In this manner, an individual's performance can be characterized by its position on the distribution curve of normal performances.
When significant variability in performances across functional domains is assessed, it is necessary to consider whether or not the pattern of functioning is consistent with a known cognitive profile. That is, does the individual demonstrate a pattern of impairment that makes sense or can be reliably explained by a known neurobehavioral syndrome or neurological disorder. For example, an adult who has sustained isolated injury to the temporal lobe of the left hemisphere would be expected to demonstrate some degree of impairment on some measures of language and verbal memory, but to demonstrate relatively intact performances on measures of visual-spatial skills. This pattern of performance reflects a cognitive profile consistent with a known neurological injury. Conversely, a claimant who demonstrates impairment on all measures after sustaining a brief concussion would be demonstrating a profile of impairment that is inconsistent with research data indicating full cognitive recovery within days in most individuals who have sustained a concussion ( McCrea et al., 2002, 2003 ).
Cognitive testing is the primary way to establish severity of cognitive impairment and is therefore a necessary component in a neuropsychological assessment. Clinical interviews alone are not sufficient to establish the severity of cognitive impairments, for two reasons: (1) patients are known to be poor reporters of their own cognitive functioning ( Edmonds et al., 2014; Farias et al., 2005; Moritz et al., 2004; Schacter, 1990) and (2) clinicians relying solely on clinical interviews in the absence of neuropsychological test results are known to be poor judges of patients' cognitive functioning ( Moritz et al., 2004 ). There is a long history of neuropsychological research linking specific cognitive impairments with specific brain lesion locations, and before the advent of neuroimaging, neuropsychological evaluation was the primary way to localize brain lesions; even today, neuropsychological evaluation is critical for identifying brain-related impairments that neuroimaging cannot identify ( Lezak et al., 2012 ). In the context of the SSA disability determination process, cognitive testing for claimants alleging cognitive impairments could be helpful in establishing a medically determinable impairment, functional limitations, and/or residual functional capacity.
The most important aspect of administration of cognitive and neuropsychological tests is selection of the appropriate tests to be administered . That is, selection of measures is dependent on examination of the normative data collected with each measure and consideration of the population on which the test was normed.
Evaluations typically consist of a (1) clinical interview, (2) administration of standardized cognitive or non-cognitive psychological tests, and (3) professional time for interpretation and integration of data. Some neuropsychological tests are computer administered, but the majority of tests in use today are paper-and-pencil tests.
The results of cognitive tests are affected by the effort put forth by the test-taker. If an individual has not given his or her best effort in taking the test, the results will not provide an accurate picture of the person's neuropsychological or cognitive functioning. Performance validity indicators, which include PVTs, analysis of internal data consistency, and other corroborative evidence, help the evaluator to interpret the validity of an individual's neuropsychological or cognitive test results. For this reason, it is important to include an assessment of performance validity at the time cognitive testing is administered. It also is important that validity be assessed throughout the cognitive evaluation.
Sensorimotor and psychomotor functioning are often measured alongside neurocognitive functioning in order to clarify the brain basis of certain cognitive impairments , and are therefore considered as one of the domains that may be included within a neuropsychological or neurocognitive evaluation.
The approach to assessing capacity can start with choosing one of two basic questions – ‘What capacity is already in place?’ or, ‘How should it be and what is missing?’, and the choice will determine how the assessment is conducted. ‘What capacity is already in place?’ starts the incremental approach of identifying existing capacity and using that as the foundation for moving forward. ‘How should it be and what is missing?’ starts the gap analysis approach, which works from how things ‘should be’, then looks at how they are now, and define the difference between the two as what is missing ‘the gap’.
The entry point and focus of the assessment will be decided by several factors: the way that capacity is defined; any capacity development framework in use; the mandate of the entity being assessed; and, the purpose of the assessment. Again in the education example capacity could be defined as the ability to deliver the full primary education. Components of the capacity would be resources such as the existence of the curriculum and the materials to teach it, sufficient teachers with the right set of skills and knowledge, and so on. Where the entity’s mandate is clear, perhaps defined by law or in a mission statement, this can be the starting point for assessing current capacity and future needs. Where the mandate isn’t clear it will be harder to assess those issues and it could, in fact, represent a capacity need in its own right.
The starting point of any capacity development planning process is assessing existing capacity. For any given context that means starting with the initial definition of capacity, in response to the question ‘ Capacity for What ?’, which is then considered at the different levels. Individual, organisational (network/sector) levels are framed in terms of performance and results, and at the institutional level in terms of conditions, but there may be overlap between these categories.
Themes for application: the capacity development framework will help to prioritise the areas for assessment. For example, according to the framework you might need to focus on human capacity, systems and procedures, knowledge management and good governance.
Processes that support self-assessment are preferable because they are very effective for creating ownership of the analysis and buy-in for any change initiatives that follow
A final important point is to safeguard the interest of less powerful stakeholders, especially beneficiaries and traditionally marginalised groups. This can be done by special consultation exercises, or by identifying those who are able to speak on behalf of these groups.
Types of capacity: remember to assess both hard and soft capacities, including powerdistribution, incentives and sanctions, leadership, and values and beliefs