CHILD NEUROPSYCHOLOGY

2022, VOL. 28, NO. 4, 510–534

https://doi.org/10.1080/09297049.2021.1993809

Clinical and training practices: A survey of pediatric

neuropsychologists serving inpatient rehabilitation
Katherine T. Baum a, Julia Smith-Paine b
, Sarah J. Tlustos c,d
, Abigail Johnson e

and Christine Petranovich c,d

a
Children’s Hospital of Philadelphia, Philadelphia, PA, USA; bCincinnati Children’s Hospital Medical Center,
Cincinnati, OH, USA; cChildren’s Hospital Colorado, Aurora, CO, USA; dDepartment of Physical Medicine and
Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA; eDepartment of Physical
Medicine and Rehabilitation, University of Michigan Medicine, Ann Arbor, MI, USA

ABSTRACT ARTICLE HISTORY

Neuropsychologists in inpatient pediatric rehabilitation settings colla­ Received 16 July 2021
borate with an interdisciplinary team to educate, evaluate, and provide Accepted 12 October 2021
intervention to patients with acquired brain injury and their families, KEYWORDS
but there are no known studies that describe or define these clinical Clinical practice;
services. Thirty-one neuropsychologists in pediatric inpatient rehabili­ rehabilitation medicine;
tation settings completed an online survey. Neuropsychologists (68.2% child; training; outpatient
female; 86.4% with PhD versus PsyD) from the U.S. and Canada, who
represented 22 pediatric inpatient rehabilitation sites comprised the
final sample. Most sites (63.6%) were embedded within medical cen­
ters, with providers dedicating 2 to 32 hours (M = 14.25, SD = 9.26)
weekly to onsite inpatient rehabilitation efforts. Providers most often
saw patients with traumatic brain injury and other acquired brain
injuries, including stroke and brain tumor. Trainees from various levels,
most commonly post-doctoral fellows, provided clinical services on
inpatient units, many with some degree of independence. Clinical
practices that were standard across all or most sites included targeted
discharge evaluations, serial cognitive monitoring, neuropsychology
consultation to rehabilitation and non-rehabilitation units, and follow-
up clinics. Provision of services was influenced by multiple factors
including patient diagnosis, timing of return to school, inpatient cen­
sus, and payor’s effect on length of stay. Findings highlight many
programmatic consistencies across sites and serve as an important
initial step to guiding pediatric neuropsychology providers seeking to
understand the current landscape of clinical care. Future efforts are
needed to establish a true clinical guideline for practice. Although
preliminary, data also support establishment of neuropsychology train­
ing programs, justify administrative resources, and serve to educate
recipients of neuropsychology services.

Neuropsychologists frequently practice within inpatient pediatric rehabilitation settings

with the goal of educating, evaluating, and providing intervention to patients with
acquired brain injury and their families. Rehabilitation neuropsychologists collaborate

CONTACT Katherine T. Baum drkatherinebaum@gmail.com Children’s Hospital of Philadelphia, 1219 S. 46th

St. Philadelphia, Philadelphia, PA 19143, USA
*Present address: University Hospitals Rainbow Babies and Children’s Hospital
© 2021 Informa UK Limited, trading as Taylor & Francis Group
 CHILD NEUROPSYCHOLOGY 511

with an interdisciplinary team of providers and offer a unique perspective on the

cognitive, emotional, behavioral, and psychosocial strengths and impairments of these
patients. With that said, it is notable that data does not yet exist to empirically justify
neuropsychology services within rehabilitation settings (Prigatano & Pliskin, 2003).
A recent review by Donders (2020) revealed a preponderance of evidence of the incre­
mental value of neuropsychological assessment in the care of individuals with traumatic
brain injury (TBI) and, to a lesser degree, stroke, and epilepsy, all of which are commonly
seen in inpatient pediatric rehabilitation. In order to demonstrate the added value of
neuropsychological services in pediatric rehabilitation, it is important to first understand
the clinical practices themselves within this unique clinical area.
Standardized clinical practices have yet to be established in part due to the relatively recent
growing interest in rehabilitation neuropsychology as an established subspecialty (Slomine,
2021), as well as the at-times unclear boundaries between various psychologists and other
rehabilitation professionals who provide services in inpatient neurorehabilitation settings
(Johnson-Greene, 2018; Novack et al., 2010). Neuropsychologists typically function as part
of interdisciplinary inpatient pediatric rehabilitation teams to guide and inform the patient,
family, and team’s understanding of the neurological injury or illness and help address barriers
to functioning. In this setting, the primary role of neuropsychology is to assess cognition and
psychosocial strengths and weaknesses, to conceptualize this data within the context of
extensive training in brain–behavior relationships and to use objective data and this con­
ceptualization to guide treatment. In fact, they are more likely than other specialties to make
recommendations based on objective data and are thus, uniquely positioned to provide
evidence-driven care to patients with acquired brain injury (Block, Santos et al., 2017;
Johnson-Greene, 2018).
In both pediatric and adult inpatient rehabilitation settings, there is overlap in
evaluation services provided as multiple specialties assess the cognitive state of an
individual, though the formality and rigor of this type of evaluation and provider
training/competence varies widely across specialty. In addition to neuropsychologists,
providers conducting assessments include pediatric and/or rehabilitation psychologists,
speech-language therapists, neurologists, physiatrists, and nurses. The Commission on
Accreditation of Rehabilitation Facilities (CARF) notes that assessments of cognitive,
developmental, and emotional needs are important to optimize outcomes; however, little
guidance was offered regarding the type, frequency, or duration of this assessment or the
qualifications needed of a provider (CARF International, 2020). Terms like cognitive
screening, targeted or brief evaluation, and comprehensive evaluation/assessment are used,
especially in inpatient rehabilitation settings, without clear and consistent guidelines as to
what constitutes each of these levels of care, when they are appropriate, and who is
adequately trained to bill for and perform them (Roebuck-Spencer et al., 2017). Recent
efforts in our field have sought to provide greater clarity around the terms used to
describe clinical services (Block, Johnson-Greene et al., 2017), including for specific
pediatric disease populations like cancer (Baum et al., 2018), but this has not been
done within rehabilitation settings. Although some adult literature exists, currently,
there are no known studies with the sole purpose of describing or defining clinical
neuropsychological practices within pediatric rehabilitation centers. Given the shared
roles and responsibilities in rehabilitation settings and the additional competencies
required of pediatric providers, it is imperative that neuropsychologists demonstrate
512 K. T. BAUM ET AL.

