Many corporations call us regarding an employee exhibiting concerning behaviors. Our assessment approach to these behaviors may fall into one of two categories: a Fitness for Duty Evaluation (FFDE) or a Direct Violence Risk Evaluation (DVRE). The distinctions between these processes reflect not only how we approach an individual, but also how we can best determine their needs, as well as those of their employer.

Common Presenting Issues – and Our First Steps

In many instances, the Human Resources Department requests that we conduct a Fitness for Duty Evaluation. Employees are typically referred for this type of evaluation after receiving supervisory concerns or complaints, and are often presenting with a sudden decline in performance, attendance, attitude and/or behavior. In many of these cases referred from HR, the employee is also described as exhibiting aggressive behaviors, ranging from chronic anger or difficulty working with others to making threatening statements towards themselves or others.

During the intake call, we want to first understand the context of the employee’s behaviors and review the facts, before offering a solution that will address their specific need. In doing so, we are afforded the opportunity to determine whether a FFDE or a DVRE would be most apt for the situation.

Most HR personnel are familiar with, and have referred employees, for FFDEs. In many cases, they also ask that we assess the employee’s potential to harm themselves or others. It is at this point we discuss with them the distinct difference between these two referral questions. An FFDE involves evaluating an employee’s ability to perform essential job requirements, while a DVRE will address their violence risk potential. In cases where both issues are present, we suggest that each referral question gets addressed individually, but during the same evaluation appointment.

Two Processes with Different Scopes and Approaches

For both evaluations, we request select records to be forwarded for review and analysis, which may include:

  • Job description
  • Employee handbook
  • Policies and procedures manual
  • Performance evaluations
  • Disciplinary action
  • Previous remediation efforts (performance improvement plans)
  • Incident / investigation reports

The FFDE includes administering a comprehensive psychological test battery to address core clinical domains including psychopathology, substance use and cognitive functioning. Other measures may be added as needed to address case-specific concerns; these often include anger management and expression and trauma exposure.

On the other hand, a DVRE may or may not include any psychological testing depending on the case. We also use the Workplace Assessment for Violence Risk (WAVR-21), a structured professional guide ideal for these types of cases. However, an additional step for DVREs includes conducting a background check for criminal and civil legal history, as well as social media research regarding the employee. This provides us with a broader understanding of the employee and helps identify known risk factors for targeted violence.

For both referral questions, we attempt to interview all known and relevant collateral sources which may provide helpful information and corroboration. In many instances during the clinical interview portion of the evaluation, the employee discloses they have a past or current mental health history. When this occurs, we first provide the rationale, and then ask the employee if they would consider signing an authorization for release of information form allowing their treatment provider(s) to release these records and participate in a collateral interview with the evaluator.

In most cases, the employee agrees to disclose this otherwise protected mental health information. This information can be very helpful in that we are able to learn about the employee’s treatment compliance, motivation, diagnosis, treatment plan, progress and prognosis. These are significant elements to understand and consider when formulating our overall opinion, and equally helpful in structuring our recommendations. We also conduct collateral telephone interviews with select supervisors and managers to gain additional context and understanding of the concerning behaviors prompting the referral.

Potential Outcomes for Each Type of Assessment

The possible outcomes for the FFDE may include one of the following findings:

  • Fit for Duty
  • Fit for Duty with Monitored Intervention (e.g., medical or mental health)
  • Temporarily Unfit for Duty with Needed Intervention (e.g., medical or mental health)
  • Unfit for Duty

Given our findings, we provide relevant treatment recommendations to address the employee’s limitations and any work-related restrictions and/or accommodations that could support a “safe return to work” plan. These evaluations address the most appropriate options for both the employee and the employer.

The possible outcomes for the DVRE may include the following findings for violence risk potential:

  • Low
  • Moderate-Low
  • Moderate-High
  • High
  • Imminent

Similarly, we include recommendations to mitigate and manage the risk potential.

Benefits to Both the Employer – and the Employee

In sum, the most important step is for the organization or company to recognize when they have concerns about an employee, and refer them to a qualified and experienced provider. In this way, they are able to share the anxiety and stress inherent in managing these types of cases, and can defend their actions by exercising their due diligence in an attempt to remedy their concerns. Once the case in our hands, we use our expertise — including the FFDE and DVRE processes — to assist in helping them make the best decisions. In some cases, these same findings also benefit the employee – either by preventing them for harming themselves or others or opening up resources and avenues for their improved wellbeing, such as access to mental health care or other support mechanism.