuries and the need for more “process-pure”
cognitive measures prompted the development of quantitative neu-
ropsychological tests, beginning with the Halstead Neuropsycho-
logical Battery (Halstead, 1947). The following decades saw in-
creasing clinical applications of neuropsychological tests to
assessment of executive functions, language disorders, memory,
and other cognitive domains relevant both to clinical care and
research.
Together with their colleagues in behavioral neurology, clinical
neuropsychologists were instrumental in establishing the Interna-
tional Neuropsychological Society (INS) in 1966. Lacking at that
time an American Psychological Association (APA) division to
address professional issues in neuropsychology, the INS served in
1977 as the first venue for the discussion and development of
educational and training guidelines in professional neuropsychol-
ogy. Three years later (1980), the Division of Clinical Neuropsy-
chology (Division 40) was established within the American Psy-
chological Association (APA), and in 1982, the Board of Trustees
of the American Board of Professional Psychology (ABPP) rec-
ognized the recently formed American Board of Clinical Neuro-
psychology (ABCN) as a specialty board within ABPP and
charged the ABCN with establishing eligibility criteria and
competency-based examination procedures for board certification
in the specialty (Meier, 1992).
In 1996, clinical neuropsychology became the first new spe-
cialty to be recognized by the APA Commission for the Recogni-
tion of Specialties and Proficiencies in Professional Psychology
(CRSPPP) beyond the traditional specialties of clinical psychol-
ogy, counseling psychology, and school psychology. Clinical neu-
ropsychology petitioned successfully for continued recognition as
a specialty in 2003 and 2010. The formal definition of the specialty
is as follows:
Clinical neuropsychology is a specialty in professional psychology
that applies principles of assessment and intervention based upon the
scientific study of human behavior as it relates to normal and abnor-
mal functioning of the central nervous system. The specialty is ded-
icated to enhancing the understanding of brain–behavior relationships
and the application of such knowledge to human problems.
This public description is available on the APA CRSPPP and the
Council of Specialties in Professional Psychology (CoS) websites
(American Psychological Association, 2010; Council of Special-
ties in Professional Psychology, 2012).
Clinical neuropsychology as a specialized area of knowledge
and practice has intradisciplinary and interdisciplinary roots. The
specialty evolved in conjunction with advances in the clinical
neurosciences and behavioral neurology as well as in the discipline
of psychology (physiological psychology, cognitive/experimental
psychology, measurement, assessment). The science and applica-
tion of brain–behavior relationships can be linked to three path-
ways: advances in neuroscience, physiological and cognitive psy-
chology; application of quantitative and qualitative
neuropsychological principles and procedures; and implementa-
tion of a syndromal approach to understanding neurobehavioral
impact of central nervous-system dysfunction or lesions (Meier,
1992). The practice of clinical neuropsychology has expanded to
encompass applications that address psychological and behavioral
consequences of a range of changes in brain functioning that can
arise across the life span.
Clinical neuropsychology can be differentiated from general
professional psychology and other psychology specialties by its
focus on understanding brain–behavior relationships as manifested
within social/cultural contexts. There is overlap with other health-
service specialties, in terms of foundational and functional com-
petencies, but in clinical neuropsychology, there is a specific focus
on neurobehavioral constructs and applications. Assessment, in-
tervention, and consultation are framed in this approach. Neuro-
psychologists assess brain-related factors that affect functioning
across domains of behavior, and often are called upon to distin-
guish contributions of mood and cognitive problems to overall
presentation in neurological as well as psychiatric disorders.
History of Education and Training Guidelines in
Clinical Neuropsychology
As indicated above, the INS established a Task Force on Edu-
cation, Accreditation, and Credentialing in clinical neuropsychol-
ogy in 1977. As reported by Adams (2002) and Meier (1992),
findings of the task force were published in newsletter form in
1981, and again in 1984 when endorsed by American Psycholog-
ical Association (APA) Division 40. Prior to the development of
these guidelines, training in clinical neuropsychology varied in
quality and quantity across programs (Boake, 2008). The INS–
Division 40 Guidelines for doctoral, internship, and postdoctoral
training programs were eventually published in journal form (INS,
1987), and served as a general yardstick by which formal training
programs could be constructed and evaluated. According to the
guidelines, internship programs should devote at least 50% time in
neuropsychology and at least 20% time in general clinical training.