their unique and added value, are clear about what services most clearly comprise this
area of focus, including what needs are better provided by others’ unique expertise, and
understand and communicate barriers to providing those services.
Further, although small and not formerly recognized as a formal subspecialty in the
field, neuropsychologists appear to be increasingly entering into roles within inpatient
pediatric rehabilitation settings, and these roles often include training psychology stu­
dents across all levels. Sweet et al.’s (2006) survey that focused on gathering salary
information from neuropsychologists reported only 4 of 121 pediatric survey respon­
dents (3.3%) indicated they worked in pediatric rehabilitation centers in 2006; this figure
more than doubled by 2020 to 21 of 264 (8.2%) pediatric providers (Sweet et al., 2020).
Although specificity does not exist for pediatrics, data from multiple sources (e.g., US
News and World Report hospital rankings (US News, 2020); CARF; the Association of
Academic Physiatrists [AAP], 2020) further describe the roughly 150 facilities and
dozens of training programs offering specialization in inpatient rehabilitation. The
clinical care, education, and training of neuropsychologists in this area of focus are
guided by foundational and functional competencies unique to neuropsychology.
Several groups and organizations have outlined the knowledge-based and applied com­
petencies of key functional areas, but none currently exist that guide the unique clinical
care of neuropsychologists in pediatric rehabilitation settings (Houston Conference
Guidelines, Hannay et al., 1998; Rey-Casserly et al., 2012; Smith, 2018).
Neuropsychologists and rehabilitation psychologists have overlapping expertise, both
addressing the crucial needs of pediatric patients with acquired brain injury and new
onset disability. Traditional neuropsychological training emphasizes assessment and the
relationship between brain and behavior relationships, while traditional rehabilitation
psychology training encompasses elements of assessment and psychotherapy specific to
individuals with disability. Neuropsychologists in rehabilitation settings may engage in
therapy and intervention activities that are in alignment with their training and compe­
tencies and typical of rehabilitation psychologists; this is especially true when there is no
dedicated pediatric and/or rehabilitation psychology support. However, there are clear
and unique training competencies that govern rehabilitation psychology and should be
prioritized when providing therapeutic intervention in rehabilitation settings (Stiers
et al., 2015) of which the provider must be able to meet. Given these distinct expertise
areas within an overlapping clinical context, further clarification about the unique role of
the rehabilitation neuropsychologist is needed.
Importantly, there are no known survey data on clinical neuropsychology practices in
pediatric rehabilitation to potentially direct the future development of clinical practice
guidelines. Governing organizations in the field of neuropsychology have developed
clinical guidelines for many aspects of neuropsychological assessment and consultation
(AACN, 2007), but the development of such guidelines specific to rehabilitation and TBI
are scarce, with only the Military TBI Task Force outlining their position on neuropsy­
chological care of military servicemen with TBI (McCrea et al., 2008). Surveys of adult
neuropsychologists in rehabilitation settings have found that they most often see patients
with TBI and stroke/vascular injury providing a multitude of services including neurop­
sychological assessment, individual behavioral intervention, multidisciplinary goal plan­
ning, and in fewer cases, cognitive rehabilitation (Block, Santos et al., 2017; Sweet et al.,
2002; Wilson et al., 2008).
 CHILD NEUROPSYCHOLOGY 513

As a starting point to establish guidelines for clinical neuropsychological care within

inpatient rehabilitation, adult providers have some data describing their practices, but in
pediatrics, there are no such survey data. Pediatric rehabilitation populations have
unique clinical needs due to ongoing developmental factors that can change across
childhood such as biological and neuronal maturation, ongoing recovery and medical
management, missed schooling and opportunities for socialization, and adjustment of
the child and family. Pediatric neuropsychologists often follow patients for years in
outpatient contexts, but they play an especially critical role in acute care and inpatient
settings by facilitating care providers’ early understanding of the behavioral expression of
neurological dysfunction on the developing brain. When psychological resources are
available, such as a rehabilitation or pediatric psychologist, neuropsychologists work in
concert with these providers to ensure appropriate education, and intervention is pro­
vided to the patient and family in need of this support. In many cases, there is a need for
both psychotherapeutic intervention and separate psychoeducation about brain injury
and behavior. Regardless, neuropsychologists’ methods of assessment, care planning, and
provision of education in the inpatient pediatric rehabilitation setting are distinct from
adults and should be more clearly understood. Further, the transition from inpatient to
outpatient care represents a challenging and overwhelming time for pediatric rehabilita­
tion patients, particularly those with brain injury (Biffl & Biffl, 2015).
Understanding standard neuropsychological practices in this population and setting
with an eye toward clinical consensus can be a first step in offering recommendations to
clinicians who aspire to establish clinical, research, and training programs in a manner
consistent with other existing programs in the field. Additionally, a better understanding
of the current practices, available evidence-based tools, and consideration of institutional
constraints and resources within inpatient pediatric rehabilitation and follow-up settings
can serve as an advocacy tool for clinicians to justify administrative supports and other
clinical and therapeutic resources. Results can also lay the groundwork for future efforts
aimed at the development of specialized clinical competencies, potential subspecialization
in rehabilitation neuropsychology and pediatric rehabilitation neuropsychology, and clin­
ical practice guidelines developed by governing organizations. Furthermore, data about
current practices across institutions can serve to educate recipients of neuropsychology
services, including medical teams, schools, therapists, and parents/families about our role,
knowledge base, and skillset. The present survey represents an important first step in
describing the demographics, services, teams, training, and clinical practices commonly
seen across rehabilitation institutions employing pediatric neuropsychologists.

Materials and methods

Participants
Thirty-one self-identified pediatric neuropsychologists started the online survey as it
pertained to their role and responsibilities in a pediatric inpatient rehabilitation unit. Six
of those participants stopped the survey after the initial two sets of questions and these data
were excluded from analyses. Respondents listed the city in which their site resides and all
but one voluntarily provided their site name. Three sites had two providers participate in
the survey. There were some inconsistencies between same-site raters (i.e., if inpatient
514 K. T. BAUM ET AL.

cognitive rehabilitation was offered), but demographic data were largely consistent. To
avoid duplication of site information, we systematically included the data from each site’s
first participant who submitted the survey. There were no significant differences between
respondents in the sample and those removed in terms of age or years in practice (p > .05).
The final sample for analysis was comprised of neuropsychologists from 22 pediatric
rehabilitation sites in both the U.S. and Canada. Not all participants completed every item,
but data were reported if participants completed at least one item within a respective
section (i.e., clinical services and trainee involvement). This resulted in a range of 17–22
participants’ data analyzed with smaller samples reporting on specific services (e.g., 15 sites
have a follow-up clinic, so details on this service are based on these data).

