A Practitioner Survey of Department of Veterans Affairs Psychologists who Provide Neuropsychological Assessments

A Practitioner Survey of Department of Veterans Affairs Psychologists who Provide... Abstract Objective The provision of neuropsychological assessments is an important part of the assessment and treatment of our veterans, yet little is known regarding who provides these assessments within Veterans Health Administration (VHA) settings, and of what they consist. The current survey provides information regarding the professional characteristics and assessment practices of VHA psychologists who provide neuropsychological assessments within VHA settings. Methods Survey invitations were emailed to 4740 psychologists who worked for the VHA, resulting in surveys from 123 VHA psychologists who self-identified as providing and/or supervising neuropsychological assessments within VHA settings. Results One hundred and twenty-three VHA doctoral level psychologists provided information regarding professional characteristics, such as demographic, training, and exerience, as well as assessment practices, such as number and types of assessment instruments used. Conclusions This professional practice survey is the first survey of VHA psytchologists who provide neuropsychological assessments within VHA settings. As such, it provides baseline information which will aid in assesment and treatment provision, policy developement, and allow future surveys to assess changes in neuropsychological assessment practices over time. Veterans, Professional practice, Neuropsychology assessment Introduction Since the 1980s, survey research has examined various aspects of neuropsychological assessment. As Rabin, Barr and Burton (2005) noted in their excellent review, Hartlage and Telzrow (1980) “conducted the first published study to directly address assessment issues in the field of neuropsychology” (p. 35). Since then, several surveys have documented changes in neuropsychology and neuropsychological assessment in terms of both practitioner characteristics, such as demographic, training and experience variables, and practitioner practices, such as test usage (see, for example, Butler, Retzlaff, & Vanderploeg, 1991; Camara, Nathan, & Puente, 2000; Guilmette, Faust, Hart, & Arkes, 1990; Putnam & DeLuca, 1990; Rabin et al., 2005; Seretny, Dean, Gray, & Hartlage, 1986; Sweet & Moberg, 1990; Sweet, Benson, Nelson, & Moberg, 2015; Sweet, Moberg, & Westergaard, 1996; Sweet, Peck, Abramowitz, & Etzweiler, 2002). However, these surveys have limited usefulness for understanding the practitioner characteristics and practices of Veteran Health Administration (VHA) psychologists who provide neuropsychological assessments within Department of Veterans Affairs (DVA) clinical settings. Existing surveys have been based on respondents who identified professionally as clinical neuropsychologists, with survey samples taken from professional neuropsychology societies, such as the American Academy of Clinical Neuropsychology, Division 40 of the American Psychological Association (APA), the International Neuropsychological Society, and the National Academy of Neuropsychology (see, for example, Camara et al., 2000; Rabin et al., 2005; Seretny et al., 1986; Sweet et al., 2015). Existing surveys do not reflect the fact that both APA and DVA policies and practices allow psychologists, other than those trained as neuropsychologists, to provide neuropsychological assessments. Regarding the former, Russo (in press) recently noted that with at least three APA recognized specialties in professional psychology, Professional Geropsychology, Clinical Neuropsychology, and Rehabilitation Psychology, “completion of the specialty purports to provide the post-doctoral fellow with competence in neuropsychological assessment with adults, despite marked differences in training models, time required for training and supervised practice in neuropsychological assessment.” Because of this, “the long-standing standard offered by Clinical Neuropsychology now competes with the markedly different standards for appropriate education and training offered by other specialties” (Russo, in press). Regarding the latter, the DVA has no national policy governing neuropsychology or neuropsychological assessment. VHA psychologists demonstrate competence by meeting the requirements for psychologists set by Public Law 96–151, and codified in Title 38U.S.C. §7402. According to VHA Handbook 5005/87 (Department of Veterans Affairs, 2016), even entry level psychologists may “conduct psychological or neuropsychological assessments” (p. II-G18-4). At the author’s VA medical center, for example, a review of all 2017 second quarter’s assessment referrals finds that the majority of all neuropsychological assessment referrals, including veterans age 30 and older, were given to fellows in the medical center’s one year geropsychology fellowship program. A review of the literature found few recent studies which examined the professional characteristics and practices of VHA psychologists who conduct neuropsychological assessments within VHA settings. Early studies addressed the adjustment and vocational issues of WWII veterans, during a time when the Army Alpha and Bellevue Wechsler tests were popular assessment instruments (see for example, Baker & Peatman, 1947), and few providers had doctoral level education (Darley & Marquis, 1946). In a recent survey, Young, Roper, and Arentsen (2016) examined the symptom validity practices of VHA clinicians who identified professionally as neuropsychologists. As they noted, participants tended to belong to at least two professional neuropsychology organizations, such as the International Neuropsychological Society, Division 40 of the American Psychological Association, or the National Association of Neuropsychology. Their study did report on select provider characteristics and practices, but the primary focus was “to establish base rate estimates for SPVT [symptom and performance validity test] failure across several VA assessment contexts and determine whether particular referral conditions had higher incidence of non-credible performance” (p. 5). The purpose of this survey is to identify the professional characteristics and assessment practices of VHA psychologists who provide neuropsychological assessments within VHA clinical settings. This study was approved by the Veterans Affairs New York Healthcare System’s Institutional Review Board. Method Survey Measure Survey development began in early 2017, and consisted of reviewing the major surveys of neuropsychologists, starting with the Hartlage and Telzrow (1980) survey. These included Butler et al. (1991), Camara et al. (2000), Guilmette et al. (1990), Putnam and DeLuca (1990), Rabin et al. (2005), Seretny et al. (1986), Sweet and Moberg (1990), Sweet et al. (1996), Sweet et al. (2015), Sweet et al. (2002), and Young et al. (2016). Where possible, common demographic, educational, training, work and practice elements were identified to allow for cross survey comparisons, with the final survey of 28 questions created following institutional review and approval. See the Appendix for the complete survey and cover text. Subjects Possible subjects were identified via two e-mail efforts conducted in July of 2017. Since all doctoral level psychologists hired by the Department of Veterans Affairs have government Microsoft Outlook e-mail accounts, the first effort consisted of identifying possible subjects via an advanced search of the Outlook email address book, using variations of the term “psychology” and “psychologist” (for example, clinical health psychologist, clinical psychologist, counseling psychologist, full time psychologist, geropsychologist, graduate psychologist, neuropsychologist, neurorehabilitation psychologist, police psychologist, psychologist, psychology fellow, psychology resident, staff psychologist, supervisory psychologist, etc.). This first effort resulted in the survey being emailed to approximately 4740 recipients. The number is an approximation because the email system noted that a very small number of emails could not be delivered. The second effort consisted of an email to 324 recipients via the Association of VA Psychologist Leaders’ AVAPL neuropsych listserv. Since this listserv is open to all VHA psychologists with an interest in neuropsychology and/or neuropsychological assessment, this mailing provided a second email to select VHA psychologists. Survey collection stopped September 1, 2017; at that time three weeks had elapsed during which no additional surveys had been received. By September, 127 surveys were returned and examined for usability. Four were rejected, resulting in a survey sample size of 123. Of the four rejected surveys, two were from respondents who neither conducted nor supervised neuropsychological assessments, one survey was largely incomplete, and one was from a bachelor’s level externship student. This survey sample consists of 123 VHA doctoral level psychologists who self-identified as providing neuropsychological assessments and/or supervising others who provide neuropsychological assessments to veterans within VHA settings. Because the number of VHA psychologists conducting neuropsychological assessments is unknown, it was not possible to calculate a precise response rate. In their 2016 survey, Young et al. (2016, p. 5) identified 387 VHA psychologists who were “likely practicing neuropsychology in at least a part-time capacity.” Using the Young et al. (2016) estimate would give a response rate of 32%. Dr Brian Shenal kindly informed me (personal communication, August 2, 2017) that at the time of this survey there were 324 members on the AVAPL neuropsych listserv; using that number which would give a response rate of 38%. Results Demographic Characteristics As seen in Table 1, 69% of all respondents were female, with 67% of all respondents between the ages of 30 and 49. Females between the ages of 30 and 49 made up the majority of respondents (52%). Table 1. Demographic information: age and sex of respondents Age (years) Female Male Total 20–29 2 0 2 30–39 42 11 53 40–49 22 8 30 50–59 13 10 23 60 and older 6 9 14 Total 85 38 123 Age (years) Female Male Total 20–29 2 0 2 30–39 42 11 53 40–49 22 8 30 50–59 13 10 23 60 and older 6 9 14 Total 85 38 123 Table 1. Demographic information: age and sex of respondents Age (years) Female Male Total 20–29 2 0 2 30–39 42 11 53 40–49 22 8 30 50–59 13 10 23 60 and older 6 9 14 Total 85 38 123 Age (years) Female Male Total 20–29 2 0 2 30–39 42 11 53 40–49 22 8 30 50–59 13 10 23 60 and older 6 9 14 Total 85 38 123 Educational Characteristics As seen in Table 2, 81% completed a doctoral program in clinical psychology. Included in this, were three respondents who reported completing a program in clinical psychology with an emphasis on neuropsychology. Seventy-one percent of all respondents completed a PhD program. Table 2. Education of respondents Doctoral Program  Major PhD PsyD Total  Clinical 66 34 100  Counseling 13 0 13  Neuropsychologya 8 2 10  Total 87 36 123 Doctoral Program  Major PhD PsyD Total  Clinical 66 34 100  Counseling 13 0 13  Neuropsychologya 8 2 10  Total 87 36 123 aNeuropsychology was only counted if it was reported as a program separate from Clinical Psychology. The Neuropsychology category included two respondents with a PhD in Physiological Psychology. Table 2. Education of respondents Doctoral Program  Major PhD PsyD Total  Clinical 66 34 100  Counseling 13 0 13  Neuropsychologya 8 2 10  Total 87 36 123 Doctoral Program  Major PhD PsyD Total  Clinical 66 34 100  Counseling 13 0 13  Neuropsychologya 8 2 10  Total 87 36 123 aNeuropsychology was only counted if it was reported as a program separate from Clinical Psychology. The Neuropsychology category included two respondents with a PhD in Physiological Psychology. Professional Characteristics The majority of respondents (59%) had 10 or fewer years post-license experience, with 31% having 5 years or less experience and 5% were not yet licensed, as seen in Table 3. Approximately 83% of all respondents had completed or were enrolled in a program of post-doctoral training in psychology. Approximately two-thirds (69%) had completed or were currently enrolled in a post-doctoral program in neuropsychology, and 27% were board certified in neuropsychology. Table 3. Professional characteristics of respondents Years of practice post-license n % Not licensed 6 4.9 0–5 38 30.9 6–10 29 23.6 11–15 15 12.2 16–20 14 11.4 21–25 10 8.1 More than 25 11 8.9 Post-doctoral Program Completed Current Neuropsychology 83 2 Geropsychologya 6 0 Rehabilitation Psychologya 3 1 Othera 7 0 Board Certified n % Neuropsychology 29 27.0 Geropsychologyb 2 1.6 Rehabilitation Psychologyb 2 1.6 Otherb 4 3.5 Years of practice post-license n % Not licensed 6 4.9 0–5 38 30.9 6–10 29 23.6 11–15 15 12.2 16–20 14 11.4 21–25 10 8.1 More than 25 11 8.9 Post-doctoral Program Completed Current Neuropsychology 83 2 Geropsychologya 6 0 Rehabilitation Psychologya 3 1 Othera 7 0 Board Certified n % Neuropsychology 29 27.0 Geropsychologyb 2 1.6 Rehabilitation Psychologyb 2 1.6 Otherb 4 3.5 aOnly includes respondents who did not complete a neuropsychology post-doctoral program. bOnly includes respondents who did not attain board certification in neuropsychology. Table 3. Professional characteristics of respondents Years of practice post-license n % Not licensed 6 4.9 0–5 38 30.9 6–10 29 23.6 11–15 15 12.2 16–20 14 11.4 21–25 10 8.1 More than 25 11 8.9 Post-doctoral Program Completed Current Neuropsychology 83 2 Geropsychologya 6 0 Rehabilitation Psychologya 3 1 Othera 7 0 Board Certified n % Neuropsychology 29 27.0 Geropsychologyb 2 1.6 Rehabilitation Psychologyb 2 1.6 Otherb 4 3.5 Years of practice post-license n % Not licensed 6 4.9 0–5 38 30.9 6–10 29 23.6 11–15 15 12.2 16–20 14 11.4 21–25 10 8.1 More than 25 11 8.9 Post-doctoral Program Completed Current Neuropsychology 83 2 Geropsychologya 6 0 Rehabilitation Psychologya 3 1 Othera 7 0 Board Certified n % Neuropsychology 29 27.0 Geropsychologyb 2 1.6 Rehabilitation Psychologyb 2 1.6 Otherb 4 3.5 aOnly includes respondents who did not complete a neuropsychology post-doctoral program. bOnly includes respondents who did not attain board certification in neuropsychology. VHA Professional Identity Characteristics As seen in Table 4, there was a fair representation of VHA psychologists from across the United States and its territories. Approximately 69% of respondents were licensed in the same state in which they identified their primary VHA worksite, with just over a quarter reporting that they were licensed in a state different from their primary VHA worksite. Table 4. VHA worksite of respondents Primary VHA worksite In State Licensea Out of State Licenseb Not licensed Total Continental 8 6 1 15 Midwest 13 9 1 23 North Atlantic 18 4 2 24 Pacific 23 4 1 28 Southeast 23 9 1 33 Total 85 32 6 123 Primary VHA worksite In State Licensea Out of State Licenseb Not licensed Total Continental 8 6 1 15 Midwest 13 9 1 23 North Atlantic 18 4 2 24 Pacific 23 4 1 28 Southeast 23 9 1 33 Total 85 32 6 123 aIn State License means respondents reported being licensed in the same state as their primary VHA worksite. bOut of State License means respondents reported being licensed in a different state from that of their primary VHA worksite. Table 4. VHA worksite of respondents Primary VHA worksite In State Licensea Out of State Licenseb Not licensed Total Continental 8 6 1 15 Midwest 13 9 1 23 North Atlantic 18 4 2 24 Pacific 23 4 1 28 Southeast 23 9 1 33 Total 85 32 6 123 Primary VHA worksite In State Licensea Out of State Licenseb Not licensed Total Continental 8 6 1 15 Midwest 13 9 1 23 North Atlantic 18 4 2 24 Pacific 23 4 1 28 Southeast 23 9 1 33 Total 85 32 6 123 aIn State License means respondents reported being licensed in the same state as their primary VHA worksite. bOut of State License means respondents reported being licensed in a different state from that of their primary VHA worksite. Table 5 summarizes respondents’ professional self-identities within the VHA. Please note that psychologists who identified themselves as either clinical or counseling psychologists were reported as such only when this was the only professional identity listed. When clinical or counseling psychologist was combined with one or more of the APA specialties of geropsychology, neuropsychology, and/or rehabilitation psychology, then the counseling or clinical designation was dropped to simplify the table. For example, respondents identifying themselves as clinical psychologists were reported as such, but those identifying themselves as clinical and geropsychologists, or clinical and neuropsychologists were reported