Completion of the internship was said to meet minimal qualifica-
tions to practice clinical neuropsychology, and postdoctoral train-
ing was intended for development of advanced competence in
clinical neuropsychological practice, with at least 50% time de-
voted to supervised clinical experience and at least 25% time in
research. Postdoctoral training was described as typically lasting
for at least two years and was directed toward achieving board
certification.
Recognition of clinical neuropsychology as a specialty brought
increasing interest and diversity to the field, giving rise to a
recognition that multiple education/training experiences and path-
ways at the predoctoral, internship, and postdoctoral levels could
contribute to the development of competencies in neuropsychol-
ogy. Recognizing such diversity and variability led to the need for
a more integrated model of training, culminating in the Houston
Conference on Specialty Education and Training in Clinical Neu-
ropsychology, held in September, 1997. The Planning Committee
for the Houston Conference solicited participant applications via
the APA Monitor and letters to members of APA Division 40, the
National Academy of Neuropsychology (NAN), and to the direc-
tors of doctoral, internship, and postdoctoral training programs
(Houston Conference, 1998). Of those who applied, 37 clinical
neuropsychologists were selected to reflect diversity in practice
settings, education and training models, subspecializations, senior-
423
NEUROPSYCHOLOGY COMPETENCIES

ity level, culture, geography, and ethnic/cultural diversity. Five
other delegates attended as representatives of the sponsoring or-
ganizations, which included NAN, APA Division 40, ABCN, the
American Academy of Clinical Neuropsychology (AACN), and
the Association of Postdoctoral Programs in Clinical Neuropsy-
chology (APPCN). The format and size of the program was fash-
ioned after those of previous successful conferences producing
consensus documents (Belar et al., 1993; Belar et al., 1989).
The policy statement from the Houston Conference on Specialty
Education and Training in Clinical Neuropsychology (Hannay et
al., 1998) remains the last major update of education and training
guidelines in clinical neuropsychology. The Houston Conference
Policy Statement calls for components of specialization to occur
incrementally at doctoral, internship, and postdoctoral training
levels (Hannay et al., 1998). Doctoral education provides generic
psychology and clinical core as well as the foundations of neuro-
psychology. The internship completes general clinical training and
extends training in neuropsychology, and the postdoctoral resi-
dency provides advanced education and training intended to
achieve competence in the specialty of clinical neuropsychology.
Houston Conference Guidelines specify that training in the spe-
cialty is rooted firmly in the scientist–practitioner tradition and, in
contrast to the earlier INS–Division 40 Guidelines, that a 2-year
postdoctoral residency is required. The policy statement makes
reference to competency-based education and training, and knowl-
edge and skill areas are broken down into several domains and
subdomains.
Four “core knowledge” areas are delineated in the Houston
Conference guidelines: “generic psychology core,” “generic clin-
ical core,” “foundations for the study of brain–behavioral relation-
ships,” and “foundations for the practice of clinical neuropsychol-
ogy.” Likewise, five skill domains are articulated, some considered
part of “generic clinical skills” and some considered unique to
clinical neuropsychology. Skills domains include “assessment,”
“treatment and interventions,” “consultation,” “research,” and
“teaching and supervision,” but there are no clear indications of
which skills describe general clinical skills and which are specific
to clinical neuropsychology. Competencies expected of the entry-
level neuropsychologist are described fairly broadly in exit criteria
for postdoctoral residencies and include:
Advanced skill in the neuropsychological evaluation, treatment and
consultation to patients and professionals sufficient to practice on an
independent basis; advanced understanding of brain–behavior rela-
tionships; scholarly activity, for example, submission of a study or
literature review for publication, presentation, submission of a grant
proposal, or outcome assessment (Hannay et al., 1998).
Formal evaluation of the degree to which these competencies
have been attained is expected to occur in the postdoctoral resi-
dency program.
