Return-to-Work Evaluation

A worker may be required to leave the workplace because of the experience of an extreme stressor on the job, disability, discipline, or concern about threat. That same worker may wish to return to the job, raising questions about whether the worker may effectively resume functioning. This entry deals with several kinds of evaluations conducted by forensic psychologists to determine if a worker is fit to return to the job. The first, the fitness-for-duty evaluation (FFDE), is a specialized evaluation that occurs in safety-related or “high-risk” jobs such as fire fighting, police work, or security. The second, the return-to-work evaluation (RTE), occurs in more general situations in which the worker has been removed from the job because of disability.

Fitness for Duty in High-Risk Occupations

High-risk occupations, such as police or security work, have much less tolerance for emotional or behavioral dysfunction than other positions. In situations in which the worker’s very life, the lives of others, or the security of the nation depend on the worker being fully functional, the anxiety disorder or impulse control problem that would cause some problems in an office job or trade, effectively disables the worker. This heightened standard requires that the employer take greater care when making decisions about returning the worker to the job.

In high-risk occupations, two kinds of concerns would prompt an FFDE. The first is when there is a reason to believe that the worker may pose a significant danger to himself or others. Concerns about the worker’s ability to function safely may arise from a number of sources, which must usually be directly observed or derive from credible third-party information. For example, a police officer may have demonstrated poor judgment or impulse control on the job and used excessive force in detaining or arresting a suspect. Or a security guard may have failed to intervene when an unidentified individual entered the secure area of an airport. These behaviors may result in disciplinary action such as suspension or consideration of permanently removing the officer from duty.

The second concern focuses on whether the worker may have symptoms of a mental or substance abuse disorder that would significantly interfere with the worker’s ability to perform essential job functions. Of course, this focus is not mutually exclusive from the first, in that a mental illness or substance abuse problem may very well underlie a safety-related issue. For example, a police officer who is dependent on alcohol may arrive on the job in a hung-over condition, which would result in impaired alertness and reduced effectiveness in a dangerous situation.

IACP Guidelines

The International Association of Chiefs of Police (IACP) Police Psychological Services Section ratified the Psychological Fitness-for-Duty Evaluation Guidelines in 2004. These constitute widely accepted considerations and procedures for these evaluations. These guidelines lay out the qualifications for examiners and remind the examiner that the client in an FFDE is the employer, not the employee. In addition, the guidelines indicate that the evaluator should be properly qualified and should obtain sufficient background information concerning the employee’s relevant work history and the issues that raised the question of fitness for duty. The examiner must obtain proper informed consent and written authorization to release the findings from the evaluation to the referring agency. The guidelines also include recommendations for the elements of the evaluation and the structure and content of the evaluation report. For professionals conducting FFDEs with police officers, the IACP guidelines are usually the best guidance, and adherence to them may be required by the referring agency.

FFDE Procedures

Prior to the evaluation, the psychologist should request information concerning the evaluee from the referral source. Particularly, the referral should include the officer’s work history, including details concerning prior incidents of concern. These may not be exactly like those prompting the evaluation and should be put into context by balance of the officer’s personnel file, which may reveal positive aspects of the worker’s past performance. If the officer has been in treatment, these records are invaluable and may be a basis for the psychologist’s later discussions with the therapist. Medical records are essential as they may reveal treatment by the officer’s primary care physician. The incident reports surrounding the incident or incidents of concern are critical reading. If it is an officer-involved shooting, the evaluating psychologist should attend to details concerning the observations of other officers or of the department’s internal investigation.

The psychologist should also have a clear idea of the duties of the officer and the skills necessary to perform those duties. Consultation with the agency’s human relations department or commanding officer should help in putting together this listing. If possible, the duties should be prioritized so that the psychologist would have an idea of which of the skills to be assessed are most critical to the performance of the officer’s job.

Although informed consent is necessary for any forensic evaluation, in the case of an FFDE, thorough informed consent is essential. In this case, the officer must understand that the agency is the psychologist’s client. Although it is commonly the case that forensic psychologists evaluate individuals who are not their clients, in this case, the interests of the officer and the interests of the agency may diverge sharply. The evaluation may have one of four outcomes for the officer: fit for duty; fit for duty with mandatory treatment; temporarily unfit for duty with mandatory treatment; or permanently unfit for duty. The officer should be presented with these four options at the onset of the evaluation so that he or she fully understands the gravity of the assessment.

The officer should be informed of the parameters of confidentiality. In most cases, the evaluation report is closely held within the referring agency. However, depending on the agency’s policies, it is often the case that the officer himself or herself may never see the evaluation report. The informed consent procedure should include the officer signing a release to allow the evaluator to release the results of the evaluation to the referring agency. In some cases in which the officer’s union is involved, it may be appropriate to forward the written consent and releases of information to the officer prior to the date of the evaluation so that the officer may confer with the union representative or counsel before signing them.

Psychological testing is required for these evaluations. The use of the Minnesota Multiphasic Personality-2 (MMPI-2) test with workers in high-risk occupations is well documented in the literature and provides a basis for comparing the examinee with other individuals. Some testing services offer specific scoring and reports for this population. The Personality Assessment Inventory (PAI) test also has personnel-oriented report formats. If the issue raised in the referral has to do with failures of attention and concentration, a full cognitive battery, including the Weschsler Adult Intelligence Scale-III test, may be appropriate. Specialized testing that has been standardized on populations of police officers, such as the Hilson or Inwald Scales, may also be appropriate.