as geropsychologists or neuropsychologists, respectively. Table 5. VHA psychology identity and privileges Professional Identitya Hospital Privilegesb Neuropsychology Specialtyc NP Post DocCompletedd N Clinical/Counseling 15 13 3 0 Geropsychologist 7 6 1 1 Geropsych/Neuropsych 6 6 6 4 Geropsych/Neuropsych/Rehab 2 2 2 1 Neuropsychologist 88 84 83 75 Neuropsy/Rehab 2 1 1 2 Rehabilitation Psychologist 3 1 0 0 Total 123 113 96 83 Professional Identitya Hospital Privilegesb Neuropsychology Specialtyc NP Post DocCompletedd N Clinical/Counseling 15 13 3 0 Geropsychologist 7 6 1 1 Geropsych/Neuropsych 6 6 6 4 Geropsych/Neuropsych/Rehab 2 2 2 1 Neuropsychologist 88 84 83 75 Neuropsy/Rehab 2 1 1 2 Rehabilitation Psychologist 3 1 0 0 Total 123 113 96 83 aRespondents who identified either clinical or counseling psychology as their sole professional identity were combined. Respondents who identified either clinical or counseling psychology as an additional identity along with geropsychology, neuropsychology and/or rehabilitation psychology were combined under geropsychology, neuropsychology and/or rehabilitation, respectively. bHospital Privileges means respondent claimed having VHA hospital privileges as a psychologist. cNeuropsychology Specialty means respondent claimed having VHA hospital specialty privileges as a neuropsychologist. dNP Post Doc Completed means completion of a post-doctoral program in neuropsychology. Table 5. VHA psychology identity and privileges Professional Identitya Hospital Privilegesb Neuropsychology Specialtyc NP Post DocCompletedd N Clinical/Counseling 15 13 3 0 Geropsychologist 7 6 1 1 Geropsych/Neuropsych 6 6 6 4 Geropsych/Neuropsych/Rehab 2 2 2 1 Neuropsychologist 88 84 83 75 Neuropsy/Rehab 2 1 1 2 Rehabilitation Psychologist 3 1 0 0 Total 123 113 96 83 Professional Identitya Hospital Privilegesb Neuropsychology Specialtyc NP Post DocCompletedd N Clinical/Counseling 15 13 3 0 Geropsychologist 7 6 1 1 Geropsych/Neuropsych 6 6 6 4 Geropsych/Neuropsych/Rehab 2 2 2 1 Neuropsychologist 88 84 83 75 Neuropsy/Rehab 2 1 1 2 Rehabilitation Psychologist 3 1 0 0 Total 123 113 96 83 aRespondents who identified either clinical or counseling psychology as their sole professional identity were combined. Respondents who identified either clinical or counseling psychology as an additional identity along with geropsychology, neuropsychology and/or rehabilitation psychology were combined under geropsychology, neuropsychology and/or rehabilitation, respectively. bHospital Privileges means respondent claimed having VHA hospital privileges as a psychologist. cNeuropsychology Specialty means respondent claimed having VHA hospital specialty privileges as a neuropsychologist. dNP Post Doc Completed means completion of a post-doctoral program in neuropsychology. Taking into account all of the responses in which neuropsychology was one of the professional identities endorsed, almost 80% of the respondents listed their professional identity as a neuropsychologist. In other words, 20% of respondents who provided or supervised neuropsychological assessments did not self-identify as neuropsychologists. Almost 92% of respondents reported having hospital privileges to practice within the VHA as psychologists, with 78% of respondents reporting VHA hospital specialty privilege as a neuropsychologist. Respondents did not have to complete a neuropsychology post-doctoral program or even identify as a neuropsychologist to have VHA hospital specialty privilege as a neuropsychologist, although most did. VHA Professional Activity Characteristics Of the 123 respondents, 115 provided information on their VHA professional activities. As seen in Table 6, the Direct Provision of Assessments was the professional activity most reported, with means and medians near the 50th percentile (mean = 46.9%; median = 50.0%). Training and Supervision were endorsed as a distant second, with mean and median of 14.1% and 10.0%, respectively. Table 6. VHA professional activity allocation (n = 115) Mean (%) SDa (%) Median (%) SIRb (%) Direct Provision of Assessments 46.9 29.9 50.0 52.5 Training and/or Supervision 14.1 12.4 10.0 15.0 Psychotherapy 13.0 23.7 0.0 15.0 Administrative 11.9 14.2 10.0 15.0 Research 6.7 16.3 0.0 5.0 Cognitive Remediation 2.6 6.8 0.0 2.0 Other 4.7 12.9 0.0 0.0 Mean (%) SDa (%) Median (%) SIRb (%) Direct Provision of Assessments 46.9 29.9 50.0 52.5 Training and/or Supervision 14.1 12.4 10.0 15.0 Psychotherapy 13.0 23.7 0.0 15.0 Administrative 11.9 14.2 10.0 15.0 Research 6.7 16.3 0.0 5.0 Cognitive Remediation 2.6 6.8 0.0 2.0 Other 4.7 12.9 0.0 0.0 aStandard deviation. bSIR = semi-interquartile range. Table 6. VHA professional activity allocation (n = 115) Mean (%) SDa (%) Median (%) SIRb (%) Direct Provision of Assessments 46.9 29.9 50.0 52.5 Training and/or Supervision 14.1 12.4 10.0 15.0 Psychotherapy 13.0 23.7 0.0 15.0 Administrative 11.9 14.2 10.0 15.0 Research 6.7 16.3 0.0 5.0 Cognitive Remediation 2.6 6.8 0.0 2.0 Other 4.7 12.9 0.0 0.0 Mean (%) SDa (%) Median (%) SIRb (%) Direct Provision of Assessments 46.9 29.9 50.0 52.5 Training and/or Supervision 14.1 12.4 10.0 15.0 Psychotherapy 13.0 23.7 0.0 15.0 Administrative 11.9 14.2 10.0 15.0 Research 6.7 16.3 0.0 5.0 Cognitive Remediation 2.6 6.8 0.0 2.0 Other 4.7 12.9 0.0 0.0 aStandard deviation. bSIR = semi-interquartile range. VHA Referral and Place of Assessment Characteristics Of the 123 respondents, 108 provided information on neuropsychological assessment referral sources, while 106 provided information on the VHA setting in which the assessment was provided. As seen in Table 7, the primary source for referrals came from mental health, with a near tie for second place for neurology and other medicine. As seen in Table 8, most neuropsychological assessments were provided within a medical center outpatient setting. Table 7. VHA neuropsychological assessment referral source and worksite top three ranking Rank First Second Third Totala Neuropsychological Assessments Referral Sources (n = 108)  Mental health 30 30 28 88  Neurology 16 28 27 71  Other medicine 23 18 11 52  PM&R 16 8 11 35  Substance abuse 1 3 4 8  VBAb 2 1 1 4  Vocational rehab. 0 0 1 1  Other 19 6 2 27 Settings within which neuropsychological assessments provided (n = 106)  Medical Center Outpatient 77 12 2 91  Medical Center Inpatient 7 40 13 60  VBA C&Pc 2 12 6 20  CBOC/OPCd 10 2 1 13  Domiciliary 1 4 6 11  Telehealth 2 5 4 11  Home Base 3 0 0 3  Veteran Center 0 1 0 1  Other 0 0 1 1 Rank First Second Third Totala Neuropsychological Assessments Referral Sources (n = 108)  Mental health 30 30 28 88  Neurology 16 28 27 71  Other medicine 23 18 11 52  PM&R 16 8 11 35  Substance abuse 1 3 4 8  VBAb 2 1 1 4  Vocational rehab. 0 0 1 1  Other 19 6 2 27 Settings within which neuropsychological assessments provided (n = 106)  Medical Center Outpatient 77 12 2 91  Medical Center Inpatient 7 40 13 60  VBA C&Pc 2 12 6 20  CBOC/OPCd 10 2 1 13  Domiciliary 1 4 6 11  Telehealth 2 5 4 11  Home Base 3 0 0 3  Veteran Center 0 1 0 1  Other 0 0 1 1 aTotal = sum of first, second and third rankings. bVBA = Veterans Benefits Administration. cVBA C&P = VBA Compensation and Pension. dCBOC/OPC = Community Based Outpatient Clinic/Out Patient Center. Table 7. VHA neuropsychological assessment referral source and worksite top three ranking Rank First Second Third Totala Neuropsychological Assessments Referral Sources (n = 108)  Mental health 30 30 28 88  Neurology 16 28 27 71  Other medicine 23 18 11 52  PM&R 16 8 11 35  Substance abuse 1 3 4 8  VBAb 2 1 1 4  Vocational rehab. 0 0 1 1  Other 19 6 2 27 Settings within which neuropsychological assessments provided (n = 106)  Medical Center Outpatient 77 12 2 91  Medical Center Inpatient 7 40 13 60  VBA C&Pc 2 12 6 20  CBOC/OPCd 10 2 1 13  Domiciliary 1 4 6 11  Telehealth 2 5 4 11  Home Base 3 0 0 3  Veteran Center 0 1 0 1  Other 0 0 1 1 Rank First Second Third Totala Neuropsychological Assessments Referral Sources (n = 108)  Mental health 30 30 28 88  Neurology 16 28 27 71  Other medicine 23 18 11 52  PM&R 16 8 11 35  Substance abuse 1 3 4 8  VBAb 2 1 1 4  Vocational rehab. 0 0 1 1  Other 19 6 2 27 Settings within which neuropsychological assessments provided (n = 106)  Medical Center Outpatient 77 12 2 91  Medical Center Inpatient 7 40 13 60  VBA C&Pc 2 12 6 20  CBOC/OPCd 10 2 1 13  Domiciliary 1 4 6 11  Telehealth 2 5 4 11  Home Base 3 0 0 3  Veteran Center 0 1 0 1  Other 0 0 1 1 aTotal = sum of first, second and third rankings. bVBA = Veterans Benefits Administration. cVBA C&P = VBA Compensation and Pension. dCBOC/OPC = Community Based Outpatient Clinic/Out Patient Center. Table 8. VHA neuropsychological assessment practice Mean (SDa) Median (SIRb) Range Assessments Provided Each Month (n = 117)c 10.8 (8.3) 10.0 (12.0) Assessments Supervised Each Month (n = 91)d 6.5 (5.6) 4.5 (5.8) Number of tests used per assessment (n = 123) 13.0 (6.6) 12.0 (8.0) 1/30 Percent of tests that remain the same (n = 123) 69.0 (22.1) 75.0 (35.0) 10/100 Consent (n = 123)  No/implied 9.4%  Verbal 83.9%  Written 6.7% Psychometrician/Technician Used 33.3% Mean (SDa) Median (SIRb) Range Assessments Provided Each Month (n = 117)c 10.8 (8.3) 10.0 (12.0) Assessments Supervised Each Month (n = 91)d 6.5 (5.6) 4.5 (5.8) Number of tests used per assessment (n = 123) 13.0 (6.6) 12.0 (8.0) 1/30 Percent of tests that remain the same (n = 123) 69.0 (22.1) 75.0 (35.0) 10/100 Consent (n = 123)  No/implied 9.4%  Verbal 83.9%  Written 6.7% Psychometrician/Technician Used 33.3% aSD = standard deviation. bSIR = semi-interquartile range. cN = 117, excluded were six respondents who reported no direct provision of assessments. dN = 91, excluded were 32 respondents who reported no supervision of assessments. Table 8. VHA neuropsychological assessment practice Mean (SDa) Median (SIRb) Range Assessments Provided Each Month (n = 117)c 10.8 (8.3) 10.0 (12.0) Assessments Supervised Each Month (n = 91)d 6.5 (5.6) 4.5 (5.8) Number of tests used per assessment (n = 123) 13.0 (6.6) 12.0 (8.0) 1/30 Percent of tests that remain the same (n = 123) 69.0 (22.1) 75.0 (35.0) 10/100 Consent (n = 123)  No/implied 9.4%  Verbal 83.9%  Written 6.7% Psychometrician/Technician Used 33.3% Mean (SDa) Median (SIRb) Range Assessments Provided Each Month (n = 117)c 10.8 (8.3) 10.0 (12.0) Assessments Supervised Each Month (n = 91)d 6.5 (5.6) 4.5 (5.8) Number of tests used per assessment (n = 123) 13.0 (6.6) 12.0 (8.0) 1/30 Percent of tests that remain the same (n = 123) 69.0 (22.1) 75.0 (35.0) 10/100 Consent (n = 123)  No/implied 9.4%  Verbal 83.9%  Written 6.7% Psychometrician/Technician Used 33.3% aSD = standard deviation. bSIR = semi-interquartile range. cN = 117, excluded were six respondents who reported no direct provision of assessments. dN = 91, excluded were 32 respondents who reported no supervision of assessments. VHA Neuropsychological Assessment Characteristics Of the 123 respondents, 117 reported some time allocated to the direct provision of neuropsychological assessments. As seen in Table 8, these 117 direct providers reported providing approximately 10 neuropsychological assessments each month (mean = 10.8; median = 10.0), but with some variation, as seen in the large standard deviation (8.3) and semi-interquartile range (12.0). Of the 123 respondents, 91 reported some time allocated to supervising the provision of neuropsychological assessments. This group of 91 supervisors reported supervising approximately 5–7 assessments each month (mean = 6.5’ median = 4.5), but again with some variation, as seen in the large standard deviation (5.6) and semi-interquartile range (5.8). All respondents (n = 123) reported using from one to thirty tests per assessment, with a mean of 13 (SD = 6.6) and a median of 12.0 (SIR = 8.0). All reported that from 10% to 100% of their assessment batteries remained the same across assessments, with a mean percent of 69 (SD = 22.1) and a median percent of 75 (35.0). Approximately one-third (n = 31) reported using a psychometrician or technician. The vast majority of respondents (83.9%) reported gaining explicit verbal consent, with 6.7% obtaining written consent. Almost 10% of respondents (9.4%) either did not obtain consent or relied on implied consent. VHA Neuropsychological Assessment Expectations As seen in Table 9, almost 20% of all respondents reported that their VHA worksite set a minimum number of assessments each week. This ranged from one to eight assessments, but with an average of approximately 4 (mean = 4.1; median = 4.0). Only seven respondents (5.7%) reported that their VHA worksite set a maximum amount of time per assessment. This ranged from 1 to 12 hr, but with an average of approximately seven and a half hours (mean = 6.7; median = 8.0). Table 9. VHA weekly assessment expectations n % Worksite sets minimum number of assessments 23 18.7% Mean (SDa) Median (SIRb) Range If yes, how many (n = 23) 4.1 (1.7) 4.0 (1.0) 1/8 n % Worksite sets maximum time per assessment 7 5.7% Mean (SDa) Median (SIRb) Range If yes, how long in hours (n = 7) 6.7 (3.5) 8.0 (3.0) 1/12 n % Worksite sets minimum number of assessments 23 18.7% Mean (SDa) Median (SIRb) Range If yes, how many (n = 23) 4.1 (1.7) 4.0 (1.0) 1/8 n % Worksite sets maximum time per assessment 7 5.7% Mean (SDa) Median (SIRb) Range If yes, how long in hours (n = 7) 6.7 (3.5) 8.0 (3.0) 1/12 aSD = standard deviation. bSIR = semi interquartile range. Table 9. VHA weekly assessment expectations n % Worksite sets minimum number of assessments 23 18.7% Mean (SDa) Median (SIRb) Range If yes, how many (n = 23) 4.1 (1.7) 4.0 (1.0) 1/8 n % Worksite sets maximum time per assessment 7 5.7% Mean (SDa) Median (SIRb) Range If yes, how long in hours (n = 7) 6.7 (3.5) 8.0 (3.0) 1/12 n % Worksite sets minimum number of assessments 23 18.7% Mean (SDa) Median (SIRb) Range If yes, how many (n = 23) 4.1 (1.7) 4.0 (1.0) 1/8 n % Worksite sets maximum time per assessment 7 5.7% Mean (SDa) Median (SIRb) Range If yes, how long in hours (n = 7) 6.7 (3.5) 8.0 (3.0) 1/12 aSD = standard deviation. bSIR = semi interquartile range. VHA Neuropsychological Assessment Test Usage Two different strategies, reflected in the last two questions of the survey, were employed to help identify the measures VHA psychologists used when providing neuropsychological assessments. The first strategy captured test instrument usage data by using the reported results of the most recent comprehensive neuropsychological assessment, and limiting this to those respondents who self-identified as direct providers of neuropsychological assessments. This limited the sample pool to 117 of the total 123 respondents. The second strategy captured test instrument usage data by including all test instruments used anytime during the past full month, as reported by the entire pool of 123 respondents. Several rules were employed in calculating test usage frequencies. First, a cutoff of 20% usage was decided upon to control for the large number of tests that were used by a small number of respondents. For example, when asked to identify the instruments used during the last full months, respondents provided at least 215 different instruments. The “at least” reflects the fact that measures such as verbal fluency had multiple names, as discussed below, and were simply listed in this study under the category, “Verbal Fluency (any)”. But of these 215 different instruments, 50% (108) of all instruments were reported used by only one respondent, and 72% of all instruments reported were used by less than 5% of the respondents. One respondent reported using only one of the mental status evaluation variants as an assessment; all other respondents reported using multiple instruments as part of their assessments. Second, variations of a test were combined as a generic measure (a) to help identify similar tasks that were commonly used, and (b) to control for imprecision in reporting. With the former (identification of similar tasks), almost one-third of direct providers reported screening for mental status during their most recent assessment using the Mini Mental Status Exam (MMSE), the Montreal Cognitive Assessment (MOCA), or the Saint Louis University Mental Status Examination (SLUMS). Since no one screen reached the 20% cutoff, only the broad category “Mental Status Exam (MMSE, MOCA, or SLUM)” was listed. However, when all respondents were asked to report on their assessment use during the past full month, almost half of all respondents reported using these instruments, with the MMSE and MOCA now exceeding the 20% cutoff. So the MMSE and MOCA were listed as specific tests (with the frequency of test use) under the broad “Mental Status Exam” category. With the latter (control for imprecision), respondents gave varied names for measures of verbal fluency. These