Competency Initiatives in Professional Psychology
Formulation of the Houston Conference guidelines came at a
time when professional psychology as a whole was beginning to
pay closer attention to competency-based approaches to education
and training. Much continued development has taken place since
the Houston Conference policy statement was published. A major
event in what has become known as the “competency movement”
in professional psychology was the 2002 Competencies Confer-
ence: Future Directions in Education and Credentialing, which
aimed to address the core competencies expected of graduates of
professional education and training programs in psychology
(Kaslow et al., 2004). Among several articles published as a result
of the conference, the “cube model” for competency development
in professional psychology (Rodolfa et al., 2005) describes a
three-dimensional matrix, including foundational competency do-
mains, functional competency domains, and stages of professional
development. Foundational competency domains include those
areas of knowledge, skills, attitudes, and values that serve as the
foundation required of all psychologists, whereas functional com-
petency refers to broadly defined activities of professional practice
(i.e., what psychologists “do”). Stages of development are critical
in the building of competencies, which in the cube model begin at
the doctoral level and include lifelong learning through continuing
education. In 2004, APA’s Board of Educational Affairs (BEA)
established the Task Force on the Assessment of Competencies in
Professional Psychology Education, Training, and Credentialing,
resulting in a final report in 2006 (American Psychological Asso-
ciation, 2006; Kaslow et al., 2007). The report noted that both
general and specialty foundational and functional competencies
must be evaluated in a comprehensive competency assessment.
The report also called for more collaboration among constituency
groups in creating coherent strategies for evaluating competencies.
The Council of Chairs of Training Councils (CCTC) proposed an
initiative to further delineate specific benchmarks of competencies
across the training sequence and a work group was authorized by
the APA Board of Educational Affairs to address this. In 2006, the
Assessment of Competency Benchmarks Work Group met and
developed a document that identified 15 core competency areas at
three developmental levels—readiness for practicum, readiness for
internship, and readiness for entry to practice (Fouad et al., 2009).
The recognized specialties in professional psychology have begun
to apply competency models to evaluating training outcomes in their
specialties. Oxford University Press is publishing a book series on
specialty competencies (Packer & Grisso, 2011; Stanton & Welsh,
2011), and further volumes are forthcoming. The foundational/
functional approach to competencies has been applied to rehabilitation
psychology (Hibbard & Cox, 2010). Clinical-health psychology spon-
sored a summit meeting to revise education and training guidelines in
the specialty and used the cube model of core competency domains
(Rodolfa et al., 2005) and the assessment of competency benchmarks
framework (Fouad et al., 2009) to delineate expected competencies of
the entry-level clinical-health psychologist (France et al., 2008). In the
current article, we use the France et al., approach as a model to
similarly describe the competencies required of practicing clinical
neuropsychologists, but we have incorporated subsequent develop-
ments in the field in framing these competencies. Consistent with the
approach of France et al., although we refer to the “competency
cube,” we do not address the third axis (specific stages or sequence in
acquisition of competencies), as our focus is on entry-level specialty
practice.
Professional psychology-competency initiatives, as supported
by the APA Board of Educational Affairs, have continued to
develop in two ways: (a) refining and adapting the core compe-
tency domains, and, (b) identifying assessment tools for measuring
attainment of competencies through the training sequence. A com-
petency assessment toolkit for professional psychology has been
424 REY–CASSERLY, ROPER, AND BAUER

developed that reviews assessment techniques and provides a
resource for psychology education and training and credentialing
(http://www.apa.org/ed/graduate/competency.aspx). The Compe-
tency Benchmarks in Professional Psychology have been revised
to reduce redundancy, improve consistency, and to be more useful
for educational programs (American Psychological Association,
2011b). The current revision is organized under six overarching
clusters: the foundational clusters include professionalism, rela-
tional, and science; functional clusters include application, educa-
tion, and systems (American Psychological Association, 2011a).
The revision preserves the core competencies within this new
organizational scheme and adds the additional competency of
evidence-based practice under the “application” cluster. We
elected to incorporate this revision because it provides a clearer
organizational structure and emphasizes the scientific basis of
psychology practice.
As described above, the 1997 Houston Conference policy state-
ment employed broad strokes in outlining the knowledge base and
Table 1
Foundational Competencies Unique to Clinical Neuropsychology but Common Across Functional Domains
The clinical neuropsychologist
Cluster/Foundational domain Competency
Professionalism
Professionalism •demonstrates professional identity as a clinical neuropsychologist; understands the unique
contributions of neuropsychology to different contexts.
•demonstrates awareness of the roles of clinical neuropsychologists, and how those roles vary
across practice settings and assessment/intervention contexts.
