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Fitness-For-Duty Evaluations: A Tool For Financial and Safety Risk Management Steven E. Rothke, Ph.D., ABPP
Definitions  <ul><li>Neuropsychology </li></ul><ul><li>Rehabilitation Psychology  </li></ul>
<ul><li>(ADA) A limitation in physical, cognitive (thinking), sensory, or emotional functioning which significantly affect...
<ul><li>“ A specialized formal medical-legal examination of an employee … with a central purpose being the determination o...
Basic Standards Of Work  <ul><li>To remember locations and work-like procedures </li></ul><ul><li>To understand, remember ...
Basic Standards Of Work  <ul><li>To perform activities within a schedule </li></ul><ul><li>To maintain regular attendance ...
Basic Standards Of Work  <ul><li>To work in coordination or in the </li></ul><ul><li>presence of others without being  </l...
Basic Standards Of Work  <ul><li>To ask questions of request assistance </li></ul><ul><li>To accept instructions and respo...
Job Description <ul><li>Essential functions </li></ul><ul><li>Non-essential functions (accommodations) </li></ul><ul><li>A...
FFDE: Informed Consent Issues <ul><li>Discussed at the outset </li></ul><ul><li>Who made the referral; who is paying for t...
Neuropsychological Perspectives
Major Neuropsychological Evaluation Procedures <ul><li>Clinical Interview </li></ul><ul><li>Wechsler Adult Intelligence Sc...
The Clinical Interview <ul><li>Appearance </li></ul><ul><li>Behavior </li></ul><ul><li>Speech </li></ul><ul><li>Affect </l...
Major Neuropsychological Evaluation Procedures <ul><li>Clinical Interview </li></ul><ul><li>Wechsler Adult Intelligence Sc...
What does a Neuropsychological  Evaluation tell you about a patient or claimant?   <ul><li>Orientation </li></ul><ul><li>A...
What does a Neuropsychological  Evaluation tell you about a patient or claimant?   <ul><li>Memory </li></ul><ul><ul><li>Im...
Executive Abilities <ul><li>Insight </li></ul><ul><li>Judgment </li></ul><ul><li>Forethought/ Anticipation of consequences...
Executive Abilities <ul><li>Self-monitoring capacity (error awareness and correction) </li></ul><ul><li>Awareness of impac...
Issues in Test Interpretation <ul><li>Age </li></ul><ul><li>Educational background </li></ul><ul><li>Occupational backgrou...
Issues in Test Interpretation <ul><li>Time Since Onset </li></ul><ul><li>Effects of retesting </li></ul><ul><li>Effects of...
Risk Factors To Assess Evaluate: Factors That Limit Inhibition Intervene: To Enhance Inhibition
History of Previous Violence <ul><li>Employee’s account of event </li></ul><ul><li>Emotional experience during event </li>...
Psychiatric History <ul><li>Sexual/physical abuse </li></ul><ul><li>Hospitalizations </li></ul><ul><li>Episodes of depress...
Emotional Status <ul><li>The Affects of Violence </li></ul><ul><li>Fear </li></ul><ul><li>Anger </li></ul>
Personality Characteristics <ul><li>Signs of Psychopathy and  </li></ul><ul><li>Antisocial Personality Disorder </li></ul>...
Personality Characteristics <ul><li>Signs of Psychopathy and  </li></ul><ul><li>Antisocial Personality Disorder </li></ul>...
Thought Disorder <ul><li>Psychotic Features </li></ul><ul><li>Delusions (paranoid) </li></ul><ul><li>Hallucinations (comma...
Thought Disorder <ul><li>Threat Control/Override Features  </li></ul><ul><li>Belief that your mind is dominated by forces ...
Substance Abuse <ul><li>Stimulants (cocaine): </li></ul><ul><ul><li>Paranoia </li></ul></ul><ul><ul><li>Grandiosity </li><...
Combination of Substance Abuse and Mental Disorder  <ul><li>Mental Disorder in the US (19%) </li></ul><ul><li>Substance Ab...
