Management of Behavioral Health Concerns
3.3 Additional Assessment Components to Add to the BH Evaluation
3.3.6 Corroborating Documentation and Data
It is essential for the BH evaluator to obtain as much collaborative information as possible regarding the issues that the person with the reported BH concern has noted. Examples of collaborative information are workplace documentation, review
of other TPs’ treatment records, and medical records. Workplace documentation and medical records will be discussed further (ACOEM, 2006; AMA, 2008; Lerner
& Henke, 2008; Melhorn & Ackerman, 2008).
Workplace documentation is simply the documentation of current job title, written job responsibilities, current supervisor, length of employment, internal departmental transfers, name of the current department, job performance evalua- tions, workplace attendance records, past and current disability records, workplace disciplinary records, workplace advancement and recognition, and if legally allowed, direct communication with the employer. It should be noted that this listing is not all-inclusive nor is always possible to obtain all workplace documentation. Despite this, it is important to request as much information and documentation as possible.
In addition, requests that were not fulfilled should be noted in the finalized report (ACOEM, 2006, 2008; Grant, 2005; Lerner & Henke, 2008; Warren, 2009).
A trend that has been ascertained has been the aspect of the BH professional utilizing one set of standards to determine treatment when the individual presents with personal issues and a different set of professional standards when the work place is the primary issue. Interestingly, Weinstein (1969) observed a trend of some psychiatric patients improving, while others did not. He called this the “illness pro- cess.” Weinstein noted a series of discrete steps that led from the individual’s subjec- tive distress (e.g., anxiety and depression) which led to the “emergence of stress-related sanctioned disability.” An example of this would occur if the patient/
applicant presented with personal difficulties and a troubled life situation; this typi- cally was viewed in Weinstein’s model as an unacceptable cause of disability. The rationale was it was viewed that the individual could conceivably make changes to better one’s life. However, Weinstein observed that if the person presented with personal difficulties, a troubled life situation, and either alcoholism, an illness, injury, or as the result of an accident, then the BH professional tended to label the person as disabled. Weinstein held that BH health professionals must help the indi- vidual seeking assistance in learning positive coping strategies in either instance, not just the second example. In this way, the individual is taken out of the sanctioned disability model and taught to return to life and all of its challenges fully (Table 3.1).
When BH clinicians do not assist their clients or patients in learning to adapt to life and work situations or to problem-solve effectively, then the professional is utilizing one’s own subjective opinions versus appropriate clinical evaluation protocol, stan- dardized, diagnostic criteria, and evidenced-based treatment (Grove, Zald, Lebow, Smitz, & Nelson, 2000; Harding, 2004). This results in questionable clinical opinions and inappropriate psychological care (NBGH, 2007; Surgeon General’s Report, 1999). Weinstein opined that BH professionals have contributed to the development and persistence of disability in the manner in which clients or patients were facilitated through the disability process, with being placed on permanent disability as the end- ing point. It is a major cause of iatrogenic BH disability (AMA, 2008).
Table 3.1 A 40+ year old recognized formula from psychiatric literature Weinstein, 1969 a) Personality difficulties + b) Troubled life situation = c) Unacceptable disability
c) Unacceptable disability + d) Accidents, illness, alcoholism, etc. = e) Acceptable disability
There are several ways to avoid this problematic approach. First, it is important to remember that in both instances of acceptable and unacceptable disability that Weinstein noted the primary role of the BH professional is to help the individual to learn to cope with the situation and how to live life as active as possible in order to preserve physical and emotional functioning . Second, it is essential to ensure that the appropriate psychological diagnosis is made and is documented in the records. If the professional does not note this information than the lack of appropriate documentation leaves the BH professional vulnerable to legal issues, such as insufficient documenta- tion to support the resulting psychological services, and makes it likely that the appli- cant will have a disability claim denied because of poor documentation. This results in unnecessary increased costs and leaves the BH professional vulnerable to legal chal- lenges of misrepresentation and malpractice. Third, the BH professional must be clear as what the precise professional role that the professional is in during the BH disability process. Specifically, the BH professional avoids being in the dual role of TP and evaluating professional simultaneously. When the BH professional takes this approach, then s/he has a strong sense of the legal implications of causation of disability, makes the distinction between impairment and disability, and to thoroughly understands the com- plexities of the biopsychosocial evaluation and treatment model for psychological disor- ders. A simple means to point the BH professional in the right direction is to remember that psychological impairment must meet two criteria: (1) Psychological impairment is the objective loss of psychological function; and (2) It may represent a limitation.
Limitation is (a) something an individual cannot do because of functional loss or (b) something a person should not do because of realistic harm to self or others as deter- mined by the comprehensive BH evaluation and standardized psychological testing.
This is called psychological determination (Gold et al., 2008; Grant, 2005; Heilbrun, 2001, Heilbrun et al., 2002, 2003, 2007, 2009; Young, Kane, & Nicholson, 2007).
On the other hand, BH disability is a non-standardized term loosely employed by various organizations and laws as is taken generally to mean the loss of the ability to perform a defined role (e.g., a work role) because of medical or psychological circum- stances as noted in Chap. 2. This issue of disability is one that all BH professionals are asked to answer during their careers. However, it is important to keep in mind that abil- ity to function, in this case, ability to work primarily represents contractual and legal constructs. Importantly, it is not an issue decided by the BH professional, but a legal and contractual agreement between the employer and the employee, in some instances and in legal procedures in other situations. Therefore, in most instances, BH professionals will not be deciding the issue of psychological disability, but instead will be evaluating whether objective impairment actually exists and if so, in what capacity is the individual limited in functioning. However, in those instances where the BH professional attempts to answer the BH disability question on a BH disability application, one should be aware and consider the risks of the legal consequences for practicing beyond one’s area of professional competency, such as not being licensed as an attorney (Gold et al., 2008;
Grant, 2005; Heilbrun, 2001, Heilbrun et al., 2002, 2003, 2007, 2009).
Medical records, both past and present, should be obtained in order to evaluate the types of professional who provided treatment, diagnoses provided, types of treatment conducted, MRI, CT, and blood work, and other test results. This allows the BH evaluator to understand the biological component of the issues that may
contribute to the person’s current level of functioning (Gold et al., 2008; Grant, 2005; Heilbrun, 2001, Heilbrun et al., 2002, 2003, 2007, 2009).