This is the first research in Singapore into preparation for culturally competent practice in pro... more This is the first research in Singapore into preparation for culturally competent practice in professional clinical psychology training programmes. It analyses experiences of multicultural clinical psychology training and practice and asks how well current programmes are meeting the needs for cultural competency. These questions were explored with qualitative data from interviews about multicultural practice with five students, five academics and five alumni of clinical psychology. Interpretative Phenomenological Analysis revealed four themes: highlighting the culture of clinical psychology, the cultural context of training and practice, cultural competencies, and pathways for developing cultural competency. These outcomes demonstrate that the training programmes are considered valuable for improving psychological service provision in Singapore, although improvements to these programmes are desired for cultural competency development. These findings point to the need for particular competencies to be developed, as well as at directions for further research that may benefit clinical psychology training.
This study quantified the monetary cost of family caregiving for 51 patients with different sever... more This study quantified the monetary cost of family caregiving for 51 patients with different severity of dementia. The mean annual informal cost of care was higher (M=SG$44,530.55, SD=SG$31,354.82) compared to the mean annual formal cost of care (M=SG$25,654.11, SD=SG$10,016.48). Costs were found to increase with severity of dementia (Severe: SG$47,251.30; Moderate: SG$38,607.84; Mild: SG$13,847.68). For each point increase in CMMSE scores, the informal cost lowered by SG$1,173.94. There was a significant negative correlation of cost and cognitive impairment but not functional impairment. The informal cost of care did not vary much with or without the use of day care centres, however the costs for those who did not have domestic helpers (DHs) was more than twice the costs for those with DHs. Results from this study show there were cost savings in care of people with dementia with DHs.
Journal of the American Medical Directors Association, 2016
Case-finding services using a composite total risk score (TRS) and the informant AD8 have been pr... more Case-finding services using a composite total risk score (TRS) and the informant AD8 have been previously recommended to detect cognitive impairment (CI) in government subsidized primary health care centers of Singapore (ie, polyclinics). We compared the feasibility of implementing the services recommended for government-subsidized primary health care in private, primary health care service providers such as general practitioner (GP) clinics. 123 patients ≥60 years of age were recruited from 2 GP clinics within Singapore. Trained research personnel administered the AD8 to informants. Patients of the present study were compared against a random sample of 123 patients selected from polyclinics. Significantly higher positive screening rates (AD8 ≥3) were found among patients in polyclinics than GP clinics (P < .001). Patients attending polyclinics reported more comorbid medical issues such as subjective cognitive complaint (P < .001) and heart disease (P < .001). The TRS of pa...
Journal of clinical and experimental neuropsychology, 2017
Prospective memory (PM) is crucial to the maintenance of functional independence in late adulthoo... more Prospective memory (PM) is crucial to the maintenance of functional independence in late adulthood and is consistently impaired in mild cognitive impairment (MCI). There remains a need for brief but valid measures of this construct that can be used as part of a comprehensive clinical assessment of cognition. Since the distinctiveness of PM cues is argued to determine the degree of strategic, controlled demands of PM paradigms, two variants of a brief measure were developed, one of which presented low-salience and the other high-salience PM cues. A large cohort of older adults with normal cognition or MCI was assessed with one of the two variants of our brief, novel measure of PM. Participants were asked to remember to execute PM tasks where the target cue was either high or low in salience, while concurrently engaged in an ongoing task of olfactory assessment. The task was able to discriminate between groups of participants with MCI or no cognitive impairment, albeit with a small ef...