Procedure
Institutional Review Board (IRB) approval was obtained from the primary author’s
institution. Several of the authors, who are pediatric neuropsychologists that work in
different inpatient rehabilitation settings, created a survey using the Survey Monkey
platform. Input was sought from two additional neuropsychologists at other pediatric
rehabilitation centers who completed the entire survey to ensure accuracy, appropriate­
ness of content, and seamless operation of the survey platform. Questions were devel­
oped with the goal of briefly but comprehensively assessing the practices of pediatric
neuropsychologists in rehabilitation settings, with a particular focus on clinical services,
teams, and training. These included questions related to 1) the clinicians themselves [e.g.
gender, years in practice, and board certification], 2) the site at which they practice, 3) the
makeup of their interdisciplinary rehabilitation team and clinical services, and 4) trainee
involvement. See Addendum for the relevant survey questions.
Similar to the methodology used in the neuropsychology salary surveys (Sweet et al.,
2002, 2006, 2020), the survey was distributed via e-mail to neuropsychology professionals
in various regional, national, and international neuropsychological organizations as well as
by word of mouth. Specifically, invitations were sent via multiple listservs, including the
International Mail List for Pediatric Neuropsychologists (PED-NPSY list), the Pediatric
Rehabilitation Neuropsychology Google group, the Loring Neuropsychology Listserv, and
those overseen by the American Association of Clinical Neuropsychologists (AACN). The
invitation e-mail included the study details, survey hyperlinks, contact information for the
primary investigator, and a request for participation by Ph.D. or PsyD level pediatric
neuropsychologists who are independently licensed and provide cognitive assessment
within inpatient rehabilitation settings. Thus, unlike the salary surveys, only a small
proportion of e-mail recipients were eligible to participate. Participants provided consent
via the online interface. Based on early trials, the survey took 15–20 minutes to complete.

Data analysis
Data from the survey results were exported, cleaned, and evaluated through IBM SPSS
Statistics, Version 19. Several items were rated on a Likert scale, ranging from 1 – Not at
all to 5 – Very much. When number ranges were included in a response, the average was
included in analyses. Descriptive statistics were used to determine range, means, standard
deviations, and medians, as well as to calculate percentages.
 CHILD NEUROPSYCHOLOGY 515

Results
● Respondent demographics: All 22 respondents who completed the survey were
Caucasian and most were non-Hispanic (95.5%), female (68.2%) and had attained
a PhD versus a PsyD (86.4%). Most (87.5%) completed at least 2 years of post­
doctoral fellowship training. Two-thirds (68.2%) were early to mid-career or
within 10 years of completing postdoctoral training, and many were younger
than 50 (77.3%; mean age = 41.5 (8.1) years). Close to half (40.9%) were board
certified and mostly in clinical neuropsychology, although one respondent was
board certified in rehabilitation psychology as well. Most considered themselves
pediatric focused (86.4%) and the remaining three respondents identified as
lifespan.
● Sites and patient populations: Respondents represented sites in nearly all geographic
regions of the United States as well as a city in Canada. Rehabilitation units were in
both general hospitals/academic medical centers (63.6%) and free-standing rehabi­
litation hospitals. About one-quarter of sites (27.0%) were CARF accredited with
one site being “in process.” The size of units varied greatly (range 6–154 beds,
mean = 37.05, median = 16, SD = 41.51). Providers generally staffed units with high
percentages of neurologically involved patients, with 36.4% of respondents indicat­
ing 76–100% of patients fall in this category, generally making them appropriate for
neuropsychological services. Diagnoses most commonly seen varied within pedia­
tric rehabilitation units, though all but one site indicated moderate-to-severe TBI
was their most common condition (see Figure 1).

Figure 1. Most common presenting conditions in pediatric inpatient rehabilitation.

TBI = Traumatic brain injury; “Neurodev. Conditions” included myelomeningocele, autism spectrum disorder, and
cerebral palsy as examples. “Other Neuro. Conditions” included neuroimmunological diseases (e.g., multiple
sclerosis, acute disseminated encephalomyelitis, and ADEM), as well as conditions such as metabolic disorders
and empyema, as examples. Several conditions listed were not ranked by any program, including burns,
amputation, functional neurological disorders, pain disorder, cardiac conditions, or other non-neurological
disorders.
516 K. T. BAUM ET AL.

● Providers: While most sites (59.1%) had rehabilitation units staffed by one neurop­
sychologist, more than a third (36.3%) had 2–3 neuropsychologists. One large site
(with 115 beds) had 6 neuropsychologists, although two larger sites had fewer (2–3
neuropsychologists). The number of weekly hours dedicated to inpatient rehabilita­
tion varied widely amongst providers who responded, ranging from 2 to 32 hours
(M = 14.25, SD = 9.26) with 20 hours being the most commonly reported (18.2%).
For sites with more than one neuropsychologist, we did not ask respondents to
report on the hours or inpatient commitment of colleagues, nor whether they had
funding to support non-billable activities.
● Training: Trainees of various levels were involved in delivery of neuropsychological
services at most sites (77.8%) and were generally providing some services indepen­
dently/without in-room supervision. About one-quarter of sites (28.5%) reported
trainees operate independently 50–100% of the time and 42.9% of the respondents
indicated their trainee(s) rarely (0–25% of the time) provided services without
a supervisor present. While most sites (57.1%) had only one trainee, nearly a third
(28.6%) had three or more trainees. The majority of sites (66.7%) reported their
training program was accredited by the American Psychological Association (APA)
or Canadian Psychological Association (CPA) with nearly half (40.0%) having
rehabilitation-specific tracks. Of the 16 respondents who work with trainees, 12
reported consistently having a post-doctoral fellow in their program, six (37.5%)
work with pre-doctoral level intern(s), and even fewer (25.0%) reported having
externs/graduate students rotate on inpatient rehabilitation.
● Clinical Services and Team Members: (see Table 1)

Table 1. Inpatient clinical teams and services offered within pediatric rehabilita­
tion sites.
Team Member N Percent (%)
Yes
Physical therapist(s) 22 100%
Occupational therapist(s) 22 100%
Speech therapist(s) 22 100%
Neuropsychologist 22 95.5%
Social worker 22 90.9%
Case manager 22 90.9%
Child life workers 22 86.4%
Recreational therapists 22 68.2%
School teacher 22 68.2%
Educational liaison/coordinator 22 59.1%
Pediatric/Rehabilitation psychologist 22 59.1%
Clinical Services
Outpatient neuropsychology assessment 22 100%
Neuropsychology consultation on:
Inpatient rehabilitation units 22 100%
Non-rehabilitation inpatient units 22 72.7%
Psychological consultation on:
Non-rehabilitation inpatient units 21 71.4%
Day hospital 22 50.0%
Follow-up rehab medicine/brain injury clinic 22 72.7%
Specialty follow-up clinics (stroke, neuro-oncology, etc.) 22 68.2%
Cognitive intervention/rehabilitation (inpatient) 21 66.7%
Cognitive intervention/rehabilitation (outpatient) 21 61.9%
 CHILD NEUROPSYCHOLOGY 517

Inpatient. Generally speaking, inpatient neuropsychologists reported that they pro­

vided 1) serial cognitive assessment to track cognitive recovery, 2) interviews and
psychoeducation for caregivers and patients, and 3) discharge evaluations and school
transition planning services all the while collaborating with the interdisciplinary team via
team meetings. Intervention services, including behavior management, psychotherapy,
and cognitive rehabilitation, were also commonly provided at rehabilitation sites
(Slomine, 2021). The frequency and nature of these services varied across sites. See
Figure 2 for a summary of clinical practice and services data. The figure also outlines
proposed recommendations based on clinical consensus across sites. In cases where
decisions need to be made to maximize use of clinical resources, survey respondents
ranked several diagnostic groups as “high” priority for clinical care including severe TBI
(100% ranked as “high”), moderate TBI (94.4%), stroke (94.4%), encephalitis (88.9%),
anoxic brain injury (88.9%), brain tumor (72.2%), and autoimmune disease (72.2%).
Spinal cord injury, cerebral palsy, functional pain disorders, and patients with burns or
amputations were rated as lowest priority. Respondents also rated several other factors
and their influence on triaging decisions (as rated on a Likert scale ranging from 1, Not at
all, to 5, Very much). Timing of return to school and the current inpatient census were
reported to be the most influential factors, with family distress and geographic factors
also strongly affecting decision-making. Figure 3 details ratings of other relevant factors.

