Cuando nos encontramos ante situaciones extremas queda claro que no vale solo con disponer de la prevención y los medios de intervención necesarios. En el contexto norteamericano la concienciación referente a los riesgos en general está llevándose a situaciones que diez años atrás eran impensables. técnicos de safety ó security hablando de dos conceptos: preparedness and awareness.
Desde luego, si ya anteriormente hemos observado que la tendencia integradora de ambas disciplinas es una realidad ahora nos queda claro que la integración de los integrantes puede que a medio plazo sea un modelo válido para Europa.
¿No hablamos de mitigar riesgos?¿crees que en todos los ámbitos pueden darse por separado?¿no piensas que exige diferente madurez el análisis de las dos causas?
martes, 9 de diciembre de 2008
miércoles, 25 de junio de 2008
Seguridad y prevención dentro del marco de intervención en el comportamiento humano: dos fines con un sistema común
Un ejemplo de seguridad y prevención integrada. Misma misión conjunta pero diferente visión. Mitigar el riesgo/ prevenir e intervenir
Behavioral Risk Management for Enhanced Security and Safety
Joseph A. Kinney, MPA
Employers should develop appropriate and effective procedures and policies for effectively managing employees who appear to be at-risk of injury or high-risk behavior, including violence. Such procedures should be taught to supervisory and management personnel who are on the frontlines of critical decision-making. We all intuitively know that it is best to manage problems in their infancy, yet we seldom take the initiative to do just that.
Employees must be properly diagnosed and treated at the earliest possible time in order to ensure that they represent little or no threat to themselves, co-employees, or the public. Once inappropriate behavior has been noted, identified or discussed at any level of management, something must be done to curb the behavior that is the source of concern Generally, the invention may come in the form of supervisory counseling, a medical intervention, or discipline. These options can be enumerated in the following ways:
* Supervisory counseling involves a management or supervisory professional discussing the pertinent issues with the employee in question. Usually this should involve one or two sessions depending upon the response.
* A medical intervention could be a referral to an Employee Assistance Program or for a "fitness-for-duty" evaluation by a trained psychologist or psychiatrist. This typically occurs after the counseling step.
* Discipline comes when it is clear that the employee has no medical issue yet is failing to respond. There are many aspects to discipline up to and including termination.
There are a number of recommendations that employers should consider as part of a program to properly manage behavioral risks. Any program should be developed in concert with an expert as well as outside legal counsel.
Consistent Guidelines:
Consistent guidelines should be developed and used to determine when an employee should have a fitness-for-duty evaluation or other outside medical intervention. The guidelines should also identify appropriate professionals who should be responsible for assessing appropriateness of referral for mandatory psychological evaluation.
Monitoring Procedures:
Monitoring procedures must be established to ensure that appropriate diagnostic procedures are undertaken and that appropriate clinical treatment is pursued. Appropriate confidentiality agreements are central to sound monitoring.
Outside resource:
Contract with an outside resource that can manage the referral process to ensure that proper and consistent procedures are being followed irrespective of the location of the employee.
Human Resource Training:
Include as part of human resource training programs that a requirement that managers receive information on the need to refer potentially dangerous employees for medical evaluation. In developing a training initiative, recognize that many managers are reluctant to make personnel decisions that have adverse consequences for employees.
Incident Documentation:
Improve incident and behavior documentation procedures. Information of this nature can be valuable to future supervisors who may not know an employee’s history, mental health evaluators downstream, or for the employer in defending its decisions to a regulator or in a court.
KEYS TO BEHAVIOR RISK MANAGEMENT
Employees who engage in behaviors that may suggest the possibility of violence or risk of injury pose a peril for employers that should be addressed. When inappropriate behavior is identified, it should be analyzed in the context of resolving the problem. Such employees should be counseled or participate in psychological evaluations or behavioral interventions for their own benefit––as well as for the safety of others. If unanswered behavior continues, a past failure to manage such problems can result in a potential lawsuit for negligent retention or negligent supervision.