Lifetime Prevalence of  Mental Disorder in the US <ul><li>Anxiety Disorder (29%) </li></ul><ul><li>Mood Disorder (21%) </l...
Medical/Neurological History <ul><li>Traumatic Brain Injury </li></ul><ul><ul><li>high incidence in prison population </li...
Plan/Intent 1) Wish to harm self and/or others 2) Frequency of thoughts or statements 3) Sequence thought through 4) Avail...
Malignant Signs <ul><li>Feeling of “nothing to lose” </li></ul><ul><li>Belief that an injustice (humiliation) has been don...
Coping Skills 1) Self-Esteem 2) Stress management strategies 3) How has the person dealt with prior losses/trauma (is this...
Other Stressors/Supports <ul><li>Ongoing legal difficulties (divorce, bankruptcy, criminal) </li></ul><ul><li>Financial st...
Assessment Tools RAGE-V (Risk Assessment Guideline for Violence) www.atapworldwide.org Hit tab for Education, then scroll ...
“ Tarasoff Warnings:  What is the Law in Illinois? Mental Health & Developmental Disabilities Confidentiality Act  (740 IL...
“ Records and communications may be disclosed … when, and to the extent, a therapist, in his or her sole discretion, deter...
“ Records and communications may be disclosed … when, and to the extent, in the therapist’s sole discretion, disclosure is...
“ Tarasoff Warnings:  What is the Law in Illinois? Mental Health & Developmental Disabilities Code (405 ILCS 5) Available ...
“ There shall be no liability on the part of, and no cause of action shall rise against, any person who is a physician, cl...
Common Mental Diagnoses of Workers Referred for FFD Exams <ul><li>Post-Concussion Syndrome (PCS) </li></ul><ul><li>Traumat...
DIAGNOSIS     DISABILITY
Accommodating Disabilities: Getting People Back to Work <ul><li>Concentration deficits, distractibility  - enhance signal ...
Accommodating Disabilities: Getting People Back to Work <ul><li>Short-term memory impairment  -  present information in mu...
Accommodating Disabilities: Getting People Back to Work <ul><li>Perseveration, rigidity  - enhance differences in task com...
Accommodating Disabilities: Getting People Back to Work <ul><li>PTSD/Anxiety  -  place worker closer to security, quieter ...
Case Presentation Luke  -- predicting violence three years into the future
 
Illinois Psychologically Healthy Workplace Program (PHWA)   <ul><li>www.illinoispsychology.org </li></ul><ul><li>Click the...
Why Have a PHWA?   <ul><li>$300 Billion per year.  That is the estimated annual aggregate cost to US businesses due to wor...
Psychologically Healthy  Workplace Practices <ul><li>Employee Involvement </li></ul><ul><li>Work-Life Balance </li></ul><u...