Serial Cognitive Assessment. Neuropsychologists at nearly all sites (88.9%) reported

that they conduct brief cognitive screenings serially, with many (55.6%) using the
Cognitive and Linguistic Scale (CALS), a standardized but not norm-referenced measure
developed at the Kennedy Krieger Institute (Slomine et al., 2008). Several other measures
were also reported to be commonly used for repeat assessments, including the Repeatable
Battery for the Assessment of Neuropsychological Status (RBANS; Randolph et al., 1998)
used by half the sample. While many sites (44.4%) conduct these screenings weekly,
others reported every 2 weeks (27.8%) or as needed.

Figure 2. Inpatient neuropsychology services offered at pediatric rehabilitation sites and proposed
recommendations.
518 K. T. BAUM ET AL.

Figure 3. Triaging factors affecting clinical neuropsychology services on inpatient rehabilitation units.
“Geographic” refers to factors such as family distance to hospital/access to other providers. “Patient history”
referred to prior developmental disability, previous medical risk factors, etc.

A common assessment practice in acute monitoring of TBI is to formally assess post-

traumatic amnesia (PTA) and time to follow commands (TFC), given their strong
association with functional outcomes (Austin et al., 2013; Davis et al., 2016). The
majority of sites (77.8%) followed a specific protocol to assess these variables and most
(80.0%) do so on a daily basis. Fewer sites (13.3%) did so multiple times a day. Formal
disorders of consciousness (DoC) protocols were followed less frequently, but still at
most sites (63.2%) with patients seen at least weekly at all sites. About half of the sites
(54.5%) administered standardized protocols daily or multiple times a day. Multiple
measures were used to assess patients in DoC, with roughly half the sites (52.9%) using
the JFK Coma Recovery Scale-Revised (CRS-R; Giacino et al., 2004) and/or the
Rappaport Coma-Near Coma Scale (Rappaport, 2000, p. 47.1%). While neuropsycholo­
gists were noted to be the ones most often conducting the DoC and PTA/TFC assess­
ments (75–76.5%), speech therapists also frequently took the lead (58.8–62.5%). Figure 4
outlines services and the disciplines that provided them.

Intake Interview and Psychoeducation: As part of a routine clinical intake interview,

neuropsychologists on inpatient rehabilitation teams uniquely seek to assess premorbid
functioning, as a child with preexisting developmental, learning, attention, or behavioral/
mood concerns are at higher risk for poor outcomes following brain injury (Yeates et al.,
2005). Based on sites’ responses, it is a clear standard (100% of the sites) to obtain school
records (e.g., grades, test scores, and educational plans). It is also common practice (72.2% of
sites) to request parents complete behavioral/emotional questionnaires based on a child’s
functioning in the months prior to the injury/hospitalization. Retrospective reports of
cognitive functioning (44.4%) and adaptive functioning (44.4%) were less common practices.
The measures most commonly reported include the Behavior Assessment System for
 CHILD NEUROPSYCHOLOGY 519

100
Percent of sites reporting participation by provider 90

80

70

60

50

40

30

20

10

Neuropsych SLP Ped/Rehab Psych Child Life Other OT PT PM&R Nursing

Figure 4. Common clinical practices of inpatient neuropsychologists and team member participation.
Abbreviations are as follows: post-traumatic amnesia (PTA), time to follow commands (TFC), disorders of
consciousness (DoC), speech language pathology (SLP), occupational therapy (OT), physical therapy (PT) and
physical medicine and rehabilitation (PM&R). “Other” consisted of social work (for Brain Injury Education and
Behavior/Psychotherapy) and neurology (for DoC Protocol and PTA/TFC Assessment).

Children-Third Edition (BASC-3; Reynolds & Kamphaus, 2015), and the Behavior Rating
Inventory of Executive Functions-Second Edition (BRIEF2; Gioia, Isquith, Guy &
Kenworthy, 2015). Another common technique (66.7%) was to rely on scores on perfor­
mance-based measures of crystallized skills (e.g., word reading) to estimate premorbid
abilities.
All sites offered brain injury education, with most noting the frequency depends on
individual family and patient needs. While the vast majority (18 of 20 sites, 90.0%)
provided education to the individual patient/family, two sites did so in a group format.
Regardless of format, sites were split with regard to using formalized/structured
educational programs, with 45.0% of sites noting they did. All respondents indicated
that they provide brain injury education, though pediatric/rehabilitation psychology
(57.9%) and child life providers (21.1%) also supported patient/family education (see
Figure 4).
520 K. T. BAUM ET AL.

Discharge Evaluations and School Reintegration. All sites conducted discharge neu­
ropsychological evaluations and most appeared to formulate the battery based on indi­
vidual patient factors. However, about one-fifth (4 of 20) noted they followed assessment
protocols for specific diagnostic populations, with oncology protocols being the most
common. Discharge evaluation reports from neuropsychologists and therapists guided
school reintegration and at about two-thirds of sites, these results and recommendations
were shared within school reentry meetings.
Intervention Services. Psychotherapy interventions, behavioral modification, and/or
family-based support were options at most sites (94.4%) with many sites (70.6%) offering
it weekly or as needed. The most common presenting concerns for psychology consul­
tants were patient coping (94.4%), closely followed by behavior management (88.9%).
About three-quarters of sites (all 72.2%) reported parental coping, brain injury educa­
tion, and concerns for patient anxiety/depression as being key presenting problems.
Pediatric/rehabilitation psychologists were most likely to provide psychotherapy ser­
vices (13 of 17 sites), though neuropsychologists overlap and solely or additionally
provide intervention at 10 of 18 sites. On inpatient units that offer cognitive rehabilita­
tion services, most offered it daily (73.3%) and this is primarily provided by speech-
language therapists (at 92.9% of sites), though neuropsychologists also offered this service
at about half of sites (46.2%). While most sites (60.0%) provide the service on an
individual basis, a sizable proportion (40.0%) offered both group and individual sessions.
Rehabilitation intervention and consultation services are done collaboratively by
many neuropsychologists, with roughly three-quarters of neuropsychologists reporting
they co-treat regularly (every 2 weeks or more). Co-treatment sessions most often
occurred with speech/language therapists (SLT) with 50% of respondents having noted
51–100% of sessions are with SLT. Fewer occurred with OT and PT, with all respondents
having indicated <50% of the sessions were with OT/PT.

