Increasing Culturally Competent Neuropsychological Services for Ethnic Minority Populations: A Call to Action

Abstract

US demographic and sociopolitical shifts have resulted in a rapidly growing need for culturally competent neuropsychological services. However, clinical neuropsychology as a field has not kept pace with the needs of ethnic minority clients. In this discussion we review: historical precedents and the limits of universalism in neuropsychology; ethical/professional guidelines pertinent to neuropsychological practice with ethnic minority clients; critical cultural considerations in neuropsychology; current disparities germane to practice; and challenges to the provision of services to racial/ethnic minority clients. We provide a call to action for neuropsychologists and related organizations to advance multiculturalism and diversity within the field by increasing multicultural awareness and knowledge, multicultural education and training, multicultural neuropsychological research, and the provision of culturally competent neuropsychological services to racial/ethnic minority clients. Lastly, we discuss strategies for increasing the provision of culturally competent neuropsychological services, and offer several resources to meet these goals.

Considerations for the Neuropsychological Evaluation of Older Ethnic Minority Populations

“…If a neuropsychologist determines that they s/he does not currently have the requisite competence to evaluate a particular ethnic minority patient, s/he may be able to cultivate that competence through the acquisition of speci fi c, culturally appropriate assessment, intervention, and communication skills necessary to effectively work with individuals from speci fi c ethnic minority groups [ 13 ] . For instance, supplemental training can be acquired through continuing education courses or workshops focused on working with culturally diverse populations (such as those offered through APA Division 40, the National Academy of Neuropsychology, the American Academy of Clinical Neuropsychology, or the Hispanic Neuropsychological Society) [ 75 ] , readings, and consultation [ 13 ] . In addition, neuropsychologists are also responsible for carefully considering the cultural competence of their psychometrists or graduate students, if used in the assessment process.…”

“…Extensive resources for such consultation are available elsewhere [ 13 ] . If a neuropsychologist determines that he or she does not have the requisite competence (either due to language or other concerns), it is recommended that the patient be referred to a more appropriate clinician.…”

“…There is also potential test bias related to the lack of support for the cultural equivalence and construct validity of several measures with ethnic minority populations [ 13,68,69 ] . Thus, it is important for clinical neuropsychologists to be aware of these research fi ndings to more accurately diagnose and serve ethnic minority patients.…”

“…Rivera Mindt et al [ 13 ] proposed a cultural competence in neuropsychology (CCN) model [71][72][73][74] that assists neuropsychologists in examining their cultural competence by evaluating their own cultural awareness and knowledge of the ethnically diverse populations they would like to serve. If a neuropsychologist determines that they s/he does not currently have the requisite competence to evaluate a particular ethnic minority patient, s/he may be able to cultivate that competence through the acquisition of speci fi c, culturally appropriate assessment, intervention, and communication skills necessary to effectively work with individuals from speci fi c ethnic minority groups [ 13 ] .…”

“…If such a referral is not feasible (due to geographic location or other barriers), then the neuropsychologist should consider how best to evaluate the patient, through use of a well-trained interpreter (which is less than ideal, but sometimes necessary) or in consultation with a neuropsychologist who does have the necessary cultural competence to ethically provide supervision. More thorough discussion of ethical obligations and competency issues related to neuropsychological evaluation with ethnic minority individuals is provided elsewhere and the interested reader is encouraged to review the available literature [ 13,70,71,[78][79][80][81] .…”