For More Information Steven E. Rothke, Ph.D, ABPP (847) 480-5744 [email_address]
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Fitness For Duty And Risk Assessments

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Presentation given to the Northern Illinois Association of Employee Assistance Professionals

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Fitness For Duty And Risk Assessments

  1. 1. Fitness-For-Duty Evaluations: A Tool For Financial and Safety Risk Management Steven E. Rothke, Ph.D., ABPP
  2. 2. Definitions <ul><li>Neuropsychology </li></ul><ul><li>Rehabilitation Psychology </li></ul>
  3. 3. <ul><li>(ADA) A limitation in physical, cognitive (thinking), sensory, or emotional functioning which significantly affects a person’s ability to work, to learn, to manage personal or family responsibilities, to maintain relationships, or to participate in recreational activities. </li></ul>Definitions <ul><li>Disability </li></ul>
  4. 4. <ul><li>“ A specialized formal medical-legal examination of an employee … with a central purpose being the determination of whether the employee is able to safely perform a defined job.” </li></ul><ul><li>Anthony V. Stone (2000) Fitness For Duty: Principles, Methods and Legal Issues. Boca Raton, FL: CRC Press </li></ul>Definitions <ul><li>Fitness-For-Duty Evaluation </li></ul>
  5. 5. Basic Standards Of Work <ul><li>To remember locations and work-like procedures </li></ul><ul><li>To understand, remember and execute very short and simple </li></ul><ul><li>instructions </li></ul><ul><li>To maintain attention for extended periods </li></ul><ul><li>To persist in the performance of simple tasks </li></ul>
  6. 6. Basic Standards Of Work <ul><li>To perform activities within a schedule </li></ul><ul><li>To maintain regular attendance and to be punctual within </li></ul><ul><li>customary tolerances </li></ul><ul><li>To sustain an ordinary routine without special supervision </li></ul><ul><li>To make simple work-related decisions </li></ul>
  7. 7. Basic Standards Of Work <ul><li>To work in coordination or in the </li></ul><ul><li>presence of others without being </li></ul><ul><li>distracted by them </li></ul><ul><li>To complete a normal workday and work </li></ul><ul><li>week without interruption from mental </li></ul><ul><li>symptoms and to perform at a consistent </li></ul><ul><li>pace without an unreasonable number of </li></ul><ul><li>rest periods </li></ul>
  8. 8. Basic Standards Of Work <ul><li>To ask questions of request assistance </li></ul><ul><li>To accept instructions and respond appropriately to criticism from </li></ul><ul><li> supervisors </li></ul><ul><li>To maintain socially appropriate behavior and to adhere to basic </li></ul><ul><li>standards of neatness and cleanliness </li></ul><ul><li>To respond appropriately to changes in the work setting </li></ul>
  9. 9. Job Description <ul><li>Essential functions </li></ul><ul><li>Non-essential functions (accommodations) </li></ul><ul><li>Ask about availability of other sites, other assignments, can you speak with managers and/or coworkers </li></ul>
  10. 10. FFDE: Informed Consent Issues <ul><li>Discussed at the outset </li></ul><ul><li>Who made the referral; who is paying for the exam </li></ul><ul><li>What will the results be used for </li></ul><ul><li>Confidentiality: Who will see the report </li></ul><ul><li>Will the subject (employee) be given feedback and from whom </li></ul>
  11. 11. Neuropsychological Perspectives