included animal fluency, category fluency, Controlled Oral Word Association (COWA), Delis Kaplan Executive Functioning System (DKEF) verbal fluency, FAS, letter fluency, verbal fluency, and so on. These were combined in one category and reported as “Verbal Fluency (any)”. When specific variants, such as the DKEF Verbal Fluency test reached 20% usage, the specific variants were also reported as a specific test, along with its frequency of test use. Three, different test editions were combined, and reported as such, along with more specific editions, when these reached the 20% usage threshold. For example, respondents reported using various parts of the Wechsler Adult Intelligence Scales (WAIS), including the WAIS-R, WAIS III, WAIS IV, and Wechsler Abbreviated Scale of Intelligence (WASI); these were combined in one “WAIS (any)” broad category. For example, both the Minnesota Multiphasic Personality Inventory2 (MMPI-2) and its Restructured Form (MMPI-RF) were combined under “MMPI (any)”, as well as listed separately, if they reached the 20% cutoff. The Wechsler Adult Reading Test (WTAR) and Wechsler Test of Premorbid Functioning (TOPF) were combined under “Wechsler Reading (WTAR & TOPF),” since the latter is a revision of the former (Holdnack & Drozdick, 2009), and each was listed separately when then reached the 20% cutoff. VHA Most Recent Neuropsychological Assessment Test Usage A sample using the 117 respondents who self-identified as direct providers of neuropsychological assessments were used to identify test usage during the respondent’s most recent comprehensive neuropsychological assessment. As seen in Table 10, 70% or more of the respondents reported using some variant of the “Trails,” with almost 60% reporting a specific use of the Trails A & B task. Almost three quarters used some part of the WAIS IV, with use of the Digit Span subtest specifically reported by 45% of respondents. Approximately 73% of respondents reported using some variant of a verbal fluency task. The remaining instruments were used by less than 50% of the sample of direct providers. Table 10. Tests used by at least 20% of direct providers in the most recent assessment (n = 117)a Instrument Percent Subtest Percent Trails or DKEFSb Trails 80.8  Trails A & B 59.2 Wechsler Adult Intelligence Scale (any)c 78.3 Wechsler Adult Intelligence Scale IV (any)d 74.2  WAIS IV Digit Span 45.0  WAIS IV Coding 25.0  WAIS IV Similarities 21.7  WAIS IV Block Design 20.0 Verbal Fluency (any) 72.5 Boston Naming Test 47.5 Wechsler Memory Scale (any)e 46.7 California Verbal Learning Test II 45.0 Wechsler Memory Scale IV (any) 39.2  WMS 4 Logical Memory 30.8 Wechsler Reading Test (TOPF or WTAR)f 40.0  Wechsler Test of Adult Reading 20.8 Wisconsin Card Sort 39.2 Rey Complex Figure Test 36.7 Stroop (any) or DKEFS Color Word Interference 34.2 Test of Memory Malingering 34.2 Mental Status Exam (MMSE, MOCA, or SLUM)g 32.5 Delis–Kaplan Executive Function System (any) 30.8 Brief Visual Spatial Memory Test 28.3 Geriatric Depression Scale 28.3 Beck Depression Inventory 25.8 Beck Anxiety Inventory 25.0 Clock Drawing (any) 25.0 RBANSh 25.0 Grooved Peg Board 20.8 Instrument Percent Subtest Percent Trails or DKEFSb Trails 80.8  Trails A & B 59.2 Wechsler Adult Intelligence Scale (any)c 78.3 Wechsler Adult Intelligence Scale IV (any)d 74.2  WAIS IV Digit Span 45.0  WAIS IV Coding 25.0  WAIS IV Similarities 21.7  WAIS IV Block Design 20.0 Verbal Fluency (any) 72.5 Boston Naming Test 47.5 Wechsler Memory Scale (any)e 46.7 California Verbal Learning Test II 45.0 Wechsler Memory Scale IV (any) 39.2  WMS 4 Logical Memory 30.8 Wechsler Reading Test (TOPF or WTAR)f 40.0  Wechsler Test of Adult Reading 20.8 Wisconsin Card Sort 39.2 Rey Complex Figure Test 36.7 Stroop (any) or DKEFS Color Word Interference 34.2 Test of Memory Malingering 34.2 Mental Status Exam (MMSE, MOCA, or SLUM)g 32.5 Delis–Kaplan Executive Function System (any) 30.8 Brief Visual Spatial Memory Test 28.3 Geriatric Depression Scale 28.3 Beck Depression Inventory 25.8 Beck Anxiety Inventory 25.0 Clock Drawing (any) 25.0 RBANSh 25.0 Grooved Peg Board 20.8 aN = 117, excluded were six respondents who reported that they were not involved in the direct provision of assessments. bDKEFS = Delis Kaplan Executive Function Delis–Kaplan Executive Function System. cWechsler Adult Intelligence Scale (any) includes all Wechsler Adult Intelligence Scale variants, including the WASI, WAIS-III, and WAIS IV. d(any) means any mention of all of part of the instrument. eWechsler Memory Scale (any) includes all Wechsler Memory Scale variants, including the WMS-R, WMS-III, and WMS-IV. fWTAR = Wechsler Test of Adult Reading; TOPF = Test of Premorbid Functioning. gMMSE, MOCA, or SLUM = Mini Mental Status Exam, Montreal Cognitive Assessment, and Saint Louis University Mental Status Examination, respectively. hRBANS = Repeatable Battery for the Assessment of Neuropsychological Status. Table 10. Tests used by at least 20% of direct providers in the most recent assessment (n = 117)a Instrument Percent Subtest Percent Trails or DKEFSb Trails 80.8  Trails A & B 59.2 Wechsler Adult Intelligence Scale (any)c 78.3 Wechsler Adult Intelligence Scale IV (any)d 74.2  WAIS IV Digit Span 45.0  WAIS IV Coding 25.0  WAIS IV Similarities 21.7  WAIS IV Block Design 20.0 Verbal Fluency (any) 72.5 Boston Naming Test 47.5 Wechsler Memory Scale (any)e 46.7 California Verbal Learning Test II 45.0 Wechsler Memory Scale IV (any) 39.2  WMS 4 Logical Memory 30.8 Wechsler Reading Test (TOPF or WTAR)f 40.0  Wechsler Test of Adult Reading 20.8 Wisconsin Card Sort 39.2 Rey Complex Figure Test 36.7 Stroop (any) or DKEFS Color Word Interference 34.2 Test of Memory Malingering 34.2 Mental Status Exam (MMSE, MOCA, or SLUM)g 32.5 Delis–Kaplan Executive Function System (any) 30.8 Brief Visual Spatial Memory Test 28.3 Geriatric Depression Scale 28.3 Beck Depression Inventory 25.8 Beck Anxiety Inventory 25.0 Clock Drawing (any) 25.0 RBANSh 25.0 Grooved Peg Board 20.8 Instrument Percent Subtest Percent Trails or DKEFSb Trails 80.8  Trails A & B 59.2 Wechsler Adult Intelligence Scale (any)c 78.3 Wechsler Adult Intelligence Scale IV (any)d 74.2  WAIS IV Digit Span 45.0  WAIS IV Coding 25.0  WAIS IV Similarities 21.7  WAIS IV Block Design 20.0 Verbal Fluency (any) 72.5 Boston Naming Test 47.5 Wechsler Memory Scale (any)e 46.7 California Verbal Learning Test II 45.0 Wechsler Memory Scale IV (any) 39.2  WMS 4 Logical Memory 30.8 Wechsler Reading Test (TOPF or WTAR)f 40.0  Wechsler Test of Adult Reading 20.8 Wisconsin Card Sort 39.2 Rey Complex Figure Test 36.7 Stroop (any) or DKEFS Color Word Interference 34.2 Test of Memory Malingering 34.2 Mental Status Exam (MMSE, MOCA, or SLUM)g 32.5 Delis–Kaplan Executive Function System (any) 30.8 Brief Visual Spatial Memory Test 28.3 Geriatric Depression Scale 28.3 Beck Depression Inventory 25.8 Beck Anxiety Inventory 25.0 Clock Drawing (any) 25.0 RBANSh 25.0 Grooved Peg Board 20.8 aN = 117, excluded were six respondents who reported that they were not involved in the direct provision of assessments. bDKEFS = Delis Kaplan Executive Function Delis–Kaplan Executive Function System. cWechsler Adult Intelligence Scale (any) includes all Wechsler Adult Intelligence Scale variants, including the WASI, WAIS-III, and WAIS IV. d(any) means any mention of all of part of the instrument. eWechsler Memory Scale (any) includes all Wechsler Memory Scale variants, including the WMS-R, WMS-III, and WMS-IV. fWTAR = Wechsler Test of Adult Reading; TOPF = Test of Premorbid Functioning. gMMSE, MOCA, or SLUM = Mini Mental Status Exam, Montreal Cognitive Assessment, and Saint Louis University Mental Status Examination, respectively. hRBANS = Repeatable Battery for the Assessment of Neuropsychological Status. VHA Neuropsychological Assessment Test Used During the Last Full Month The entire pool of 123 respondents was used to determine test usage during the most recent full month. As seen in Table 11, the largest number of respondents also reported using the WAIS-IV, Trails (any) and Verbal Fluency (any), with at least three quarters reporting use of each instrument. The California Verbal Learning Test II tied with the Wechsler Memory Scale for next most popular instrument, with approximately 68% of respondents reporting use, with the WAIS IV logical memory subtest specifically reported by 53% of respondents. Also popular, with usage reported by almost two-thirds of respondents, were the Boston Naming Test at 65% and the Repeatable Battery for the Assessment of Neuropsychological Status at almost 64%. Table 11. Tests used by at least 20% of all respondents in the last full month (n = 123) Instrument Percent Subtest percent Wechsler Adult Intelligence Scale (any)a 86.0 Wechsler Adult Intelligence Scale IV (any)b 81.8  WAIS IV Digit Span 43.8  WAIS IV Coding 29.8  WAIS IV Similarities 26.4  WAIS IV Block Design 23.1  WAIS IV Matrix Reasoning 20.7 Trails (any) 81.0 Verbal Fluency (any) 76.9  DKEF Verbal Fluency 25.6 California Verbal Learning Test II 67.8 Wechsler Memory Scale (any)c 67.8 Boston Naming Test 65.3 RBANSd 63.6 Wechsler Memory Scale IV (any) 62.8  WMS IV Logical Memory 52.9 Wisconsin Card Sort (any) 59.5 Rey Complex Figure Test (any) 58.7 Test of Memory Malingering 53.7 Delis–Kaplan Executive Function System (DKEFS) (any) 49.6  DKEF Color Word Interference 30.6  DKEF Verbal Fluency 25.6 Beck Depression Inventory 49.6 Mental Status Exam (MMSE, MOCA, SLUMS) 48.8  Montreal Cognitive Assessment MOCA 26.4  Mini Mental Status Exam (MMSE) 20.7 Wechsler Reading Test (TOPF or WTAR) 47.9  Wechsler Test of Adult Reading (WTAR) 26.4  Test of Premorbid Functioning (TOPF) 23.1 Brief Visual Spatial Memory Test Revised 44.6 Beck Anxiety Inventory 40.5 Minnesota Multiphasic Personality Inventory (any) 39.7  MMPI 2 RF 30.6 Grooved Peg Board 36.4 Clock Drawing (any) 34.7 Stroop or Dkef Color Word Interference (any) 34.7 Neuropsychological Assessment Battery (any) 33.1 PTSD Check List (PCL) (any) 29.8 Dot Counting 28.1 Wide Range Achievement Test (any) 26.4 Judgment of Line Orientation 25.6 Geriatric Depression Scale 25.6 Hopkins Verbal Learning Test 24.8 Dementia Rating Scale 24.8 Independent Living Scales 22.3 Instrument Percent Subtest percent Wechsler Adult Intelligence Scale (any)a 86.0 Wechsler Adult Intelligence Scale IV (any)b 81.8  WAIS IV Digit Span 43.8  WAIS IV Coding 29.8  WAIS IV Similarities 26.4  WAIS IV Block Design 23.1  WAIS IV Matrix Reasoning 20.7 Trails (any) 81.0 Verbal Fluency (any) 76.9  DKEF Verbal Fluency 25.6 California Verbal Learning Test II 67.8 Wechsler Memory Scale (any)c 67.8 Boston Naming Test 65.3 RBANSd 63.6 Wechsler Memory Scale IV (any) 62.8  WMS IV Logical Memory 52.9 Wisconsin Card Sort (any) 59.5 Rey Complex Figure Test (any) 58.7 Test of Memory Malingering 53.7 Delis–Kaplan Executive Function System (DKEFS) (any) 49.6  DKEF Color Word Interference 30.6  DKEF Verbal Fluency 25.6 Beck Depression Inventory 49.6 Mental Status Exam (MMSE, MOCA, SLUMS) 48.8  Montreal Cognitive Assessment MOCA 26.4  Mini Mental Status Exam (MMSE) 20.7 Wechsler Reading Test (TOPF or WTAR) 47.9  Wechsler Test of Adult Reading (WTAR) 26.4  Test of Premorbid Functioning (TOPF) 23.1 Brief Visual Spatial Memory Test Revised 44.6 Beck Anxiety Inventory 40.5 Minnesota Multiphasic Personality Inventory (any) 39.7  MMPI 2 RF 30.6 Grooved Peg Board 36.4 Clock Drawing (any) 34.7 Stroop or Dkef Color Word Interference (any) 34.7 Neuropsychological Assessment Battery (any) 33.1 PTSD Check List (PCL) (any) 29.8 Dot Counting 28.1 Wide Range Achievement Test (any) 26.4 Judgment of Line Orientation 25.6 Geriatric Depression Scale 25.6 Hopkins Verbal Learning Test 24.8 Dementia Rating Scale 24.8 Independent Living Scales 22.3 aWechsler Adult Intelligence Scale (any) includes all Wechsler Adult Intelligence Scale variants, including the WASI, WAIS-III, and WAIS IV. b“Any” includes any reported use of the instrument or part of the instrument. cWechsler Memory Scale (any) includes all Wechsler Memory Scale variants, including the WMS-R, WMS-III, and WMS-IV. dRBANS = Repeatable Battery for the Assessment of Neuropsychological Status. Table 11. Tests used by at least 20% of all respondents in the last full month (n = 123) Instrument Percent Subtest percent Wechsler Adult Intelligence Scale (any)a 86.0 Wechsler Adult Intelligence Scale IV (any)b 81.8  WAIS IV Digit Span 43.8  WAIS IV Coding 29.8  WAIS IV Similarities 26.4  WAIS IV Block Design 23.1  WAIS IV Matrix Reasoning 20.7 Trails (any) 81.0 Verbal Fluency (any) 76.9  DKEF Verbal Fluency 25.6 California Verbal Learning Test II 67.8 Wechsler Memory Scale (any)c 67.8 Boston Naming Test 65.3 RBANSd 63.6 Wechsler Memory Scale IV (any) 62.8  WMS IV Logical Memory 52.9 Wisconsin Card Sort (any) 59.5 Rey Complex Figure Test (any) 58.7 Test of Memory Malingering 53.7 Delis–Kaplan Executive Function System (DKEFS) (any) 49.6  DKEF Color Word Interference 30.6  DKEF Verbal Fluency 25.6 Beck Depression Inventory 49.6 Mental Status Exam (MMSE, MOCA, SLUMS) 48.8  Montreal Cognitive Assessment MOCA 26.4  Mini Mental Status Exam (MMSE) 20.7 Wechsler Reading Test (TOPF or WTAR) 47.9  Wechsler Test of Adult Reading (WTAR) 26.4  Test of Premorbid Functioning (TOPF) 23.1 Brief Visual Spatial Memory Test Revised 44.6 Beck Anxiety Inventory 40.5 Minnesota Multiphasic Personality Inventory (any) 39.7  MMPI 2 RF 30.6 Grooved Peg Board 36.4 Clock Drawing (any) 34.7 Stroop or Dkef Color Word Interference (any) 34.7 Neuropsychological Assessment Battery (any) 33.1 PTSD Check List (PCL) (any) 29.8 Dot Counting 28.1 Wide Range Achievement Test (any) 26.4 Judgment of Line Orientation 25.6 Geriatric Depression Scale 25.6 Hopkins Verbal Learning Test 24.8 Dementia Rating Scale 24.8 Independent Living Scales 22.3 Instrument Percent Subtest percent Wechsler Adult Intelligence Scale (any)a 86.0 Wechsler Adult Intelligence Scale IV (any)b 81.8  WAIS IV Digit Span 43.8  WAIS IV Coding 29.8  WAIS IV Similarities 26.4  WAIS IV Block Design 23.1  WAIS IV Matrix Reasoning 20.7 Trails (any) 81.0 Verbal Fluency (any) 76.9  DKEF Verbal Fluency 25.6 California Verbal Learning Test II 67.8 Wechsler Memory Scale (any)c 67.8 Boston Naming Test 65.3 RBANSd 63.6 Wechsler Memory Scale IV (any) 62.8  WMS IV Logical Memory 52.9 Wisconsin Card Sort (any) 59.5 Rey Complex Figure Test (any) 58.7 Test of Memory Malingering 53.7 Delis–Kaplan Executive Function System (DKEFS) (any) 49.6  DKEF Color Word Interference 30.6  DKEF Verbal Fluency 25.6 Beck Depression Inventory 49.6 Mental Status Exam (MMSE, MOCA, SLUMS) 48.8  Montreal Cognitive Assessment MOCA 26.4  Mini Mental Status Exam (MMSE) 20.7 Wechsler Reading Test (TOPF or WTAR) 47.9  Wechsler Test of Adult Reading (WTAR) 26.4  Test of Premorbid Functioning (TOPF) 23.1 Brief Visual Spatial Memory Test Revised 44.6 Beck Anxiety Inventory 40.5 Minnesota Multiphasic Personality Inventory (any) 39.7  MMPI 2 RF 30.6 Grooved Peg Board 36.4 Clock Drawing (any) 34.7 Stroop or Dkef Color Word Interference (any) 34.7 Neuropsychological Assessment Battery (any) 33.1 PTSD Check List (PCL) (any) 29.8 Dot Counting 28.1 Wide Range Achievement Test (any) 26.4 Judgment of Line Orientation 25.6 Geriatric Depression Scale 25.6 Hopkins Verbal Learning Test 24.8 Dementia Rating Scale 24.8 Independent Living Scales 22.3 aWechsler Adult Intelligence Scale (any) includes all Wechsler Adult Intelligence Scale variants, including the WASI, WAIS-III, and WAIS IV. b“Any” includes any reported use of the instrument or part of the instrument. cWechsler Memory Scale (any) includes all Wechsler Memory Scale variants, including the WMS-R, WMS-III, and WMS-IV. dRBANS = Repeatable Battery for the Assessment of Neuropsychological Status. Discussion This pilot survey is the first survey of VHA psychologists who provide neuropsychological assessments within Department of Veterans Affairs settings. As such, it provides information on the professional characteristics of VHA psychologists, and on their assessment practices. Since the Department of Veterans Affairs is one of the largest employers of psychologists (Goldstein, 2010), it may also provide useful information on the practice of neuropsychological assessment in the United States. For the most part, the survey results are simple and straightforward. The meaning of most of the data is self-explanatory, requiring no further interpretation or discussion. Instead of providing an explanation of the already obvious, a select discussion and analysis follows, along with comments on limitations of this study and suggestions for future research. Select Discussion The most surprising finding was the discovery of the large number of non-neuropsychologists performing neuropsychological assessments within VHA settings. Approximately