Division of Neuropsychology

Overview of systems

DCP Introductory guide to commissioning

The aim of this document is to describe commissioning concepts structures and systems and to make this knowledge accessible and useful for clinical psychologists at all levels, including trainees.

Service specific guidance

Clinical Neuropsychology Services - delivering value for the NHS (March 2015)

Written for NHS commissioners and policy makers, this document looks at the role of Clinical Neuropsychologists within the health service.

This document reports the development of a competency framework for the UK profession of Clinical Neuropsychology.

• Findings and Response to the Consultation on the Implementation of the Competency Framework for Training the Future UK Clinical Neuropsychology Profession

• Management of patients with neurological medically unexplained symptoms within clinical services in NHS Scotland

This paper describes the role of clinical neuropsychology services in the specialist assessment and management of patients with medically unexplained neurological symptoms.

Developing Pathways in the UK for the assessment of cognitive and behaviour change in people with MND

Cognitive and behavioural changes occur in approximately 50% of patients with Motor Neurone Disease (MND) which can manifest as deficits in executive and language functions and poor social cognition. Up to 15% also suffer from a frontotemporal dementia (see for review (Goldstein and Abrahams 2013). These deficits can impact caregiver burden, adherence to life-prolonging interventions and care planning.

NICE Guidelines on the Management of MND

The new NICE guidelines on MND (NICE 2016) state that

1.3 "At diagnosis and if there is a concern about cognition and behaviour, explore any cognitive or behaviour changes with the person and their family members and/or carers as appropriate. If needed refer the person for a formal assessment".

The guidelines continue to state  1.3.2"The multidisciplinary team should assess, manage and review the following areas… Cognition and Behaviour"

And most importantly: 1.5.5"The multidisciplinary team should have established relationships with, and prompt access to the following: Clinical psychology and neuropsychology"

Edinburgh Cognitive and Behavioural ALS Screen

People with MND have a range of physical disabilities which can make it difficult for them to undergo standard clinical neuropsychological assessment. In response to this Professor Sharon Abrahams and Thomas Bak from the University of Edinburgh have developed the Edinburgh Cognitive and Behavioural ALS screen (ECAS), a multi-domain brief assessment,  which is designed for people with motor dysfunction and has been validated against extensive neuropsychological assessment (Abrahams, Newton et al. 2014, Niven 2015). The ECAS provides a brief assessment of executive functions, fluency, language functions, memory and visuospatial functions and can be undertaken in written or spoken form, making it suitable for physical disability. In addition it provides an informant behaviour interview based on the latest diagnostic criteria for behavioural variant FTD.

Within Scotland, routine assessment of MND patients using the ECAS has been implemented through a dual pathway method. The first pathway involves direct referral from the MND team (consultant neurologist) to local clinical neuropsychology services who undertake an ECAS as part of their assessment. Where at all possible these patients are given priority status as long waiting lists are often inappropriate for this rapid neurodegenerative condition. The second pathway (which is applicable for those people with MND who do not or cannot access neuropsychology services) is for a member of the multidisciplinary team (usually the MND nurse specialist) to undertake an ECAS, with supervision on interpretation and possible intervention from local clinical neuropsychology services. As such the clinical neuropsychologist provides regular supervision of MND health specialists and indirect input into the multidisciplinary team with less time committed.

MNDA: Developing Pathways in the UK for assessment of cognitive and behaviour change in people with MND

The Motor Neurone Disease Association (MNDA) are funding a project led by Professor Sharon Abrahams at the University of Edinburgh to develop pathways to a UK national assessment programme for the identification of changes in cognition and behaviour in people living with MND. Part of this process is to encourage the development of local links between MND Teams and local clinical neuropsychological services.

Throughout 2017, across the UK, the MNDA and Professor Abrahams will be delivering Advanced Masterclasses in 'Using the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) to assess change in Motor Neurone Disease'. This training programme is accredited by the European Network to Cure ALS and is aimed at health professionals working in MND teams.

At these meetings trained health professionals will be encouraged to make contact with their local clinical neuropsychology services to develop local care pathways.

