D

Interview with Clinical Neuropsychologist Dr. Meta Raymond

Professional Identity & Current Role

  • Name: Netta Raymond, Ph.D.

  • Title: Clinical Neuropsychologist & Coordinator of Neuropsychological Services

  • Workplace: El Camino Health / El Camino Hospital

  • Years in current hospital post: since 2018

  • Years practicing as an independent neuropsychologist: since post-doctoral fellowship completion in 2013

  • Core passion:

    • Linking brain changes to behavior

    • Translating test data into concrete, individualized treatment recommendations

Educational Path & Credentials

  • Undergraduate

    • B.A. in Psychology, Santa Clara University (Northern California)

  • Doctoral Training

    • Ph.D. in Clinical Psychology, University of Nevada–Las Vegas (UNLV)

    • Emphasis: Neuropsychology

    • Master’s thesis: alexithymia (difficulty identifying & describing emotion)

    • Dissertation: cognitive impact of combat-related PTSD in veterans

  • Predoctoral Internship

    • Neuropsychology track, North Texas VA (full APA-accredited internship year)

  • Postdoctoral Fellowship

    • Two-year specialty fellowship in Clinical Neuropsychology, VA Palo Alto

    • Focus: inpatient neuro-rehabilitation + outpatient neuropsychological assessment

  • Licensure & Optional Board Certification

    • Requirement: state psychologist license

    • Optional: ABPP board certification in Clinical Neuropsychology (not mandatory for most jobs)

Developmental & Geographic Background

  • Born in Canada

  • Childhood/Adolescence spread across:

    • Canada

    • Middle East (Kuwait, Abu Dhabi)

    • United States (moved during junior year of high school)

Practice Settings & Inter-Professional Collaboration

  1. Inpatient Neuro-Rehabilitation Unit

    • Works within an interdisciplinary team: physicians, nurses, PT/OT, speech therapy, social work

    • Common medical conditions encountered: stroke, traumatic brain injury (TBI), post-tumor resection, multiple sclerosis (MS), Parkinson’s disease (PD)

  2. Outpatient Neuropsychology Clinic

    • Referrals mainly from neurologists for differential diagnosis of memory or cognitive change

    • Provides pre-surgical baseline & candidacy evaluations (e.g., deep brain stimulation for PD)

Populations Served

  • Age range: adolescents \ge 12 years through the “oldest old” (≈85 +)

  • Adolescent focus: ADHD, learning disorders, other neuro-developmental issues

  • Adult/Elder focus: acquired brain injuries, neurodegenerative disease, psychiatric-related cognitive change

Why Neuropsychological Assessment Is Performed

  • Inpatient goals

    • Identify cognitive strengths/weaknesses to tailor therapy approaches (e.g., limiting verbal instructions for patients with severe short-term memory loss)

  • Outpatient goals

    • Clarify diagnosis: Alzheimer’s vs. depression vs. normal aging, etc.

    • Establish baselines for progressive disorders

  • Global outcomes

    • Inform safety decisions, return-to-work/school accommodations, and treatment planning

Core Assessment Instruments Utilized

1. Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV)

  • Purpose: Comprehensive measure of intellectual function

  • Main indices

    1. Verbal Comprehension (VCI) – “verbal intellect”

    2. Perceptual Reasoning (PRI) – “non-verbal / visual-spatial intellect”

    3. Working Memory (WMI) – attentional capacity & mental manipulation

    4. Processing Speed (PSI) – psychomotor & cognitive speed

  • Structure

    • 10 core subtests + 5–6 supplemental subtests

    • Mixed response formats: block design, picture completion, vocabulary definitions, digit/letter spans, symbol search, etc.

  • Administration

    • Paper-and-pencil (with manipulatives such as blocks)

    • Standardized instructions read verbatim

    • Examiner seated face-to-face; stimuli presented & removed per subtest

    • Full battery time: 60–90 (up to 120) minutes; each subtest ≈5–10 min

    • Flexible: can administer isolated subtests or divide sessions

  • Age range: 16–90 years

  • Scoring

    • Raw scores → scaled scores (mean 10, SD 3)

    • Composite index scores (mean 100, SD 15)

    • Can score by hand or via computer software generating interpretive reports & strength/weakness analyses

  • Reporting

    • Inpatient: shared with treatment team, patient, and (when permitted) family

    • Outpatient: included in written neuropsychological report forwarded to referring provider(s)

  • Psychometrics

    • Gold-standard reliability (high internal consistency & test–retest)

    • Robust construct & concurrent validity with other cognitive measures

2. Beck Depression Inventory-II (BDI-II) & Beck Anxiety Inventory (BAI)

  • Purpose: Quantify current severity of depressive or anxiety symptoms; monitor change over time

  • Format

    • Self-report; 21 items each; Likert responses 0–3 per item

    • Total score range: 0–63

    • Depression or anxiety severity cut-offs: minimal, mild, moderate, severe (per manual)

  • Administration

    • Paper-pencil or computer; instructions printed at top

    • Typical completion time: 5–7 minutes each

    • Can re-administer serially (e.g., day 1 vs. day 30 of treatment) to track progress

  • Population: Adults \ge 18; Youth versions exist (Beck Youth Inventories) for children/adolescents

  • Scoring & Interpretation

    • Simple hand addition of item points→total

    • Embedded validity items not required; relies on patient honesty & reading comprehension

  • Psychometrics

    • Extensive evidence for high internal consistency, temporal stability, and convergent validity with clinician-rated mood scales

Ethical & Professional Considerations

  • Informed Consent

    • Must clearly explain purpose, procedures, potential impact, and data-sharing before testing

    • Patients may refuse or limit portions of the evaluation; autonomy respected

  • Confidentiality & Data Release

    • Raw data rarely sent directly to non-psychologists without interpretation

    • Reports only shared with individuals authorized in writing by the patient

  • Capacity Evaluations

    • Special ethical sensitivity when test findings could remove legal rights (e.g., guardianship, conservatorship)

Illustrative Case Example (Anonymized)

  • Patient: 81-year-old female, avid horseback rider

  • Incident: Thrown from horse → traumatic brain injury & intracranial bleed

  • Presenting problem: Progressive confusion & mismanagement of complex investments/property portfolio

  • Evaluation components: Multi-hour cognitive battery, structured clinical interview, functional capacity assessment

  • Findings

    • Met criteria for dementia

    • Lacked decisional capacity for complex financial management

  • Recommendations: Appointment of a fiduciary/financial conservator to safeguard assets, protect autonomy in other life areas, and coordinate ongoing care

  • Outcome: Test data provided objective evidence that guided family & legal decisions, preventing further financial harm

Practical Impact of Assessment Results

  • Clarify diagnoses (neurological vs. psychiatric vs. developmental)

  • Shape individualized treatment & rehabilitation plans

  • Determine school or workplace accommodations (e.g., extended test time, note-taking assistance)

  • Guide safety decisions: driving, medication self-management, independent living

  • Provide baseline metrics for tracking disease progression or treatment effectiveness

  • Facilitate inter-professional communication by translating complex cognitive profiles into actionable strategies

These notes encapsulate all key information shared in the interview, from Dr. Raymond’s training background through detailed test mechanics, ethical nuances, and real-world clinical applications.