Team Meetings. During inpatient admissions, all sites reported having multidisciplinary
team planning or care coordination meetings with most sites (61.1%) conducting these
weekly. Four of the 18 providers who responded to this item have meetings twice weekly.
Family meetings were also a standard of care and offered at all sites, with most (61.1%)
providing these to every family.

● Inpatient Rehabilitation Follow-up. The range of follow-up outpatient services

offered by neuropsychologists varied across sites and are summarized in Table 1.
Most sites had a follow-up clinic for patients discharging from the inpatient
rehabilitation unit. The follow-up clinics are funded by physical medicine and
rehabilitation divisions/departments at 15 of the 18 sites (83.3%) and the healthcare
specialties that comprised the clinics varied. Most clinics had physical medicine and
rehabilitation physicians (87.5%), neuropsychology (78.6%), occupational therapy
(64.3%), physical therapy (71.4%), and social work (64.3%). Half (50.0%) included
other providers, such as speech/language therapy and education/school coordina­
tion. Even fewer clinics reported involvement of doctoral-level specialists, such as
separate pediatric/rehabilitation psychology (42.9%), neurology (42.9%), and
 CHILD NEUROPSYCHOLOGY 521

neurosurgery (14.3%). Rehabilitation clinics, on rare occasions, offered additional

specialty consultations, including case management, recreational therapy, dietician
services, and optometry.

Discussion
Neuropsychologists often work in pediatric inpatient and outpatient rehabilitation set­
tings to educate, evaluate, and at times provide intervention to families and to children
and adolescents who have sustained an injury or insult to the brain. Within an inter­
disciplinary rehabilitation context, pediatric neuropsychologists offer a unique perspec­
tive on the cognitive, emotional, behavioral, and psychosocial impairments of patients
with acquired neurological diagnoses and identify strengths and resiliency factors.
However, there is currently a dearth of evidence regarding the incremental value of
neuropsychological assessment in these settings and no existing data or guidelines for
clinical practice within pediatric populations. This survey aimed to take an initial step
toward filling these gaps by proposing basic guidelines based on the clinical practices
currently used across 22 programs. In doing so, our goal was to provide a preliminary
resource for developing common practice expectations and call for further investigation.
The results of this survey highlight many patient, site, training, and clinical practice
consistencies among the programs represented. Consistent with other work that focuses
on inpatient rehabilitation broadly (Block, Santos et al., 2017), TBI followed by brain
tumor and stroke were among the most common diagnoses seen by pediatric neuropsy­
chologists in rehabilitation settings, with pediatric encephalitis being another common
population. Although not true for all sites, neurodevelopmental conditions were also
commonly served, highlighting a difference from most adult settings. The changing
brain–behavior relationships across development within complex medical and develop­
mental conditions suggest that there is a need for neuropsychologists to provide con­
sultation, education and/or intervention, and assessment during periods of acute
functional change for a wide range of pediatric conditions. Representing an additional
important consideration, sites generally reported having at least one dedicated neurop­
sychologist, with most sites integrating trainees with varying levels of experience and
independence into the interdisciplinary team. Indeed, training is an important respon­
sibility of many neuropsychologists that work in inpatient rehabilitation settings as this
offers neuropsychology-focused trainees unique opportunities to develop core neurop­
sychology competencies, including knowledge of neuroanatomy, neuroscience, neurop­
sychopharmacology, diagnostic techniques, measurement and psychometric theory, and
psychiatric disorders and manifestations (Rey-Casserly et al., 2012; Smith et al., 2018).
Similar to efforts in rehabilitation psychology (Stiers et al., 2015), the field would benefit
from future efforts that focus on defining the unique training and clinical competencies
required of neuropsychologists within rehabilitation settings, including the potential
creation of a formal subspecialty (Slomine, 2021).
Models of inpatient neuropsychology care varied across sites and this may be related
to multiple factors, including the size of the unit/service, patients seen (e.g., diagnoses
and level of functioning), and available resources. Universally, the pediatric neuropsy­
chologists that were surveyed provided consultation to rehabilitation teams, brain injury
education to families, and neuropsychological evaluation around the time of discharge,
522 K. T. BAUM ET AL.

suggesting these are the core responsibilities of the role and the foundation of
a pediatric neuropsychology provider within a rehabilitation program. We therefore
recommend these as standards of pediatric neuropsychology care within inpatient
rehabilitation settings (see Figure 2). Discharge evaluations have many purposes, most
notably to document the child’s current neuropsychological status. This is important
given an evolving literature supporting the utility of neuropsychological assessment in
the acute phase of recovery for predicting longer-term outcomes (Hanks et al., 1999,
2008). In addition, these evaluations help guide community reintegration and transition
planning, the most important of which for school-age children is arguably return-to-
school planning. Indeed, returning to school is a common and complex hurdle that
children with brain injuries and their families face, the success of which can have
a significant impact on their ongoing recovery, academic and social-emotional func­
tioning (Deidrick & Farmer, 2005; Hawley et al., 2004). Perhaps, the most important job
of neuropsychologists in this setting is to communicate the evaluation results and
recommendations to the family and to other professionals that are involved in the
child’s care. Though not consistently offered, school reentry meetings were also impor­
tant services provided by neuropsychologists; school-related consultation and guidance
are particularly important in the pediatric setting given the integral role education plays
in the lives of patients before, during, and following hospitalization. If resources and
adequate rehabilitation team investment are in place, pediatric neuropsychologists are
well positioned to support school reentry meetings and provide return to school
recommendations.
Interdisciplinary collaboration is arguably the rule on inpatient rehabilitation units,
with several neuropsychology services provided in concert with other disciplines, most
often speech-language therapy, and pediatric/rehabilitation psychology. Consistent with
previous research, providers that completed this survey were frequently involved in
integrated and collaborative care with other providers, including providing psychoedu­
cation related to the child’s condition, serial assessment, behavioral management, and
other psychosocial intervention (Block, Santos et al., 2017; Johnson-Greene, 2018). Given
how commonly intervention services were offered across sites, behavioral support and/or
psychotherapeutic interventions are also a recommended standard, though these services
may be provided by other clinicians, such as rehabilitation/pediatric psychologists, child
life specialists, and/or recreation therapists. Collaboration with other providers is parti­
cularly important in the inpatient setting as patients and their families adjust to new
deficits and a rapidly changing context.
Continued research efforts that outline the unique training, roles, and responsibilities
of rehabilitation psychologists and pediatric psychologists, with the recognition that
aspects of care overlap with neuropsychology, will be important for the future. The
needs of the team, family, and patients seen within this unique inpatient setting are
extensive and require the expertise of providers trained from these specialty areas in
addition to neuropsychology. Based on the results of this study, collaborative interven­
tion services are commonly individual and/or group-based, though fewer sites use group
formats. Specifically, 40% of the sites offer group cognitive rehabilitation and 10% of the
sites offer group brain injury education. These rates are comparable to previous authors
who reported roughly 30% of the neuropsychologists offer group intervention (Wilson
et al., 2008). At present, clear guidelines for brain injury education curriculum do not
 CHILD NEUROPSYCHOLOGY 523