Resources

• Abrahams, S., J. Newton, E. Niven, J. Foley and T. H. Bak (2014). "Screening for cognition and behaviour changes in ALS." Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration 15(1-2): 9-14.
• Goldstein, L. H. and S. Abrahams (2013). "Changes in cognition and behaviour in amyotrophic lateral sclerosis: Nature of impairment and implications for assessment." The Lancet Neurology 12(4): 368-380.
• NICE (2016). "National Institute for Health and Care Excellence."
• Niven, E., Newton, J., Foley, J., Colville, S., Swingler, R., Chandran, S., Bak, T.H. & Abrahams S. (2015). "Validation of the Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis SCreen (ECAS): A cognitive tool for motor disorders." Amyotroph Lateral Scler Frontotemporal Degener 16(3-4): 172-179.

A Briefing to further understand the nature of neuropsychology services in other areas of the country in the absence of official data.

The evidence presented in the briefing refers to the current arrangements of neuropsychology services located within neuroscience centres many of which have different regional contexts. The Division of Neuropsychology has not taken a position on appropriate staffing levels or how services should be funded in general.  As a result care should be taken in presenting or sharing the data to external audiences. 

Where information from the report is presented or shared it should be referenced as internal Division of Neuropsychology mapping as the report has not been approved by the BPS Professional Practice Board or externally published.'

Population data for regional neuroscience centres was sourced from individual trusts websites and associated publications.

• Consultation on the Deprivation of Liberty Safeguards legislation
• Empowerment matters website
• Mental Capacity Act 2005
• NHS Choices MCA webpages

The House of Commons debated Acquired Brain Injury, on the 18 June 2018 for an hour, considering a ranges of issues, including: the incredible toll on families and carers of caring for someone with ABI; the potentially devastating impact of even a mild TBI; the need for a joined up approach for children with ABI from Health, Social Care and Education in care planning; the significant financial cost savings to health, social care and the justice system when neuropsychological rehabilitation is  provided; and the potential vulnerability of ABI sufferers to offending and, if unrecognised and untreated, re-offending.  

• Access the transcript of the full debate
• Watch the entire debate

Both the BPS Policy team and the DoN's own Policy Unit have worked hard – on behalf of BPS and DoN members but also on behalf of all your patients with neurological conditions - to make connections with MPs and to really raise awareness of the widespread impact of this issue.  And the debate was notable for the very real understanding shown by the speakers about the consequences of, not just TBI, but of AB,I across the life span.  Some MPs spoke movingly and with amazing candour about their own personal family experiences of ABI.  This must be the first time 'neuropsychology' has been mentioned in Hansard.

Steve Brine, Parliamentary Under-Secretary of State for Health and Social Care opened the debate with an excellent encapsulation of the definition and prevalence of ABI.

As part of the debate, Clinical Psychologist, and now Member of Parliament for East Kilbride SNP, Dr Lisa Cameron, spoke specifically and knowledgeably about the cognitive and psychological effects of brain injury, and the importance of timely access to Neuropsychology as a key part of rehabilitation, saying"Access to Neuropsychology is a key part of rehabilitation". 

Chris Bryant, Member of Parliament for Rhondda Lab, said, "Acquired brain injury is an invisible epidemic in this country".

Expert panels for the REF 2021 exercise are made up of senior academics, international members, and research users.  Psychological research falls under the remit of the Psychology, Psychiatry and Neuroscience Sub-Panel.

Members of the BPS Research Board have expressed some concerns that the composition of the new REF 2021 panel does not reflect the diversity of research models used in psychological research, in particular concerns have been raised that the new panel may not have sufficient expertise to evaluate the value of qualitative research.

The BPS has written to the chair of REF Psychology, Psychiatry and Neuroscience Sub-Panel to express these concerns and has received assurances with respect to the value of all research methodologies. The REF panel welcomes submissions from ALL areas and methodologies in psychology and ALL submissions will be treated equally and fairly.

International Classification of Health Interventions (ICHI) is the new classification system developed by the World Health Organisation, which compliments the existing International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF).

