The Joy of Tests: Use it or Lose it
A cognitive assessment can be used to gain an understanding of a person’s higher mental functions, and how these skills and abilities impact on their lives. The potential benefits of assessment include: obtaining a profile of cognitive deficits and strengths to assist formulation and treatment plans; clarifying cognitive profiles that exist alongside co-morbid mental health issues which may aid diagnosis (- e.g. differentiating between progressive and non-progressive conditions); assisting clients, families, carers and colleagues in understanding cognitive issues and the likely impact on the client’s everyday function; and, providing evidence to assist with decisions about Capacity issues.
Over a period of time, and with the development of QiCN training for Neuropsychologists, there has tended to be a view amongst some Clinical Psychologists that they are no longer able/ competent to do cognitive assessments – I disagree. All Clinical Psychologists start their qualified working life with sufficient training experience to carry out a basic cognitive assessment, and it is one skill/ competence that is distinctive to us as a profession of Clinical Psychologists – no one else should be doing such assessments. When a colleague says they cannot do a cognitive assessment, they are de-skilling themselves, and sending the wrong message to service colleagues and service managers.
But Neuropsychological Assessment is a specialist area you say. Note that I have deliberately used the term ‘cognitive assessment’ in the paragraphs above, and therefore would look to make a distinction between what we might call a ‘cognitive assessment’ and a more detailed/ specialist ‘Neuropsychological Assessment’. I would suggest that all Clinical Psychologists have sufficient basic training to do a basic cognitive assessment involving the use of standardised tools such as the TOPF, WAIS-IV / WISC-V, and WMS-IV (- and perhaps a few other well-known tests). The normal whirl of clinical life and service arrangements may not give many colleagues opportunities to do such assessments on a regular basis but, perhaps with access to guidance and support from colleagues who do regular assessment work, a basic assessment should be within our grasp. It may well be that the outcome of a cognitive assessment would be a recommendation that a colleague then pursue a more detailed Neuropsychological Assessment.
Now, those of you who know me will know that I have built a role, nay career, from offering a specialist Neuropsychology Assessment service within Specialist Mental Health Services, and thus contributing to the inadvertent de-skilling of dozens of colleagues over a period of time in respect of assessment work !! In reality, it is interesting to note that a good percentage of my colleagues in Mental Health and Specialist Services recognise a need to keep their assessment skills active by doing some assessment work themselves (- and with support / consultation/ advice gladly being given in such cases). In specialist mental health services, the ‘cognitive/ neuro’ data thus obtained contributes greatly to formulations, and to an understanding of what might be rate-limiting factors in terms of clients’ progress with treatment and rehabilitation.
So, Clinical Psychologists, busy as we all are, do make time now and again to reacquaint yourself with the Blocks and the mental arithmetic, with Anna Thompson and Joe Grant (- they are still there!), and with all those lovely norms tables in the manuals. The ability to use such tests appropriately to inform clinical work is one of our distinctive skills – let’s not let these skills go to waste!