Individual and Cultural Diversity •integrates knowledge of diversity issues in neuropsychological assessment, research, treatment,
and consultation (e.g. health disparities, language differences, educational level, cultural
context, literacy, individual differences).
•understands and appreciates how cultural, linguistic, disability, and other
demographic/socioeconomic factors affect the process and outcomes of neuropsychological
assessments and the application of normative data and interpretations in specific populations.
Ethical, legal standards and policy •applies ethical concepts and demonstrates awareness of legal issues relevant to the professional
activities of clinical neuropsychologists across practice settings, including healthcare, research,
school, military/veteran, industry, and forensic (e.g., criminal, personal injury, disability
determination, fitness for duty, etc.).
•appreciates specific ethical and legal issues that are relevant to neuropsychology practice across
settings, including informed consent, third party assessments, use of technicians/psychometrists,
third party observers, disclosure of neuropsychological test data, and test security.
Reflective practice/self-assessment/self-care •engages in reflective self-assessment regarding the dynamic knowledge base and skill sets
necessary for practice in clinical neuropsychology across practice settings with the goal of
improving skill level over time; understands limits of competence in particular populations or
settings and seeks to lessen their impact through continuing education and additional training.
Relational
Relationships •maintains effective and productive relationships with patients, families, caregivers, colleagues,
team members, and communities across the complex interprofessional settings involved in
neuropsychological practice.
•communicates clearly and effectively, explaining neuropsychological concepts and
interpretations in a manner best suited to particular audience (patients, families, and caregivers
as well as other professionals).
Science
Scientific knowledge and methods •demonstrates advanced knowledge of the clinical and cognitive neurosciences, including
neurology, neuroanatomy, neurobiology, brain development, and neurophysiology.
•maintains currency with key scientific developments in fields related to practice (e.g., genetics,
pharmacology, translational science, bioinformatics).
•demonstrates knowledge of scientific and scholarly developments in clinical neuropsychology.
Research/evaluation •understands and applies scientific method in generating neuropsychological knowledge and
evaluating findings related to neuropsychological techniques, brain–behavior relationships,
assessment strategies, and interventions.
•understands research design and analysis relevant to clinical neuropsychological science and
practice.
•appreciates the wide array of factors that mediate and modulate behavior and their implications
for neuropsychological research.
•selects research topics and performs literature reviews effectively.
•demonstrates skills in conceptualizing, implementing, and interpreting research design and
statistical analysis.
•performs research activities, monitoring of progress, and evaluation of outcomes accurately and
effectively.
•communicates research findings effectively.
•applies research methods in evaluating effectiveness of professional activities in clinical
neuropsychology.
425
NEUROPSYCHOLOGY COMPETENCIES

skills required for specialty practice in clinical neuropsychology.
Generic core competencies in the Houston document do not align
exactly with professional psychology competencies as described in
the Competencies Benchmarks document. Houston Conference
guidelines do not clearly distinguish generic clinical skills from
those specific to clinical neuropsychology. Furthermore, the de-
scriptions of competencies are often vague, for example, referring
to competencies in “administration of tests and measures” and
“interpretation and diagnosis” with no elaboration. As such, the
level of detail is minimal in comparison to competencies as de-
scribed in the Competencies Benchmarks document. Our approach
in this article incorporates the areas covered in the Houston Con-
ference guidelines and transforms these into contemporary com-
petency constructs. Furthermore, Houston Conference guidelines
include only brief statements regarding the contributions that each
level of training (predoctoral, internship, residency, continuing
education) is expected to make to the development of competen-
cies in the specialty. Although this paper focuses on specific
competencies required for the entry-level practicing clinical neu-
ropsychologist, more systematic delineation of the development of
skills at each level in the sequence of training will be needed.
Foundational Competencies in Clinical
Neuropsychology
In what follows, the Revised Competency Benchmarks docu-
ment was used as a model to describe the general and specialized
competencies expected for specialty practice in neuropsychology.
Clinical neuropsychology is by nature an integrative, scientifically
based discipline, and at some level, it can be challenging to extract
and identify discrete competencies within one domain of activity
without acknowledging the simultaneous importance of other do-
mains.
Clinical neuropsychologists have foundational and functional
skills in professional psychology obtained in professional psychol-
ogy doctoral programs that, among other roles as scientists and
educators, train psychologists as health-service providers. Training
is based in the scientist–practitioner tradition, and integration of
knowledge and skills across the sequence of training is empha-
sized. Competency requires a foundation in psychological science
and practice in professional psychology.
