Abstract
If there is any one subject wherein human resource, security, and legal specialists tend to need defined leadership, it centers upon how a fitness for duty evaluation is pursued, if one is needed at all. There are so many phrases used when a workplace threat team convenes: should we have this person undergo an independent medical examination? Should we seek a suitability letter from their physician? What are the perimeters and essentials of a fitness for duty examination (FFDE?). Because the last category is increasingly used by employers on a global scale, it is important for those in all disciplines to understand how clinical specialists can provide important insight into security, human resource, and other internal resources in understanding the potentiality that a person with a problem could blossom into the problem person.
In selecting a clinical specialist who can effectively interview and provide a professional opinion regarding whether someone is fit for work, an employer has an obligation to properly vet that individual. The following protocol represents a methodology that has served many employers well >30 years of supporting a wide range of employers, from universities and medical centers to for-profit entities.
An initial suggestion is that the employer should seek several evaluators within specific regions or provinces so that the expert selected can be more readily deployed to visit with an employer whose behaviors or statements have caused concern for the potentiality of violence. In a study completed in 2019 at the University of Central Florida, we found that ∼34% of employers surveyed globally have already prepared a list of preapproved fitness evaluators within specific markets where the employer operates. This facilitates the evaluative process in that critical window in between when a person shares a potential threat for self-harm, or may be a victim of intimate partner violence and is concerned for her well-being, and when an aggressor may act.
A first suggestion is that employers should aggressively seek a credible fitness evaluator whose education and understanding of workplace dynamics are suitable given the occupation or sector. Such evaluators can be identified by contacting the licensing board for psychologists in a specific jurisdiction. Organizations such as the American Psychological Association (APA), British Psychological Society and others routinely update their directories.
When the employer identifies a potential good fit based on training, open-mindedness, and a sense of urgency that often exist when a person with risk factors is under scrutiny, the organizational threat assessment team will want to ensure that due diligence has been accomplished through a variety of tasks such as:
Verify the CV, validating credentials to ensure they are not fraudulent.
Contacting state licensing boards for disciplinary actions.
Reviewing insurance coverage to ensure the evaluator has limits of coverage consistent with others in that region.
Review the general experience of the evaluator: how many years have they been providing reports? Can they provide a sample report so you have assurance that their insights are consistent with those you would expect? What types of threat assessments have they done, and which industries have they supported?
Can they outline a general concept of their fee structure for interviews, administering and evaluating personality test reports, pre- and postevaluation consultations, and any additional psychological testing or collateral interviews with supervisors and others that may be needed?
What is their general estimate of how quickly they can be deployed during a busy and nonbusy time in their practice and who is their professional alternative if they are not available?
Ensure that they are doctoral level providers and have degrees from American, British, or other national accredited psychological programs.
Interview the expert for at least 45 min without compensation to determine whether they are genuinely committed to the effort; in this interview they would articulate their backgrounds and area of expertise and the project captain can ensure that they are trained and experienced in evaluating individuals at risk for self-harm, homicide, and femicide, and other inappropriate behaviors in the workplace.
Ask specific questions regarding their awareness of state and federal laws as it pertains to the workplace topics including privacy regulations.
Enquire whether they are familiar with return-to-work agreements and to what degree they have helped employers craft those agreements including reasonable accommodation requests from employees at risk.
Knowing What to Ask
The employer will want to ensure that if a fitness evaluator understands what is expected of them, they are expected to provide expert insight into the emotional and psychological stability of the employee in question (Barton, 2020). They should reflect on the maturity of mind of the persons and whether they understand the reason why they are being evaluated. Are they cooperative or avoidant during the in-person evaluation? Remember that as a result of the Covid-19 pandemic of 2020, many such evaluations were conducted by videoconference, a significant departure in protocol for the mental health community. Ensuring that a threat evaluator understands how to conduct an interview that is technology based rather than in person is literally new territory for all of us concerned with violence and gender. This issue, combined with the fact that most employee assistance programs globally suspended in-person counseling as the virus disrupted workplaces globally, merits a deep evaluation in the years ahead.
The fitness evaluator must be a person who is not interviewed and hired based on an urgency alone because the depth of his or her education and training can be paramount in how the employer determines whether the employee in question will be retained, placed on a short-term or long-term medical leave, or separated: the consequences of these and other options are significant because retaliation and self-harm based on such a formal report are one of many potential options that the employer must carefully balance as other factors: a case management report, social networking posts, past performance infractions, and other issues are all reviewed in depth. Another way the employer can help reduce rancor and subsequent questions about the quality of the evaluation is to ensure that the specialist selected has not been a party as a plaintiff or defendant in any pending major lawsuit and that they understand and can appreciate the role of human resources, employment law, and physical security at the site where the employee works.
Most evaluators can travel to meet with the employee within a few days, but remember that most have a private practice with patients, and they may not be available immediately. Just as we have seen an impressive adaptation toward Teladoc® technologies for medical discussions, some evaluators have the flexibility and technical savvy to interview employees through videoconference. In doing so, be sure you understand whether such discussions can be recorded by either party according to national law in any market and ensure that the evaluator conducting the conversation is the actual clinician and not a research assistant or other person. Like in every profession, there are people who can attempt to “skirt around” the process and capitalize on high anxiety within the organization.
