Fitness for Duty Neuropsychological Evaluation

[PikminOC]

Nurse who lost her license for substance abuse needs a fitness for duty evaluation. I am going to send her to a forensic neuropsychologist. Do you know what testing they do for this so I can understand the scope and breadth of this too?

Thanks,

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[psych.meout]

Nurse who lost her license for substance abuse needs a fitness for duty evaluation. I am going to send her to a forensic neuropsychologist. Do you know what testing they do for this so I can understand the scope and breadth of this too?

Thanks,

Unless there are cognitive concerns related to a patient's case, neuropsych probably isn't a necessity if the referral question is just related to substance abuse. In fact, it might be better to send them to someone who specializes in SUDs.

 

[WisNeuro]

Not sure about the SUD issue, seems like she'd more of a psych eval, not a neuropsych eval. I'm more familiar with FFD evals for older docs who have cog concerns.

 

[PikminOC]

She has every reason to present things favorably. I want objective measures

 

[BuckeyeLove]

I'm not exactly of the neuro issue here.

 

[erg923]

She has every reason to present things favorably. I want objective measures

Objective measures are part of a psychological testing eval.

 

[AcronymAllergy]

Nurse who lost her license for substance abuse needs a fitness for duty evaluation. I am going to send her to a forensic neuropsychologist. Do you know what testing they do for this so I can understand the scope and breadth of this too?

Thanks,

I don't perform FFD evaluations, but a lot of it can depend on the nature of the job, the nature of the board's reason for removing the license, and the stipulations they've potentially put in place for re-instating the license.

Broadly speaking, a neuropsychologist may perform a breadth of testing across a number of cognitive domains. Will likely perform an in-depth interview, and ideally may gather information about the nature of the job and its requirements. Given the substance abuse component, I imagine that in addition to the interview, they will utilize some self-report questionnaires.

You might've already known all that, but it's tough to answer more specifically without knowing a good bit of information about the situation. Although folks who perform these regularly could probably add a bit more.

I agree that if it's relating to SUD predominantly or entirely, with no cognitive concerns, neuropsych eval may not be necessary. But a forensic neuropsychologist may still be able to conduct a psychologically-oriented FFD eval.

 

[PsyDr]

Many psychiatrists have the opinion that neuropsych= objective testing; psychology= interview or psychotherapy. I think that's something that is present here

 

[PikminOC]

Many psychiatrists have the opinion that neuropsych= objective testing; psychology= interview or psychotherapy. I think that's something that is present here

No, I know the neuropsych does both.

 

[PsyDr]

No, I know the neuropsych does both.

I think that you are getting some push back because there does not seem to be an identified cognitive issue in the referral. Is the nurse cognitively dulled? forgetful? talking funny? IF the issue is simply about the drinking, then a forensic psychololgist is a better fit than a forensic neuropsycholgoist.

In any case, the neuropsych will administer tests of cognition to include IQ, executive functioning, memory, language, sensorimotor, attention, effort, and emotional tests. Should be about 5-8 hrs of testing. Might request you order GGT per DSM5.

 

[PikminOC]

I think that you are getting some push back because there does not seem to be an identified cognitive issue in the referral. Is the nurse cognitively dulled? forgetful? talking funny? IF the issue is simply about the drinking, then a forensic psychololgist is a better fit than a forensic neuropsycholgoist.

In any case, the neuropsych will administer tests of cognition to include IQ, executive functioning, memory, language, sensorimotor, attention, effort, and emotional tests. Should be about 5-8 hrs of testing. Might request you order GGT per DSM5.

I didn't think neuropsych testing is just for cognition.

 

[CatsFan]

I didn't think neuropsych testing is just for cognition.

I think what people are trying to say is that if there is not a cognitive question, a forensic psychologist is entirely capable of completing this eval. They will administer objective testing. Psychologists of all sorts do testing all the time (eg, IQ, personality), they just don’t do more extensive testing of cognitive domains such as memory, executive functioning, etc. That’s what a neuropsychologist would add, but it sounds like it’s not needed in this case.

 

[PsyDWannabe]

Simply put OP, yes substance use can have long and short term neurocognitive effects on a person. If the job administration is concerned that the substance use is impacting his/her job functioning on a cognitive level (i.e. any of the cognitive domains), neuropsych is indicated.

Otherwise, if their suspicions have less to do with brain-behavior relationships psych assessment should do.

 

[PsyDr]

I didn't think neuropsych testing is just for cognition.

It is essentially to test cognition.