exist, though programs of this type have been developed and more widespread imple­
mentation of these and cognitive rehabilitation approaches could optimize the clinical
care of rehabilitation patients (Koterba et al., 2020; see Cicerone et al., 2011, 2019;
Laatsch et al., 2007, for reviews).
From a research perspective, one of the challenges in the inpatient rehabilitation
setting is the lack of consistent and sensitive outcome measures. Attempts have been
made to improve this via the National Institutes of Health Common Data Elements
(CDEs) initiative (Adelson et al., 2012; McCauley et al., 2012; Wade & Kurowski, 2017)
and several pediatric brain injury research groups exist, including the recently established
Pediatric Brain Injury Consortium (Watson et al., 2020). Collaborative groups like these
can aid in developing consistent outcome measures to facilitate more effective inter-
institutional collaborations, leading to larger scale studies on outcomes of pediatric
rehabilitation patients. One target could be for sites to utilize the CALS for serial
cognitive assessment as current survey results demonstrated its widespread use.
Furthermore, it can be used across most pediatric age ranges, functional levels, and
periods of recovery and has clear utility in predicting functional outcomes in children
even beyond the Functional Independence Measure for Children (WeeFIM), the stan­
dard rehabilitation outcome measure in pediatrics (Blackwell et al., 2020; Slomine et al.,
2016).
Another area for continued research is assessment and treatment for patients with
DoC. In this survey, there was variability regarding protocols for serial assessment of
patients with DoC, with only half of sites reporting that a protocol was in place. This may
reflect the variability in the interpretation of recently established guidelines (Giacino
et al., 2018) as well as limitations in terms of resources. Collaborative assessment was
common, and a team approach is often needed to meet the high burden of clinical care
for frequent assessment in this population. The CRS-R and Rappaport Coma-Near Coma
Scale were the most common tools for tracking responsiveness. As an advancement in the
effort to assess functioning in pediatric patients in DoC, Slomine et al. (2019) validated
a modified version of the CRS-R, the most commonly used measure to assess patients in
DoC, making it more reliable in assessing children younger than 4 years of age. The
adaptation provides an opportunity for clinical consistency and more accurate assess­
ment of DoC in young patients.
There are several limitations of this study. This study included a small number of
respondents and a larger sample size would allow for targeted comparisons based on site
and provider-related factors. That being said, pediatric inpatient rehabilitation neurop­
sychology is a small and specialized group of professionals, though the exact number of
programs and providers is difficult to quantify. Our sample was comparable to Sweet’s
most recent large-scale salary survey, which only included 21 pediatric providers who
were identified as working in pediatric rehabilitation (Sweet et al., 2020). US News and
AAP identified 150 rehabilitation facilities nationwide, many with rehabilitation medi­
cine training programs. Despite attempts to specify the proportion of these facilities or
programs that are pediatric focused, there is currently no available or published data and
even less available information to identify those with integrated neuropsychology ser­
vices. Our sample characteristics are broadly comparable to those of other surveys of
neuropsychologists practicing in rehabilitation settings, although some differences were
observed. The age of our respondents was comparable to that of the sample of Block,
524 K. T. BAUM ET AL.

Santos et al. (2017), although both samples were slightly older compared to the sample in
the survey completed by Sweet et al. (2020). Our sample and Block’s sample also both had
slightly fewer females compared to those from Sweet’s survey. Compared to Sweet et al.
(2020) our sample was also more likely to have a PhD instead of a PsyD (87.5 vs. 77.8%).
Representing an additional limitation, efforts were made to minimize time and burden
on those taking the survey and, for this reason, not all potentially relevant factors were
assessed. This limited our ability to make clinically meaningful comparisons between
sites. For example, it would be helpful to better characterize the percentage time or
number of hours dedicated to inpatient rehabilitation across and between all neuropsy­
chological rehabilitation providers, the level of each trainee and degree of independence,
and the average caseload or number of patients followed per provider. Finally, given the
limited sample size and lack of representation from all U.S. states and regions in Canada,
these results may not generalize to all pediatric neuropsychologists who serve rehabilita­
tion populations and all settings and geographic regions in which they practice. Further
adult rehabilitation and non-rehabilitation pediatric settings with these specialty provi­
ders would benefit from future research efforts aimed at better understanding best
practices in the context of patient age and practice settings.
These findings elucidate our understanding of trends in this field, emerging
standards of practice in this setting, and directions for growth. Of relevance, there
is a lack of racial and ethnic diversity in the sample of clinicians who completed this
survey, with all respondents identifying as Caucasian and only one as Hispanic/
Latino. Further, it is unclear the degree to which these providers serve patients of
diverse ethnicities, cultures, or languages or have training to do so (i.e., bilingual­
ism). The sample’s ethnic makeup is similar in some respects to that reported in
other neuropsychological surveys (Sweet et al., 2015). This lack of diversity repre­
sents an important problem as individuals who identify as ethnic minorities com­
prise an estimated 6% of neuropsychologists in the field as a whole (despite being
34% in the population in 2006) and this gap seems to be widening (Rivera Mindt
et al., 2010). Thus, we echo the call of Rivera Mindt et al. (2010, p. 442) to “mend
the broken pipeline in neuropsychology” by recruiting and supporting students and
faculty from racial and ethnic minorities and promoting cultural competence,
including in pediatric rehabilitation. While our data did not ask specifically about
bilingualism, this too represents a gap in our field.
Considering other future directions, additional work is needed to define and
create a shared and consistent nomenclature among neuropsychologists for pediatric
rehabilitation, building upon work in other pediatric and adult populations (Baum
et al., 2018; Block, Johnson-Greene et al., 2017). Clear definitions and consensus on
a shared language will facilitate consistency in the expectations for clinical, research,
and training practices within this setting. Existing rehabilitation medicine guidelines,
including those that dictate accreditation from our governing bodies (CARF
International, 2020), could serve as a starting point to determine the terminology
used. Another long-term goal is to develop an evidence-based service model that
balances meeting patient needs based on risk while managing the practical and
clinical pressures for efficiency and revenue generation. We hope these data serve as
an important first step in understanding current clinical neuropsychological prac­
tices in order to help educate medical systems and recipients of neuropsychology
 CHILD NEUROPSYCHOLOGY 525

services about the role and benefits of inpatient neuropsychological practices in

a manner that can advocate for necessary support. Data additionally support the
proposal for the establishment of pediatric rehabilitation neuropsychology as
a subspecialty given the unique needs of the patient population that demand
neuropsychologists draw upon expertise in clinical, rehabilitation, and pediatric
neuropsychology (Slomine, 2021).
While we offer proposed recommendations based on current practice standards described
by our small sample, there is a need for more specific and data-driven clinical practice
guidelines. This may include a shared understanding and consensus of the levels of neurop­
sychological service, how each may be provided, and at what point(s) during inpatient and
outpatient rehabilitation care is most effective as this can optimize utilization of resources.
This type of comprehensive care guide must simultaneously reflect the majority of providers
and practice parameters within pediatric rehabilitation settings while also capturing the
complex clinical decision-making that inpatient rehabilitation neuropsychologists make
during triage, balancing resources with patient and team needs. Our sample size was
insufficient to fully understand these factors. Better characterization of existing resources,
patients, institutions, and family-related factors that influence clinical decision-making (e.g.,
school plan, patient census, and patient history), funding sources, and billing practices are still
needed to allow for providers to advocate for the required support to provide effective care to
this complex population. Doing so will allow for the continued development and refinement
of empirically supported guidelines for the delivery of neuropsychological services in inpa­
tient pediatric rehabilitation settings.