There is a growing body of research exploring differences in behavioral and psychological symptom... more There is a growing body of research exploring differences in behavioral and psychological symptoms of dementia (BPSD) between Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD) and vascular dementia (VaD), yet these differences are inconsistent and it is uncertain whether this inconsistency might be due to the confounding effect of differing severities of dementia. BPSD, measured with the Behavior Problems Check List (BPCL) and Revised Memory and Behavior Problems Check List (RMBPCL) and CDR-measured severity of dementia were examined using archival data of individuals with AD (N = 377) or VaD (including multi-infarct and other vascular causes; N = 74) presenting to a Sydney memory disorders clinic over a 20-year period. There was no significant difference in scores for AD and VaD patients on the BPCL or on the RMBPCL when controlling for sex and severity of dementia. However, severity of BPSD increased with increasing severity of dementia. BPSD severity is no different in AD and VaD at the time of initial assessment in a memory disorders clinic population of mild to moderate dementia. However, BPSD increases with severity of dementia in this group.
Journal of the International Neuropsychological Society, 2010
When compared with controls, both mild cognitive impairment (MCI) and dementia are each associate... more When compared with controls, both mild cognitive impairment (MCI) and dementia are each associated with impaired memory for future intentions, or prospective memory (PM). However, prior studies have failed to agree on whether there are group differences in PM function between those with MCI and dementia. Furthermore, the degree and nature of the impairment remains to be clarified, as does the degree to which this impairment is secondary to deficits in other aspects of cognition. In the present study, MCI (n = 48), dementia (n = 39), and control participants (n = 53) were compared on Virtual Week, a measure that closely represents the types of PM tasks that occur in everyday life. Both clinical groups exhibited impairment irrespective of the specific task demands, but the magnitude of this deficit was greater for those with dementia. After covarying for other key cognitive parameters, although the absolute magnitude of the deficit was reduced, significant impairment remained. These results indicate that individuals with MCI, and to a greater extent dementia, experience generalized difficulties with PM. It is suggested that, while other cognitive deficits contribute to these difficulties, there is something unique to prospective remembering that may be additionally disrupted in these groups.
There is a growing body of research exploring differences in behavioral and psychological symptom... more There is a growing body of research exploring differences in behavioral and psychological symptoms of dementia (BPSD) between Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD) and vascular dementia (VaD), yet these differences are inconsistent and it is uncertain whether this inconsistency might be due to the confounding effect of differing severities of dementia. BPSD, measured with the Behavior Problems Check List (BPCL) and Revised Memory and Behavior Problems Check List (RMBPCL) and CDR-measured severity of dementia were examined using archival data of individuals with AD (N = 377) or VaD (including multi-infarct and other vascular causes; N = 74) presenting to a Sydney memory disorders clinic over a 20-year period. There was no significant difference in scores for AD and VaD patients on the BPCL or on the RMBPCL when controlling for sex and severity of dementia. However, severity of BPSD increased with increasing severity of dementia. BPSD severity is no different in AD and VaD at the time of initial assessment in a memory disorders clinic population of mild to moderate dementia. However, BPSD increases with severity of dementia in this group.
Communication difficulties due to aphasia following stroke are particularly stressful to caregive... more Communication difficulties due to aphasia following stroke are particularly stressful to caregivers. To examine the impact of a psychoeducation programme on caregivers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; burden and stress and communication between the caregiver and aphasic stroke patient. Randomized wait-list controlled trial with immediate or three-month delayed treatment. Three public hospital rehabilitation services in Sydney, Australia. Thirty-nine caregivers of aphasic stroke patients, up to 12 months post stroke: 19 given immediate treatment and 20 in a delayed treatment control group. Four-session weekly caregiver programme that included elements of education, support and communication skills conducted by a speech pathologist, social worker and clinical psychologist. The General Health Questionnaire (GHQ) was used to measure caregiver stress, the Relatives&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; Stress Scale was used to measure caregiver burden and a communication questionnaire was designed specifically for this project. Thirty-one caregivers completed the study. Caregivers in the immediate treatment group had significant reductions in GHQ measured stress (GHQ mean (SD) at baseline= 6.26 (5.67), GHQ post treatment 3.21 (SD 4.20), P = 0.006). There was no improvement in wait-listed caregivers. Improvement was not maintained at three-month follow-up. There were no significant effects of the programme on communication skills or on caregiver burden. Stroke caregiver support, education and training programmes have short-term effects on caregiver stress levels but are likely to require ongoing involvement to maintain their effect.