Foundational Competencies in Common With
Professional–Scientific Psychology
The generic core knowledge areas and core clinical skills de-
lineated in the Houston Conference policy statement (described
above) can be mapped onto the more detailed and elaborated
Competency Benchmarks framework. These competencies are ex-
pected of all professional psychologists trained to provide health-
care services. Foundational competencies include professionalism
(integrity, concern for public welfare), reflective practice, scien-
tific knowledge and methods (science of human behavior and
research methods), relationship skills, appreciation of and ability
to integrate issues of individual and cultural diversity, and knowl-
edge of/adherence to ethical and legal standards. For clinical
neuropsychology, a strong foundation in the scientific method,
including critical and integrative thinking is fundamental. Clinical
neuropsychologists also need to have a strong and enduring com-
mitment to lifelong learning given the rapid development of
knowledge in neuroscience, cognitive science, and neuromedicine,
the expanding evidence base for practice, and the need to contin-
uously update understanding of issues of cultural and individual
diversity in neuropsychology.
Foundational Competencies Unique to Clinical
Neuropsychology but Common Across Functional
Domains
Foundational competencies expected for specialty practice in
clinical neuropsychology have additional unique components.
These unique competencies in the clusters of professionalism,
relational, and science are described in Table 1. Clinical neuro-
psychologists function in a range of settings, addressing complex
problems with varied characteristics and challenges. Adopting a
professional identity as a neuropsychologist entails a set of
competencies that are detailed under the area of “professionalism.”
These professional competencies include attention to professional
Table 2
Evidence-Based Practice
Type Content
Knowledge-based competencies The clinical neuropsychologist will have knowledge of:
•key signs and symptoms of disease processes relevant to practice and how patient characteristics (e.g.,
demographic factors, comorbidities) affect their expression.
•age-related changes in brain functioning and behavior across the lifespan.
•scientific basis for assessment strategy, including test selection, use of appropriate normative standards,
psychometric characteristics of selected tests, and test operating characteristics.
•decision-making strategies and their applications in differential diagnosis.
•scientific basis for diagnostic conclusions and interpretations across a range of neuropsychological
disorders.
Applied competencies The clinical neuropsychologist will be able to:
•incorporate and use outcome research in neuropsychology in guiding assessments and formulating
interventions, integrating patient and contextual factors.
•apply key components of evidence-based practice (i.e., best evidence, clinical expertise, and patient
characteristics/values) in selecting appropriate assessment and intervention approaches.
•apply information technology (informatics) to assess and evaluate best evidence to guide practice.
426 REY–CASSERLY, ROPER, AND BAUER

roles, understanding of specific cultural and diversity issues rele-
vant to neuropsychology, adherence to standards and appreciation
of legal, ethical and policy implications inherent in neuropsychol-
ogy practice, and commitment to lifelong learning and mainte-
nance of competence. Neuropsychologists are integral members of
communities and teams, providing specialty evaluation and treat-
ment often in conjunction with other professionals. Foundational
skills in establishing and maintaining successful relationships, not
only with patients, families and caregivers, but also with commu-
nities and interprofessional teams are key relational skills that
Table 3
Assessment
Type Content
Knowledge-based competencies The clinical neuropsychologist will have knowledge of:
•neuropsychology of behavior, including information processing theories, cognitive/affective
neuroscience, social neuroscience, cultural neuroscience, and behavioral neurology.
•patterns of behavioral, cognitive, and emotional impairments associated with neurological and related
diseases and conditions that affect brain functioning.
•neurochemistry, neuropsychopharmacology, neuroendocrinology, and related areas relevant to practice.
•neurodiagnostic techniques relevant to practice.
•effects on brain functioning and behavior of common medical systemic medical illnesses.
•patterns of behavioral, cognitive, and emotional impairments associated with psychiatric disorders.
•medications used for common medical diseases and their effects on brain functioning and behavior.
•measurement and psychometrics relevant to cognitive abilities, social and emotional functioning, and
brain-behavior relationships.
•functional implications of neuropsychological conditions, including service needs based on the
assessment context and implications related to functional ability level and social/living environment.
Applied competencies The clinical neuropsychologist will be able to:
•employ evidence based assessment techniques.