A vague framework:

1) All psychologists are trained in administering and interpreting emotional tests and IQ tests. All training will include testing for emotional stuff like substance abuse, affective disorders.
2) Some get or choose more in depth training in this area during their general training. Some get or choose more anatomy/physiology/etc during their general training.
3) We do 4-6 years of classwork and clinical rotations. THEN we do a year old "residency" that used the same match system as medicine. After we complete our "residency", we graduate with our degree.
3) AFTER graduating from "residency", some psychologists do an additional 2 year fellowship in neuropsych. This encompasses anatomy/patho/phys/etc. The general idea of neuropsych is to differentiate psych complaints from neuro complaints OR to measure cognition for a specific purpose (e.g., a Kiloh-esque pseudodementia vs Alz). Just like in medicine, some residencies have reputations in different areas (e.g., epilepsy, gero, TBI, etc). In doing a differential like pseudodementia vs dementia, the neuropsychs are probably somewhat better at some emotional testing than some psychologists, but not all. The aforementioned might be similar to the skills of a psychiatrist vs. a pathologist in reading labs, I dunno.



4) In practice, neuropsychs are generally seeing people for specific cognitive complaints or specific neuropathologies (e.g., patient complains of memory loss, OR obtain baseline for patient who has recently been diagnosed with Parkinson's OR differential dx between binswangers and alz). There are absolutely emotional components and complaints to all of this. In an ideal patient, the test results show it's just emotional.

So the point was that in just asking for emotional testing, you're kinda missing an additional 2 years of training. Maybe having someone that has more training suits your needs for another reason, I dunno.


Forensics is another sub-specialty with specific training requirements.

Maybe that helps, maybe you know all that, maybe I'm wrong.

 

[Therapist4Chnge]

I've done these types of evals for physicians mostly, but also nurses, lawyers, etc. The first clarification I'd get is WHY the referral....caught drinking on the job, adverse outcomes, bad reviews, etc. A FFD following a stroke, progressive MS, or TBI are quite different and def would require a neuropsychologist. A typical FFD for sub abuse is more about behavior and coping. A clinician with solid assessment skills and a sub abuse background should be fine with it. Obviously, someone who has done FFD before is preferred.

States can often have guidelines about what should be covered. Certain industries, agencies, and licensing boards have their own requirements too. The FAA is the most obvious example, as they are super picky about their evals and basically everything....though they have good reasons when it comes to pilots.

 

[AbnormalPsych]

I didn't think neuropsych testing is just for cognition.

Keyword: Neuro

 

[PikminOC]

I've done these types of evals for physicians mostly, but also nurses, lawyers, etc. The first clarification I'd get is WHY the referral....caught drinking on the job, adverse outcomes, bad reviews, etc. A FFD following a stroke, progressive MS, or TBI are quite different and def would require a neuropsychologist. A typical FFD for sub abuse is more about behavior and coping. A clinician with solid assessment skills and a sub abuse background should be fine with it. Obviously, someone who has done FFD before is preferred.

States can often have guidelines about what should be covered. Certain industries, agencies, and licensing boards have their own requirements too. The FAA is the most obvious example, as they are super picky about their evals and basically everything....though they have good reasons when it comes to pilots.

Ive seen the FAA ones. I think the nurse, doctor, ones should be stringent too.

And yes, I realized I may be using the neuropsych term incorrectly. Thanks!

The FAA has different requirements for the psychiatric eval vs psychological eval. Does a person need to see both?
When I get those cases, I refer for psych testing.

Guide for Aviation Medical Examiners

www.faa.gov

 

[PikminOC]

I've done these types of evals for physicians mostly, but also nurses, lawyers, etc. The first clarification I'd get is WHY the referral....caught drinking on the job, adverse outcomes, bad reviews, etc. A FFD following a stroke, progressive MS, or TBI are quite different and def would require a neuropsychologist. A typical FFD for sub abuse is more about behavior and coping. A clinician with solid assessment skills and a sub abuse background should be fine with it. Obviously, someone who has done FFD before is preferred.

States can often have guidelines about what should be covered. Certain industries, agencies, and licensing boards have their own requirements too. The FAA is the most obvious example, as they are super picky about their evals and basically everything....though they have good reasons when it comes to pilots.

The licensing board is saying only a nurse can do this evaluation.

 

[psych.meout]

The licensing board is saying only a nurse can do this evaluation.

Which is a catch-22, because it's not within a nurse's scope of practice to do an FFD eval.

 

[Therapist4Chnge]

The licensing board is saying only a nurse can do this evaluation.

Nursing Licensing Boards are some of the most dysfunctional out there....so I'm not surprised. I don't think it is appropriate for a nurse to do it, but they are the ones requesting the FFD.

 

[PikminOC]

Nursing Licensing Boards are some of the most dysfunctional out there....so I'm not surprised. I don't think it is appropriate for a nurse to do it, but they are the ones requesting the FFD.

Dysfunctional how compared to other boards?