The practice of sending employees for external evaluation has long been demonstrated. Such evaluations, which have been established as a clinical method for many years, are generally called "fitness-for-duty" evaluations or dangerousness assessments. This process originally for law enforcement and other public safety personnel but has been extended broadly to other occupational classifications.
Unfortunately, many employees who are asked to voluntarily participate in such evaluations decline. This failure to cooperate may leave an employer with no real option but to mandate an evaluation as a condition for continued employment. The alternative, allowing a person to work, may expose that person’s co-workers and/or the public to physical as well as psychological harm (which may have already occurred).
Ideally, employers should not wait for an act of violence or employee injury to promulgate policies and procedures that have the promise of preventing such injury. Employers should realize that preventive strategies are more effective than crisis-oriented responses that follow injury and destruction. When it comes to violence, employers realize that there are many reasons why they must take action when an employee has exhibited behavior which suggests the possibility of aggression or has engaged in threats or threatening acts or has exhibited behavior that is high-risk of injury.
The issue of violent employees has concerned employers and the mental health profession for many years. For example, law enforcement agencies have recognized for a long time that the stress related to this occupation result in aggressive behavior by certain employees. As a result, the law enforcement community, in working with the mental health profession, developed what is called "fitness-for-duty" examinations or dangerousness assessments. Either licensed clinical psychologists or psychiatrists should be used determine if a person represents a danger to themselves, their co-employees, or the public. These examinations have been used during this century and have been increasingly used since World War II. Ideally such examinations or assessments should follow an on-site, non-clinical evaluation to determine whether this person, in fact, is in need of a formal mandated evaluation. The individual that completes the non-clinical evaluation should not be involved in the formal examination or assessment.
In the past two decades, an increasing number of employers have utilized these clinical methods for evaluating their employees. For example, public utilities that operate nuclear installations are obligated by statute to psychologically screen their employees prior to employment and they have the legal right to impose fitness-for-duty examinations whenever circumstances or conditions dictate that such examinations could be necessary. The federal government does not require that employees participate in such examinations, but agencies have the right to terminate employees who are unwilling to participate in such examinations. Many corporations have also followed such an approach.
General guidelines for behavioral interventions that are consistently applied are required to effectively realize the goal of mandatory referral. While some discretion should rest with the manager or other appropriate official to make referrals, there is a real need for consistency. A lack of consistency will lead to potential problems down the road although it is likely that an imperfect approach is more desirable than ignoring problems. Naturally, managers who have carefully observed employees over a long period of time may have intuitive feelings or anxieties about employees that should be considered. They, after all, are exposed to these problems on a daily basis.
There are also a number of medical/psychiatric disorders that increase threat potential. These symptoms should be considered during an evaluation of an employee’s fitness-for-duty when certain disorders or behaviors have been exhibited, or threats communicated, consistent with symptoms that are associated with the disorder. In some cases, medical interventions including pharmacology or vitamin therapy may be effective in medicating the disorder leading to a restoration of job duties by the employee. A list of the medical/psychiatric disorders increasing threat potential is shown on the next page.
MEDICAL/PSYCHIATRIC DISORDERS INCREASING THREAT POTENTIAL
Disorder Possible Symptom(s)
Brain Tumor or Infection Emotional dyscontrol; extreme irritability
Hypertension (high blood pressure) Fatigue, moodiness, concentration problems
Hyperthyroidism (overactive thyroid gland) Hyperactive, "manic," anger, irritability
Sleep Disorders (i.e. insomnia) Fatigue, extreme irritability, confusion
Bipolar Disorder (Manic Depressive Illness) Extreme mood swings, problems with impulse control; hyperactivity and inappropriate
behavior
Major Depression Suicidal thoughts; hopelessness; confusion
Alcohol and Substance Abuse Paranoid thoughts; confusion/disorientation; withdrawal symptoms (hallucinations, delusions, hyperactivity and aggressiveness)
Paranoid Disorders Homicidal thoughts, extreme anger, blaming others; "rage" attacks
Anxiety Disorders Sleeplessness; extreme irritability, poor attention and concentration
Source: DR. JAMES CAVANNAUGH, M.D., ISAAC RAY CENTER, CHICAGO.
