Synaptic Connections. In Every Issue: Featured Articles: From the Board 1

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1 Synaptic Connections The Official Newsletter for California Psychological Association- Division 8 (Neuropsychology) July, 2014 Editor-in-Chief Delia Silva, Psy.D., ABPP-CN DSilva@SDPsyD.com Associate Editors Elizabeth Romero, M.A. Mary Goodarzi, M.A. Contributing Authors (This Issue) Thomas Hardey, Ph.D., FACPN Roxanna Rabhan, Ph.D. In Every Issue: From the Board 1 Member Spotlight 4 Classifieds & 7-8 Announcements Featured Articles: Sport Neuropsychology 3 and Concussion Screening Welcoming Division VIII s 5 New Student Rep Immigration Evaluations 6 From the Board Spotlight on Neuropsychological QME Changes DISCLAIMER: The content of these articles reflect the opinions of the authors, which do not necessarily represent the opinion of Division 8 or California Psychological Association. By: Linda D. Nelson, Ph.D., ABN, Div. VIII Chair For this month s newsletter, I interviewed Claude Munday, Ph.D., Forensic Neuropsychologist. Dr. Munday has been working in the area of Traumatic Brain Injuries since He has been doing Workers Compensation evaluations over the past 33 years. He has a busy private practice in Oakland, CA. In 2009, he was elected president of C-SIMS (California Society of Industrial Medicine. Dr. Munday was the only non-md to ever preside over one of our major workers compensation professional organizations. What is the biggest change in workers compensation CA law affecting psychologists? Psychologists and others can no longer add on Permanent Disability (PD) ratings for psych injuries. (Continued on page 2) About Linda Nelson, Ph.D., ABN Dr. Linda Nelson is Professor, Emerita, in the Department of Psychiatry and Biobehavioral Sciences at UCLA, where she is Principal Investigator of studies concerning diagnosis and treatment of Alzheimer's disease. Dr. Nelson's clinical work is primarily devoted to comprehensive neuropsychological assessments and treatment with adults.

2 What is the difference between a psych injury and a brain injury? Look in chapter 13 of the AMA Guides. It says, psychiatric symptoms may also be rooted in a medical (e.g., neurological) disorder. Medication side effects, for example, cause psychiatric and neurological problems. Therefore, medication side effects may be considered medical and not psychiatric. PTSD causes brain changes. Therefore, PTSD, a psychiatric disorder, may be considered a medical or neurological condition. A concussive component may apply. Consider this condition in your QME. In contrast, a psychiatric injury may be reactive in nature. For example, reactive depression may develop from conditions surrounding a medical claim. So it is important to think out of the box when drawing clinical conclusions regarding medical bases or evidence for your diagnoses. What exactly does the new law say? Compensable consequences psych injuries are no longer added to PD. So if have back injury, get depressed later, cannot claim depression. What role will neuropsychologists play in the future of workers comp? Neuropsych QME s are up and in demand. Psychiatric and psychological evaluations are down. If there is a brain basis for the disorder, it s still allowed. How can neuropsychologists build a practice doing QMEs? Some advice is to try and sort out for parties as best you can whether or not there is brain dysfunction. If so, what is the etiology? Determine and differentiate what is brain dysfunction vs. psychiatric dysfunction? Use Table 13-6 (AMA Guides) for assistance in compensation for cognitive deficits and how to interpret these issues. What tests would you recommend neuropsychologists use to help in addressing the above issues? Up to the neuropsychologist. Observations are important. If you can t answer QME questions in four hours of testing, than nothing is going to answer the questions. Be specific to what you want answered and select tests accordingly in a reasonable time frame. You re not in graduate school. You re not working for a professor. Your task, as a neuropsychologist is to be efficient and expedient. If you give 8 hours of tests, then one score is bound to be low. What s the best advice you can give neuropsychologists, post 1/1/13? Understand the legal issues and write reports that address legal issues. There are certain things that the system needs to know from us, that we don t do clinically. Our job is to put the medical facts in context so parties can go forward to resolve the case. In the real world, write reports for insurance carriers, attorneys. Explain terms in lay language. You ll be successful. Dr. Claude Munday, Ph.D., may be reached through Newton Medical Group, Oakland CA

