Bulletin

Bulletin vol. 34 no. 1 | 11 The resultant clinical report should discuss the special considerations related to the evaluation throughout the report. That is, the report should explicitly discuss how empirical literature and sociocultural data were used to inform the test selection, interpretation, case conceptualization, diagnosis, and recommendations. Further, the report should cite the normative datasets used to contextualize the patient's performance. Finally, the limitations of the evaluation, including behavioral observations (e.g., did the patient seem comfortable in the testing environment), language/bilingual concerns, test selection, and normative samples should be highlighted at least during relevant results discussion and reiterated in the conclusions (APA, 2017; Rivera Mindt et al., 2010). Finally, the feedback session should be an open dialogue between the clinical neuropsychologist, the patient, and family/ caretakers. Review the report and ensure that the patient and family/caretakers agree with the appropriate history, background, and sociocultural factors detailed in the report. Next, confirm that everyone involved understands the findings, implications, and recommendations. Further, recommendations should be realistic for the patient and caretakers to maximize the benefit of the evaluation. Displaying respect, adaptability, and advocacy on behalf of the patient is also essential to the feedback process, including modifying recommendations and advocating on behalf of the patient so the patient may receive the care necessary. Addressing the Leaky Pipeline and Workforce Neuropsychological test performance is influenced by a complex set of interrelated variables, such as an individual's disease, genes, age, sex, gender, education, occupation, race/ethnicity, and culture. Therefore, a deep understanding of cultural issues within the field of clinical neuropsychology is necessary for valid assessment and clinical practice. However, there are currently significant disparities within the field. Although racial/ ethnic minorities comprise over 36% of the U.S. population, they remain sorely underrepresented within the field of clinical neuropsychology (U.S. Census Bureau, 2010). According to a survey of demographic characteristics from the APA Division 40 - Society for Clinical Neuropsychology - (2017), over 66% of members identified as White, while 2.4% identified as Hispanic, 0.8% as Black, 1.5% as Asian, and 0.8% as Multiethnic. One major barrier is the lack of a national movement to cultivate racial/ethnic minority neuropsychologists at the early stages of professional development (Rivera Mindt et al., 2010). Racial/ ethnic minority individuals remain underrepresented within clinical neuropsychology training programs due to barriers reported by training directors, such as an overemphasis on GRE scores for graduate admission, a lack of exposure to neuropsychology coursework prior to graduate school, and limited funding sources (Rivera Mindt et al., 2010; Romero et al., 2009). Such factors continue to affect recruitment and retention of racial/ethnic minority students and trainees due to a lack of diversity within faculty, student bodies, or the general community surrounding some universities. This results in graduate programs that lack minority faculty to serve as mentors for ethnic minority students and subpar training in cross-cultural clinical neuropsychology (Rivera Mindt et al., 2010; Romero et al., 2009). Additionally, some graduate level training programs lack the racially, ethnically, and linguistically diverse populations required for culturally appropriate research or clinical experience. This results in highly limited training that is not tailored to the specific needs of racial/ ethnic minorities and linguistically diverse individuals. Several approaches in addressing this leaky pipeline include: working to expose others to the field of clinical neuropsychology earlier (e.g., networking at the high school and undergraduate levels); adjusting entrance criteria that overemphasize GRE scores; and increasing attention to both internal and external funding mechanisms specific to racial/ethnic minority individuals (Romero et al., 2009). A concerted effort is also necessary at the university level to target the recruitment of underrepresented individuals for both doctoral study and faculty positions. This may, in turn, increase graduate student retention by creating opportunities for an academic environment that supports diversity and provides mentorship that supports research and clinical experience with racial/ethnic minority populations of interest (Rabin, Brodale, Elbulok-Charcape, & Barr, 2017). Additional efforts can be made in working to establish diversity committees at universities to meet with incoming graduate applicants, and to provide unique advancement opportunities to trainees, such as minority member representation on councils, volunteer opportunities, and networking and professional development events (Romero et al., 2009). By doing so, clinicians and researchers within the field of clinical neuropsychology can systematically mend the leaky pipeline at all stages of the process. In addition to the expansion of recruitment efforts of racial/ ethnic minorities in the field of clinical neuropsychology, there is a need for proper and required training in multicultural issues. Such training is generally provided at the graduate level and/ or during postdoctoral fellowship; however, many clinicians and researchers obtain this training at the professional level through continuing education workshops or self-education (Rabin et al., 2017). Without a more standardized approach, many clinicians and researchers may entirely overlook additional training in multicultural issues. Solutions include introducing multicultural training into existing doctoral program curricula, both by offering formalized coursework and by regularly infusing diversity issues into core coursework (Rabin et al., 2017). Additionally, encouraging students to join professional organizations (e.g., Hispanic Neuropsychological Society, APA Division 45: Society for the Psychological Study of Culture, Ethnicity, and Race) that prioritize diversity and inclusion issues at the graduate level may provide them with continuing education programs, symposia, discussion groups, and networking opportunities that are beneficial in increasing overall cultural competency. Conclusion The challenges of conducting culturally-tailored research and clinical practice are multifaceted and include the need to prioritize the wellbeing of racial/ethnic minority populations who may be distrustful in research settings; utilize appropriate normative data and tailor the research and clinical environment - and physical space - to racial/ethnic minorities; and work to recruit and retain significantly greater proportions of students, trainees, and faculty who are racial/ethnic minorities and/or who have interest in working with racial/ethnic minorities. These issues are urgent in the field of clinical neuropsychology, not only for the betterment of the field as a whole, but perhaps more so because of the growing need for research and clinical services for the increasingly older and more diverse US population.

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