This paper provides landmarks for the study of the historical development and current expansion o... more This paper provides landmarks for the study of the historical development and current expansion of academic psychology and clinical psychology education in Australia and three countries of the Malay Archipelago (Indonesia, Malaysia, Singapore). It reviews literature on the history of clinical psychology, and information from universities and psychological associations, and includes an overview of the current providers and forms of psychology education programmes and their curricula. A critical analysis informed
by cultural anthropology indicates that psychology has only to a small extent been adjusted to different cultural contexts, while ‘western’ models of the discipline remain dominant. The neglect of attention to culture in psychology and clinical psychology raises important questions about the future of the discipline in the tropical regions of Australia and the Malay Archipelago.
In the last two decades transnational education has intensified. This paper provides a case study... more In the last two decades transnational education has intensified. This paper provides a case study of transnational education in South East Asia by mapping historical and current transnational psychology education in Australia, Singapore and Malaysia. Given psychology’s roots in Europe and the United States of America, and its close interrelation with norms of ‘western’ societies, the data accrued from research for this paper raises important questions regarding how South East Asian countries are dealing with foreign influence through education.
This is the first research in Singapore into preparation for culturally competent practice in pro... more This is the first research in Singapore into preparation for culturally competent practice in professional clinical psychology training programmes. It analyses experiences of multicultural clinical psychology training and practice and asks how well current programmes are meeting the needs for cultural competency. These questions were explored with qualitative data from interviews about multicultural practice with five students, five academics and five alumni of clinical psychology. Interpretative Phenomenological Analysis revealed four themes: highlighting the culture of clinical psychology, the cultural context of training and practice, cultural competencies, and pathways for developing cultural competency. These outcomes demonstrate that the training programmes are considered valuable for improving psychological service provision in Singapore, although improvements to these programmes are desired for cultural competency development. These findings point to the need for particular competencies to be developed, as well as at directions for further research that may benefit clinical psychology training.
This study quantified the monetary cost of family caregiving for 51 patients with different sever... more This study quantified the monetary cost of family caregiving for 51 patients with different severity of dementia. The mean annual informal cost of care was higher (M=SG$44,530.55, SD=SG$31,354.82) compared to the mean annual formal cost of care (M=SG$25,654.11, SD=SG$10,016.48). Costs were found to increase with severity of dementia (Severe: SG$47,251.30; Moderate: SG$38,607.84; Mild: SG$13,847.68). For each point increase in CMMSE scores, the informal cost lowered by SG$1,173.94. There was a significant negative correlation of cost and cognitive impairment but not functional impairment. The informal cost of care did not vary much with or without the use of day care centres, however the costs for those who did not have domestic helpers (DHs) was more than twice the costs for those with DHs. Results from this study show there were cost savings in care of people with dementia with DHs.
Journal of the American Medical Directors Association, 2016
Case-finding services using a composite total risk score (TRS) and the informant AD8 have been pr... more Case-finding services using a composite total risk score (TRS) and the informant AD8 have been previously recommended to detect cognitive impairment (CI) in government subsidized primary health care centers of Singapore (ie, polyclinics). We compared the feasibility of implementing the services recommended for government-subsidized primary health care in private, primary health care service providers such as general practitioner (GP) clinics. 123 patients ≥60 years of age were recruited from 2 GP clinics within Singapore. Trained research personnel administered the AD8 to informants. Patients of the present study were compared against a random sample of 123 patients selected from polyclinics. Significantly higher positive screening rates (AD8 ≥3) were found among patients in polyclinics than GP clinics (P < .001). Patients attending polyclinics reported more comorbid medical issues such as subjective cognitive complaint (P < .001) and heart disease (P < .001). The TRS of pa...