3 Concussion Screening in Sports Neuropsychology By: Thomas Hardey, Ph.D., FACPN The NFL is one of the many areas in which neuropsychologists are now playing a key role in the evaluation, treatment, and management of concussions. Other areas that require a significant increase in neuropsychologists include working with high school and college sports teams throughout California. The NFL concussion screening program was started by Dr. Mark Lovell in 1994 at the Pittsburg Steelers. In 1997, I started the concussion screening program with the San Francisco 49ers and remained with that team until In 1998, I started the concussion screening evaluation and management program with the Oakland Raiders and remain with that team to the present. Before the pre-season and the regular season, all players undergo baseline neuropsychological screening as part of their annual physical examination. Later, players with suspected concussion are reevaluated by the neuropsychologist. If a player is found to have a concussion utilizing a combination of neuropsychological and medical evaluation, then the patient is held out of play until he has returned to full physical and neuropsychological functioning. Like football, the health care team includes many specialists, including athletic trainers, physical therapists, physicians & neuropsychologists. Since 2012, the "Madden Rule," named for the former coach of the Super Bowl-winning Oakland Raiders, requires that no player with a concussion can return to play the same day as his injury. The NFL has now donated tens of millions of dollars to research studying all aspects of concussion management & treatment, including neuropsychological research, medical research, and equipment research. I would strongly recommend to any qualified sports neuropsychologist that they contact local high school and college sports teams to determine if they have the services of a neuropsychologist. If they do not, this is an opportunity for both the schools and for an enterprising & qualified neuropsychologist. It is now mandated that student athletes who have sustained a suspected concussion must be evaluated by a physician/psychologist to be returned to play. Finally, it is important for neuropsychologists to realize that their colleagues have been working (quietly) for 20 years in the NFL to make evidence-based changes in the way concussions are diagnosed, treated and return-to-play decisions are made. Similar contributions have been made in the National Hockey League, Major League Baseball, National Basketball Association, soccer and other major sports. For more information on how you might become more involved, please consider joining the Sports Neuropsychology Society. Also consider presentations sponsored by the Neuropsychology Division of CPA, by the National Academy of Neuropsychology, the Society of Clinical Neuropsychology (Div. 40 APA) & the Society for Sports & Exercise Psychology (Div. 47 APA). For other questions, contact me at neuropsy@sonic.net : Put Div. VIII newsletter in subject line. About Delia Silva, Psy.D., ABPP-CN, About Thomas Hardey, Ph.D., FACPN QME Dr. Hardey began his career as a NP in the USN. After leaving active duty, he went into Dr. Silva is a neuropsychologist private in private practice and focused on NP, injured college & professional athletes, & injured practice (Pacific Neurobehavioral workers. Clinic, Always Inc.) active in professional psychology issues, he has also remained active in San Diego, CA. She serves as playing secretary tennis. of He is in private practice with Dr Cecilia Hardey. Their son is a USN active CPA Division 8 as well as member-at-large duty submarine of officer. the Hispanic Neuropsychological Society (HNS).

4 Member Spotlight: Ariati Rakic, Ph.D. By: Mary Goodarzi, M.A. Dr. Ariati Rakic, Ph.D. characterizes her work as a blending of core sciences based on our psychometric measures along with the art of discovery and possibilities. Dr. Rakic began her training in Clinical Neuropsychology at Kaiser Permanente Medical Center-Vallejo, and then followed with multiple neuropsychology practicum, internship, and postdoctoral positions. In addition to her vast clinical training sites, Dr. Rakic was also extensively trained in depression and anxiety disorders with adult and pediatric populations. With her extensive training and experience in the medical and clinical settings, Dr. Rakic s assessments blend the individual s brain and body s process in order to completely understand the presenting issues at hand. Her process-oriented approach compiles the scores and behavioral observations during testing, but also the individual s patterns of responses, words that were typically being used, and other clues to piece together parts of the puzzle that will provide her patient with the most comprehensive feedback. Not only is Dr. Rakic extensively trained within the field, she is also able to provide assessments and feedback in three languages other than English: Spanish, French, and Portuguese. Her ability to play detective by taking all information into consideration in conjunction with her strong morals and values, Dr. Rakic determines the root of the presenting problem by looking outside of the box. Dr. Rakic has a thriving private practice, but not without many struggles and years of hard work. As Dr. Rakic pointed out, the logistics of establishing and maintaining a private practice comes with its hardships and struggles. She illustrates some major differences between private practice versus other settings: in private practice, you are solely responsible for the billing, tracking of hours, clientele, marketing. In the medical and hospital settings, you receive one stable income no matter what the outcomes were and did not have to deal with as many logistics. However, Dr. Rakic demonstrates that hard work and determination does pay off. She has built a strong referral system through neurologists and pediatricians and continues to follow her conscious decision to focus on the quality of her assessments rather than the number of clients. She works in three different locations: Walnut Creek, Santa Rosa, and Pleasanton. She enjoys working with a full-range population with both children and adults, where each case is very different from the last. Dr. Rakic s advice for students exemplifies the advice she follows herself: to be able to think for yourself and ask questions when you need it. She recommends students to spend many hours in training as a volunteer or psych assistant as well as being open to feedback, both praise and criticism. That s how you learn, through the rights and the wrongs and being open to both. That s how I did it, she states. One last thing for students, You have to have the passion to be in this field. Without that, you won t reach your full potential. Thank you Dr. Rakic for your wise words and dedication to this field. About Mary Goodarzi, M.A. Mary Goodarzi is a doctoral student at The Wright Institute in Berkeley and received her MA from Pepperdine University in West Los Angeles. She is currently a practicum trainee within an integrated primary care clinic, working collaboratively with physicians, clinicians, and other medical health professionals.

