Findings from a survey investigating neuropsychological intervention across Quebec

Prof Caroline Cellard, School of Psychology, Université Laval, Quebec, Canada and Scientific director of Centre de recherche universitaire sur les jeunes et les familles

In Quebec, neuropsychologists are mostly recognized as cognitive assessment specialists — they must be members of the Ordre des psychologues du Québec and hold a specific qualification to evaluate neuropsychological disorders. Their role isn't limited to assessment: many also offer neuropsychological intervention, including cognitive remediation. However, this practice is still emerging, with little data available on how or how often it is being implemented in clinical settings. Two clinical research teams from Université Laval surveyed neuropsychological intervention practices in Quebec, Canada, to understand barriers and facilitators influencing the implementation of cognitive remediation in clinical practice.  

Among those who offer cognitive interventions (67% of the total sample), the most common approach was psychoeducation about cognitive functioning, tailored to the person's assessment results. Many personalized cognitive strategies without necessarily supporting their implementation. Only about half deliver an established cognitive remediation program. In practice, neuropsychological intervention is delivered in the feedback session after a neuropsychological assessment, based on recommendations in the written report, rather than delivered through dedicated, ongoing sessions.

There was a strong interest among Quebec neuropsychologists in expanding the use of cognitive remediation, with 74% intending to integrate it into their practice. But despite these intentions, there were barriers to overcome. The first is lack of time: neuropsychologists' mandates are centered almost entirely on assessment. Other barriers included insufficient training opportunities, limited access to resources, and a lack of recognition of cognitive remediation as a core component of neuropsychological practice. Ambiguity surrounding the definition and scope of cognitive remediation also contributes to implementation challenges, and the absence of regulatory frameworks in Quebec creates uncertainty about who should provide cognitive remediation.

There were some facilitators, including having protected time for intervention delivery, stronger beliefs in the effectiveness of cognitive remediation, and a greater sense of professional competence. Requests from people with lived experience also play a key role, as demand for support in understanding cognitive functioning and applying compensatory strategies encourages clinicians to provide these services.

Our findings highlight a pressing need to support cognitive remediation implementation, including through enhanced training at both doctoral and continuing education levels that emphasise the importance of cognitive problems in achieving recovery and the therapies that can provide support. There is also a need for improved access to tools and resources, and clearer integration of cognitive remediation into the neuropsychologist’s professional mandate and responsibilities. These findings are similar to those of other international initiatives demonstrating the importance of structured training programs, institutional support, and coordinated service delivery in promoting large-scale implementation.

Although cognitive remediation is widely supported by research and applicable across many clinical populations, it remains underused in Quebec. Addressing systemic barriers, particularly time constraints, training gaps, and organizational support, will be essential to improve access to this intervention.

As an initial step, the findings of this report were presented during a conference to inform neuropsychologists in Quebec. The research team is also encouraging neuropsychologists to share these findings directly with their managers and team leaders. The unmet training needs identified have been communicated to the professional association of neuropsychologists in Quebec (Association québécoise des neuropsychologues [AQNP]) as well as to academics working in the field of neuropsychology. Implementation efforts in other countries have showed the relevance of establishing a professional community of practice (Dark et al., 2024; Wykes et al., 2024). In Quebec, the AQNP’s initiative to establish the Intervention Axis provides a strong starting point. A strong community of practice facilitates the dissemination of current research evidence and supports the development of training initiatives tailored to the needs of professionals.

This infographic gives a visual summary of the findings:

I would like to thank all the neuropsychologists who participated in the survey, as well as the members of the research team at Université Laval (Quebec) - Ariane Giguère-Rancourt, Lauriane Blanchette, Caroline East-Richard, Alexandra Ribon-Demars and Simon Beaulieu-Bonneau.