one-third (31%) of all respondents did not have any current or prior post-doctoral training in neuropsychology, and one-fifth did not identity as a neuropsychologist. With the increase in the number of APA approved specialties in professional psychology that now purport to provide the graduate with competence in neuropsychological assessment, the proportion of non-neuropsychologists providing neuropsychological assessments may increase. This is all the more likely given the number of APA approved post-doctoral programs providing shorter and more flexible routes to competency. As Russo (in press) recently noted, what is remarkable about these new models is that competence in neuropsychological assessment can “now be acquired without the rigorous foundation in the neurosciences articulated in the Houston Conference, and in half the time required of a neuropsychology fellowship.” A second notable finding is the move away from the standard neuropsychological battery approach represented by the Halstead-Reitan Neuropsychological Battery (HRNB) and the Luria-Nebraska Neuropsychological Battery (LNNB). When Hartlage and Telzrow (1980) first surveyed test usage among neuropsychologists in 1980, both instruments ranked in the top seven most popular instruments used. Twenty-five years later, when Rabin et al. (2005) asked clinical neuropsychologists to list their three most frequently used assessment instruments, the HRB ranked sixth and the LNNB tied for 16th place. Combined, the HRB/LNNB ranked third, only surpassed in popularity by the Wechsler Adult Intelligence Scales and Wechsler Memory Scales, which ranked first and second, respectively. In the current survey, no respondent reported using these batteries en totum, although the Trails A & B test continues to be popular. A third finding was the absence of auditory processing measures. While respondents reported using instruments that assessed several aspects of cognitive functioning, such as memory, reasoning, visual spatial functioning, and so on, the percent of respondents using an instrument that assessed any aspect of auditory processing was less than 5%. This was all the more remarkable, given that tinnitus and hearing loss are the most prevalent service-connected (SC) disabilities (Veteran Benefits Administration, 2017). Survey Limitations and Recommendations The response rate was impossible to determine, since the number of VHA psychologists providing or supervising neuropsychological assessments within VHA settings is unknown. However, using either the 387 number Young et al. (2016) identified as the number of likely practicing VHA neuropsychologists or the 324 members of the AVAPL neuropsych listserv leaves a response rate of less than 40%. This raised the question of whether this survey of 123 was truly representative of all the VHA psychologists who provide or supervise neuropsychological assessments. As Draugalis and Plaza (2009) caution, when response rates drop below 50%, “those who responded have a greater chance of being self-selected (i.e., there is something inherently different about those who responded and those who did not respond), and thus not representative of the target population” (pp. 1–3). This survey relied on the self-reports of respondents who identified as VHA psychologists to report in hindsight the tests they used on their last comprehensive assessment and the tests they used during the last full month. As such, the accuracy of the results depended directly on the precision and accuracy respondents employed. Many respondents provided detailed accounts of every instrument, with anecdotal information on the norms used and deviations from standard administration when this occurred. Others reported only the battery used, with some giving ambiguous or vague initials to identify tests. Lees-Haley, Smith, Williams, and Dunn (1996) employed a different survey strategy in which they surveyed a sample of actual tests used to prevent such possible errors. Specifically, they examined 100 forensic neuropsychological evaluations, and tabulated test usage based on actual tests cited in the evaluations. Future surveys might compliment the self-report type survey used in this study, with a focused survey methodology in which actual neuropsychological assessments conducted within a select time period (e.g., all assessments completed with the second quarter) and select location (e.g., VA medical center or VISN) are examined to determine actual test usage. Similar focused research conducted across several MA medical centers or VISNs could then be pooled to arrive at an approximation of actual test usage based on examined assessments. Finally, this is the first known survey of VHA psychologists and the first survey conducted within the past forty years which did not limit itself to psychologists who self-identified as neuropsychologists. By doing so, this survey identified a significant proportion of non-neuropsychologists as providers and/or supervisors of neuropsychological assessments. Future research should make every effort to include all VHA psychologists in order to arrive at the best understanding of who is providing neuropsychological assessments in VHA settings and of what these assessments consist. Acknowledgements This paper is the result of work supported in part with resources and the use of facilities at the Department of Veterans Affairs New York Harbor Healthcare System; as such it is in the public domain. Contents do not necessarily reflect the views of the Department of Veterans Affairs or U.S. Government. Conflict of interest None declared. References Baker , G. , & Peatman , J. ( 1947 ). Tests used in Veterans Administration advisement units . The American Psychologist , 2 , 99 – 102 . Google Scholar CrossRef Search ADS PubMed Butler , M. , Retzlaff , P. , & Vanderploeg , R. ( 1991 ). Neuropsychological test usage . Professional Psychology: Research and Practice , 22 , 510 – 512 . 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The American Academy of Clinical Neuropsychology, National Academy of Neuropsychology, and Society for Clinical Neuropsychology (APA Division 40) 2015 TCN Professional Practice and ‘Salary Survey’: Professional Practices, Beliefs, and Incomes of U.S. Neuropsychologists . The Clinical Neuropsychologist , 29 , 1069 – 1162 . Google Scholar CrossRef Search ADS PubMed Sweet , J. , & Moberg , P. ( 1990 ). A survey of practices and beliefs among ABPP and non-ABPP clinical neuropsychologists . The Clinical Neuropsychologist , 4 , 101 – 120 . Google Scholar CrossRef Search ADS Sweet , J. , Moberg , P. , & Westergaard , C. ( 1996 ). Five-year follow-up survey of practices and beliefs of clinical neuropsychologists . The Clinical Neuropsychologist , 10 , 202 – 221 . Google Scholar CrossRef Search ADS Sweet , J. , Peck , E. , Abramowitz , C. , & Etzweiler , S. ( 2002 ). 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Google Scholar CrossRef Search ADS PubMed Appendix Dear colleague, Thank you for participating in this survey Professional psychological practice within the Department of Veterans Affairs has grown in recent years but little is known of about the assessment practices of VA psychologists who provide neuropsychological assessments within VA settings. This survey is designed to address that lack by capturing information on the assessment practices of psychologists who conduct neuropsychological assessments as they are actually provided within Department of Veterans Affair settings. This study has IRB approval. If you are a VA psychologist and provide or supervise neuropsychological assessments, would you take a few minutes to complete this survey? Please be assured that no personal identifying information will be collected or entered into the survey database, and please do not include any personal identifying information below. The results of this survey will be peer reviewed, published, and available online at no cost. Thank you again for your participation. Arthur Christopher Russo, MS, PhD. Clinical and Neuropsychologist VANY Harbor Healthcare System – Brooklyn Campus Arthur.Russo@va.gov 718-836-6600 ext. 6471 Please note: This survey is limited to psychologists who provide or supervise neuropsychological assessments within VA settings. If your work does not include neuropsychological assessment, then this survey would not apply to you. Still, I thank you for your interest. Please email your completed form to Arthur.Russo@va.gov. Please put “professional practice survey” in the email subject line. I prefer you email your survey, but you can also mail the completed survey to: Attention: Arthur Russo, PhD. Brooklyn VA Medical Center Psychology Department 800 Poly Place Brooklyn, New York 11209 Demographic Questions 1. Age [ ] 20 to 29        [ ] 30 to 39        [ ] 40 to 49 [ ] 50 to 59        [ ] 60 to 69        [ ] 70 or older 2. Gender:    [ ] female            [ ] male 3. Highest Psychology Degree [ ] Ed.D.            [ ] PhD. [ ] Psy.D.            [ ] Other (please specify) __________________________ 4. Within which field of psychology was you doctoral degree awarded? [ ] Clinical psychology    [ ] Counseling psychology [ ] Neuropsychology    [ ] Other (please specify) _________________________ 5a. Have you completed a post-doctoral program in neuropsychology? [ ] No            [ ] Yes 5b. if no to 5a, have you completed a post-doctoral program in another specialty? [ ] No            [ ] Yes, if yes, in what specialty: ________________________ 6. Are you currently a postdoctoral resident or fellow? [ ] No            [ ] Yes, if yes, in what specialty: _________________________ 7. Are you currently licensed to practice psychology?    [ ] No        [ ] Yes 8. How many years have you been practicing as a psychologists post license (include years practicing both within and outside a VA setting)? [ ] 0 to 5            [ ] 6 to 10 [ ] 11 to 15            [ ] 16 to 20 [ ] 21 to 25            [ ] more than 25 9. Are you board certified in clinical neuropsychology? [ ] No        [ ] ABPP        [ ] Other (please specify): ___________________ 9b. if no to 9a, are you board certified in another specialty? [ ] No            [ ] Other (please specify): _________________________ The following questions pertain to your work providing neuropsychological assessments within Department of Veterans Affairs settings. Please limit your responses to work that you actually provide as a psychologist while working within a VA setting. 10. Within which area of the country is your primary VA work site for providing VA neuropsychological assessments? [ ]    North Atlantic, Connecticut, Delaware, District of Colombia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia [ ]    Southeast Alabama, Florida, Georgia, Kentucky, Puerto Rico, South Carolina, Tennessee, Virgin Islands [ ]    Midwest Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Montana, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin [ ]    Continental Arkansas, Colorado, Louisiana, Mississippi, Oklahoma, Texas, Utah, Wyoming [ ]    Pacific Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Nevada, New Mexico, Oregon, Philippine Island, Washington 11. Is your primary VA work site in the state in which you hold a license to practice as a psychologist? [ ] No        [ ] Yes        [ ] n/a – not licensed 12. For VA professional activities only, what percentage of time to you devote to the following specific professional activities (please check that these add up to 100%). [ ] Direct provision of neuropsychological assessments [ ] Rehabilitation or Cognitive Remediation of Cognitive/Neuropsychological Problems [ ] Psychotherapy [ ] Research [ ] Training (teaching and supervision) [ ] Administrative [ ] Other, please specify: _________________________ 13. Do you have VA hospital privileges to practice as a psychologist? [ ] No            [ ] Yes 14. Do you have VA hospital specialist privileges to practice as a neuropsychologist? [ ] No            [ ] Yes 15. Within the VA, with which specialty/specialties do you identify yourself, professionally? [ ] clinical psychologist    [ ] neuropsychologist [ ] geropsychologist        [ ] other (please specify): _________________________ 16. Please rank the top three VA work settings within which you provide neuropsychological assessments. [ ] VA medical center inpatient setting [ ] VA medical center day hospital setting [ ] VA medical center outpatient setting [ ] VA domiciliary setting [ ] VA community outpatient setting (CBOC &OPC) [ ] VA Home Based setting [ ] VA telehealth [ ] VBA C&P evaluations [ ] Veteran Center [ ] Other, please specify: _________________________ 17. Please rank the top three referral sources for your VA neuropsychological assessments [ ] Mental Health [ ] Substance Abuse [ ] Neurology [ ] Physical Medicine and Rehabilitation [ ] Other Medicine [ ] Veteran Benefits Administration (C&P) [ ] Vocational Rehab and Training [ ] Other, please specify: _________________________ 18. Within the past month, did you use a technician or psychometrician to collect assessment data? [ ] No            [ ] Yes 19. On average, how many neuropsychological assessments do you provide each month? 20. On average, how many neuropsychological assessments do you supervise others’ providing each month? 21. Does your VA worksite set a minimum number of neuropsychological assessments that you are required to do each week, and if so, how many? [ ] No set minimum        [ ] Yes, if yes, how many: _________________________ 22. Does your VA worksite allocate a maximum amount of time for each neuropsychological assessment, and if so, up to how many hours are allowed? [ ] No set maximum    [ ] Yes, if yes, how much time: _________________________ 23. For the past month, with what percent of neuropsychological assessments did you include (percents should equal 100%) [ ] No consent [ ] Implied consent in which it was assumed patients knew why they were being assessed and who would have access to the report [ ] Explicit verbal consent in which patients were told why they were being assessed, and who would have access to the repot [ ] Written consent in which patients were told in writing why they were being assessed, and who would have access to the repot 24. On average, during the past month, how many tests or subtests did you tend to use per neuropsychological assessment? 25. During the past month, what percent of test instruments did you tend to use for every assessment; in other words, how many tests remained the same across assessments compared to total number of instruments used? 26. What is your primary philosophical approach towards tests selection? [ ] Few if any tests provided in common across assessments; [ ] A core group of tests that tend to be the same, supplemented by other tests; [ ] Routine groupings of tests for different types of patients that tend to be the same, supplemented by other tests; [ ] Most or all tests remaining the same across batteries, with a few additions as needed; [ ] Other; please specify: _________________________ The next two questions are designed to determine exactly what measures VA psychologists use when doing a neuropsychological assessment. Since there are many hundreds of tests, with several batteries comprised of numerous tests and subtests, please write in the actual tests and parts of tests you use. Please be as specific as possible. Some batteries include several tests, and some tests include several parts, all or only some of which may be administered. Please list only those parts you actually use. For example, if you administered the WAIS digit span forwards and digit span backwards, but not the digit span sequence, please note this. If you use all parts of a subtest or test, simply say “all”. 27. Please list the test instruments you administered in your most recent comprehensive assessment. 28. Please list the test instruments you have used in the assessments you have conducted during the most recent past full month. Thank you for your participation. Please email your completed form to Arthur.Russo@va.gov. Also, please put “professional practice survey” in the email subject line. Published by Oxford University Press 2018. This work is written by (a) US Government employee(s) and is in the public domain in the US. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Clinical Neuropsychology Oxford University Press

A Practitioner Survey of Department of Veterans Affairs Psychologists who Provide Neuropsychological Assessments

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Oxford University Press
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Published by Oxford University Press 2018. This work is written by (a) US Government employee(s) and is in the public domain in the US.