5 Welcoming Division VIII s New Student Representative By Elizabeth Romero, M.A. I am honored to introduce our new Division VIII representative,monica U. Ellis. Monica is a doctoral student in Clinical Neuropsychology and is also obtaining her master s degree student in Christian Leadership from Fuller Theological Seminary in Pasadena, California. She earned her master s degree in Psychology from Pepperdine University where she conducted extensive research on trauma recovery (e.g., recovery from sexual assault, childhood trauma, and intimate partner violence, and on the role of the Black church in HIV/ AIDS prevention). Since commencing her studies at Fuller, Monica has continued to pursue research and clinical training in the areas of neuropsychiatric symptom recovery/coping and spiritual resilience following trauma, HIV/AIDS diagnoses, and pediatric brain injury. Monica professionally serves as a part-time professor of Psychology Research Methods at California State University Dominguez Hills and as the Co-Chair of Membership in the Society for the Psychology of Women, Division 35 of the American Psychological Association. She is looking forward to once more serving as the Division VIII student representative. One of her goals this year is to help create peer-colleague networks. She is also working towards understanding and addressing the needs of Neuropsychology students with regard to program concerns, resources, and so forth. About Elizabeth Romero, M.A. Elizabeth Romero is a third year Psy.D. student in Clinical Psychology at Pepperdine University (Los Angeles, CA). Her research interests include recovery and rehabilitation from traumatic brain injury, ethnic bias among neuropsychological measures and memory impairment. Clinically she is interested in working with at risk populations and culturally diverse populations. She is currently serves as the student representative for CPA Division 88. Elizabeth.romero@pepperdine.edu

6 Immigration Psychological Evaluations By: Roxanna Rahban, Ph.D. Immigration psychological evaluations involving discretionary waivers due to psychological hardship for the qualifying relatives of undocumented aliens have been a demand in the field of psychological assessment. Such evaluations require a working knowledge of various issues related to immigration law, solid assessment skills, as well as a clear understanding of what constitutes extreme and unusual hardship. Many questions arise during these evaluations, such as, is the qualifying relative of the undocumented alien indeed related or are they superficially claimed to be a family member? Another question for might be, what are the sources of hardship for the relative (economical, educational, medical, emotional, etc.) that can be backed up with solid assessment data and record review? or what is the psychological value or impact of removing the undocumented alien from his or her qualifying relative? Psychologists are placed in a difficult position by needing to somehow predict the consequences of the alien s removal, despite having only examined the client on a few occasions. Furthermore, there appears to be a lack of education and appropriate training among graduate programs in this area. How can psychologists increase the predictive validity and consistency of their professional opinions, which will be used to make immigration determinations? The use of evidence-based clinical instruments and tools, such as the MMPI-2 and structured clinical interviews would typically increase the validity and reliability of the assessment data used to support psychologist s professional opinions and recommendations. In the end, the assessment psychologist s duty is to properly examine the client, collect and review the objective facts of the immigration case, and to offer an unbiased opinion using reliable data sources regardless of the expected outcome of the case. Further education and training in the field is warranted for psychological evaluators pursuing such assessments. About Roxanna Rabhan, Ph.D. Dr. Rabhan is a clinical psychologist and certified consultant who practices in Los Angeles, CA. She specializes in psychoeducational, med-lega, immigration, adoption, and forensic examinations. She provides treatment for parenting support and ADHD/LD. She can be reached at: roxyrabhan@gmail.com

7 ANNOUNCEMENTS & CLASSIFIEDS Posting announcements and classifieds is a benefit for Division VIII members. Please see submission guidelines on the next page to learn more.

8 Submission Guidelines The following content is free for Division 8 members: Article submissions (250 words) Job announcements (150 words) Referral requests Continuing Education announcements Classified listings are $25 for members, $40 for non-members for the first 40 words. There is a $5 charge for each additional 7 words, for a maximum of 150 words. The ads run for one month. Images are $25 extra. Students may submit wanted ads seeking psychological assistantships for $15 to run for the month. 40 word limit. All articles and announcements need to be ed in Word format to: dsilva@sdpsyd.com. Photos should be in.jpg format. If payment is required, it is due by the 20th of each month for inclusion in the next month s issue. Synaptic Connections is the official newsletter of CPA Division. It is distributed to all current members of Division 8 which mainly consists of practicing neuropsychologists and students in neuropsychology.