Fitness-for-duty and risk assessments: employers and EAPs can help ensure the effectiveness of fitness-for-duty and risk evaluations by carefully selecting the examining doctor and providing him or her with well-written referral questions.
Employers and EA professionals can safeguard the workplace with psychological fitness-for-duty (FFD) evaluations and risk assessments. FFD evaluations can assess an employee's ability to cope with problems such as depression, anxiety, and conflicts with co-workers. Risk assessments, meanwhile, can determine if an employee, because of psychological difficulties, might present a risk of self-harm or danger to others.
These evaluations are distinct from EAP mental health assessments, in which an evaluating physician establishes a doctor-patient relationship with the employee. A treating doctor, perhaps working through an EAR might prescribe medications, perform psychotherapy, or give an employee advice. In contrast, FFD exams and risk assessments require the doctor to maintain a position of neutrality and advocate neither for the employer nor the employee.
Doctors performing an FFD exam or risk assessment typically use a variety of specialized techniques to thoroughly evaluate an employee's behavior within the context of both the work and home environments. This article describes what employers and EA professionals need to know about FFD exams and risk assessments and discusses how they can best take advantage of the information these tools provide.
SELECTING A DOCTOR
When an employer or EA professional needs an FFD evaluation or risk assessment to be performed, one of the first tasks is to select an examining psychologist or psychiatrist. The employee and the examining doctor clearly should not work for the same employer, as this would create a conflict of interest for the doctor. One resulting complication might be that an attorney would have little difficulty challenging the doctor's opinion in court. For example, cross-examination questions might include, "Doctor, how does the jury know you weren't promoted because you decided that Mr. Smith couldn't work?" or "Isn't it true, doctor, that your employer pressured you to conclude that my client was exaggerating his problems?"
EA professionals and employers may also face questions about potential conflicts of interest if they select the examining doctors. This practice could give rise to accusations of "hand picking" doctors who write reports consistent with the employer's or EAP's interests. Making a third party responsible for selecting the doctor protects both the employer and the EAP
The doctor who is selected should have training in forensic (legal) psychology or psychiatry Forensically experienced doctors conduct their evaluations with considerable attention to documentation, perform objective psychological testing, and are specially trained to detect dishonesty. They also write their reports in a manner designed to withstand scrutiny by courts and regulators.
A psychiatrist with an M.D. or D.O. degree is often the ideal type of doctor to hire for an FFD exam or risk assessment if there is a suspected medical cause or cure for a mental illness (bipolar disorders and problems with concentration caused by medication are two examples). Psychologists with Ph.D. or Psy.D. degrees are often chosen when specialized psychological testing is required or when employees' environments need to be examined in detail. If an employee has trouble with his/her memory or concentration or experiences other problems with thinking, a neuropsychologist (with a Ph.D. or PsyD. degree) may be the only professional with the requisite skills to conduct a competent assessment.
Many well-qualified psychiatrists have been certified in forensic psychiatry by the American Board of Medical Specialties, and the American Board of Professional Psychology often certifies psychologists who have especially strong skills. Employers typically prefer doctors with specialty certifications specific to the nature of the presenting problem (such as substance abuse) when appropriate.
COMMUNICATING WITH THE DOCTOR
It is critical for the employer or EA professional to provide well-written referral questions to the examining doctor. Such questions help the doctor discern and address an employer's specific concerns and discourage him/her from delving into areas of less importance.
Consider the referral question, "Does this person have psychological problems that would interfere with his/her job performance?" A doctor answering this question might simply respond "yes" or "no" and perhaps offer a diagnosis but would not necessarily provide helpful information about the specific kinds of tasks the employee could not perform. If, however, an EA professional were to ask a doctor to identify specific job duties an employee is unable to complete because of psychological problems, the doctor likely would provide a detailed response that focuses on specific work-related behaviors.
Common topics of referral questions to doctors include the following:
* Whether the employee presents an increased risk (physical or otherwise) to him/herself or to other employees;
* The type(s) of harm that might befall the employee or his/her co-workers;
* Measures the employer might consider to reduce the likelihood of harm or other work-related problems;
* Whether there are psychological limitations that would make it impossible for the employee to perform job duties safely;
* Suggested treatment or educational plans for the employee;
* The need (if any) for additional mental health or medical assessments;
* Appropriate suggestions to manage the employee or modify the employee's work environment;
* Whether there is a need for continuous or intermittent time off from work (and the reason for and duration of that leave); and
* Future employee behaviors that might signal the need for further evaluation or intervention.