Acknowledgments
We wish to thank Drs Christine Koterba and William Watson for their review and input on the
survey, as well as the many survey respondents who donated their time.

Disclosure statement
No potential conflict of interest was reported by the author(s).

Funding
The author(s) reported that there is no funding associated with the work featured in this article.

ORCID
Katherine T. Baum http://orcid.org/0000-0002-5534-8296
Julia Smith-Paine http://orcid.org/0000-0001-5357-7477
Sarah J. Tlustos http://orcid.org/0000-0002-7653-4637
Abigail Johnson http://orcid.org/0000-0002-6558-9210
Christine Petranovich http://orcid.org/0000-0001-8044-8953
526 K. T. BAUM ET AL.

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0000159947.50523.64

Addendum
Survey Questions
1. Demographics of sample

a. Do you identify as: Male, Female, Prefer not to answer

b. What is your age? [Free text]
c. How would you identify racially/ethnically?
i. White
ii. Black or African American
iii. American Indian or Alaska Native
iv. Hispanic or Latino/a/x
v. Asian
vi. Native Hawaiian or Other Pacific Islander
vii. Other
viii. Prefer not to answer

d. How many years have you been in independent practice?

i. <1-5
ii. 6–10
iii. 11-15
iv. 16–20
v. 21-25
vi. >25 years

e. What is the highest degree you have obtained?

i. PhD
ii. PsyD
iii. Other

f. How many years did you spend on postdoctoral fellowship?

i. 1
ii. 2
iii. >2
iv. Did not complete a post-doctoral fellowship
530 K. T. BAUM ET AL.

g. Are you board certified in any specialty (e.g., ABPP and ABN)? (Yes/No)
i. In neuropsychology (Yes/No)
ii. In rehabilitation psychology (Yes/No)
iii. Other [free text]

h. How would you describe your professional identity?

i. Pediatric only
ii. Adult only
iii. Lifespan

2. Inpatient Rehabilitation Unit Information

a. How many beds are in the inpatient rehabilitation unit? [free text]
i. What is the average percentage of neurologically involved patients? (DROP
DOWN with range of percentages; 0–25%; 26–50%, 51–75%, 76–100%
b. How would you describe the area served by your hospital?
i. Rural
ii. Urban
iii. Suburban

c. The rehabilitation unit is located at what type of hospital? (Free-standing rehab center,
General hospital, other – [free text])

d. Is your rehabilitation unit CARF accredited? (Yes/No/In the process of accreditation)

iii. How often do you provide neuropsychology services on inpatient rehab to the following
patient populations? (rate never, infrequently (few x/year), occasionally (about once a month)
and often (multiple times a month or more)
a. TBI (moderate to severe)
b. Mild TBI/Concussion
c. Stroke
d. Brain tumor
e. Epilepsy
f. Other oncology
g. Encephalitis (e.g., HSV, Anti-NMDAR, and bacterial)
h. Other Neuroimmunological disease (e.g., ADEM and MS)
i. Anoxic Brain Injury
j. Spinal Cord Injury
k. Burn
l. Amputation
m. Functional Pain Disorder/Somatization/Chronic Pain
n. Infant/Perinatal acquired brain injury (i.e., non-accidental trauma)
o. Neurodevelopmental conditions/Disability (e.g., Spina Bifida, ASD, and CP)
p. Cardiac conditions/ECMO support
q. Other Neurological Disorder (i.e., metabolic/genetic, empyema – or other example!)

iv. List your top three most commonly seen diagnoses (allow rank order of above listed groups)

v. Do you have the following personnel as part of your inpatient rehab service? (Y/N)
a. Neuropsychologist (Y/N). If yes, please indicate:
i How many neuropsychologists serve inpatient [free text]
ii What is the average time dedicated to inpatient rehab: 0–25%, 26–50%, 51–
75%, 76–100
 CHILD NEUROPSYCHOLOGY 531

iii Full-time or Part-time (Choose one). % FTE, if known – (free text)

iv Who funds your position/pays your salary? (Rehabilitation/PM&R,
Psychology/Psychiatry, Funding is split (please specify ___________), Other)
v Do you bill for your inpatient time? (Y/N). If so, how are these numbers
tracked (DROP DOWN: Hours, RVU, Revenue collected, Other-free text)
b. Pediatric psychologist (Y/N)
c. Rehab psychologist (not neuropsychologist) (Y/N)
d. School teacher (Y/N)
e. Educational liaison/coordinator (Y/N)
f. Social worker (Y/N)
g. Case management (Y/N)
h. Physical therapist (Y/N)
i. Occupational therapist (Y/N)
j. Speech/Language pathologist (Y/N)
k. Child life (Y/N)
vi. Do you have the following types of neuropsychology clinics/services at your institution? (Y/N)
a. Inpatient rehabilitation
b. Inpatient/acute care (non-rehab) neuropsychology consultation or testing
c. Inpatient/acute care (non-rehab) psychology consultation liaison
d. Day hospital
e. Follow-up rehab/PM&R or brain injury clinic – consult or brief assessment model
i If yes: Which disciplines are involved in this clinic? (check all that apply,
PM&R, Neuropsychology, Speech therapy, Occupational therapy, physical ther­
apy, social work, educational coordinator/liaison, social work, neurology, neuro­
surgery, other medical teams – please specify, free text)
f. Outpatient neuropsychology clinic (that sees rehab and other patient populations)
g. Specialty clinic follow-up for specific diagnoses:
i [DROP DOWNfor stroke, neuro-oncology, encephalitis, CP, Other – Free text]
• Is this multidisciplinary (Y/N). If yes – is neuropsych involved (Y/N)

vii. Inpatient rehab services offered

a. Responsiveness protocol and/or formal disorders of consciousness program (Y/N). If
yes:
i Frequency – How often is the formal responsiveness protocol completed?
(Multiple times a day, Daily, Weekly, Every 2 weeks, Other (free text))
ii Duration – For what period of time do you follow the responsiveness protocol
with no significant improvement in responsiveness? (1 week, 2 weeks,
1 month, other (free text))
iii Who provides this service? (CHECK ALL THAT APPLY: Neuropsychology,
Ped/Rehab Psych, PM&R, Nursing, Speech, OT, PT, Other-free text)
iv What measure(s) are used? (CHECK ALL THAT APPLY: JFK Coma Recovery
Scale, Rappaport Coma-Near Coma Scale, Western Neuro Sensory Stimulation
Protocol, other free text)
v Which of the following are included in your disorders of consciousness
program? (CHECK ALL THAT APPLY: None, Somatosensory event-related
potentials (SSEPs), brainstem auditory evoked potentials (BAERs), visually
evoked potentials (VERs), other ERPs-please specify).