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0887-6177
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1873-5843
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10.1093/arclin/acx139
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Abstract

Abstract Objective The provision of neuropsychological assessments is an important part of the assessment and treatment of our veterans, yet little is known regarding who provides these assessments within Veterans Health Administration (VHA) settings, and of what they consist. The current survey provides information regarding the professional characteristics and assessment practices of VHA psychologists who provide neuropsychological assessments within VHA settings. Methods Survey invitations were emailed to 4740 psychologists who worked for the VHA, resulting in surveys from 123 VHA psychologists who self-identified as providing and/or supervising neuropsychological assessments within VHA settings. Results One hundred and twenty-three VHA doctoral level psychologists provided information regarding professional characteristics, such as demographic, training, and exerience, as well as assessment practices, such as number and types of assessment instruments used. Conclusions This professional practice survey is the first survey of VHA psytchologists who provide neuropsychological assessments within VHA settings. As such, it provides baseline information which will aid in assesment and treatment provision, policy developement, and allow future surveys to assess changes in neuropsychological assessment practices over time. Veterans, Professional practice, Neuropsychology assessment Introduction Since the 1980s, survey research has examined various aspects of neuropsychological assessment. As Rabin, Barr and Burton (2005) noted in their excellent review, Hartlage and Telzrow (1980) “conducted the first published study to directly address assessment issues in the field of neuropsychology” (p. 35). Since then, several surveys have documented changes in neuropsychology and neuropsychological assessment in terms of both practitioner characteristics, such as demographic, training and experience variables, and practitioner practices, such as test usage (see, for example, Butler, Retzlaff, & Vanderploeg, 1991; Camara, Nathan, & Puente, 2000; Guilmette, Faust, Hart, & Arkes, 1990; Putnam & DeLuca, 1990; Rabin et al., 2005; Seretny, Dean, Gray, & Hartlage, 1986; Sweet & Moberg, 1990; Sweet, Benson, Nelson, & Moberg, 2015; Sweet, Moberg, & Westergaard, 1996; Sweet, Peck, Abramowitz, & Etzweiler, 2002). However, these surveys have limited usefulness for understanding the practitioner characteristics and practices of Veteran Health Administration (VHA) psychologists who provide neuropsychological assessments within Department of Veterans Affairs (DVA) clinical settings. Existing surveys have been based on respondents who identified professionally as clinical neuropsychologists, with survey samples taken from professional neuropsychology societies, such as the American Academy of Clinical Neuropsychology, Division 40 of the American Psychological Association (APA), the International Neuropsychological Society, and the National Academy of Neuropsychology (see, for example, Camara et al., 2000; Rabin et al., 2005; Seretny et al., 1986; Sweet et al., 2015). Existing surveys do not reflect the fact that both APA and DVA policies and practices allow psychologists, other than those trained as neuropsychologists, to provide neuropsychological assessments. Regarding the former, Russo (in press) recently noted that with at least three APA recognized specialties in professional psychology, Professional Geropsychology, Clinical Neuropsychology, and Rehabilitation Psychology, “completion of the specialty purports to provide the post-doctoral fellow with competence in neuropsychological assessment with adults, despite marked differences in training models, time required for training and supervised practice in neuropsychological assessment.” Because of this, “the long-standing standard offered by Clinical Neuropsychology now competes with the markedly different standards for appropriate education and training offered by other specialties” (Russo, in press). Regarding the latter, the DVA has no national policy governing neuropsychology or neuropsychological assessment. VHA psychologists demonstrate competence by meeting the requirements for psychologists set by Public Law 96–151, and codified in Title 38U.S.C. §7402. According to VHA Handbook 5005/87 (Department of Veterans Affairs, 2016), even entry level psychologists may “conduct psychological or neuropsychological assessments” (p. II-G18-4). At the author’s VA medical center, for example, a review of all 2017 second quarter’s assessment referrals finds that the majority of all neuropsychological assessment referrals, including veterans age 30 and older, were given to fellows in the medical center’s one year geropsychology fellowship program. A review of the literature found few recent studies which examined the professional characteristics and practices of VHA psychologists who conduct neuropsychological assessments within VHA settings. Early studies addressed the adjustment and vocational issues of WWII veterans, during a time when the Army Alpha and Bellevue Wechsler tests were popular assessment instruments (see for example, Baker & Peatman, 1947), and few providers had doctoral level education (Darley & Marquis, 1946). In a recent survey, Young, Roper, and Arentsen (2016) examined the symptom validity practices of VHA clinicians who identified professionally as neuropsychologists. As they noted, participants tended to belong to at least two professional neuropsychology organizations, such as the International Neuropsychological Society, Division 40 of the American Psychological Association, or the National Association of Neuropsychology. Their study did report on select provider characteristics and practices, but the primary focus was “to establish base rate estimates for SPVT [symptom and performance validity test] failure across several VA assessment contexts and determine whether particular referral conditions had higher incidence of non-credible performance” (p. 5). The purpose of this survey is to identify the professional characteristics and assessment practices of VHA psychologists who provide neuropsychological assessments within VHA clinical settings. This study was approved by the Veterans Affairs New York Healthcare System’s Institutional Review Board. Method Survey Measure Survey development began in early 2017, and consisted of reviewing the major surveys of neuropsychologists, starting with the Hartlage and Telzrow (1980) survey. These included Butler et al. (1991), Camara et al. (2000), Guilmette et al. (1990), Putnam and DeLuca (1990), Rabin et al. (2005), Seretny et al. (1986), Sweet and Moberg (1990), Sweet et al. (1996), Sweet et al. (2015), Sweet et al. (2002), and Young et al. (2016). Where possible, common demographic, educational, training, work and practice elements were identified to allow for cross survey comparisons, with the final survey of 28 questions created following institutional review and approval. See the Appendix for the complete survey and cover text. Subjects Possible subjects were identified via two e-mail efforts conducted in July of 2017. Since all doctoral level psychologists hired by the Department of Veterans Affairs have government Microsoft Outlook e-mail accounts, the first effort consisted of identifying possible subjects via an advanced search of the Outlook email address book, using variations of the term “psychology” and “psychologist” (for example, clinical health psychologist, clinical psychologist, counseling psychologist, full time psychologist, geropsychologist, graduate psychologist, neuropsychologist, neurorehabilitation psychologist, police psychologist, psychologist, psychology fellow, psychology resident, staff psychologist, supervisory psychologist, etc.). This first effort resulted in the survey being emailed to approximately 4740 recipients. The number is an approximation because the email system noted that a very small number of emails could not be delivered. The second effort consisted of an email to 324 recipients via the Association of VA Psychologist Leaders’ AVAPL neuropsych listserv. Since this listserv is open to all VHA psychologists with an interest in neuropsychology and/or neuropsychological assessment, this mailing provided a second email to select VHA psychologists. Survey collection stopped September 1, 2017; at that time three weeks had elapsed during which no additional surveys had been received. By September, 127 surveys were returned and examined for usability. Four were rejected, resulting in a survey sample size of 123. Of the four rejected surveys, two were from respondents who neither conducted nor supervised neuropsychological assessments, one survey was largely incomplete, and one was from a bachelor’s level externship student. This survey sample consists of 123 VHA doctoral level psychologists who self-identified as providing neuropsychological assessments and/or supervising others who provide neuropsychological assessments to veterans within VHA settings. Because the number of VHA psychologists conducting neuropsychological assessments is unknown, it was not possible to calculate a precise response rate. In their 2016 survey, Young et al. (2016, p. 5) identified 387 VHA psychologists who were “likely practicing neuropsychology in at least a part-time capacity.” Using the Young et al. (2016) estimate would give a response rate of 32%. Dr Brian Shenal kindly informed me (personal communication, August 2, 2017) that at the time of this survey there were 324 members on the AVAPL neuropsych listserv; using that number which would give a response rate of 38%. Results Demographic Characteristics As seen in Table 1, 69% of all respondents were female, with 67% of all respondents between the ages of 30 and 49. Females between the ages of 30 and 49 made up the majority of respondents (52%). Table 1. Demographic information: age and sex of respondents Age (years) Female Male Total 20–29 2 0 2 30–39 42 11 53 40–49 22 8 30 50–59 13 10 23 60 and older 6 9 14 Total 85 38 123 Age (years) Female Male Total 20–29 2 0 2 30–39 42 11 53 40–49 22 8 30 50–59 13 10 23 60 and older 6 9 14 Total 85 38 123 Table 1. Demographic information: age and sex of respondents Age (years) Female Male Total 20–29 2 0 2 30–39 42 11 53 40–49 22 8 30 50–59 13 10 23 60 and older 6 9 14 Total 85 38 123 Age (years) Female Male Total 20–29 2 0 2 30–39 42 11 53 40–49 22 8 30 50–59 13 10 23 60 and older 6 9 14 Total 85 38 123 Educational Characteristics As seen in Table 2, 81% completed a doctoral program in clinical psychology. Included in this, were three respondents who reported completing a program in clinical psychology with an emphasis on neuropsychology. Seventy-one percent of all respondents completed a PhD program. Table 2. Education of respondents Doctoral Program  Major PhD PsyD Total  Clinical 66 34 100  Counseling 13 0 13  Neuropsychologya 8 2 10  Total 87 36 123 Doctoral Program  Major PhD PsyD Total  Clinical 66 34 100  Counseling 13 0 13  Neuropsychologya 8 2 10  Total 87 36 123 aNeuropsychology was only counted if it was reported as a program separate from Clinical Psychology. The Neuropsychology category included two respondents with a PhD in Physiological Psychology. Table 2. Education of respondents Doctoral Program  Major PhD PsyD Total  Clinical 66 34 100  Counseling 13 0 13  Neuropsychologya 8 2 10  Total 87 36 123 Doctoral Program  Major PhD PsyD Total  Clinical 66 34 100  Counseling 13 0 13  Neuropsychologya 8 2 10  Total 87 36 123 aNeuropsychology was only counted if it was reported as a program separate from Clinical Psychology. The Neuropsychology category included two respondents with a PhD in Physiological Psychology. Professional Characteristics The majority of respondents (59%) had 10 or fewer years post-license experience, with 31% having 5 years or less experience and 5% were not yet licensed, as seen in Table 3. Approximately 83% of all respondents had completed or were enrolled in a program of post-doctoral training in psychology. Approximately two-thirds (69%) had completed or were currently enrolled in a post-doctoral program in neuropsychology, and 27% were board certified in neuropsychology. Table 3. Professional characteristics of respondents Years of practice post-license n % Not licensed 6 4.9 0–5 38 30.9 6–10 29 23.6 11–15 15 12.2 16–20 14 11.4 21–25 10 8.1 More than 25 11 8.9 Post-doctoral Program Completed Current Neuropsychology 83 2 Geropsychologya 6 0 Rehabilitation Psychologya 3 1 Othera 7 0 Board Certified n % Neuropsychology 29 27.0 Geropsychologyb 2 1.6 Rehabilitation Psychologyb 2 1.6 Otherb 4 3.5 Years of practice post-license n % Not licensed 6 4.9 0–5 38 30.9 6–10 29 23.6 11–15 15 12.2 16–20 14 11.4 21–25 10 8.1 More than 25 11 8.9 Post-doctoral Program Completed Current Neuropsychology 83 2 Geropsychologya 6 0 Rehabilitation Psychologya 3 1 Othera 7 0 Board Certified n % Neuropsychology 29 27.0 Geropsychologyb 2 1.6 Rehabilitation Psychologyb 2 1.6 Otherb 4 3.5 aOnly includes respondents who did not complete a neuropsychology post-doctoral program. bOnly includes respondents who did not attain board certification in neuropsychology. Table 3. Professional characteristics of respondents Years of practice post-license n % Not licensed 6 4.9 0–5 38 30.9 6–10 29 23.6 11–15 15 12.2 16–20 14 11.4 21–25 10 8.1 More than 25 11 8.9 Post-doctoral Program Completed Current Neuropsychology 83 2 Geropsychologya 6 0 Rehabilitation Psychologya 3 1 Othera 7 0 Board Certified n % Neuropsychology 29 27.0 Geropsychologyb 2 1.6 Rehabilitation Psychologyb 2 1.6 Otherb 4 3.5 Years of practice post-license n % Not licensed 6 4.9 0–5 38 30.9 6–10 29 23.6 11–15 15 12.2 16–20 14 11.4 21–25 10 8.1 More than 25 11 8.9 Post-doctoral Program Completed Current Neuropsychology 83 2 Geropsychologya 6 0 Rehabilitation Psychologya 3 1 Othera 7 0 Board Certified n % Neuropsychology 29 27.0 Geropsychologyb 2 1.6 Rehabilitation Psychologyb 2 1.6 Otherb 4 3.5 aOnly includes respondents who did not complete a neuropsychology post-doctoral program. bOnly includes respondents who did not attain board certification in neuropsychology. VHA Professional Identity Characteristics As seen in Table 4, there was a fair representation of VHA psychologists from across the United States and its territories. Approximately 69% of respondents were licensed in the same state in which they identified their primary VHA worksite, with just over a quarter reporting that they were licensed in a state different from their primary VHA worksite. Table 4. VHA worksite of respondents Primary VHA worksite In State Licensea Out of State Licenseb Not licensed Total Continental 8 6 1 15 Midwest 13 9 1 23 North Atlantic 18 4 2 24 Pacific 23 4 1 28 Southeast 23 9 1 33 Total 85 32 6 123 Primary VHA worksite In State Licensea Out of State Licenseb Not licensed Total Continental 8 6 1 15 Midwest 13 9 1 23 North Atlantic 18 4 2 24 Pacific 23 4 1 28 Southeast 23 9 1 33 Total 85 32 6 123 aIn State License means respondents reported being licensed in the same state as their primary VHA worksite. bOut of State License means respondents reported being licensed in a different state from that of their primary VHA worksite. Table 4. VHA worksite of respondents Primary VHA worksite In State Licensea Out of State Licenseb Not licensed Total Continental 8 6 1 15 Midwest 13 9 1 23 North Atlantic 18 4 2 24 Pacific 23 4 1 28 Southeast 23 9 1 33 Total 85 32 6 123 Primary VHA worksite In State Licensea Out of State Licenseb Not licensed Total Continental 8 6 1 15 Midwest 13 9 1 23 North Atlantic 18 4 2 24 Pacific 23 4 1 28 Southeast 23 9 1 33 Total 85 32 6 123 aIn State License means respondents reported being licensed in the same state as their primary VHA worksite. bOut of State License means respondents reported being licensed in a different state from that of their primary VHA worksite. Table 5 summarizes respondents’ professional self-identities within the VHA. Please note that psychologists who identified themselves as either clinical or counseling psychologists were reported as such only when this was the only professional identity listed. When clinical or counseling psychologist was combined with one or more of the APA specialties of geropsychology, neuropsychology, and/or rehabilitation psychology, then the counseling or clinical designation was dropped to simplify the table. For example, respondents identifying themselves as clinical psychologists were reported as such, but those identifying themselves as clinical and geropsychologists, or clinical and neuropsychologists were reported as geropsychologists or neuropsychologists, respectively. Table 5. VHA psychology identity and privileges Professional Identitya Hospital Privilegesb Neuropsychology Specialtyc NP Post DocCompletedd N Clinical/Counseling 15 13 3 0 Geropsychologist 7 6 1 1 Geropsych/Neuropsych 6 6 6 4 Geropsych/Neuropsych/Rehab 2 2 2 1 Neuropsychologist 88 84 83 75 Neuropsy/Rehab 2 1 1 2 Rehabilitation Psychologist 3 1 0 0 Total 123 113 96 83 Professional Identitya Hospital Privilegesb Neuropsychology Specialtyc NP Post DocCompletedd N Clinical/Counseling 15 13 3 0 Geropsychologist 7 6 1 1 Geropsych/Neuropsych 6 6 6 4 Geropsych/Neuropsych/Rehab 2 2 2 1 Neuropsychologist 88 84 83 75 Neuropsy/Rehab 2 1 1 2 Rehabilitation Psychologist 3 1 0 0 Total 123 113 96 83 