RELATED ISSUES
There are a number other related issues that should be considered in the context of a program of behavioral risk management. These issues and concepts are integral to developing and maintaining a sound problem.
Incident & Behavior Documentation:
Prudence suggests that employers document safety-related behaviors and threats more comprehensively than is currently the case. Documentation will tend will record what specific managers believed to be the case rather than to leave such issues for future debate and Monday quarterbacking. This is sound administrative procedure and should be seen as such.
Ideally, managers should document unacceptable behaviors and communications as quickly as possible. In some cases, organizations utilize what is called a Behavior Observation Program (BOP) for subsequent documentation. It would make sense for such documents to be reviewed by a human resources manager early in the process in order to ensure that information is being properly recorded.
Referral Coordination:
Employers typically use psychologists and other mental health consultants to conduct such examinations or to supervise such evaluations. These individuals will consult with employers on issues concerning employee behavior.
The idea of centralizing the referral process through a mental health consultant is both professionally and legally sound. A mental health consultant can consult with managers about the appropriateness of a referral and, perhaps, help monitor clinical treatment of the employee.
Likewise, such consultants can be helpful in terms of developing guidelines on when to refer an employee for evaluation. They also can be useful in helping to develop incidental documentation procedures and for evaluating when proper documentation has been prepared. From a legal perspective, it is important that medical methods be used to meet ADA standards. Also, a mental health consultant may be helpful in managing the sensitive return-to-work process.
Predicting Violence
While the mental health profession strives to improve methods and procedures, there is evidence that fitness-for-duty evaluations have failed on occasion to predict the possibility of violence in employees. Indeed, experts such as Dr. John Monahan, Ph.D., a psychologist on the faculty of the University of Virginia School of Law, suggest that there are limitations in predicting violent behavior in individuals. However, Dr. Monahan and others believe that dangerousness assessments have helped to identify dangerous people and should be used in the future where appropriate.
Essentially, behavioral risk management concerns (1) methods to identify problems and (2) how to best use available capabilities. Appropriate methods are available to employers for the purpose of identifying, with as much validity as possible, potentially dangerous employees as part of the course of protecting the employee, the employer’s workforce, and the public. There are legitimate disagreements on which instruments, psychometric tests, and diagnostic procedures are the most valid. Research hopefully will help us gain insight into these important questions. In the meantime, employers must rely on professional practitioners to conduct such reviews. The utilization of a consultant can help with such determinations.
Finally, we should consider what happens to an employee after an outside professional has evaluated them. Once again, this is the most rational and thoughtful way of understanding the consequences of a mandatory referral policy. As one can see from the following table, management has a large number of options that it can consider. Obviously, these options should be considered in consultation with a professional mental health provider, human resources managers, security professionals, and other appropriate individuals.
OPTIONS AFTER EVALUATION OF EMPLOYEE
1. Refer for medical examination.
2. Place individual on medical leave. Re-evaluate after treatment.
3. Mandatory counseling with treatment monitoring.
4. Opportunity to resign without prejudice.
5. Discipline.
6. Voluntary counseling.
7. Restraining order.
8. Law enforcement criminally charges suspect.
9. Warn targets of threats.
10. Provide security during interviews (if necessary).
©Joseph A. Kinney
Behavioral Risk Management for Enhanced Security and Safety
Joseph A. Kinney, MPA
Employers should develop appropriate and effective procedures and policies for effectively managing employees who appear to be at-risk of injury or high-risk behavior, including violence. Such procedures should be taught to supervisory and management personnel who are on the frontlines of critical decision-making. We all intuitively know that it is best to manage problems in their infancy, yet we seldom take the initiative to do just that.
Employees must be properly diagnosed and treated at the earliest possible time in order to ensure that they represent little or no threat to themselves, co-employees, or the public. Once inappropriate behavior has been noted, identified or discussed at any level of management, something must be done to curb the behavior that is the source of concern Generally, the invention may come in the form of supervisory counseling, a medical intervention, or discipline. These options can be enumerated in the following ways:
* Supervisory counseling involves a management or supervisory professional discussing the pertinent issues with the employee in question. Usually this should involve one or two sessions depending upon the response.