  12. 12. Major Neuropsychological Evaluation Procedures <ul><li>Clinical Interview </li></ul><ul><li>Wechsler Adult Intelligence Scale, 4 th Edition (WAIS-IV) </li></ul><ul><li>Wechsler Memory Scale, 4 th Edition (WMS-IV) </li></ul><ul><li>Halstead-Reitan Neuropsychological Test Battery </li></ul><ul><li>Wisconsin Card Sorting Test </li></ul><ul><li>Rey or California Verbal Learning Tests </li></ul><ul><li>Grooved Pegboard Test </li></ul><ul><li>Symptom validity tests </li></ul><ul><li>Minnesota Multiphasic Personality Inventory (MMPI-2) </li></ul>
  13. 13. The Clinical Interview <ul><li>Appearance </li></ul><ul><li>Behavior </li></ul><ul><li>Speech </li></ul><ul><li>Affect </li></ul><ul><li>Thinking </li></ul><ul><li>Perception </li></ul><ul><li>Insight </li></ul><ul><li>Judgment </li></ul>
  14. 14. Major Neuropsychological Evaluation Procedures <ul><li>Clinical Interview </li></ul><ul><li>Wechsler Adult Intelligence Scale, 4 th Edition (WAIS-IV) </li></ul><ul><li>Wechsler Memory Scale, 4 th Edition (WMS-IV) </li></ul><ul><li>Halstead-Reitan Neuropsychological Test Battery </li></ul><ul><li>Wisconsin Card Sorting Test </li></ul><ul><li>Rey or California Verbal Learning Tests </li></ul><ul><li>Grooved Pegboard Test </li></ul><ul><li>Symptom validity tests </li></ul><ul><li>Minnesota Multiphasic Personality Inventory (MMPI-2) </li></ul>
  15. 15. What does a Neuropsychological Evaluation tell you about a patient or claimant? <ul><li>Orientation </li></ul><ul><li>Attention / Concentration </li></ul><ul><ul><li>Focus </li></ul></ul><ul><ul><li>Selective </li></ul></ul><ul><ul><li>Sustaining </li></ul></ul><ul><ul><li>Shifting </li></ul></ul><ul><li>Speech / Language </li></ul><ul><ul><li>Naming </li></ul></ul><ul><ul><li>Word finding </li></ul></ul>
  16. 16. What does a Neuropsychological Evaluation tell you about a patient or claimant? <ul><li>Memory </li></ul><ul><ul><li>Immediate, short-term and long-term </li></ul></ul><ul><ul><li>Verbal and nonverbal </li></ul></ul><ul><li>Visuospatial Reasoning </li></ul><ul><li>Complex Motor </li></ul><ul><li>Abstract Reasoning </li></ul><ul><li>Emotional / Psychological </li></ul><ul><li>Executive Abilities </li></ul>
  17. 17. Executive Abilities <ul><li>Insight </li></ul><ul><li>Judgment </li></ul><ul><li>Forethought/ Anticipation of consequences </li></ul><ul><li>Planning/Sequencing </li></ul>
  18. 18. Executive Abilities <ul><li>Self-monitoring capacity (error awareness and correction) </li></ul><ul><li>Awareness of impact on others </li></ul><ul><li>Strategy Shifting (flexibility) </li></ul><ul><li>Inhibition of impulses/ delay of gratification </li></ul>
  19. 19. Issues in Test Interpretation <ul><li>Age </li></ul><ul><li>Educational background </li></ul><ul><li>Occupational background </li></ul><ul><li>Premorbid psychiatric and medical conditions </li></ul><ul><li>ETOH and recreational drug abuse </li></ul><ul><li>Effects of medications </li></ul>
  20. 20. Issues in Test Interpretation <ul><li>Time Since Onset </li></ul><ul><li>Effects of retesting </li></ul><ul><li>Effects of rehabilitation efforts </li></ul><ul><li>Incentives to perform poorly </li></ul><ul><li>Going beyond the bounds of the data </li></ul><ul><li>Being overly localizationsitic </li></ul>
  21. 21. Risk Factors To Assess Evaluate: Factors That Limit Inhibition Intervene: To Enhance Inhibition
  22. 22. History of Previous Violence <ul><li>Employee’s account of event </li></ul><ul><li>Emotional experience during event </li></ul><ul><li>Signs of remorse vs. blaming others </li></ul>
  23. 23. Psychiatric History <ul><li>Sexual/physical abuse </li></ul><ul><li>Hospitalizations </li></ul><ul><li>Episodes of depression, PTSD </li></ul><ul><li>Suicide attempts </li></ul><ul><li>Emotional traumas, losses </li></ul>
  24. 24. Emotional Status <ul><li>The Affects of Violence </li></ul><ul><li>Fear </li></ul><ul><li>Anger </li></ul>