Journal of clinical and experimental neuropsychology, 2017
Prospective memory (PM) is crucial to the maintenance of functional independence in late adulthoo... more Prospective memory (PM) is crucial to the maintenance of functional independence in late adulthood and is consistently impaired in mild cognitive impairment (MCI). There remains a need for brief but valid measures of this construct that can be used as part of a comprehensive clinical assessment of cognition. Since the distinctiveness of PM cues is argued to determine the degree of strategic, controlled demands of PM paradigms, two variants of a brief measure were developed, one of which presented low-salience and the other high-salience PM cues. A large cohort of older adults with normal cognition or MCI was assessed with one of the two variants of our brief, novel measure of PM. Participants were asked to remember to execute PM tasks where the target cue was either high or low in salience, while concurrently engaged in an ongoing task of olfactory assessment. The task was able to discriminate between groups of participants with MCI or no cognitive impairment, albeit with a small ef...
There is a growing body of research exploring differences in behavioral and psychological symptom... more There is a growing body of research exploring differences in behavioral and psychological symptoms of dementia (BPSD) between Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD) and vascular dementia (VaD), yet these differences are inconsistent and it is uncertain whether this inconsistency might be due to the confounding effect of differing severities of dementia. BPSD, measured with the Behavior Problems Check List (BPCL) and Revised Memory and Behavior Problems Check List (RMBPCL) and CDR-measured severity of dementia were examined using archival data of individuals with AD (N = 377) or VaD (including multi-infarct and other vascular causes; N = 74) presenting to a Sydney memory disorders clinic over a 20-year period. There was no significant difference in scores for AD and VaD patients on the BPCL or on the RMBPCL when controlling for sex and severity of dementia. However, severity of BPSD increased with increasing severity of dementia. BPSD severity is no different in AD and VaD at the time of initial assessment in a memory disorders clinic population of mild to moderate dementia. However, BPSD increases with severity of dementia in this group.
Journal of the International Neuropsychological Society, 2010
When compared with controls, both mild cognitive impairment (MCI) and dementia are each associate... more When compared with controls, both mild cognitive impairment (MCI) and dementia are each associated with impaired memory for future intentions, or prospective memory (PM). However, prior studies have failed to agree on whether there are group differences in PM function between those with MCI and dementia. Furthermore, the degree and nature of the impairment remains to be clarified, as does the degree to which this impairment is secondary to deficits in other aspects of cognition. In the present study, MCI (n = 48), dementia (n = 39), and control participants (n = 53) were compared on Virtual Week, a measure that closely represents the types of PM tasks that occur in everyday life. Both clinical groups exhibited impairment irrespective of the specific task demands, but the magnitude of this deficit was greater for those with dementia. After covarying for other key cognitive parameters, although the absolute magnitude of the deficit was reduced, significant impairment remained. These results indicate that individuals with MCI, and to a greater extent dementia, experience generalized difficulties with PM. It is suggested that, while other cognitive deficits contribute to these difficulties, there is something unique to prospective remembering that may be additionally disrupted in these groups.
There is a growing body of research exploring differences in behavioral and psychological symptom... more There is a growing body of research exploring differences in behavioral and psychological symptoms of dementia (BPSD) between Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD) and vascular dementia (VaD), yet these differences are inconsistent and it is uncertain whether this inconsistency might be due to the confounding effect of differing severities of dementia. BPSD, measured with the Behavior Problems Check List (BPCL) and Revised Memory and Behavior Problems Check List (RMBPCL) and CDR-measured severity of dementia were examined using archival data of individuals with AD (N = 377) or VaD (including multi-infarct and other vascular causes; N = 74) presenting to a Sydney memory disorders clinic over a 20-year period. There was no significant difference in scores for AD and VaD patients on the BPCL or on the RMBPCL when controlling for sex and severity of dementia. However, severity of BPSD increased with increasing severity of dementia. BPSD severity is no different in AD and VaD at the time of initial assessment in a memory disorders clinic population of mild to moderate dementia. However, BPSD increases with severity of dementia in this group.
