TO REFER OR TO REFER OR NOT TO REFER….NOT TO REFER….

THAT’S THE THAT’S THE QUESTION!QUESTION!

Sepideh A. Souris, Psy.D.Sepideh A. Souris, Psy.D.

Chief of Psychological Chief of Psychological ServicesServices

Occupational Health Occupational Health ProgramsPrograms

Chief Executive OfficeChief Executive Office1

Types of ReevaluationTypes of Reevaluation

Return to Work Clearance

Psychological Reevaluation

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Exclusions from Reevaluation Process

I. Active Workers’ Compensation claim- WCAB has jurisdiction, County may not determine fitness, unless issue is unrelated to claim- WCAB loses jurisdiction, if claim is: denied, not litigated, or adjudicated & 5 years post DOI

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Exclusions (continued)

II. FMLA limitation on Reevaluations, Health Care Provider (HCP) certification prevails- No independent reevaluation by Psychological Services Unit (PSU). We may clarify for the Department and may reevaluate after FMLA expiration, if problems persist or resurface.

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Return to Work (RTW) Clearance for Psychological

Issues• Generally accept RTW clearance

by Health Care Provider (HCP) - unless it involves safety concerns

• Necessity of clearance from OHP is determined on case-by-case basis via consultation with Chief of Psychological Services (213-738-4200)

Assumes need for clarification is evident (i.e., restrictions contrary to job demands)

Assumes HCP doesn’t or can’t clarify or hasn’t offered “informed clearance”

Assumes employee will cooperate

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RTW Clearance for Psychological Issues

(Continued)Other circumstances requiring RTW clearance from OHP/PSU:

Employee is in safety sensitive and/or law enforcement position and was committed to involuntary 72 hour hold, i.e., WIC 5150 Employee is in safety sensitive, law enforcement or other position with job nexus who is returning to work after receiving treatment for substanceEmployee provides a series of medical certification from treatment provider that continuously extend return to work dateEmployee was originally removed from work by OHP/PSU and is now presenting directly to the Department with a clearance from his/her own provider

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Psychological Reevaluation

Under CSR 9.07 (B) a department may request a psychological re-evaluation to discern fitness for duty when there is a question about existence of a condition impacting the employee’s ability to perform their job-related duties satisfactorily and without undue risk to self or others. - While relieved/restricted from duty - While working

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Psychological Reevaluation (Continued)

• Verbal or behavioral actions that present an Verbal or behavioral actions that present an immediate risk to the health and safety of the immediate risk to the health and safety of the employee or others; employee or others;

• Verbal or behavioral actions that have Verbal or behavioral actions that have increased in frequency and present a concern increased in frequency and present a concern for violence in the workplace;for violence in the workplace;

• When other measures, such as supervisory When other measures, such as supervisory counseling or reasonable accommodation counseling or reasonable accommodation measures have failed to resolve performance measures have failed to resolve performance and safety concerns of the employee or and safety concerns of the employee or others.others.

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Requesting Psychological Reevaluation

• Verify that there isn’t any Workers’ Comp or FMLA conflicts

• Seek consultation with Chief of Psychological Services

• Send a formal request and include: Name of employee, SS#, position, and item Employee’s work history as well as current

duties ( not a class specification)

Performance- relevant justification –(e.g., what has the employee exhibited at the work site? Does the employee understand, remember and carry out instructions? Can he attend to tasks or duties at a busy work site with multiple distractions? Does he perform in a situationally appropriate manner under stressful conditions? Does he remain composed and productive when confronted with emotionally charged situations? Does he work alone or in close proximity with others? Does he interact well with public? Does he accept instructions and responds appropriately to constructive comments from peers or supervisors? )

Any documents supporting request Departmental contact’s name, position, and

phone Employee’s consent or refusal (advise

employee of request and basis for it to obtain his/her consent) 9

Ordered Absence ( formerly Paid Administrative Leave) Pending

Reevaluation

• Typically pending psychological reevaluation and for safety-related concerns

• Useful short-term precaution during investigation

• Establish monitoring provisions, so that the misconduct is not rewarded 10

Ordered Absence Pending Reevaluation (Continued)

• The Department should specify to the employee conditions of ordered absence at the outset Compliance with Department’s

instructions Employee must remain reachable Employee must keep scheduled

appointment(s) May be discipline pending (if applicable) Ordered absence with pay will end with

notice from PSU or lack of compliance

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Requesting Authority to Order Reevaluation