  25. 25. Personality Characteristics <ul><li>Signs of Psychopathy and </li></ul><ul><li>Antisocial Personality Disorder </li></ul><ul><li>Manipulativeness </li></ul><ul><li>Lack of remorse for actions </li></ul><ul><li>Refusal to accept responsibility </li></ul><ul><li>Lack of empathy </li></ul><ul><li>Pathological lying </li></ul>
  26. 26. Personality Characteristics <ul><li>Signs of Psychopathy and </li></ul><ul><li>Antisocial Personality Disorder </li></ul><ul><li>Sense of grandiosity </li></ul><ul><li>Impulsivity </li></ul><ul><li>Poor behavioral controls </li></ul><ul><li>Disregard for the welfare of others </li></ul><ul><li>Criminal history </li></ul>
  27. 27. Thought Disorder <ul><li>Psychotic Features </li></ul><ul><li>Delusions (paranoid) </li></ul><ul><li>Hallucinations (command) </li></ul>
  28. 28. Thought Disorder <ul><li>Threat Control/Override Features </li></ul><ul><li>Belief that your mind is dominated by forces outside your control </li></ul><ul><li>Thought insertion </li></ul><ul><li>Belief that people wish to harm you </li></ul>
  29. 29. Substance Abuse <ul><li>Stimulants (cocaine): </li></ul><ul><ul><li>Paranoia </li></ul></ul><ul><ul><li>Grandiosity </li></ul></ul><ul><ul><li>Disinhibition </li></ul></ul><ul><li>Alcohol </li></ul><ul><ul><li>Disinhibition </li></ul></ul>
  30. 30. Combination of Substance Abuse and Mental Disorder <ul><li>Mental Disorder in the US (19%) </li></ul><ul><li>Substance Abuse Disorder (6%) </li></ul><ul><li>Combination (3%) </li></ul><ul><li>U.S. Surgeon General (1999). Mental Health: A Report of the Surgeon General. www.surgeongeneral.gov/sgoffice.htm (Reports) </li></ul>
  31. 31. Lifetime Prevalence of Mental Disorder in the US <ul><li>Anxiety Disorder (29%) </li></ul><ul><li>Mood Disorder (21%) </li></ul><ul><li>Impulse Control Disorder (25%) </li></ul><ul><li>Substance Abuse Disorder (15%) </li></ul><ul><li>Kessler, RC et al (2005). Lifetime prevalence and age of onset distributions of DSM-IV disorders . </li></ul><ul><li>Archives of General Psychiatry, Vol. 62, pp. 593-602. </li></ul>
  32. 32. Medical/Neurological History <ul><li>Traumatic Brain Injury </li></ul><ul><ul><li>high incidence in prison population </li></ul></ul><ul><ul><li>increased risk of affective/impulsive violence (Episodic Explosive Disorder) </li></ul></ul><ul><ul><li>reduced executive function, reduced prefrontal activation, decreased serotonergic function </li></ul></ul><ul><ul><li>treatment with anticonvulsants or SSRIs </li></ul></ul><ul><li>Terminal illness </li></ul>
  33. 33. Plan/Intent 1) Wish to harm self and/or others 2) Frequency of thoughts or statements 3) Sequence thought through 4) Availability of weapons 5) Experience with firearms 6) Consequences considered
  34. 34. Malignant Signs <ul><li>Feeling of “nothing to lose” </li></ul><ul><li>Belief that an injustice (humiliation) has been done to you (workplace violence) </li></ul>
  35. 35. Coping Skills 1) Self-Esteem 2) Stress management strategies 3) How has the person dealt with prior losses/trauma (is this the first bad thing that has happened to them)
  36. 36. Other Stressors/Supports <ul><li>Ongoing legal difficulties (divorce, bankruptcy, criminal) </li></ul><ul><li>Financial struggles </li></ul><ul><li>Marital/relationship strains v. good family support </li></ul><ul><li>Social isolation </li></ul><ul><li>Prior job difficulties/fears of loss of job </li></ul>
  37. 37. Assessment Tools RAGE-V (Risk Assessment Guideline for Violence) www.atapworldwide.org Hit tab for Education, then scroll down to RAGE-V to download form. See other useful articles as well.