b. Assessment of PTA and time to follow commands (Y/N). If yes:

i Frequency – Generally, how often is it completed? (Multiple times a day,
Daily, Weekly, Every 2 weeks, Other (free text))
ii Who provides this service? (CHECK ALL THAT APPLY: Neuropsyc, Ped/
Rehab Psych, SLP, Other (free text))
532 K. T. BAUM ET AL.

iii What measure(s) are used? (CHECK ALL THAT APPLY: COAT, GOAT,
OLog, Westmead, Other-free text)

c. Serial cognitive assessment (Y/N). If yes:

i Frequency – Generally, how often is it completed? (Only at admission, Daily,
Weekly, Every 2 weeks, Other-free text)
ii Who provides the service? (CHECK ALL THAT APPLY: Neuropsyc, Ped/
Rehab Psych, SLP, Other (free text)
iii What measures are used? (CHECK ALL THAT APPLY: CALS, RBANS, Ped
TBI, Cognistat, LANSE, NIH Toolbox, Other-free text)

d. Comprehensive/abbreviated neuropsych evaluations for discharge planning (Y/N)

i Who provides this service? (Neuropsyc, Ped/Rehab Psych, SLP, Other (free
text))
ii Generally, how do you assess pre-injury functioning? (Check all that apply:
Parent BASC, Parent BRIEF, Parent CBCL, Parent adaptive functioning mea­
sure (ABAS-II, SIB-R, Vineland), school records (grades, test scores, educational
plans).
iii What measures are used? (free text)

e. Cognitive rehabilitation (Y/N)

i Frequency – Generally, how often is it completed for each patient? (Daily,
Weekly, Every 2 weeks, Other (free text))
ii Format (Individual, Group, or Both)
iii Who provides the service? (CHECK ALL THAT APPLY: Neuropsyc, Ped/
Rehab Psych, SLP, Other (free text)
iv Do you use a published standardized program (Y/N). If yes, please specify
(ACRM, other-free text)

f. Family education and support(Y/N)

i Frequency – Generally, how often is it completed for each patient? (Daily,
Weekly, Every 2 weeks, Other (free text))
ii Format (Individual, Group, or Both)
iii Who provides the service (CHECK ALL THAT APPLY: Neuropsych, Ped/
Rehab Psych, Child Life, Other (free text)
iv Do you use formal materials/manualized educational materials? (Y/N). If yes,
what? (free text)

g. Patient and family-based behavioral modifications/psychotherapeutic interventions

(Y/N)
i Frequency (Referral only, Daily, Weekly, Every 2 weeks, Other (free text))
ii Who provides the service (CHECK ALL THAT APPLY: Neuropsyc, Ped/
Rehab Psych, Other (free text))
iii Key presenting problems targeted [DROP DOWN – behavior management,
parental coping, patient coping, brain injury education, anxiety/depression,
other – free text]

h. Clinical data tracking and reporting(Y/N)

i Does your service have a database or clinical registry to capture the clinical
data that is collected? (if yes, then other questions)
ii How frequently are these data collected (Daily, Weekly, Every 2 weeks, Other
(free text))
 CHILD NEUROPSYCHOLOGY 533

iii Who provides the service/enters the data (CHECK ALL THAT APPLY:
Psychologist/neuropsychologist, other medical provider, Behavioral
Technicians, Research assistant, other administrative assistant, Other (free text)
iv Primary variables being collected (CHECK ALL THAT APPLY: GCS, Imaging
Findings, Surgical/Medical Interventions, Cognitive testing, Assessment of PTA,
Diagnosis/condition, demographic factors, Other (free text))

i. Co-treat with therapies(Y/N)

i Frequency (Daily, Weekly, Every 2 weeks, Other (free text))
ii Who provides the services (Neuropsyc, Ped/Rehab Psych, Other (free text)
iii What percentage of co-treat sessions is with:
● SLP (0–25%, 26–50%, 51–75%, 76%+)
● OT (0–25%, 26–50%, 51–75%, 76%+)
● PT (0–25%, 26–50%, 51–75%, 76%+)

j. Team coordination and meeting facilitation. Do you have:

i Team planning meetings/care coordination? (Y/N). If yes, how often? (Daily,
Twice weekly, Once weekly, Every two weeks, other-free text)
ii Family meetings? (Y/N). If yes, is this provided to every family (Y/N, other-free
text)?
iii School reentry meetings? If yes, is this provided to every school age patient (Y/
N, other-free text)?
iv Team consultation outside of scheduled meetings? (Y/N). If yes, do you bill
for this consultation with team members only? (Y/N)

k. Do you follow assessment protocols for specific diagnostic populations? (Y/N). If yes,
please specify defined assessment tracks or specific populations (e.g., Onc protocol,
Stroke protocol, etc.) (Free text)
i Do research protocols dictate clinical care (i.e., timing of evaluation, tests
given)? (Y/N)

viii. Training
a. Are trainees involved in clinical care for inpatient rehab? (Y/N). If Y how many? (1, 2,
2+)
b. What levels of training? (drop down – extern/graduate student, doctoral level intern,
postdoctoral fellow)
i On average, what proportion of inpatient services are provided independently
by trainees (0–24%, 25–49%, 50–74%, 75–100%)
c. Is your program APA/CPA-accredited? (Y/N/In the process of receiving accreditation
d. Do you have rehab-specific training tracks? (Y/N). If Y, what level of training (extern/
graduate student, doctoral level intern, postdoctoral fellow)
ix. Risk Stratification

How do you prioritize inpatient neuropsychological assessment for patients with the
following primary diagnoses(DROP DOWN for each group – high, medium low)?
Severe TBI
Moderate TBI
Mild TBI/Concussion
Stroke
Brain tumor
Other oncology
Epilepsy
Encephalitis
534 K. T. BAUM ET AL.

Autoimmune disease (e.g., ADEM and MS)

Anoxic Brain Injury
Spinal Cord Injury
Functional Pain Disorder
Burn
Amputation
CP
Neurodevelopmental conditions
Cardiac conditions/ECMO support
Other Neurological Disorder (i.e., metabolic/genetic)

How do you use the following factors to triage or prioritize neuropsychological inpatient
care? (1-not at all to 5-very much)
current census
insurance type
family distress
financial hardship
parent employment status
timing of return to school
geographic (i.e., family distance to hospital/access to other providers)
patient history (e.g., prior developmental disability and previous medical risk factors).
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