•evaluate assessment questions based on the context, professional roles, and the patient/examinee
presentation.
•gather information key to addressing the referral question, including interview(s), targeted behavioral
observations, and review of records.
•select tests, measures, and other information sources appropriately, consistent with best evidence and
specific context of assessment, including assessment of effort if relevant.
•administer and score tests and measures appropriately.
•interpret assessment results, with formation of an integrated conceptualization that draws from all
relevant information sources.
•provide recommendations for management that are appropriate to the assessment context and consistent
with evidence-based practices.
•provide feedback, as relevant to the assessment context, to patients, families, or caregivers in a
sensitive manner adapting to the needs of the specific audience.
•address issues related to specific populations (e.g. cultural or linguistic differences, physical or mental
disability, use of interpreters, educational level) appropriately by referring to other providers with
specialized competence, obtaining consultation, and describing limitations in assessment interpretation.
Table 4
Intervention
Type Content
Knowledge-based competencies The clinical neuropsychologist will have knowledge of:
•evidenced-based intervention practices to address cognitive and behavioral problems present in different
clinical populations.
•theoretical and procedural bases of intervention methods appropriate to address disorders of attention,
learning and memory, executive skills, problem solving, perceptual processing, sensorimotor functioning,
and psychological/emotional adjustment.
•how complex neurobehavioral disorders (e.g., aphasia, anosognosia, neuropsychiatric illness) and
sociocultural factors can affect the applicability of interventions.
•empirically supported interventions provided by psychologists and other health professionals.
Applied competencies The clinical neuropsychologist will be able to:
•identify targets of interventions and specify intervention needs.
•employ assessment and provision of feedback for therapeutic benefit.
•develop and implement treatment plans that address neuropsychological deficits while accounting for
patient preferences, individual differences, and social cultural context.
•implement evidence-based interventions in neuropsychological disorders.
•evaluate the effectiveness of interventions employing appropriate assessment and outcome measurement
strategies.
•demonstrate an awareness of ethical and legal ramifications of neuropsychological intervention strategies.
427
NEUROPSYCHOLOGY COMPETENCIES

require sensitivity, empathy, and ability to appreciate other per-
spectives. Neuropsychological interpretations and concepts can be
complex and detailed and need to be formulated and communi-
cated in a manner that addresses the needs of the specific audience
addressed. Core foundational skills in science and research meth-
ods prepare the neuropsychologist to practice effectively in a
specialty whose knowledge base is rapidly expanding.
Functional Competencies in Clinical Neuropsychology
Functional competencies in clinical neuropsychology include
effectiveness in comprehensive history taking; identification of
key neurobehavioral problems/issues to be addressed; appropriate
selection and application of a wide range of neuropsychological
assessment procedures to diverse populations; application of
knowledge of psychometric theory (test construction, reliability/
validity, diagnostic accuracy); integrative interpretive strategies
for differential diagnosis; design and implementation of rehabili-
tation and supportive interventions; and individual and systems
consultation, while applying the current knowledge base in clinical
neurosciences. Clinical neuropsychologists integrate psychologi-
cal findings from records, histories, interviews, behavioral obser-
vations, and examination results with an understanding of brain–
behavior relationships as well as social/cultural contexts.
Following the model provided by France et al. (2008), we have
divided functional competencies into knowledge-based and ap-
plied competencies, recognizing that competencies are typically
demonstrated in an integrated manner and involve a set of essential
Table 5
Consultation
Type Content
Knowledge-based competencies The clinical neuropsychologist will have knowledge of:
•professional roles and expectations of a consulting clinical neuropsychologist specific to each setting.
•relevant literatures on the roles of neuropsychologists in consultation settings.
•appropriate and contextually sensitive methods of consultation.
Applied competencies The clinical neuropsychologist will be able to:
•determine and clarify referral issues.
•educate referral sources regarding the utility and relevance of neuropsychological services.
•communicate findings from consultation activities effectively in clinical, forensic, rehabilitation, policy
and community settings.
•provide effective assessment feedback and articulate appropriate recommendations in language
appropriate for the audience.
•provide effective consultation services within common settings and contexts in clinical
neuropsychology practice.
•communicate scientific findings within clinical neuropsychology in a manner that is relevant to the
consultation setting and understandable to the recipient.