  38. 38. “ Tarasoff Warnings: What is the Law in Illinois? Mental Health & Developmental Disabilities Confidentiality Act (740 ILCS 110) Available at: www.ilga.gov/legislation/ilcs/ilcs.asp
  39. 39. “ Records and communications may be disclosed … when, and to the extent, a therapist, in his or her sole discretion, determines that such a disclosure is necessary to continue civil commitment proceedings or to otherwise protect the recipient [patient, examinee] or other person against a clear, imminent risk of serious physical or mental injury or disease or death being inflicted upon the recipient, or by the recipient on himself or another.” Section 110/11 ii
  40. 40. “ Records and communications may be disclosed … when, and to the extent, in the therapist’s sole discretion, disclosure is necessary to warn or protect a specific individual against whom a recipient has made a specific threat of violence where there exists a therapist-recipient relationship or a special recipient-individual relationship.” Section 110/11 vii
  41. 41. “ Tarasoff Warnings: What is the Law in Illinois? Mental Health & Developmental Disabilities Code (405 ILCS 5) Available at: www.ilga.gov/legislation/ilcs/ilcs.asp
  42. 42. “ There shall be no liability on the part of, and no cause of action shall rise against, any person who is a physician, clinical psychologist, or qualified examiner based on that person’s failure to warn of and protect from a recipient’s threatened or actual violent behavior except where the recipient has communicated to the person a serious threat of physical violence against a reasonably identifiable victim or victims.” Section 110/11 vii
  43. 43. Common Mental Diagnoses of Workers Referred for FFD Exams <ul><li>Post-Concussion Syndrome (PCS) </li></ul><ul><li>Traumatic Brain Injury (TBI) </li></ul><ul><li>Depression </li></ul><ul><li>Posttraumatic Stress Disorder (PTSD) </li></ul><ul><li>Anxiety/Panic Disorder </li></ul><ul><li>Dementia </li></ul><ul><li>Substance Abuse Disorder </li></ul>
  44. 44. DIAGNOSIS  DISABILITY
  45. 45. Accommodating Disabilities: Getting People Back to Work <ul><li>Concentration deficits, distractibility - enhance signal stimuli through use of headphones, bold print or colors; reduce distractions by modifying lighting, work location, sound/visual barriers </li></ul>
  46. 46. Accommodating Disabilities: Getting People Back to Work <ul><li>Short-term memory impairment - present information in multiple modalities (e.g., visual and oral; text and diagram), permit the use of cues and aids, repetition </li></ul>
  47. 47. Accommodating Disabilities: Getting People Back to Work <ul><li>Perseveration, rigidity - enhance differences in task components by performing tasks in different parts of work space or with different equipment. </li></ul>
  48. 48. Accommodating Disabilities: Getting People Back to Work <ul><li>PTSD/Anxiety - place worker closer to security, quieter work area, no one behind them, remove reminders of trauma if possible </li></ul>
  49. 49. Case Presentation Luke -- predicting violence three years into the future
  50. 51. Illinois Psychologically Healthy Workplace Program (PHWA) <ul><li>www.illinoispsychology.org </li></ul><ul><li>Click the link to the Psychologically Healthy Workplace Program </li></ul><ul><li>www.phwa.org </li></ul>
  51. 52. Why Have a PHWA? <ul><li>$300 Billion per year. That is the estimated annual aggregate cost to US businesses due to worker stress (stress leads to absenteeism, lost productivity, accidents, increased healthcare costs, turnover, conflict and violence in the workplace, and “presenteeism” – being physically present but having your mind on something else). On any given day, nearly one million employees in the US miss work due to stress. These and other compelling data are available from the American Stress Institute ( www.stress.org/job.htm ). </li></ul><ul><li>www.illinoispsychology.org </li></ul>
  52. 53. Psychologically Healthy Workplace Practices <ul><li>Employee Involvement </li></ul><ul><li>Work-Life Balance </li></ul><ul><li>Employee Growth and Development </li></ul><ul><li>Health and Safety </li></ul><ul><li>Employee Recognition </li></ul><ul><li>See: MJ Grawitch, et al. (2006), The path to a healthy workplace: A critical review linking healthy workplace practices, employee well-being, and organizational improvements. Consulting Psychology Journal, Volume 58 (3), pp. 129-147. </li></ul>
  53. 54. For More Information Steven E. Rothke, Ph.D, ABPP (847) 480-5744 [email_address]

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