The interventions contained in the ICHI are closely based upon the ICF, which includes for example, a large section on mental functions and associated limitations.  The ICHI codes the assessment and intervention (rehabilitation) of these mental functions, therefore it is of great relevance to neuropsychology.

This classification system will have many and wide ranging applications in the research, planning and organisation of health services.

One possible use for example, is by NHS coding.  This is the system by which clinical services in the UK are monitored, planned and paid for.  This is another reason why neuropsychologists should pay attention to the ICHI, to ensure that our activity is appropriately captured.

Through 2016 and 2017 the DoN has contributed to the development of the ICHI.  Through 2018 the first phase of beta testing has been completd, which will be followed by a second phase of beta testing up to September 2019.

• Review and comment on the online version

• What is clinical neuropsychology? A guide for patients and the public
• Guidance on the assessment of performance validity in neuropsychological assessments

• British Neuropsychiatry Association
• British Neuropsychological Society (BNS)
• Child Brain Injury Trust
• Edinburgh Neuroscience
• International Brain Injury Association (IBIA)
• MRC Cognition and Brain Sciences Unit
• National Institute for Health and Clinical Excellence (NICE)
• The Children's Trust for children with brain injury
• Young Epilepsy

Careful consideration on a case-by-case basis must be given as to whether use of tele-neuropsychology is necessary and will address the current need of the patient/client.

Guidance for those planning tele-neuropsychological assessment and rehabilitation/treatment is provided but should be interpreted in the context of local guidance from employers and other host organisations.  

Published studies indicate that remote administration of some neuropsychological tests can produce reliable and valid results, though the evidence base is limited.

The assessment of young children, adults with learning disabilities, and many older adults will require specific further consideration.

Below is a growing directory of regional and special interest groups and forums related to neuropsychology.

• Send your details to Member Network Services to have your group listed

Please note: inclusion on this page does not necessarily imply affiliation with, or the endorsement of, the BPS Division of Neuropsychology. 

Regional Groups - Lead

Berkshire - Dr Trevor Powell

East Anglia - Dr Kate Psaila

Glasgow - Professor Jonathan Evans

Hertfordshire - Dr Amy Lyons

Neuropsychology in Older People Network - NOPN - Dr Sarah McCrimmon 

Northampton - Dr Keith Jenkins

North East - Dr Jenna Moffitt 

North Wales - Dr Helena Blackwell

North West - Dr Gavin Newby

Northern Ireland - Dr Helena Blackwell

Southampton - Dr Jane McNeil

South Somerset - Dr Miriam Prins

South Thames - Dr Cliodhna Carroll

South Wales - Dr Claire Willson

South Wales Child - Dr Michelle Smalley

South West - Dr Phil Yates

Trent - Dr Patrick Vesey

West Midlands - Dr Amanda Mobley

The DoN Faculty for Paediatric Neuropsychology also has a number of special interest groups.

• Visit the Faculty of Paediatric Neuropsychology

Ingram Wright and Rupert Noad discuss developments in neuropsychology training in the UK including new routes for counselling psychologists to access training in neuropsychology.

This is the first in a series of 4 brief lunchtime 'taster' sessions on clinical neuropsychology for psychologists working as assistants, trainees or band 7s in neuropsychology settings, discussing some of the issues that come up.

This is the second in a series of 4 brief lunchtime 'taster' sessions on clinical neuropsychology for psychologists working as assistants, trainees or band 7s in neuropsychology settings, discussing some of the issues that come up.

Building on the first chat, this session looks in more detail at how the test data are used by clinical neuropsychologists alongside other sources of data to forge an answer to the original hypothesis or referral question.

This is the third in a series of 4 brief lunchtime 'taster' sessions on clinical neuropsychology for psychologists working as assistants, trainees or band 7s in neuropsychology settings, discussing some of the issues that come up.

Clinical neuropsychologists and clinical psychologists working in neuropsychology are all continuing to use their foundational core clinical skills.

This session follows on from behavioural formulation with some reflections on the importance of blending clinical and neuropsychological skills, using some case vignettes.

This is the fourth in a series of 4 brief lunchtime 'taster' sessions on clinical neuropsychology for psychologists working as assistants, trainees or band 7s in neuropsychology settings, discussing some of the issues that come up.