Communication difficulties due to aphasia following stroke are particularly stressful to caregive... more Communication difficulties due to aphasia following stroke are particularly stressful to caregivers. To examine the impact of a psychoeducation programme on caregivers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; burden and stress and communication between the caregiver and aphasic stroke patient. Randomized wait-list controlled trial with immediate or three-month delayed treatment. Three public hospital rehabilitation services in Sydney, Australia. Thirty-nine caregivers of aphasic stroke patients, up to 12 months post stroke: 19 given immediate treatment and 20 in a delayed treatment control group. Four-session weekly caregiver programme that included elements of education, support and communication skills conducted by a speech pathologist, social worker and clinical psychologist. The General Health Questionnaire (GHQ) was used to measure caregiver stress, the Relatives&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; Stress Scale was used to measure caregiver burden and a communication questionnaire was designed specifically for this project. Thirty-one caregivers completed the study. Caregivers in the immediate treatment group had significant reductions in GHQ measured stress (GHQ mean (SD) at baseline= 6.26 (5.67), GHQ post treatment 3.21 (SD 4.20), P = 0.006). There was no improvement in wait-listed caregivers. Improvement was not maintained at three-month follow-up. There were no significant effects of the programme on communication skills or on caregiver burden. Stroke caregiver support, education and training programmes have short-term effects on caregiver stress levels but are likely to require ongoing involvement to maintain their effect.
This paper provides landmarks for the study of the historical development and current expansion o... more This paper provides landmarks for the study of the historical development and current expansion of academic psychology and clinical psychology education in Australia and three countries of the Malay Archipelago (Indonesia, Malaysia, Singapore). It reviews literature on the history of clinical psychology, and information from universities and psychological associations, and includes an overview of the current providers and forms of psychology education programmes and their curricula. A critical analysis informed
by cultural anthropology indicates that psychology has only to a small extent been adjusted to different cultural contexts, while ‘western’ models of the discipline remain dominant. The neglect of attention to culture in psychology and clinical psychology raises important questions about the future of the discipline in the tropical regions of Australia and the Malay Archipelago.
In the last two decades transnational education has intensified. This paper provides a case study... more In the last two decades transnational education has intensified. This paper provides a case study of transnational education in South East Asia by mapping historical and current transnational psychology education in Australia, Singapore and Malaysia. Given psychology’s roots in Europe and the United States of America, and its close interrelation with norms of ‘western’ societies, the data accrued from research for this paper raises important questions regarding how South East Asian countries are dealing with foreign influence through education.
Psychology is well underway in becoming a borderless science and discipline, with universal knowl... more Psychology is well underway in becoming a borderless science and discipline, with universal knowledge that can be applied in countries across the globe. This presentation explores the history and current status of psychology education in Australia, Singapore and Malaysia as these are major areas in which transnational exchanges in psychology education take place. The data accrued from research for this presentation informs discussions on the universality of psychology education today and raises important questions about the future of the discipline in Asian societies.
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by cultural anthropology indicates that psychology has only to a small extent been adjusted to different cultural contexts, while ‘western’ models of the discipline remain dominant. The neglect of attention to culture in psychology and clinical psychology raises important questions about the future of the discipline in the tropical regions of Australia and the Malay Archipelago.
by cultural anthropology indicates that psychology has only to a small extent been adjusted to different cultural contexts, while ‘western’ models of the discipline remain dominant. The neglect of attention to culture in psychology and clinical psychology raises important questions about the future of the discipline in the tropical regions of Australia and the Malay Archipelago.
Singapore and Malaysia as these are major areas in which transnational exchanges in psychology education take place. The data accrued from research for this presentation informs discussions on the universality of psychology education today and raises important questions about the future of the discipline in Asian societies.