•provide consultation in clinical research regarding brain behavior relationships and appropriate
neurobehavioral assessment strategies and tools.
Table 6
Teaching/Supervision
Type Content
Knowledge-based competencies The clinical neuropsychologist will have knowledge of:
•varying levels of acquisition of clinical neuropsychology knowledge and skills found in trainees at
different levels and in different professions.
•appropriate teaching and training experiences to employ with trainees of varying disciplines.
•awareness of supervision methods and practices in professional psychology and clinical
neuropsychology.
Applied competencies The clinical neuropsychologist will be able to:
•manage effectively in a supervisory context issues and problems that are commonly encountered in
clinical neuropsychology professional activities (e.g., needs of cognitively impaired individuals, role
clarification).
•provide effective training to psychology trainees in the administration and scoring procedures for a
wide range of tests and measures employed in clinical neuropsychology practice.
•provide effective training to psychology trainees in psychometric theory and foundations of assessment
relevant to the wide range of tests and measures employed in clinical neuropsychology practice.
•provide training in developing and asserting professional identity and role as a clinical
neuropsychologist.
•demonstrate sensitivity to individual and cultural differences in supervisory contexts.
•provide effective supervision to psychology trainees and trainees in other disciplines.
•educate others in professional and community settings about neuropsychology, neuropsychological
disorders, and neurobehavioral functioning relevant to particular contexts.
•evaluate the effectiveness of supervisory techniques by engaging in ongoing assessment of competency
development in trainees.
428 REY–CASSERLY, ROPER, AND BAUER

attitudes and values as well. The four competency domains under
“application” (evidence-based practice, assessment, intervention
and consultation) are described in Tables 2, 3, 4, and 5. It is
understood that the knowledge-based competencies listed under
assessment are also relevant in the other application domains.
Education and training competencies (teaching, supervision) are
described in Table 6 and systems competencies (interdisciplinary
systems, management/administration and advocacy) are outlined
in Table 7.
Concluding Comments
This article offers an initial application of a contemporary
professional psychology competency model to the specialty of
clinical neuropsychology. The described competencies were based
on the Houston Conference policy statement, which remains the
most widely used set of education and training guidelines in
neuropsychology today, and serves as a resource for the accredi-
tation of neuropsychology postdoctoral residencies by the APA
Commission on Accreditation. Although clinical neuropsychology
as a specialty was in the forefront in establishing specialty educa-
tion and training guidelines, the neuropsychology community has
additional work to do in updating existing guidelines and imple-
menting a well-articulated competency approach. We hope that the
competencies defined and discussed above will serve as a helpful
contribution for broader consideration within the specialty.
Of note, this paper does not address stages of professional
development, which represents one of the three dimensions of the
competency cube model. As mentioned above, the Houston Con-
ference policy statement paints in broad strokes regarding the
competencies specified, and a similarly broad treatment is given to
the description of stages of professional development. Training in
Table 7
Systems
Type Content
Interdisciplinary Systems
Knowledge-based competencies The clinical neuropsychologist will have knowledge of:
•roles, responsibilities, skills and values/attitudes of different disciplines in a range of settings (e.g. health
care, education, forensic, policy, community).
•different systems relevant to neuropsychological practice and strategies to negotiate these systems
effectively.
•interprofessional collaboration and its role in contributing to optimal care.
•general and setting-specific contributions and limitations of neuropsychological expertise.
•functional impact of neuropsychological disorders on patient abilities to negotiate systems (e.g. healthcare,
employment, education) and relevant management strategies.
Applied competencies The clinical neuropsychologist will be able to:
•collaborate effectively with individuals and systems across disciplines, adapt communications to context
appropriately, address questions about neurobehavioral functioning, and contribute to integrated
understanding.
•work cooperatively across systems, validating shared values and demonstrating mutual respect.
•work collaboratively, providing neuropsychological expertise in clinical and research teams.
Management/Administration
Knowledge-based competencies The clinical neuropsychologist will have knowledge of:
•administrative structures of practice settings relevant to neuropsychology (independent practice, academic
health centers, group practice, forensic, military, education, research, etc.).
•specific administrative and business strategies needed to address prevalent assessment and consultation
issues in neuropsychology practice (e.g., referral patterns, coding, billing, documentation).
•methods and procedures for outcome assessment, program evaluation, and research in neuropsychology.