Time is of the essence in employee fitness for duty matters. Even if you can find a board-certified doctor in the right medical specialty, who is familiar with the FFDE process, the doctor may not be immediately available.
It is important that an organizational threat team ensures that the persons being interviewed know they must sign a substantial amount of paperwork before they meet with the clinician in person or through video, and that they understand the nuances of the medical and other releases they are signing. The employer may need to have several versions prepared in different languages depending upon your geographical imprint. Legal counsel should review these documents in advance to ensure they meet employer needs and not only that of the clinician conducting the interview.
Why These Evaluations Matter
The APA has been at the forefront of helping employers understand the value of such assessments for decades. An excellent summary on occupational evaluations, best summarized by that group on apa.org notes, is:
Psychological evaluations are often relied on by employers, professional licensing boards, and civil service commissions to make hiring and employment decisions affecting large number of applicants, workers, organizations, and the public at large (Anfang and Wall 2006; Corey and Borum 2013; Meyer and Price 2012; Piechowski and Drukteinis 2011). In an effort to promote best practices, these professional practice guidelines were developed for use by psychologists who perform clinical evaluations of individuals for occupational purposes, regardless of whether the evaluation is intended to obtain employment, to achieve licensure/certification, or to maintain either.
The organization has hosted multiple discussions and forums on what kind of data and interview techniques can inform the person evaluating someone who may pose a risk to themselves or others. In this regard, the APA has also done a good job of explaining the variabilities in criteria for information used and shared during the fitness evaluation process:
The term guidelines refer to statements that suggest or recommend specific professional behavior, endeavor, or conduct for psychologists (American Psychological Association 2015). Guidelines differ from standards in that standards are mandatory and may be accompanied by an enforcement mechanism. Thus, guidelines are aspirational in intent. They are meant to promote a high level of professional practice by psychologists and to facilitate the continued systemic development of the profession. Guidelines are not intended to be mandatory or exhaustive and may not be applicable to every professional and clinical situation.
They are not intended to take precedence over the professional judgments of psychologists that are based on the scientific and professional knowledge of the field (American Psychological Association 2015). The purpose of these guidelines is not to prescribe rules of professional conduct, but rather to serve practitioners as reflective tools for consideration in an area of practice with potentially serious implications for multiple parties (Heilbrun et al. 2008; Schopp and Wexler 1989).
Although the terms professional practice guidelines and clinical practice guidelines are often used interchangeably, APA draws a distinction between the two and encourages consistent use of terminology within the association (American Psychological Association 2015). Clinical practice guidelines provide specific recommendations about clinical interventions. They tend to be specific to conditions or treatments and are typically disorder based (e.g., substance use, depression, and attention-deficit/hyperactivity disorder). In contrast to clinical practice guidelines, professional practice guidelines consist of recommendations to professionals concerning their conduct and the issues to be considered in particular areas of practice. (apa.org)
Thus, whether in supporting human resources, security, legal, or other function in an organization, specialists in violence prevention will want to understand there are guidelines that exist in most countries that are like those of the APA. In other jurisdictions, there may be no guidelines, and this can create considerable confusion, and sometimes arguments, as terms such as “suitability” or “fit for duty” are circulated among members of a threat assessment team. This is why specialists will want to pay close attention to the laws in the specific markets where the employer operates, have a prevetted and updated list of approved evaluators, and understand how changes in laws can impact the enactment of these evaluations.
Regardless of where an entity operates, one conclusion is universal: the fitness evaluator is not there to treat your employee, they are not there to provide insight or recommendations on their mental or medical status, and they are not there to prescribe or diagnose in any way. Their role is to evaluate the emotional and psychological temperature of the employee, to identify whether the employee is reasonable and responsive to questions about why they were sent for an evaluation, and the evaluators will ideally, in addition to their professional line of questioning, administer a third party personality inventory to independently determine whether their professional conclusions are covalidated by that instrument.
The Role of Personality Tests
Before providing more insight on the importance of fitness for duty processes, it is important to reflect on why an evaluator should also embed an independent personality test into the evaluative process.
There is wide disagreement within the threat assessment community as to what tests can and should be used when trying to ascertain whether a person could be violent to themselves and/or others. It may be prudent to be cautious of any expert who embraces only one test as some “experts” helped create that precise test and receive a royalty of some sorts in return for each application of that test by others. Their names do not always appear on the instrument or on the name of the company where the test is sent for evaluation, but that does not mean that self-interest is not influencing their choices. This represents one of the dirty secrets, of sorts, within the threat assessment community.
A qualified threat assessor should be able to provide an objective overview of the many personality tests that are commonly used within the employment realm. Although it has been estimated by Columbia University researchers that >2000 such tests exist, the vast majority are nonoccupational in nature; they may be used to determine whether a person may share compatible interests for dating, or they may be helpful in preselection if couples would be comparably matched with those of similar interest in a hike in Peru—but these are not occupational personality tests. Thus, it is important that violence and gender specialists understand the nuances of these tests with diligence.