A face-to-face interview is essential. This interview should cover the officer’s family history, school history, and work history. A legal history, including driving violations and domestic violence, should be obtained. A medical history, including any hospitalizations or broken bones is part of this interview. Mental health issues, such as prior counseling or psychiatric hospitalizations, should be covered. Another critical issue is substance abuse history, focusing most often on alcohol (as officers are prohibited from using illegal drugs). Prescription drug use may be an issue, especially if the FFDE is prompted by a physical injury, perhaps from an on-duty auto accident or shooting.

Collateral interviews are critical for most forensic evaluations, but in FFDEs, they are essential. The officer’s current immediate supervisor should be among those interviewed. Past supervisors are also important to determine if the behavioral problems prompting the evaluation antedated the incident that necessitated the FFDE. Discussions with the officer’s spouse or a critical other are also important as this person may provide additional information about the problems that led up to the incident. The officer’s past or current therapists are also important collateral sources and may provide information concerning the officer’s participation in therapy and the degree to which therapeutic efforts proved fruitful.

The evaluation report should include a listing of the data relied on for the evaluation. The officer’s history should include information critical to the agency’s understanding of the officer’s path to the current state of affairs, including no more of the officer’s personal history than necessary to achieve this goal. The report should include a clear statement of the officer’s current status, complete with ongoing symptoms and problems. The officer’s status should be discussed in light of the critical aspects of the officer’s current position. For example, if the officer has become paranoid, it may no longer be appropriate for him or her to evaluate the performance of subordinates. If the officer has developed a generalized anxiety disorder, it may be inappropriate for the officer to serve “on the street,” where critical minute-to-minute decisions must be made.

A clear statement of the officer’s fitness for duty status in light of the four alternatives listed above is essential. This should be followed with recommendations for the next step in the process. If the recommendations include modified duty, the nature and extent of the job modifications should be outlined. If the recommendations include counseling, the kind and duration of that treatment should be specified. If the recommendation is that the officer is unfit for duty, the report should include a discussion of how the departure from duty should be accomplished. In particular circumstances in which the officer is a danger to himself or others, the report should include procedures to minimize the probability of harm to either the officer or others. This may include a recommendation for an extended period of medical leave while the officer receives both treatment and a paycheck. Such periods allow for the “cooling down” of the officer’s condition to reduce the probability of a dangerous outcome.

As has been noted in one of the recommended readings, particular attention should be paid to situations of officer-involved shootings. Both shooting another person or witnessing the shooting of a fellow officer are rated as being among the most traumatic experiences that an officer may have while on duty. As in other cases of trauma, the range of responses of affected individuals varies widely. A good understanding of posttraumatic stress disorder and its particular manifestations among workers in high-risk occupations is necessary so as not to unduly burden an officer who is doing well with months of treatment or of allowing an officer who is brittle but “looking good” to return to work prematurely.

Return-to-Work Evaluations

Although most FFDEs are RTEs, not all RTEs involve workers in high-risk occupations. In almost any work setting, a worker may develop a mental illness or substance abuse problem that results in temporary disability. In many cases, it makes sense for the employer to get the employee back to work as soon as possible. If the position requires extensive training or if the employee is a long-time incumbent in the position, the employer has a significant financial investment in the employee. Likewise, the employee has an investment in the job and the relationships and income that come from it.

RTEs are carried out very much in the same way as FFDEs. The psychologist must have an understanding of the worker’s duties and work setting. A clear history of the events that led up to the worker leaving the workplace must be developed, both from the employer’s perspective and from the history of the worker. Informed consent is also essential in this setting, including the worker knowing whether a copy of the report will be made available. Testing may be used as appropriate, although for most other occupations specialized test reports are usually not available. The report should include the same elements, with a well-developed recommendation section.

RTEs may often be conducted with individuals with chronic illnesses, such as a major depressive disorder or a substance dependence disorder, which would eliminate a security or police officer from consideration for employment. Because of considerations of the Americans with Disabilities Act, employers may be required to provide reasonable accommodation for these chronic conditions. An RTE may be part of this process and may include recommendations for specific accommodations for the worker to be able to function in the workplace.

Conclusion

Both FFDEs and RTEs assess the worker’s fit with the job duties and job setting. In the case of workers in high-risk occupations, the FFDE often occurs at a critical juncture in the officer’s career. For the RTE, this may also be the case, but it may also occur in situations with more chronic illnesses or recurring problems than would be tolerated in high-risk jobs.

The psychologist should be aware that the ramifications of an FFDE are serious. An officer who has demonstrated a history of problems on the job is going to be returned to duty, a situation that may place not only the officer but his or her fellow officers and members of the public in danger. This makes essential the performance of these evaluations within the highest professional standards.

References:

  1. Borum, R., Super, J., & Rand, M. (2003). Forensic assessment for high-risk occupations. In A. M. Goldstein (Ed.), Handbook of psychology: Vol. 11. Forensic psychology (pp. 133-147). Hoboken, NJ: Wiley.
  2. Foote, W. E. (2003). Forensic evaluation in Americans with Disabilities Act cases. In A. D. Goldstein & I. B. Weiner (Eds.), Comprehensive handbook of forensic psychology: Vol. 11. Forensic psychology. New York: Wiley.
  3. IACP Police Psychological Services Section. (2004). Psychological fitness-for-duty evaluation guidelines. Los Angeles: Author. Retrieved June 26, 2015, fromhttp://www.theiacp.org/portals/0/documents/pdfs/Psych-FitnessforDutyEvaluation.pdf

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