aRespondents who identified either clinical or counseling psychology as their sole professional identity were combined. Respondents who identified either clinical or counseling psychology as an additional identity along with geropsychology, neuropsychology and/or rehabilitation psychology were combined under geropsychology, neuropsychology and/or rehabilitation, respectively. bHospital Privileges means respondent claimed having VHA hospital privileges as a psychologist. cNeuropsychology Specialty means respondent claimed having VHA hospital specialty privileges as a neuropsychologist. dNP Post Doc Completed means completion of a post-doctoral program in neuropsychology. Table 5. VHA psychology identity and privileges Professional Identitya Hospital Privilegesb Neuropsychology Specialtyc NP Post DocCompletedd N Clinical/Counseling 15 13 3 0 Geropsychologist 7 6 1 1 Geropsych/Neuropsych 6 6 6 4 Geropsych/Neuropsych/Rehab 2 2 2 1 Neuropsychologist 88 84 83 75 Neuropsy/Rehab 2 1 1 2 Rehabilitation Psychologist 3 1 0 0 Total 123 113 96 83 Professional Identitya Hospital Privilegesb Neuropsychology Specialtyc NP Post DocCompletedd N Clinical/Counseling 15 13 3 0 Geropsychologist 7 6 1 1 Geropsych/Neuropsych 6 6 6 4 Geropsych/Neuropsych/Rehab 2 2 2 1 Neuropsychologist 88 84 83 75 Neuropsy/Rehab 2 1 1 2 Rehabilitation Psychologist 3 1 0 0 Total 123 113 96 83 aRespondents who identified either clinical or counseling psychology as their sole professional identity were combined. Respondents who identified either clinical or counseling psychology as an additional identity along with geropsychology, neuropsychology and/or rehabilitation psychology were combined under geropsychology, neuropsychology and/or rehabilitation, respectively. bHospital Privileges means respondent claimed having VHA hospital privileges as a psychologist. cNeuropsychology Specialty means respondent claimed having VHA hospital specialty privileges as a neuropsychologist. dNP Post Doc Completed means completion of a post-doctoral program in neuropsychology. Taking into account all of the responses in which neuropsychology was one of the professional identities endorsed, almost 80% of the respondents listed their professional identity as a neuropsychologist. In other words, 20% of respondents who provided or supervised neuropsychological assessments did not self-identify as neuropsychologists. Almost 92% of respondents reported having hospital privileges to practice within the VHA as psychologists, with 78% of respondents reporting VHA hospital specialty privilege as a neuropsychologist. Respondents did not have to complete a neuropsychology post-doctoral program or even identify as a neuropsychologist to have VHA hospital specialty privilege as a neuropsychologist, although most did. VHA Professional Activity Characteristics Of the 123 respondents, 115 provided information on their VHA professional activities. As seen in Table 6, the Direct Provision of Assessments was the professional activity most reported, with means and medians near the 50th percentile (mean = 46.9%; median = 50.0%). Training and Supervision were endorsed as a distant second, with mean and median of 14.1% and 10.0%, respectively. Table 6. VHA professional activity allocation (n = 115) Mean (%) SDa (%) Median (%) SIRb (%) Direct Provision of Assessments 46.9 29.9 50.0 52.5 Training and/or Supervision 14.1 12.4 10.0 15.0 Psychotherapy 13.0 23.7 0.0 15.0 Administrative 11.9 14.2 10.0 15.0 Research 6.7 16.3 0.0 5.0 Cognitive Remediation 2.6 6.8 0.0 2.0 Other 4.7 12.9 0.0 0.0 Mean (%) SDa (%) Median (%) SIRb (%) Direct Provision of Assessments 46.9 29.9 50.0 52.5 Training and/or Supervision 14.1 12.4 10.0 15.0 Psychotherapy 13.0 23.7 0.0 15.0 Administrative 11.9 14.2 10.0 15.0 Research 6.7 16.3 0.0 5.0 Cognitive Remediation 2.6 6.8 0.0 2.0 Other 4.7 12.9 0.0 0.0 aStandard deviation. bSIR = semi-interquartile range. Table 6. VHA professional activity allocation (n = 115) Mean (%) SDa (%) Median (%) SIRb (%) Direct Provision of Assessments 46.9 29.9 50.0 52.5 Training and/or Supervision 14.1 12.4 10.0 15.0 Psychotherapy 13.0 23.7 0.0 15.0 Administrative 11.9 14.2 10.0 15.0 Research 6.7 16.3 0.0 5.0 Cognitive Remediation 2.6 6.8 0.0 2.0 Other 4.7 12.9 0.0 0.0 Mean (%) SDa (%) Median (%) SIRb (%) Direct Provision of Assessments 46.9 29.9 50.0 52.5 Training and/or Supervision 14.1 12.4 10.0 15.0 Psychotherapy 13.0 23.7 0.0 15.0 Administrative 11.9 14.2 10.0 15.0 Research 6.7 16.3 0.0 5.0 Cognitive Remediation 2.6 6.8 0.0 2.0 Other 4.7 12.9 0.0 0.0 aStandard deviation. bSIR = semi-interquartile range. VHA Referral and Place of Assessment Characteristics Of the 123 respondents, 108 provided information on neuropsychological assessment referral sources, while 106 provided information on the VHA setting in which the assessment was provided. As seen in Table 7, the primary source for referrals came from mental health, with a near tie for second place for neurology and other medicine. As seen in Table 8, most neuropsychological assessments were provided within a medical center outpatient setting. Table 7. VHA neuropsychological assessment referral source and worksite top three ranking Rank First Second Third Totala Neuropsychological Assessments Referral Sources (n = 108)  Mental health 30 30 28 88  Neurology 16 28 27 71  Other medicine 23 18 11 52  PM&R 16 8 11 35  Substance abuse 1 3 4 8  VBAb 2 1 1 4  Vocational rehab. 0 0 1 1  Other 19 6 2 27 Settings within which neuropsychological assessments provided (n = 106)  Medical Center Outpatient 77 12 2 91  Medical Center Inpatient 7 40 13 60  VBA C&Pc 2 12 6 20  CBOC/OPCd 10 2 1 13  Domiciliary 1 4 6 11  Telehealth 2 5 4 11  Home Base 3 0 0 3  Veteran Center 0 1 0 1  Other 0 0 1 1 Rank First Second Third Totala Neuropsychological Assessments Referral Sources (n = 108)  Mental health 30 30 28 88  Neurology 16 28 27 71  Other medicine 23 18 11 52  PM&R 16 8 11 35  Substance abuse 1 3 4 8  VBAb 2 1 1 4  Vocational rehab. 0 0 1 1  Other 19 6 2 27 Settings within which neuropsychological assessments provided (n = 106)  Medical Center Outpatient 77 12 2 91  Medical Center Inpatient 7 40 13 60  VBA C&Pc 2 12 6 20  CBOC/OPCd 10 2 1 13  Domiciliary 1 4 6 11  Telehealth 2 5 4 11  Home Base 3 0 0 3  Veteran Center 0 1 0 1  Other 0 0 1 1 aTotal = sum of first, second and third rankings. bVBA = Veterans Benefits Administration. cVBA C&P = VBA Compensation and Pension. dCBOC/OPC = Community Based Outpatient Clinic/Out Patient Center. Table 7. VHA neuropsychological assessment referral source and worksite top three ranking Rank First Second Third Totala Neuropsychological Assessments Referral Sources (n = 108)  Mental health 30 30 28 88  Neurology 16 28 27 71  Other medicine 23 18 11 52  PM&R 16 8 11 35  Substance abuse 1 3 4 8  VBAb 2 1 1 4  Vocational rehab. 0 0 1 1  Other 19 6 2 27 Settings within which neuropsychological assessments provided (n = 106)  Medical Center Outpatient 77 12 2 91  Medical Center Inpatient 7 40 13 60  VBA C&Pc 2 12 6 20  CBOC/OPCd 10 2 1 13  Domiciliary 1 4 6 11  Telehealth 2 5 4 11  Home Base 3 0 0 3  Veteran Center 0 1 0 1  Other 0 0 1 1 Rank First Second Third Totala Neuropsychological Assessments Referral Sources (n = 108)  Mental health 30 30 28 88  Neurology 16 28 27 71  Other medicine 23 18 11 52  PM&R 16 8 11 35  Substance abuse 1 3 4 8  VBAb 2 1 1 4  Vocational rehab. 0 0 1 1  Other 19 6 2 27 Settings within which neuropsychological assessments provided (n = 106)  Medical Center Outpatient 77 12 2 91  Medical Center Inpatient 7 40 13 60  VBA C&Pc 2 12 6 20  CBOC/OPCd 10 2 1 13  Domiciliary 1 4 6 11  Telehealth 2 5 4 11  Home Base 3 0 0 3  Veteran Center 0 1 0 1  Other 0 0 1 1 aTotal = sum of first, second and third rankings. bVBA = Veterans Benefits Administration. cVBA C&P = VBA Compensation and Pension. dCBOC/OPC = Community Based Outpatient Clinic/Out Patient Center. Table 8. VHA neuropsychological assessment practice Mean (SDa) Median (SIRb) Range Assessments Provided Each Month (n = 117)c 10.8 (8.3) 10.0 (12.0) Assessments Supervised Each Month (n = 91)d 6.5 (5.6) 4.5 (5.8) Number of tests used per assessment (n = 123) 13.0 (6.6) 12.0 (8.0) 1/30 Percent of tests that remain the same (n = 123) 69.0 (22.1) 75.0 (35.0) 10/100 Consent (n = 123)  No/implied 9.4%  Verbal 83.9%  Written 6.7% Psychometrician/Technician Used 33.3% Mean (SDa) Median (SIRb) Range Assessments Provided Each Month (n = 117)c 10.8 (8.3) 10.0 (12.0) Assessments Supervised Each Month (n = 91)d 6.5 (5.6) 4.5 (5.8) Number of tests used per assessment (n = 123) 13.0 (6.6) 12.0 (8.0) 1/30 Percent of tests that remain the same (n = 123) 69.0 (22.1) 75.0 (35.0) 10/100 Consent (n = 123)  No/implied 9.4%  Verbal 83.9%  Written 6.7% Psychometrician/Technician Used 33.3% aSD = standard deviation. bSIR = semi-interquartile range. cN = 117, excluded were six respondents who reported no direct provision of assessments. dN = 91, excluded were 32 respondents who reported no supervision of assessments. Table 8. VHA neuropsychological assessment practice Mean (SDa) Median (SIRb) Range Assessments Provided Each Month (n = 117)c 10.8 (8.3) 10.0 (12.0) Assessments Supervised Each Month (n = 91)d 6.5 (5.6) 4.5 (5.8) Number of tests used per assessment (n = 123) 13.0 (6.6) 12.0 (8.0) 1/30 Percent of tests that remain the same (n = 123) 69.0 (22.1) 75.0 (35.0) 10/100 Consent (n = 123)  No/implied 9.4%  Verbal 83.9%  Written 6.7% Psychometrician/Technician Used 33.3% Mean (SDa) Median (SIRb) Range Assessments Provided Each Month (n = 117)c 10.8 (8.3) 10.0 (12.0) Assessments Supervised Each Month (n = 91)d 6.5 (5.6) 4.5 (5.8) Number of tests used per assessment (n = 123) 13.0 (6.6) 12.0 (8.0) 1/30 Percent of tests that remain the same (n = 123) 69.0 (22.1) 75.0 (35.0) 10/100 Consent (n = 123)  No/implied 9.4%  Verbal 83.9%  Written 6.7% Psychometrician/Technician Used 33.3% aSD = standard deviation. bSIR = semi-interquartile range. cN = 117, excluded were six respondents who reported no direct provision of assessments. dN = 91, excluded were 32 respondents who reported no supervision of assessments. VHA Neuropsychological Assessment Characteristics Of the 123 respondents, 117 reported some time allocated to the direct provision of neuropsychological assessments. As seen in Table 8, these 117 direct providers reported providing approximately 10 neuropsychological assessments each month (mean = 10.8; median = 10.0), but with some variation, as seen in the large standard deviation (8.3) and semi-interquartile range (12.0). Of the 123 respondents, 91 reported some time allocated to supervising the provision of neuropsychological assessments. This group of 91 supervisors reported supervising approximately 5–7 assessments each month (mean = 6.5’ median = 4.5), but again with some variation, as seen in the large standard deviation (5.6) and semi-interquartile range (5.8). All respondents (n = 123) reported using from one to thirty tests per assessment, with a mean of 13 (SD = 6.6) and a median of 12.0 (SIR = 8.0). All reported that from 10% to 100% of their assessment batteries remained the same across assessments, with a mean percent of 69 (SD = 22.1) and a median percent of 75 (35.0). Approximately one-third (n = 31) reported using a psychometrician or technician. The vast majority of respondents (83.9%) reported gaining explicit verbal consent, with 6.7% obtaining written consent. Almost 10% of respondents (9.4%) either did not obtain consent or relied on implied consent. VHA Neuropsychological Assessment Expectations As seen in Table 9, almost 20% of all respondents reported that their VHA worksite set a minimum number of assessments each week. This ranged from one to eight assessments, but with an average of approximately 4 (mean = 4.1; median = 4.0). Only seven respondents (5.7%) reported that their VHA worksite set a maximum amount of time per assessment. This ranged from 1 to 12 hr, but with an average of approximately seven and a half hours (mean = 6.7; median = 8.0). Table 9. VHA weekly assessment expectations n % Worksite sets minimum number of assessments 23 18.7% Mean (SDa) Median (SIRb) Range If yes, how many (n = 23) 4.1 (1.7) 4.0 (1.0) 1/8 n % Worksite sets maximum time per assessment 7 5.7% Mean (SDa) Median (SIRb) Range If yes, how long in hours (n = 7) 6.7 (3.5) 8.0 (3.0) 1/12 n % Worksite sets minimum number of assessments 23 18.7% Mean (SDa) Median (SIRb) Range If yes, how many (n = 23) 4.1 (1.7) 4.0 (1.0) 1/8 n % Worksite sets maximum time per assessment 7 5.7% Mean (SDa) Median (SIRb) Range If yes, how long in hours (n = 7) 6.7 (3.5) 8.0 (3.0) 1/12 aSD = standard deviation. bSIR = semi interquartile range. Table 9. VHA weekly assessment expectations n % Worksite sets minimum number of assessments 23 18.7% Mean (SDa) Median (SIRb) Range If yes, how many (n = 23) 4.1 (1.7) 4.0 (1.0) 1/8 n % Worksite sets maximum time per assessment 7 5.7% Mean (SDa) Median (SIRb) Range If yes, how long in hours (n = 7) 6.7 (3.5) 8.0 (3.0) 1/12 n % Worksite sets minimum number of assessments 23 18.7% Mean (SDa) Median (SIRb) Range If yes, how many (n = 23) 4.1 (1.7) 4.0 (1.0) 1/8 n % Worksite sets maximum time per assessment 7 5.7% Mean (SDa) Median (SIRb) Range If yes, how long in hours (n = 7) 6.7 (3.5) 8.0 (3.0) 1/12 aSD = standard deviation. bSIR = semi interquartile range. VHA Neuropsychological Assessment Test Usage Two different strategies, reflected in the last two questions of the survey, were employed to help identify the measures VHA psychologists used when providing neuropsychological assessments. The first strategy captured test instrument usage data by using the reported results of the most recent comprehensive neuropsychological assessment, and limiting this to those respondents who self-identified as direct providers of neuropsychological assessments. This limited the sample pool to 117 of the total 123 respondents. The second strategy captured test instrument usage data by including all test instruments used anytime during the past full month, as reported by the entire pool of 123 respondents. Several rules were employed in calculating test usage frequencies. First, a cutoff of 20% usage was decided upon to control for the large number of tests that were used by a small number of respondents. For example, when asked to identify the instruments used during the last full months, respondents provided at least 215 different instruments. The “at least” reflects the fact that measures such as verbal fluency had multiple names, as discussed below, and were simply listed in this study under the category, “Verbal Fluency (any)”. But of these 215 different instruments, 50% (108) of all instruments were reported used by only one respondent, and 72% of all instruments reported were used by less than 5% of the respondents. One respondent reported using only one of the mental status evaluation variants as an assessment; all other respondents reported using multiple instruments as part of their assessments. Second, variations of a test were combined as a generic measure (a) to help identify similar tasks that were commonly used, and (b) to control for imprecision in reporting. With the former (identification of similar tasks), almost one-third of direct providers reported screening for mental status during their most recent assessment using the Mini Mental Status Exam (MMSE), the Montreal Cognitive Assessment (MOCA), or the Saint Louis University Mental Status Examination (SLUMS). Since no one screen reached the 20% cutoff, only the broad category “Mental Status Exam (MMSE, MOCA, or SLUM)” was listed. However, when all respondents were asked to report on their assessment use during the past full month, almost half of all respondents reported using these instruments, with the MMSE and MOCA now exceeding the 20% cutoff. So the MMSE and MOCA were listed as specific tests (with the frequency of test use) under the broad “Mental Status Exam” category. With the latter (control for imprecision), respondents gave varied names for measures of verbal fluency. These included animal fluency, category fluency, Controlled Oral Word Association (COWA), Delis Kaplan Executive Functioning System (DKEF) verbal fluency, FAS, letter fluency, verbal fluency, and so on. These were combined in one category and reported as “Verbal Fluency (any)”. When specific variants, such as the DKEF Verbal Fluency test reached 20% usage, the specific variants were also reported as a specific test, along with its frequency of test use. Three, different test editions were combined, and reported as such, along with more specific editions, when these reached the 20% usage threshold. For example, respondents reported using various parts of the Wechsler Adult Intelligence Scales (WAIS), including the WAIS-R, WAIS III, WAIS IV, and Wechsler Abbreviated Scale of Intelligence (WASI); these were combined in one “WAIS (any)” broad category. For example, both the Minnesota Multiphasic Personality Inventory2 (MMPI-2) and its Restructured Form (MMPI-RF) were combined under “MMPI (any)”, as well as listed separately, if they reached the 20% cutoff. The Wechsler Adult Reading Test (WTAR) and Wechsler Test of Premorbid Functioning (TOPF) were combined under “Wechsler Reading (WTAR & TOPF),” since the latter is a revision of the former (Holdnack & Drozdick, 2009), and each was listed separately when then reached the 20% cutoff. VHA Most Recent Neuropsychological Assessment Test Usage A sample using the 117 respondents who self-identified as direct providers of neuropsychological assessments were used to identify test usage during the respondent’s most