State and federal laws limit what can be included in a mental health FFD/risk assessment report. These reports should not contain information that is not essential to addressing employers' concerns. For example, it is rarely necessary for the evaluating doctor to give the employer information about diagnoses, medications, and personal matters such as marital difficulties. Including such sensitive information in an employee's file can expose the employer to considerable legal risk. Some employees have filed lawsuits claiming their employer unfairly terminated them solely because of personal information that was revealed in their FFD examination report.
Many doctors, including some who are relatively experienced in FFD/risk assessments, are not accustomed to writing reports that exclude sensitive information. Emphasize to the doctor that you do not want any information that is not necessary to answer your referral questions. Specifically, state that you do not want the report to contain confidential medical information such as psychological test scores, a description of psychological difficulties, or a diagnosis.
TOOLS FOR PREDICTING VIOLENCE
There is a persistent myth that in just one interview a psychologist or psychiatrist, relying on many years of clinical knowledge, can identify whether an individual is likely to become violent. In fact, there is little, if any, credible evidence that experienced mental health professionals are able to predict violence using their clinical judgment alone. Through proper use of a broad range of assessment measures, a psychologist or psychiatrist can better determine who is at greatest risk for violent behavior.
More than 100 years of research has demonstrated that objective psychological testing can measure people's skills and behavior and, in some cases, predict their future behavior more accurately than can the most skilled doctors. This fact has been established with at least as much confidence as any other finding in the social sciences literature. Some of the original research in this area dates to turn-of-the-century psychologists who pioneered the study of intelligence, memory, and personality, More recently, computers have made it possible to perform sophisticated data analyses on objective test results from thousands of people, thus greatly increasing our ability to scientifically measure and predict behavior.
As objective psychological testing has evolved, national psychiatric and psychological assessment standards have increasingly acknowledged the importance of considering objective psychological testing when evaluating human behavior. Courts, too, have begun to stress the importance of an objective, scientifically defensible assessment. Consequently, it is best if the psychologist or psychiatrist relies in part on objective psychological test results when assessing fitness for duty or risk.
Examining doctors should also use collateral interviews to gather additional information about employees' long-term behavior. These interviews typically are discussions with spouses, supervisors, and co-workers who have observed the worker for extended periods. Because past behavior is generally the best predictor of future actions, these collateral sources often provide valuable information. Furthermore, collateral interviews frequently help the doctor identify when employees are not being truthful.
Of course, forensic doctors also know that employees' surroundings influence their behavior. When determining whether an employee is able to perform the essential functions of his/her job, the doctor should complete an analysis of the specific demands and stressors at the workplace.
Collateral interviews with supervisors can yield valuable details about the environment in which the employee is expected to function, For example, they can help identify other workers who are" harassing or intimidating the employee or work tasks that are particularly stressful. They can provide information about the availability of break rooms, the employer's flexibility in modifying.job duties, and details about other employ ees' reactions to similar job circumstances. They can reveal information about an employee's anticipated level of social support and potential work accommodations and stressors at the workplace that the doctor should consider when making recommendations.
Whenever possible, evaluating doctors should review prior medical records, including medication history and previous diagnoses. Ideally, the employee will assemble this information and deliver it to the evaluating doctor before the assessment occurs.
Employers have potentially helpful information in employees' files, including job descriptions, job performance ratings, histories of reprimands, and other observations of employees' work habits. Videotapes of an employee at work and direct observations of an employee's interactions with the doctor's staff can also be useful.
Psychologists and psychiatrists should follow formal, peer-reviewed assessment protocols when assessing risk and fitness for duty These protocols ensure that doctors are thorough on every evaluation and employ each of the assessment strategies described above. Such formal protocols minimize the risk of haphazard evaluation techniques that miss important aspects relevant to assessing employees' abilities and risks.
David Fisher is a founder and president of PsyBar LLC. He supervises psychiatric and psychological fitness-forduty and risk assessments and lectures frequently on this topic.
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|Title Annotation:||employee assistance professionals|
|Publication:||The Journal of Employee Assistance|
|Date:||Aug 1, 2003|
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