Clinical Neuropsychology as a Specialist Profession in European Health Care: Developing a Benchmark for Training Standards and Competencies Using the Europsy Model?

Core Competencies in Clinical Neuropsychology as a Training Model in Europe

The multitude of training models and curricula for the specialty of clinical neuropsychology around the world has led to organized activities to develop a framework of core competencies to ensure sufficient expertise among entry-level professionals in the field. The Standing Committee on Clinical Neuropsychology of the European Federation of Psychologists’ Associations is currently working toward developing a specialty certification in clinical neuropsychology to establish a cross-national standard against which to measure levels of equivalency and uniformity in competence and service provision among professionals in the field. Through structured interviews with experts from 28 European countries, we explored potential areas of core competency. Specifically, questions pertained to the perceived importance of a series of foundational, functional, and other competencies, as well as current training standards and practices, and optimal standards. Our findings revealed considerable agreement (about three quarters and above) on academic and clinical training, despite varied actual training requirements currently, with fewer respondents relegating importance to training in teaching, supervision, and research (a little over half), and even fewer to skills related to management, administration, and advocacy (fewer than half). European expert clinical neuropsychologists were in agreement with previous studies (including those conducted in the United States, Australia, and other countries) regarding the importance of sound theoretical and clinical training but management, administrative, and advocacy skills were not central to their perspective of a competent specialist in clinical neuropsychology. Establishing a specialty certificate in clinical neuropsychology based on core competencies may enable mobility of clinical neuropsychologists across Europe, and, perhaps, provide an impetus for countries with limited criteria to reconsider their training requirements and harmonize their standards with others.

Status of Clinical Neuropsychology Training in Finland

This paper provides information on different training models within clinical neuropsychology in Finland. Systematic specialization training program began in Finland in 1983. It was first organized mainly by the Finnish Neuropsychological Society and since 1997 by the Finnish universities. At present, close to 400 clinical neuropsychologists have completed the training. The number of professionals still does not cover the needs of the country (population 5.5 million, area 338,440 km2), and geographical disparities are a constant concern. The training models in Finland have changed over the years and will continue to evolve. Specialization training can be organized by national societies or by universities. It can lead to an academic degree or a diploma. It can be linked to doctoral studies or form a parallel track. Financial model can involve student fees or be governed by ministries (such as the Ministry of Education or Ministry of Health). This paper describes and compares different strategies in education that have impact on the output of professionals. One model does not fit all, or even one country at all times. The strategies of the stakeholder ministries can change over time. The experiences from Finland can be useful for other countries that are developing their models. The estimated need of practitioners and the educational resources including the available financial models for training differ between countries. The guiding principles in specialist training should focus on the advanced competencies expected from the neuropsychologist when entering the profession.

Clinical Neuropsychology in Germany

Clinical neuropsychologists have been working in Germany since the 1980s, and specific training in the discipline has been available since 1993. The qualification currently requires 3 years of practical training, 400 h of theoretical learning, 100 h of supervision, five reports on patients and an oral examination. After its completion, neuropsychologists can work as employees in clinical settings. For a substantial period of time, neuropsychologists working in their own practices faced complex challenges in working with outpatients, whose health insurers did not cover the cost of this treatment. State approval of neuropsychological diagnostic procedures and therapy was achieved in 2011, on the basis of evidence showing the method’s high effectiveness; statutory health insurers therefore now pay out for delivery of these services on an outpatient basis, too. In Germany, neuropsychologists work in all areas of the diagnosis of functional disorders, with children, adolescents, adults and older adults, and carry out treatment. Clinical neuropsychologists provide patients with individualized tools for managing their brain damage, supply exercises and tasks for them to undertake at home, and give input on administrative matters, such as determining the degree of a patient’s disability. Treatment takes place in close collaboration with members of related professions, such as physiotherapists, occupational therapists and speech therapists. Neuropsychologists also work as assessors, investigating, for example, the extent of a patient’s ability to work after sustaining CNS damage or the need for medical retirement. The earnings of clinical neuropsychologists vary widely, currently averaging between €3,000 and €4,000 gross per month for employed neuropsychologists; self-employed neuropsychologists in their own practices can currently bill statutory health insurers for around €100.00 per hour. Despite the generally good working conditions in this discipline, Germany is suffering from a shortage of clinical neuropsychologists. An approximate total of 800 psychologists have completed training in this field, while around 50,000 patients could benefit from neuropsychological treatment every year.

European Clinical Neuropsychology: Role in Healthcare and Access to Neuropsychological Services

This study analyzed aspects of the work of clinical neuropsychologists across Europe. There are no published comparisons between European countries regarding the nature of clinical neuropsychologists' work. Forty-one national psychological and neuropsychological societies were approached, of which 31 (76%) responded. Data from seven countries with less than 10 neuropsychologists were excluded. A license is required to practice clinical neuropsychology in 50% of the countries. Clinical neuropsychologists work independently in 62.5%. Diagnostic/assessment work is the most frequently reported activity (54%). Most neuropsychologists work in public hospitals, followed by health centers. Adult neuropsychology was the most frequent area of activity. Services in public institutions are covered by public entities (45.8%), or by a combination of patient funds and public entities (29.2%) and only 4.2% by the patient; whereas services in private institutions are covered by the patient (26.1%) and the combination of patient, public entities (21.7%) or patient and private entities (17.4%). The data suggest that the number of neuropsychologists working across European countries is considerably low in comparison to other medical professionals. The results of the survey identified similar aspects of neuropsychologists' work, despite variations in terms of reimbursement and mechanisms, reflecting economic and healthcare differences. Estimates on the number of clinical neuropsychologists suggest insufficient access to neuropsychological services.