recent comprehensive neuropsychological assessment. As seen in Table 10, 70% or more of the respondents reported using some variant of the “Trails,” with almost 60% reporting a specific use of the Trails A & B task. Almost three quarters used some part of the WAIS IV, with use of the Digit Span subtest specifically reported by 45% of respondents. Approximately 73% of respondents reported using some variant of a verbal fluency task. The remaining instruments were used by less than 50% of the sample of direct providers. Table 10. Tests used by at least 20% of direct providers in the most recent assessment (n = 117)a Instrument Percent Subtest Percent Trails or DKEFSb Trails 80.8  Trails A & B 59.2 Wechsler Adult Intelligence Scale (any)c 78.3 Wechsler Adult Intelligence Scale IV (any)d 74.2  WAIS IV Digit Span 45.0  WAIS IV Coding 25.0  WAIS IV Similarities 21.7  WAIS IV Block Design 20.0 Verbal Fluency (any) 72.5 Boston Naming Test 47.5 Wechsler Memory Scale (any)e 46.7 California Verbal Learning Test II 45.0 Wechsler Memory Scale IV (any) 39.2  WMS 4 Logical Memory 30.8 Wechsler Reading Test (TOPF or WTAR)f 40.0  Wechsler Test of Adult Reading 20.8 Wisconsin Card Sort 39.2 Rey Complex Figure Test 36.7 Stroop (any) or DKEFS Color Word Interference 34.2 Test of Memory Malingering 34.2 Mental Status Exam (MMSE, MOCA, or SLUM)g 32.5 Delis–Kaplan Executive Function System (any) 30.8 Brief Visual Spatial Memory Test 28.3 Geriatric Depression Scale 28.3 Beck Depression Inventory 25.8 Beck Anxiety Inventory 25.0 Clock Drawing (any) 25.0 RBANSh 25.0 Grooved Peg Board 20.8 Instrument Percent Subtest Percent Trails or DKEFSb Trails 80.8  Trails A & B 59.2 Wechsler Adult Intelligence Scale (any)c 78.3 Wechsler Adult Intelligence Scale IV (any)d 74.2  WAIS IV Digit Span 45.0  WAIS IV Coding 25.0  WAIS IV Similarities 21.7  WAIS IV Block Design 20.0 Verbal Fluency (any) 72.5 Boston Naming Test 47.5 Wechsler Memory Scale (any)e 46.7 California Verbal Learning Test II 45.0 Wechsler Memory Scale IV (any) 39.2  WMS 4 Logical Memory 30.8 Wechsler Reading Test (TOPF or WTAR)f 40.0  Wechsler Test of Adult Reading 20.8 Wisconsin Card Sort 39.2 Rey Complex Figure Test 36.7 Stroop (any) or DKEFS Color Word Interference 34.2 Test of Memory Malingering 34.2 Mental Status Exam (MMSE, MOCA, or SLUM)g 32.5 Delis–Kaplan Executive Function System (any) 30.8 Brief Visual Spatial Memory Test 28.3 Geriatric Depression Scale 28.3 Beck Depression Inventory 25.8 Beck Anxiety Inventory 25.0 Clock Drawing (any) 25.0 RBANSh 25.0 Grooved Peg Board 20.8 aN = 117, excluded were six respondents who reported that they were not involved in the direct provision of assessments. bDKEFS = Delis Kaplan Executive Function Delis–Kaplan Executive Function System. cWechsler Adult Intelligence Scale (any) includes all Wechsler Adult Intelligence Scale variants, including the WASI, WAIS-III, and WAIS IV. d(any) means any mention of all of part of the instrument. eWechsler Memory Scale (any) includes all Wechsler Memory Scale variants, including the WMS-R, WMS-III, and WMS-IV. fWTAR = Wechsler Test of Adult Reading; TOPF = Test of Premorbid Functioning. gMMSE, MOCA, or SLUM = Mini Mental Status Exam, Montreal Cognitive Assessment, and Saint Louis University Mental Status Examination, respectively. hRBANS = Repeatable Battery for the Assessment of Neuropsychological Status. Table 10. Tests used by at least 20% of direct providers in the most recent assessment (n = 117)a Instrument Percent Subtest Percent Trails or DKEFSb Trails 80.8  Trails A & B 59.2 Wechsler Adult Intelligence Scale (any)c 78.3 Wechsler Adult Intelligence Scale IV (any)d 74.2  WAIS IV Digit Span 45.0  WAIS IV Coding 25.0  WAIS IV Similarities 21.7  WAIS IV Block Design 20.0 Verbal Fluency (any) 72.5 Boston Naming Test 47.5 Wechsler Memory Scale (any)e 46.7 California Verbal Learning Test II 45.0 Wechsler Memory Scale IV (any) 39.2  WMS 4 Logical Memory 30.8 Wechsler Reading Test (TOPF or WTAR)f 40.0  Wechsler Test of Adult Reading 20.8 Wisconsin Card Sort 39.2 Rey Complex Figure Test 36.7 Stroop (any) or DKEFS Color Word Interference 34.2 Test of Memory Malingering 34.2 Mental Status Exam (MMSE, MOCA, or SLUM)g 32.5 Delis–Kaplan Executive Function System (any) 30.8 Brief Visual Spatial Memory Test 28.3 Geriatric Depression Scale 28.3 Beck Depression Inventory 25.8 Beck Anxiety Inventory 25.0 Clock Drawing (any) 25.0 RBANSh 25.0 Grooved Peg Board 20.8 Instrument Percent Subtest Percent Trails or DKEFSb Trails 80.8  Trails A & B 59.2 Wechsler Adult Intelligence Scale (any)c 78.3 Wechsler Adult Intelligence Scale IV (any)d 74.2  WAIS IV Digit Span 45.0  WAIS IV Coding 25.0  WAIS IV Similarities 21.7  WAIS IV Block Design 20.0 Verbal Fluency (any) 72.5 Boston Naming Test 47.5 Wechsler Memory Scale (any)e 46.7 California Verbal Learning Test II 45.0 Wechsler Memory Scale IV (any) 39.2  WMS 4 Logical Memory 30.8 Wechsler Reading Test (TOPF or WTAR)f 40.0  Wechsler Test of Adult Reading 20.8 Wisconsin Card Sort 39.2 Rey Complex Figure Test 36.7 Stroop (any) or DKEFS Color Word Interference 34.2 Test of Memory Malingering 34.2 Mental Status Exam (MMSE, MOCA, or SLUM)g 32.5 Delis–Kaplan Executive Function System (any) 30.8 Brief Visual Spatial Memory Test 28.3 Geriatric Depression Scale 28.3 Beck Depression Inventory 25.8 Beck Anxiety Inventory 25.0 Clock Drawing (any) 25.0 RBANSh 25.0 Grooved Peg Board 20.8 aN = 117, excluded were six respondents who reported that they were not involved in the direct provision of assessments. bDKEFS = Delis Kaplan Executive Function Delis–Kaplan Executive Function System. cWechsler Adult Intelligence Scale (any) includes all Wechsler Adult Intelligence Scale variants, including the WASI, WAIS-III, and WAIS IV. d(any) means any mention of all of part of the instrument. eWechsler Memory Scale (any) includes all Wechsler Memory Scale variants, including the WMS-R, WMS-III, and WMS-IV. fWTAR = Wechsler Test of Adult Reading; TOPF = Test of Premorbid Functioning. gMMSE, MOCA, or SLUM = Mini Mental Status Exam, Montreal Cognitive Assessment, and Saint Louis University Mental Status Examination, respectively. hRBANS = Repeatable Battery for the Assessment of Neuropsychological Status. VHA Neuropsychological Assessment Test Used During the Last Full Month The entire pool of 123 respondents was used to determine test usage during the most recent full month. As seen in Table 11, the largest number of respondents also reported using the WAIS-IV, Trails (any) and Verbal Fluency (any), with at least three quarters reporting use of each instrument. The California Verbal Learning Test II tied with the Wechsler Memory Scale for next most popular instrument, with approximately 68% of respondents reporting use, with the WAIS IV logical memory subtest specifically reported by 53% of respondents. Also popular, with usage reported by almost two-thirds of respondents, were the Boston Naming Test at 65% and the Repeatable Battery for the Assessment of Neuropsychological Status at almost 64%. Table 11. Tests used by at least 20% of all respondents in the last full month (n = 123) Instrument Percent Subtest percent Wechsler Adult Intelligence Scale (any)a 86.0 Wechsler Adult Intelligence Scale IV (any)b 81.8  WAIS IV Digit Span 43.8  WAIS IV Coding 29.8  WAIS IV Similarities 26.4  WAIS IV Block Design 23.1  WAIS IV Matrix Reasoning 20.7 Trails (any) 81.0 Verbal Fluency (any) 76.9  DKEF Verbal Fluency 25.6 California Verbal Learning Test II 67.8 Wechsler Memory Scale (any)c 67.8 Boston Naming Test 65.3 RBANSd 63.6 Wechsler Memory Scale IV (any) 62.8  WMS IV Logical Memory 52.9 Wisconsin Card Sort (any) 59.5 Rey Complex Figure Test (any) 58.7 Test of Memory Malingering 53.7 Delis–Kaplan Executive Function System (DKEFS) (any) 49.6  DKEF Color Word Interference 30.6  DKEF Verbal Fluency 25.6 Beck Depression Inventory 49.6 Mental Status Exam (MMSE, MOCA, SLUMS) 48.8  Montreal Cognitive Assessment MOCA 26.4  Mini Mental Status Exam (MMSE) 20.7 Wechsler Reading Test (TOPF or WTAR) 47.9  Wechsler Test of Adult Reading (WTAR) 26.4  Test of Premorbid Functioning (TOPF) 23.1 Brief Visual Spatial Memory Test Revised 44.6 Beck Anxiety Inventory 40.5 Minnesota Multiphasic Personality Inventory (any) 39.7  MMPI 2 RF 30.6 Grooved Peg Board 36.4 Clock Drawing (any) 34.7 Stroop or Dkef Color Word Interference (any) 34.7 Neuropsychological Assessment Battery (any) 33.1 PTSD Check List (PCL) (any) 29.8 Dot Counting 28.1 Wide Range Achievement Test (any) 26.4 Judgment of Line Orientation 25.6 Geriatric Depression Scale 25.6 Hopkins Verbal Learning Test 24.8 Dementia Rating Scale 24.8 Independent Living Scales 22.3 Instrument Percent Subtest percent Wechsler Adult Intelligence Scale (any)a 86.0 Wechsler Adult Intelligence Scale IV (any)b 81.8  WAIS IV Digit Span 43.8  WAIS IV Coding 29.8  WAIS IV Similarities 26.4  WAIS IV Block Design 23.1  WAIS IV Matrix Reasoning 20.7 Trails (any) 81.0 Verbal Fluency (any) 76.9  DKEF Verbal Fluency 25.6 California Verbal Learning Test II 67.8 Wechsler Memory Scale (any)c 67.8 Boston Naming Test 65.3 RBANSd 63.6 Wechsler Memory Scale IV (any) 62.8  WMS IV Logical Memory 52.9 Wisconsin Card Sort (any) 59.5 Rey Complex Figure Test (any) 58.7 Test of Memory Malingering 53.7 Delis–Kaplan Executive Function System (DKEFS) (any) 49.6  DKEF Color Word Interference 30.6  DKEF Verbal Fluency 25.6 Beck Depression Inventory 49.6 Mental Status Exam (MMSE, MOCA, SLUMS) 48.8  Montreal Cognitive Assessment MOCA 26.4  Mini Mental Status Exam (MMSE) 20.7 Wechsler Reading Test (TOPF or WTAR) 47.9  Wechsler Test of Adult Reading (WTAR) 26.4  Test of Premorbid Functioning (TOPF) 23.1 Brief Visual Spatial Memory Test Revised 44.6 Beck Anxiety Inventory 40.5 Minnesota Multiphasic Personality Inventory (any) 39.7  MMPI 2 RF 30.6 Grooved Peg Board 36.4 Clock Drawing (any) 34.7 Stroop or Dkef Color Word Interference (any) 34.7 Neuropsychological Assessment Battery (any) 33.1 PTSD Check List (PCL) (any) 29.8 Dot Counting 28.1 Wide Range Achievement Test (any) 26.4 Judgment of Line Orientation 25.6 Geriatric Depression Scale 25.6 Hopkins Verbal Learning Test 24.8 Dementia Rating Scale 24.8 Independent Living Scales 22.3 aWechsler Adult Intelligence Scale (any) includes all Wechsler Adult Intelligence Scale variants, including the WASI, WAIS-III, and WAIS IV. b“Any” includes any reported use of the instrument or part of the instrument. cWechsler Memory Scale (any) includes all Wechsler Memory Scale variants, including the WMS-R, WMS-III, and WMS-IV. dRBANS = Repeatable Battery for the Assessment of Neuropsychological Status. Table 11. Tests used by at least 20% of all respondents in the last full month (n = 123) Instrument Percent Subtest percent Wechsler Adult Intelligence Scale (any)a 86.0 Wechsler Adult Intelligence Scale IV (any)b 81.8  WAIS IV Digit Span 43.8  WAIS IV Coding 29.8  WAIS IV Similarities 26.4  WAIS IV Block Design 23.1  WAIS IV Matrix Reasoning 20.7 Trails (any) 81.0 Verbal Fluency (any) 76.9  DKEF Verbal Fluency 25.6 California Verbal Learning Test II 67.8 Wechsler Memory Scale (any)c 67.8 Boston Naming Test 65.3 RBANSd 63.6 Wechsler Memory Scale IV (any) 62.8  WMS IV Logical Memory 52.9 Wisconsin Card Sort (any) 59.5 Rey Complex Figure Test (any) 58.7 Test of Memory Malingering 53.7 Delis–Kaplan Executive Function System (DKEFS) (any) 49.6  DKEF Color Word Interference 30.6  DKEF Verbal Fluency 25.6 Beck Depression Inventory 49.6 Mental Status Exam (MMSE, MOCA, SLUMS) 48.8  Montreal Cognitive Assessment MOCA 26.4  Mini Mental Status Exam (MMSE) 20.7 Wechsler Reading Test (TOPF or WTAR) 47.9  Wechsler Test of Adult Reading (WTAR) 26.4  Test of Premorbid Functioning (TOPF) 23.1 Brief Visual Spatial Memory Test Revised 44.6 Beck Anxiety Inventory 40.5 Minnesota Multiphasic Personality Inventory (any) 39.7  MMPI 2 RF 30.6 Grooved Peg Board 36.4 Clock Drawing (any) 34.7 Stroop or Dkef Color Word Interference (any) 34.7 Neuropsychological Assessment Battery (any) 33.1 PTSD Check List (PCL) (any) 29.8 Dot Counting 28.1 Wide Range Achievement Test (any) 26.4 Judgment of Line Orientation 25.6 Geriatric Depression Scale 25.6 Hopkins Verbal Learning Test 24.8 Dementia Rating Scale 24.8 Independent Living Scales 22.3 Instrument Percent Subtest percent Wechsler Adult Intelligence Scale (any)a 86.0 Wechsler Adult Intelligence Scale IV (any)b 81.8  WAIS IV Digit Span 43.8  WAIS IV Coding 29.8  WAIS IV Similarities 26.4  WAIS IV Block Design 23.1  WAIS IV Matrix Reasoning 20.7 Trails (any) 81.0 Verbal Fluency (any) 76.9  DKEF Verbal Fluency 25.6 California Verbal Learning Test II 67.8 Wechsler Memory Scale (any)c 67.8 Boston Naming Test 65.3 RBANSd 63.6 Wechsler Memory Scale IV (any) 62.8  WMS IV Logical Memory 52.9 Wisconsin Card Sort (any) 59.5 Rey Complex Figure Test (any) 58.7 Test of Memory Malingering 53.7 Delis–Kaplan Executive Function System (DKEFS) (any) 49.6  DKEF Color Word Interference 30.6  DKEF Verbal Fluency 25.6 Beck Depression Inventory 49.6 Mental Status Exam (MMSE, MOCA, SLUMS) 48.8  Montreal Cognitive Assessment MOCA 26.4  Mini Mental Status Exam (MMSE) 20.7 Wechsler Reading Test (TOPF or WTAR) 47.9  Wechsler Test of Adult Reading (WTAR) 26.4  Test of Premorbid Functioning (TOPF) 23.1 Brief Visual Spatial Memory Test Revised 44.6 Beck Anxiety Inventory 40.5 Minnesota Multiphasic Personality Inventory (any) 39.7  MMPI 2 RF 30.6 Grooved Peg Board 36.4 Clock Drawing (any) 34.7 Stroop or Dkef Color Word Interference (any) 34.7 Neuropsychological Assessment Battery (any) 33.1 PTSD Check List (PCL) (any) 29.8 Dot Counting 28.1 Wide Range Achievement Test (any) 26.4 Judgment of Line Orientation 25.6 Geriatric Depression Scale 25.6 Hopkins Verbal Learning Test 24.8 Dementia Rating Scale 24.8 Independent Living Scales 22.3 aWechsler Adult Intelligence Scale (any) includes all Wechsler Adult Intelligence Scale variants, including the WASI, WAIS-III, and WAIS IV. b“Any” includes any reported use of the instrument or part of the instrument. cWechsler Memory Scale (any) includes all Wechsler Memory Scale variants, including the WMS-R, WMS-III, and WMS-IV. dRBANS = Repeatable Battery for the Assessment of Neuropsychological Status. Discussion This pilot survey is the first survey of VHA psychologists who provide neuropsychological assessments within Department of Veterans Affairs settings. As such, it provides information on the professional characteristics of VHA psychologists, and on their assessment practices. Since the Department of Veterans Affairs is one of the largest employers of psychologists (Goldstein, 2010), it may also provide useful information on the practice of neuropsychological assessment in the United States. For the most part, the survey results are simple and straightforward. The meaning of most of the data is self-explanatory, requiring no further interpretation or discussion. Instead of providing an explanation of the already obvious, a select discussion and analysis follows, along with comments on limitations of this study and suggestions for future research. Select Discussion The most surprising finding was the discovery of the large number of non-neuropsychologists performing neuropsychological assessments within VHA settings. Approximately one-third (31%) of all respondents did not have any current or prior post-doctoral training in neuropsychology, and one-fifth did not identity as a neuropsychologist. With the increase in the number of APA approved specialties in professional psychology that now purport to provide the graduate with competence in neuropsychological assessment, the proportion of non-neuropsychologists providing neuropsychological assessments may increase. This is all the more likely given the number of APA approved post-doctoral programs providing shorter and more flexible routes to competency. As Russo (in press) recently noted, what is remarkable about these new models is that competence in neuropsychological assessment can “now be acquired without the rigorous foundation in the neurosciences articulated in the Houston Conference, and in half the time required of a neuropsychology fellowship.” A second notable finding is the move away from the standard neuropsychological battery approach represented by the Halstead-Reitan Neuropsychological Battery (HRNB) and the Luria-Nebraska Neuropsychological Battery (LNNB). When Hartlage and Telzrow (1980) first surveyed test usage among neuropsychologists in 1980, both instruments ranked in the top seven most popular instruments used. Twenty-five years later, when Rabin et al. (2005) asked clinical neuropsychologists to list their three most frequently used assessment instruments, the HRB ranked sixth and the LNNB tied for 16th place. Combined, the HRB/LNNB ranked third, only surpassed in popularity by the Wechsler Adult Intelligence Scales and Wechsler Memory Scales, which ranked first and second, respectively. In the current survey, no respondent reported using these batteries en totum, although the Trails A & B test continues to be popular. A third finding was the absence of auditory processing measures. While respondents reported using instruments that assessed several aspects of cognitive functioning, such as memory, reasoning, visual spatial functioning, and so on, the percent of respondents using an instrument that assessed any aspect of auditory processing was less than 5%. This was all the more remarkable, given that tinnitus and hearing loss are the most prevalent service-connected (SC) disabilities (Veteran Benefits Administration, 2017). Survey Limitations and Recommendations The response rate was impossible to