As early as 1927, personality tests were used by large banks, railroads, and coal companies to determine whether a person may be “a good fit” for a large employer. Since background checks were virtually impossible to complete with any measure of success—private investigators were expensive, often fraudulent, and not diligent, let alone practical given hundreds of persons often needed for specific projects—these tests, once they matured and were validated by university researchers, fundamentally changed candidate selection. Paper-and-pencil administered tests were often used in concert with interview techniques that could, in some cases, become somewhat of a competitive prize for certain companies.
For example, Proctor & Gamble executives found by the early 1930s that the use of personality tests and the use of structured questions by managers hiring for marketing specialists who would sell toothpaste and personal grooming products helped personnel (now human resource) leaders make better hires. By tracking the performance of those who scored well both in interviews and in personality tests, P&G became formidable beyond consumer products: they were building an arsenal of knowledge about what the personality factors that were essential for a good hire (saving costs so the person did not need to be separated) and then tracking how long that person remained with the company (longer tenure reduced costs for cycling personnel in-and-out and this led to proprietary models where profitability per employee emerged—a process now a mainstay at many multinationals. Eventually, General Motors, Ford Motor Company, and others would adapt similar tactics.
Military organizations quickly found similar results.
The Woodworth Personal Data Sheet was first distributed by the U.S. Army in 1919 to determine whether a soldier had experienced “shell shock,” a potential indicator for aggression, isolationism, and other issues. The United States, Canadian, British, and Australian military all moved to comparable models in short order. By the 1930s, the Office of Strategic Services, the precursor agency to the U.S. Central Intelligence Agency, was leveraging a variety of methods, some appropriate and many today that would be considered unethical and medically harmful, to determine whether a person could lie on tests and thus potentially serve as a sympathizer or collaborator with an enemy operative.
At the end of World War II, many of the psychologists, psychiatrists, and physicians who worked for intelligence agencies took their knowledge, some brilliant and sophisticated, and some arcane and dangerous, into the private sectors. Many in the field believe that the positive findings from this body of work were best captured by the Minnesota Multi-Phasic Inventory (MMPI), which was first published in 1942. Thus, looking at all of this within the framework of how critical world events influenced the workplace evaluation of risk is fascinating and unfortunately, often, overlooked.
The quality of written instruments used became more sophisticated concurrent with academic rigor in HR, organizational behavior, and leadership studies.
Today there are about a dozen primary instruments used by fitness evaluators. Some popular instruments have been found to have psychometric deficiencies. Thus, it is important that a threat assessment resource understand the essentials of these tests, their advantages, and potential flaws as outlined in litigation or peer review. Talk with members of the psychology department at a local university with a strong reputation and find that local resource who can meet with employers and discuss how both verbal interviews and written instruments can provide, but never insure, a better hire as well as strategic insight when a person may be escalating from a safety perspective.
Remembering that the evaluator is expected to interview the person in question, administer a credible personality test, review a job description, and engage with the employer and potentially selected employees about why a person is being evaluated, a brief written conclusion, is the person fit for duty or unfit, should be generated within 1 week to 10 days. In most countries the employees in question may view the final report and seek their own similarly qualified evaluator if a counter opinion may provide new insight. Worker counsels and unions often provide guidance to employees under such scrutiny. In most Western nations, when the finding of an evaluator selected by the employer differs from that hired and paid for by the employee, a final decision may be rendered by a judge or arbitrator.
Privacy considerations are paramount, and General Data Protection Regulation (GDPR) standards that are widely utilized in members of the European Union are among the most stringent. The Genetic Information Nondiscrimination Act is a federal law that protects individuals from genetic discrimination in health insurance and employment decisions. This means that it is illegal for employers and their fitness for duty evaluator to require an employee to answer questions about family medical history during a fitness for duty evaluation. There is substantial case law indicating that the disclosure of information in a report that is not relevant to the actual referral question at hand can create and attach significant liability to both the examiner and the business entity.
In general, a psychologist who conducts fitness for duty evaluations for an employer should not be responsible for making employment decisions or deciding whether it is possible to make a reasonable accommodation for a person with a disability. That responsibility lies with the employer. The psychologist's role should be limited to advising the employer about an individual's functional abilities and limitations in relation to job functions and about whether the individual meet's the employer's health and safety requirements.
Given the complexity in conducting a competent fitness for duty examination, it is incumbent upon the practicing psychologist or psychiatrist to be aware of not only clinical issues but also understand the professional practice guidelines for occupationally mandated psychological evaluations.
Clearly, the time for employers to be aware of the design and implementation of a fitness for duty evaluation is before the need emerges. Although witness reports, police investigations, human resource insight, and security leaders, let alone coworker statements and social networking activity, all play a role in the evaluation of the potentiality for a person to be violent, this role of this rare and important third-party clinical insight cannot be underestimated.