Applied competencies The clinical neuropsychologist will be able to:
•function effectively within administrative systems, educating others about role of neuropsychology and
supporting structures with the goal of improving access to needed services.
•implement administrative structures to address needs in neuropsychology practice settings (e.g., quality
improvement, access to care, funding).
•train and supervise technicians/psychometrists and monitor their skills following regulatory, ethical and
legal standards.
Advocacy
Knowledge-based competencies The clinical neuropsychologist will have knowledge of:
•the evidence base of neuropsychological services and their role in clinically necessary and cost-effective
healthcare.
•psychology and neuropsychology membership organizations and their role/activities.
•regulatory and policy initiatives that can affect provision of neuropsychology services and access to care.
•the increasingly important role that board certification plays in protection of the public and insuring
continued access to neuropsychological services in a changing healthcare environment.
Applied competencies The clinical neuropsychologist will be able to:
•apply scientific knowledge and skills in neuropsychology to advocate for needs of individuals/groups across
systems.
•collaborate with psychologists and other professionals to advocate for the profession and the specialty of
neuropsychology.
•educate public policy makers regarding the importance and impact of neuropsychological science and
practice.
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NEUROPSYCHOLOGY COMPETENCIES

the specialty is expected to occur within the doctoral program,
internship, and postdoctoral residency, with internship training as
the capstone of the “general practice of professional psychology”
and postdoctoral residency as the capstone of “independent prac-
tice in the specialty” (Hannay et al., 1998). Furthermore, the
guidelines include a graphical example of how the relative pro-
portions of training in specialty knowledge and skill may vary
across doctoral, internship, and postdoctoral training levels. This
allows for flexibility in training experiences across individuals in
their paths toward independent practice, but the policy statement
does not clearly specify the degree of flexibility that is permissible.
Clearly, a tension exists between defining stages of professional
development on the one hand and allowance for flexibility of
training on the other. Future directions might include work to
better define stages of professional development from a compe-
tency standpoint, relevant to entry into practicum, internship, and
postdoctoral training experiences. In addition, we would recom-
mend that the specialty as a whole adopt a specialty-competencies
approach to defining entry-level practice that leads to board cer-
tification. As progress is made in describing stages of professional
development, the specialty will need to develop and validate tools
for the assessment of these competencies at each level of the
training sequence.
With respect to updating existing guidelines, a workgroup com-
prised of representatives of neuropsychology organizations, the
Interorganizational Summit on Education and Training (ISET),
developed a survey whose primary focus was to determine how the
Houston Conference training guidelines have influenced the de-
velopment of the specialty and the education and training of new
neuropsychological specialists. The 2010 Survey on the Influence
of the Houston Conference Training Guidelines indicated that the
Houston Conference guidelines have been very influential and
have had a positive impact on the specialty (Sweet, Perry, Ruff,
Shear, & Guidotti Breting, 2012). Neuropsychology organizations
are in the process of reviewing the survey results and proposing
methods for insuring that training guidelines keep pace with sci-
entific and professional developments in the field. An ongoing
examination of recommendations for the scientific preparation of
neuropsychologists will need to occur given the need to incorpo-
rate burgeoning knowledge bases in the neurosciences (including
developmental, affective, social, and cultural), cognitive science,
genomics, neuroimaging, and molecular biology into expected
competencies. To support true evidence-based practice that adapts
to the rapid development of new scientific knowledge, neuropsy-
chology will also need to address and develop resources in infor-
mation science (Bilder, 2011). One key issue will be the extent to
which such new developments will require formal updates to
existing curricula at the various levels of training.
In the emerging health-care climate, interprofessional compe-
tencies (Holtman, Frost, Hammer, McGuinn, & Nunez, 2011;
Interprofessional Education Collaborative Expert Panel, 2011), as
well as integrated patient-centered care with a focus on neuropsy-
chology will need to be incorporated into essential competencies.
These initiatives will require continued attention and interorgani-
zational support in the specialty. The current article can serve to
promote discussions and development of new initiatives in delin-
eating specialty competencies for clinical neuropsychology that
are consistent across education/training, credentialing, and practice
contexts and that are able to address the contemporary landscape
of practice.
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Received December 30, 2011
Revision received April 2, 2012
Accepted April 18, 2012 䡲
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