•Generally, authority request follows refusal Exception:–Employee’s refusal is anticipated, or –Circumstances warrant minimal delay, i.e., safety concern, ordered absence (advance consultation is advised)•Submit authority request in writing along with the reevaluation request or on separate document•CEO responds to authority request in writing

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Psychological Reevaluation Process

• PSU schedules PSU schedules appointment through appointment through the Department with the Department with communication of all communication of all instructionsinstructions

• At appointment, At appointment, employee signs employee signs informed consent… A informed consent… A refusal to sign ends the refusal to sign ends the evaluation sessionevaluation session

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Psychological Evaluation Elements

• Review of pertinent documentation

• Conduct structured clinical interview

• Administer psychological measures

• Consult with appropriate identified Departmental staff

• Consult with treatment provider(s), if there are any and the employee provides authorization

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Report of Findings & Recommendations

•Clinical Report remains with PSUIncludes test results, diagnosis, etc.Released only by authorization or court orderPossible release to employee’s treatment provider (at least the summary)

•PSU provides feedback to employee–Essence of reevaluation findings–Restrictions –Any recommendations for further diagnosis or treatment

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Findings & Recommendations (Cont.)

Letter to Department

Relates only job-relevant findings and recommendations – states that the person has a psychological condition which explains the observed behaviors

Formalizes any limitations and/or restrictions (frequently discussed in advance)

Notes if employee is accountable

Discussion as related to implementation of Rehabilitation Contract

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Findings &

RecommendationsInability to

Continue Work At the Time of EvaluationAbsence of

Psychological Condition-

Accountable for Conduct & Behavior

Medical Separation

Existence of a Psychological

Condition

Findings & Recommendations

(Continued)

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What is a Psychological Condition?

• A health condition characterized by A health condition characterized by alterations in thinking, mood or behavior alterations in thinking, mood or behavior associated with distress and/or impaired associated with distress and/or impaired functioning. In most cases, symptoms functioning. In most cases, symptoms and signs remit when the individual is and signs remit when the individual is compliant with treatment.compliant with treatment.

• ADA defines a “mental disability” as a ADA defines a “mental disability” as a mental disease, disorder or condition; mental disease, disorder or condition; having a record of such an impairment; having a record of such an impairment; and being “regarded as” having a mental and being “regarded as” having a mental impairment, even if not actually impairment, even if not actually impaired (including mental conditions impaired (including mental conditions perceived as disabling.)perceived as disabling.)

• However, CA FEHA specifically excludes However, CA FEHA specifically excludes the following conditions/disorders from the following conditions/disorders from protection:protection:

Sexual behavior disordersSexual behavior disorders Compulsive gamblingCompulsive gambling KleptomaniaKleptomania PyromaniaPyromania Psychoactive substance use Psychoactive substance use

disorders resulting from the disorders resulting from the currentcurrent unlawful use of unlawful use of controlled substances or controlled substances or drugsdrugs

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What If We Determine There Isn’t Any

Psychological Condition?• Some of our correspondence state that the

employee may have “an enduring pattern of interactions….”, which signals absence of a psychological condition and existence of a personality disorder. The pattern shows in two or more of the following areas:– Pervasive and inflexible– Begins in childhood or adolescence– Stable over time– Leads to distress or functional

impairment

• Personality/characterological disorders are not considered the same as mental disorders and are by far the most difficult to treat. These individuals have few strategies of relating to others; poor impulse control; different ways of perceiving the environment; and different range and intensity of emotions.

• It is important to hold the person accountable in these cases; address behaviors and conduct, document and discipline appropriately.

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Medical SeparationMedical Separation

• In cases when after several In cases when after several reevaluations, we have reevaluations, we have determined that the employee is determined that the employee is unable to fulfill the essential unable to fulfill the essential function of his/her position and function of his/her position and furthermore will not be able to furthermore will not be able to perform in any other positions, perform in any other positions, the recommendations would be the recommendations would be Medical Separation (CSR 9.08 C).Medical Separation (CSR 9.08 C).

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Interactive Process

• Department acts on letter of findings-May need to accommodate restrictions-Advise supervisors and managers -Have an interactive meeting and discuss matters with the employee

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Resources

• Job Accommodation Network -http://www.jan.wvu.edu//

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