determine, since the number of VHA psychologists providing or supervising neuropsychological assessments within VHA settings is unknown. However, using either the 387 number Young et al. (2016) identified as the number of likely practicing VHA neuropsychologists or the 324 members of the AVAPL neuropsych listserv leaves a response rate of less than 40%. This raised the question of whether this survey of 123 was truly representative of all the VHA psychologists who provide or supervise neuropsychological assessments. As Draugalis and Plaza (2009) caution, when response rates drop below 50%, “those who responded have a greater chance of being self-selected (i.e., there is something inherently different about those who responded and those who did not respond), and thus not representative of the target population” (pp. 1–3). This survey relied on the self-reports of respondents who identified as VHA psychologists to report in hindsight the tests they used on their last comprehensive assessment and the tests they used during the last full month. As such, the accuracy of the results depended directly on the precision and accuracy respondents employed. Many respondents provided detailed accounts of every instrument, with anecdotal information on the norms used and deviations from standard administration when this occurred. Others reported only the battery used, with some giving ambiguous or vague initials to identify tests. Lees-Haley, Smith, Williams, and Dunn (1996) employed a different survey strategy in which they surveyed a sample of actual tests used to prevent such possible errors. Specifically, they examined 100 forensic neuropsychological evaluations, and tabulated test usage based on actual tests cited in the evaluations. Future surveys might compliment the self-report type survey used in this study, with a focused survey methodology in which actual neuropsychological assessments conducted within a select time period (e.g., all assessments completed with the second quarter) and select location (e.g., VA medical center or VISN) are examined to determine actual test usage. Similar focused research conducted across several MA medical centers or VISNs could then be pooled to arrive at an approximation of actual test usage based on examined assessments. Finally, this is the first known survey of VHA psychologists and the first survey conducted within the past forty years which did not limit itself to psychologists who self-identified as neuropsychologists. By doing so, this survey identified a significant proportion of non-neuropsychologists as providers and/or supervisors of neuropsychological assessments. Future research should make every effort to include all VHA psychologists in order to arrive at the best understanding of who is providing neuropsychological assessments in VHA settings and of what these assessments consist. Acknowledgements This paper is the result of work supported in part with resources and the use of facilities at the Department of Veterans Affairs New York Harbor Healthcare System; as such it is in the public domain. Contents do not necessarily reflect the views of the Department of Veterans Affairs or U.S. Government. Conflict of interest None declared. References Baker , G. , & Peatman , J. ( 1947 ). Tests used in Veterans Administration advisement units . The American Psychologist , 2 , 99 – 102 . Google Scholar CrossRef Search ADS PubMed Butler , M. , Retzlaff , P. , & Vanderploeg , R. ( 1991 ). Neuropsychological test usage . Professional Psychology: Research and Practice , 22 , 510 – 512 . Google Scholar CrossRef Search ADS Camara , W. , Nathan , J. , & Puente , A. ( 2000 ). Psychological test usage: Implications in professional psychology . Professional Psychology: Research and Practice , 31 , 141 – 154 . Google Scholar CrossRef Search ADS Darley , J. , & Marquis , D. ( 1946 ). Veterans’ guidance centers: A survey of their problems and activities . Journal of Clinical Psychology , 2 , 109 – 116 . Google Scholar CrossRef Search ADS PubMed Department of Veterans Affairs . ( 2016 ). VA handbook 5005/87 . Washington, DC : Department of Veterans Affairs . Draugalis , J. , & Plaza , C. ( 2009 ). Best practices for survey research reports revisited: Implications of target population, probability sampling, and response rate . American Journal of Pharmaceutical Education , 73 ( 8 ), 1 – 3 . Google Scholar CrossRef Search ADS PubMed Goldstein , G. ( 2010 ). Advocacy for neuropsychology in the public sector: The VA experience . The Clinical Neuropsychologist , 24 , 401 – 416 . Google Scholar CrossRef Search ADS PubMed Guilmette , T. , Faust , D. , Hart , K. , & Arkes , H. ( 1990 ). A national survey of psychologists who offer neuropsychological services . Archives of Clinical Neuropsychology , 5 , 373 – 392 . Google Scholar CrossRef Search ADS PubMed Hartlage , L. , & Telzrow , C. ( 1980 ). The practice of clinical neuropsychology in the U.S . Clinical Neuropsychology , 2 , 200 – 202 . Holdnack , J. , & Drozdick , L. ( 2009 ). Advanced clinical solutions: Clinical and interpretive manual. . San Antonio, Texas : Pearson . Lees-Haley , P. , Smith , H. , Williams , C. , & Dunn , J. ( 1996 ). Forensic neuropsychological test usage: An empirical survey . Archives of Clinical Neuropsychology , 2 , 45 – 51 . Google Scholar CrossRef Search ADS Public Law 96–151 . Putnam , S. , & DeLuca , J. ( 1990 ). The TCN professional practice survey: Part I: General practices of neuropsychologists in primary employment and private practice settings . The Clinical Neuropsychologist , 4 , 199 – 244 . Google Scholar CrossRef Search ADS Rabin , L. , Barr , W. , & Burton , L. ( 2005 ). Assessment practices of clinical neuropsychologists in the United States and Canada: A survey of INS, NAN, and APA Division 40 members . Archives of Clinical Neuropsychology , 20 , 33 – 65 . Google Scholar CrossRef Search ADS PubMed Russo , A. (in press). Establishing competence in the neuropsychological assessment of older adults: Ethical considerations for post-license psychologists during a time of shifting standards. In Ravdin L. , & Katzen H. (Eds.) , Handbook on the neuropsychology of aging and dementia ( 2nd ed. ). New York : Springer . Seretny , M. , Dean , R. , Gray , J. , & Hartlage , L. ( 1986 ). The practice of clinical neuropsychology in the United States . Archives of Clinical Neuropsychology , 1 , 5 – 12 . Google Scholar CrossRef Search ADS PubMed Sweet , J. , Benson , L. , Nelson , N. , & Moberg , P. ( 2015 ). The American Academy of Clinical Neuropsychology, National Academy of Neuropsychology, and Society for Clinical Neuropsychology (APA Division 40) 2015 TCN Professional Practice and ‘Salary Survey’: Professional Practices, Beliefs, and Incomes of U.S. Neuropsychologists . The Clinical Neuropsychologist , 29 , 1069 – 1162 . Google Scholar CrossRef Search ADS PubMed Sweet , J. , & Moberg , P. ( 1990 ). A survey of practices and beliefs among ABPP and non-ABPP clinical neuropsychologists . The Clinical Neuropsychologist , 4 , 101 – 120 . Google Scholar CrossRef Search ADS Sweet , J. , Moberg , P. , & Westergaard , C. ( 1996 ). Five-year follow-up survey of practices and beliefs of clinical neuropsychologists . The Clinical Neuropsychologist , 10 , 202 – 221 . Google Scholar CrossRef Search ADS Sweet , J. , Peck , E. , Abramowitz , C. , & Etzweiler , S. ( 2002 ). National Academy of Neuropsychology/Division 40 of the American Psychological Association practice survey of clinical neuropsychology in the United States, Part I: Practitioner and practice characteristics, professional activities and time requirements . The Clinical Neuropsychologist , 16 , 109 – 127 . Google Scholar CrossRef Search ADS PubMed Title 38 U.S.C. §7402 . Veterans Benefits Administration . ( 2017 ). VBA Annual Benefits Report Fiscal Year 2016, (updated February 2017) . Washington, DC : Veterans Benefits Administration . Young , J. , Roper , B. , & Arentsen , T. ( 2016 ). Validity testing and neuropsychology practice in the VA healthcare system: Results from recent practitioner survey . The Clinical Neuropsychologist , 30 , 497 – 514 . Google Scholar CrossRef Search ADS PubMed Appendix Dear colleague, Thank you for participating in this survey Professional psychological practice within the Department of Veterans Affairs has grown in recent years but little is known of about the assessment practices of VA psychologists who provide neuropsychological assessments within VA settings. This survey is designed to address that lack by capturing information on the assessment practices of psychologists who conduct neuropsychological assessments as they are actually provided within Department of Veterans Affair settings. This study has IRB approval. If you are a VA psychologist and provide or supervise neuropsychological assessments, would you take a few minutes to complete this survey? Please be assured that no personal identifying information will be collected or entered into the survey database, and please do not include any personal identifying information below. The results of this survey will be peer reviewed, published, and available online at no cost. Thank you again for your participation. Arthur Christopher Russo, MS, PhD. Clinical and Neuropsychologist VANY Harbor Healthcare System – Brooklyn Campus Arthur.Russo@va.gov 718-836-6600 ext. 6471 Please note: This survey is limited to psychologists who provide or supervise neuropsychological assessments within VA settings. If your work does not include neuropsychological assessment, then this survey would not apply to you. Still, I thank you for your interest. Please email your completed form to Arthur.Russo@va.gov. Please put “professional practice survey” in the email subject line. I prefer you email your survey, but you can also mail the completed survey to: Attention: Arthur Russo, PhD. Brooklyn VA Medical Center Psychology Department 800 Poly Place Brooklyn, New York 11209 Demographic Questions 1. Age [ ] 20 to 29        [ ] 30 to 39        [ ] 40 to 49 [ ] 50 to 59        [ ] 60 to 69        [ ] 70 or older 2. Gender:    [ ] female            [ ] male 3. Highest Psychology Degree [ ] Ed.D.            [ ] PhD. [ ] Psy.D.            [ ] Other (please specify) __________________________ 4. Within which field of psychology was you doctoral degree awarded? [ ] Clinical psychology    [ ] Counseling psychology [ ] Neuropsychology    [ ] Other (please specify) _________________________ 5a. Have you completed a post-doctoral program in neuropsychology? [ ] No            [ ] Yes 5b. if no to 5a, have you completed a post-doctoral program in another specialty? [ ] No            [ ] Yes, if yes, in what specialty: ________________________ 6. Are you currently a postdoctoral resident or fellow? [ ] No            [ ] Yes, if yes, in what specialty: _________________________ 7. Are you currently licensed to practice psychology?    [ ] No        [ ] Yes 8. How many years have you been practicing as a psychologists post license (include years practicing both within and outside a VA setting)? [ ] 0 to 5            [ ] 6 to 10 [ ] 11 to 15            [ ] 16 to 20 [ ] 21 to 25            [ ] more than 25 9. Are you board certified in clinical neuropsychology? [ ] No        [ ] ABPP        [ ] Other (please specify): ___________________ 9b. if no to 9a, are you board certified in another specialty? [ ] No            [ ] Other (please specify): _________________________ The following questions pertain to your work providing neuropsychological assessments within Department of Veterans Affairs settings. Please limit your responses to work that you actually provide as a psychologist while working within a VA setting. 10. Within which area of the country is your primary VA work site for providing VA neuropsychological assessments? [ ]    North Atlantic, Connecticut, Delaware, District of Colombia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia [ ]    Southeast Alabama, Florida, Georgia, Kentucky, Puerto Rico, South Carolina, Tennessee, Virgin Islands [ ]    Midwest Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Montana, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin [ ]    Continental Arkansas, Colorado, Louisiana, Mississippi, Oklahoma, Texas, Utah, Wyoming [ ]    Pacific Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Nevada, New Mexico, Oregon, Philippine Island, Washington 11. Is your primary VA work site in the state in which you hold a license to practice as a psychologist? [ ] No        [ ] Yes        [ ] n/a – not licensed 12. For VA professional activities only, what percentage of time to you devote to the following specific professional activities (please check that these add up to 100%). [ ] Direct provision of neuropsychological assessments [ ] Rehabilitation or Cognitive Remediation of Cognitive/Neuropsychological Problems [ ] Psychotherapy [ ] Research [ ] Training (teaching and supervision) [ ] Administrative [ ] Other, please specify: _________________________ 13. Do you have VA hospital privileges to practice as a psychologist? [ ] No            [ ] Yes 14. Do you have VA hospital specialist privileges to practice as a neuropsychologist? [ ] No            [ ] Yes 15. Within the VA, with which specialty/specialties do you identify yourself, professionally? [ ] clinical psychologist    [ ] neuropsychologist [ ] geropsychologist        [ ] other (please specify): _________________________ 16. Please rank the top three VA work settings within which you provide neuropsychological assessments. [ ] VA medical center inpatient setting [ ] VA medical center day hospital setting [ ] VA medical center outpatient setting [ ] VA domiciliary setting [ ] VA community outpatient setting (CBOC &OPC) [ ] VA Home Based setting [ ] VA telehealth [ ] VBA C&P evaluations [ ] Veteran Center [ ] Other, please specify: _________________________ 17. Please rank the top three referral sources for your VA neuropsychological assessments [ ] Mental Health [ ] Substance Abuse [ ] Neurology [ ] Physical Medicine and Rehabilitation [ ] Other Medicine [ ] Veteran Benefits Administration (C&P) [ ] Vocational Rehab and Training [ ] Other, please specify: _________________________ 18. Within the past month, did you use a technician or psychometrician to collect assessment data? [ ] No            [ ] Yes 19. On average, how many neuropsychological assessments do you provide each month? 20. On average, how many neuropsychological assessments do you supervise others’ providing each month? 21. Does your VA worksite set a minimum number of neuropsychological assessments that you are required to do each week, and if so, how many? [ ] No set minimum        [ ] Yes, if yes, how many: _________________________ 22. Does your VA worksite allocate a maximum amount of time for each neuropsychological assessment, and if so, up to how many hours are allowed? [ ] No set maximum    [ ] Yes, if yes, how much time: _________________________ 23. For the past month, with what percent of neuropsychological assessments did you include (percents should equal 100%) [ ] No consent [ ] Implied consent in which it was assumed patients knew why they were being assessed and who would have access to the report [ ] Explicit verbal consent in which patients were told why they were being assessed, and who would have access to the repot [ ] Written consent in which patients were told in writing why they were being assessed, and who would have access to the repot 24. On average, during the past month, how many tests or subtests did you tend to use per neuropsychological assessment? 25. During the past month, what percent of test instruments did you tend to use for every assessment; in other words, how many tests remained the same across assessments compared to total number of instruments used? 26. What is your primary philosophical approach towards tests selection? [ ] Few if any tests provided in common across assessments; [ ] A core group of tests that tend to be the same, supplemented by other tests; [ ] Routine groupings of tests for different types of patients that tend to be the same, supplemented by other tests; [ ] Most or all tests remaining the same across batteries, with a few additions as needed; [ ] Other; please specify: _________________________ The next two questions are designed to determine exactly what measures VA psychologists use when doing a neuropsychological assessment. Since there are many hundreds of tests, with several batteries comprised of numerous tests and subtests, please write in the actual tests and parts of tests you use. Please be as specific as possible. Some batteries include several tests, and some tests include several parts, all or only some of which may be administered. Please list only those parts you actually use. For example, if you administered the WAIS digit span forwards and digit span backwards, but not the digit span sequence, please note this. If you use all parts of a subtest or test, simply say “all”. 27. Please list the test instruments you administered in your most recent comprehensive assessment. 28. Please list the test instruments you have used in the assessments you have conducted during the most recent past full month. Thank you for your participation. Please email your completed form to Arthur.Russo@va.gov. Also, please put “professional practice survey” in the email subject line. Published by Oxford University Press 2018. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Journal

Archives of Clinical NeuropsychologyOxford University Press

Published: Jan 4, 2018

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