Neuropsychology involves not only cognitive assessment in its various forms; neuropsychological rehabilitation and support; but also working therapeutically with people with neurological conditions.

This last session touches on therapy and looks at some of the key issues in working with people with epilepsy, subarachnoid haemorrhage and brain tumours.

Professor Anderson joins us to discuss career development in paediatric neuropsychology, the wider developments in the field, and the challenges and opportunities of this work. 

A rather rambling and content free introduction to Series 2 of the neuro clinic. It is a pleasure to be working with Cliodhna Carroll on this series and to have such a fantastic array of guests coming up...... Vicki Anderson (Paediatric Neuropsychology), Mike Carter (Neurosurgery), Ryan Van Patten and John Belone on Neuropsychology podcasting, and much more. 

This is the first in our new series! We introduce Cliodhna Carroll as a new co-host of the neuro clinic and start as we mean to go on with a great conversation with Dr John Bellone and Dr Ryan Van Patten, hosts of the NavNeuro podcast hosted by the International Neuropsychological Society 

An international episode with Dr Kate Gould from Monash University, Australia.

Kate talks about her work in understanding and providing positive support in addressing challenging behaviour after acquired brain injury as well as about her extensive collaborative research with Professor Jennie Ponsford and Dr Tim Feeney amongst others.

Great to be joined by Hannah, Helena, Melissa, Natasha, Seb and Steph to talk about the role of an Assistant Psychologist (AP) in Neuropsychology. Topics include getting a job as an AP,

the breadth of learning opportunities in neuro settings, what good supervision looks like, and when it might be time to move on to another role!

In this episode I talk to Giles Yeates about his views on the development of community neurorehabilitation, his innovative professional journey incorporating ideas from martial arts, understanding relationships and sexuality after brain injury.

A conversation with neuroscientist, author, blogger, occasional comedian, Dr Dean Burnett.

Dean is the author of the the popular Guardian Science blog 'Brain Flapping' (now 'Brain Yapping' on the Cosmic Shambles Network with accompanying podcast), the bestselling books The Idiot Brain and The Happy Brain, and his first book aimed at teens, Why Your Parents Are Driving You Up the Wall and What To Do About It.

Dr Fergus Gracey, Clinical Associate Professor in Clinical Psychology from the University of East Anglia joins me to discuss identity after brain injury and much more.

Professor Liam Dorris talks about the development of his interest in research in paediatric neuropsychology.

Penny, Pip and Ingram discuss the distinctive nature of adult and paediatric work focusing on contextual and legislative difference in addition to professional training and practice boundaries.

Jason talks about his enthusiasm for working in FND and developments in our understanding of theses conditions, their diagnosis and treatment.

Rebecca talks about services for older adults and her work spanning both neuropsychology and mental health provision.

I am joined by Clinical Psychologist and Neuropsychologist Pip Calvert, and Cognitive Analytic Therapist, Jak Smith, to talk about the application of cognitive analytic concepts to neuro work.

Professor Jon Evans and I discuss his entry into clinical neuropsychology, his orientation to neuropsychological research and an international perspective on our work.

A conversation with Alistair Teager and Ben Dawson on working and developing services in major trauma.

This is a conversation with Lorraine Haye and Abigail Methley who work as clinical psychologists in neuropsychology within a mental health trust.

We discuss the challenges that service context brings to the work that we do and the meaning of trauma in neuropsychology.

Katherine Carpenter, Chair of the British Psychological Society's Division of Neuropsychology talks to Ingram Wright about her background, her interest in neuropsychology, leadership of the profession and challenges for our profession around diversity and inclusion. Katherine is speaking in a personal capacity.

Dr Cliodhna Carroll and Dr Ben Marram in conversation about their experiences in Clinical Neuropsychology Training.

A conversation with Dr Penny Trayner and DJ Mark One about the creative application of DJ Tuition to neurorehabilitation.

This is the first of a series of podcasts in conversation with practicing clinicians.

This week, I talk to Will Curvis and Lawson Falshaw about how their interest in neuropsychology has developed.

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