TO REFER OR NOT TO REFER…. THAT’S THE QUESTION!

1. TO REFER OR NOT TO REFER….THAT’S THE QUESTION! Sepideh A. Souris, Psy.D. Chief of Psychological Services Occupational Health Programs Chief Executive Office

2. Types of Reevaluation • Return to Work Clearance • Psychological Reevaluation

3. Exclusions from Reevaluation Process • 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

4. Exclusions (continued) • 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.

5. 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

6. 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 substance • Employee provides a series of medical certification from treatment provider that continuously extend return to work date • Employee was originally removed from work by OHP/PSU and is now presenting directly to the Department with a clearance from his/her own provider

7. 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

8. Psychological Reevaluation (Continued) Verbal or behavioral actions that present an immediate risk to the health and safety of the employee or others; Verbal or behavioral actions that have increased in frequency and present a concern for violence in the workplace; When other measures, such as supervisory counseling or reasonable accommodation measures have failed to resolve performance and safety concerns of the employee or others.

9. 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)

10. 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

11. 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

12. 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

13. Psychological Reevaluation Process • PSU schedules appointment through the Department with communication of all instructions • At appointment, employee signs informed consent… A refusal to sign ends the evaluation session

14. 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

15. Report of Findings & Recommendations • Clinical Report remains with PSU • Includes test results, diagnosis, etc. • Released only by authorization or court order • Possible 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

16. 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

17. Findings & Recommendations (Continued) Existence of a Psychological Condition Findings & Recommendations Inability to Continue Work At the Time of Evaluation Absence of Psychological Condition- Accountable for Conduct & Behavior Medical Separation

18. What is a Psychological Condition? • A health condition characterized by alterations in thinking, mood or behavior associated with distress and/or impaired functioning. In most cases, symptoms and signs remit when the individual is compliant with treatment. • ADA defines a “mental disability” as a mental disease, disorder or condition; having a record of such an impairment; and being “regarded as” having a mental impairment, even if not actually impaired (including mental conditions perceived as disabling.) • However, CA FEHA specifically excludes the following conditions/disorders from protection: • Sexual behavior disorders • Compulsive gambling • Kleptomania • Pyromania • Psychoactive substance use disorders resulting from the current unlawful use of controlled substances or drugs

19. 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.

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

21. 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

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