Inter Organizational Practice Committee Guidance/Recommendation for Models of Care During the Novel Coronavirus Pandemic

Abstract

Objective The Inter Organizational Practice Committee (IOPC) convened a workgroup to develop guidance on models to provide neuropsychological (NP) care during the COVID-19 pandemic while minimizing risks of novel coronavirus transmission as lockdown orders are lifted and ambulatory clinical services resume. Method A collaborative panel of experts from major professional organizations developed provisional guidance for models of neuropsychological practice during the pandemic. The stakeholders included the American Academy of Clinical Neuropsychology/American Board of Clinical Neuropsychology, the National Academy of Neuropsychology, Society of Clinical neuropsychology (Division 40) of the American Psychological Association, the American Board of Professional Neuropsychology, and the American Psychological Association Services, Inc. Results This guidance reviews the risks and benefits of conducting NP exams in several ways, including standard in-person, mitigated in-person, in-clinic teleneuropsychology (TeleNP), and in-home TeleNP. Strategies are provided for selecting the most appropriate model for a given patient, taking into account four levels of patient risk stratification, level of community risk, and the concept of stepped models of care. Links are provided to governmental agency and professional organization resources as well as an outline and discussion of essential infection mitigation processes based on commonalities across recommendations from diverse federal, state, local, and professional organization recommendations. Conclusion This document provides recommendations and guidance with analysis of the risks relative to the benefits of various models of NP care during the COVID-19 pandemic. These recommendations may be revised as circumstances evolve, with updates posted continuously on the IOPC website (https://iopc.online/).

Survey Findings About the Experiences, Challenges, and Practical Advice/Solutions Regarding Teleneuropsychological Assessment in Adults

“…During the COVID-19 pandemic when the use of TeleNP has substantially grown, clinicians and investigators have also been faced with balancing the trade-off of test reliability and validity concerns associated with home-to-home or clinic-to-home settings with those related to in-person, pandemic-related testing protocols. Some examples include the utilization of masks, gloves, and plexiglass barriers, all of which are deviations from the procedures in which in-person cognitive assessments were designed and standardized ( Postal et al, 2021 ).…”

“…In the immediate aftermath of the COVID-19 lockdowns, several neuropsychological professional societies collaboratively developed guidance to help navigate the rapid shift from in-person assessment to TeleNP. For example, the Inter Organizational Practice Committee (IOPC) recommendations ( Bilder et al, 2020 ; Postal et al, 2021 ), as well as those advanced by other groups—such as the Neuropsychology Service within the Department of Neurology at the Emory University Brain Health Center ( Hewitt et al, 2020 ; Hewitt & Loring, 2020 ) and the Center for Cognitive Neuroscience and Aging at the University of Miami in Miami, Florida ( Kitaigorodsky et al, 2021 )—have responded to this need by focusing largely on the clinical use of TeleNP. However, the perspectives of the broader community of clinicians and researchers conducting cognitive assessments using TeleNP has not been well characterized to date, with only one recently published survey of licensed U.S. neuropsychologists by Rochette et al (2021 ), to our knowledge, more fully exploring the first-hand experiences of TeleNP users.…”

Italian telephone-based Mini-Mental State Examination (Itel-MMSE): item-level psychometric properties

“…A more appropriate standardization study of the Itel-MMSE in line with current methodological standards on remote cognitive testing [ 27 , 28 ] is desirable. Indeed, it remains to be derived norms specific to the remote modality of delivery [ 27 ], to assess its construct and criterion validity, also exploring the association with other telephone-based measures of cognitive status, as well as with in-person cognitive screening tests [ 29 , 30 ], including the assessment of the equivalence between the Itel-MMSE and its in-person version by adopting ad-hoc statistical methods [ 31 ].…”

Neuropsychological disorders after COVID-19. Urgent need for research and clinical practice

“…Despite teleconsultation-related concerns, the use of audio-or videoconferencing for the purposes of neuropsychological assessment is advancing [67]. Guidance was sought from professional organizations and several of them issued recommendations for practice amid the COVID-19 pandemic, including the COVID-19 Pandemic Health System REsilience PROGRAM (RE-PROGRAM), Inter-Organizational Practice Committee (IOPC) [68], and the NeuroCOVID-19 International Neuropsychological Society Special Interest Group [62] 1 .…”