* A medical intervention could be a referral to an Employee Assistance Program or for a "fitness-for-duty" evaluation by a trained psychologist or psychiatrist. This typically occurs after the counseling step.
* Discipline comes when it is clear that the employee has no medical issue yet is failing to respond. There are many aspects to discipline up to and including termination.
There are a number of recommendations that employers should consider as part of a program to properly manage behavioral risks. Any program should be developed in concert with an expert as well as outside legal counsel.
Consistent Guidelines:
Consistent guidelines should be developed and used to determine when an employee should have a fitness-for-duty evaluation or other outside medical intervention. The guidelines should also identify appropriate professionals who should be responsible for assessing appropriateness of referral for mandatory psychological evaluation.
Monitoring Procedures:
Monitoring procedures must be established to ensure that appropriate diagnostic procedures are undertaken and that appropriate clinical treatment is pursued. Appropriate confidentiality agreements are central to sound monitoring.
Outside resource:
Contract with an outside resource that can manage the referral process to ensure that proper and consistent procedures are being followed irrespective of the location of the employee.
Human Resource Training:
Include as part of human resource training programs that a requirement that managers receive information on the need to refer potentially dangerous employees for medical evaluation. In developing a training initiative, recognize that many managers are reluctant to make personnel decisions that have adverse consequences for employees.
Incident Documentation:
Improve incident and behavior documentation procedures. Information of this nature can be valuable to future supervisors who may not know an employee’s history, mental health evaluators downstream, or for the employer in defending its decisions to a regulator or in a court.
KEYS TO BEHAVIOR RISK MANAGEMENT
Employees who engage in behaviors that may suggest the possibility of violence or risk of injury pose a peril for employers that should be addressed. When inappropriate behavior is identified, it should be analyzed in the context of resolving the problem. Such employees should be counseled or participate in psychological evaluations or behavioral interventions for their own benefit––as well as for the safety of others. If unanswered behavior continues, a past failure to manage such problems can result in a potential lawsuit for negligent retention or negligent supervision.
The practice of sending employees for external evaluation has long been demonstrated. Such evaluations, which have been established as a clinical method for many years, are generally called "fitness-for-duty" evaluations or dangerousness assessments. This process originally for law enforcement and other public safety personnel but has been extended broadly to other occupational classifications.
Unfortunately, many employees who are asked to voluntarily participate in such evaluations decline. This failure to cooperate may leave an employer with no real option but to mandate an evaluation as a condition for continued employment. The alternative, allowing a person to work, may expose that person’s co-workers and/or the public to physical as well as psychological harm (which may have already occurred).
Ideally, employers should not wait for an act of violence or employee injury to promulgate policies and procedures that have the promise of preventing such injury. Employers should realize that preventive strategies are more effective than crisis-oriented responses that follow injury and destruction. When it comes to violence, employers realize that there are many reasons why they must take action when an employee has exhibited behavior which suggests the possibility of aggression or has engaged in threats or threatening acts or has exhibited behavior that is high-risk of injury.
The issue of violent employees has concerned employers and the mental health profession for many years. For example, law enforcement agencies have recognized for a long time that the stress related to this occupation result in aggressive behavior by certain employees. As a result, the law enforcement community, in working with the mental health profession, developed what is called "fitness-for-duty" examinations or dangerousness assessments. Either licensed clinical psychologists or psychiatrists should be used determine if a person represents a danger to themselves, their co-employees, or the public. These examinations have been used during this century and have been increasingly used since World War II. Ideally such examinations or assessments should follow an on-site, non-clinical evaluation to determine whether this person, in fact, is in need of a formal mandated evaluation. The individual that completes the non-clinical evaluation should not be involved in the formal examination or assessment.
In the past two decades, an increasing number of employers have utilized these clinical methods for evaluating their employees. For example, public utilities that operate nuclear installations are obligated by statute to psychologically screen their employees prior to employment and they have the legal right to impose fitness-for-duty examinations whenever circumstances or conditions dictate that such examinations could be necessary. The federal government does not require that employees participate in such examinations, but agencies have the right to terminate employees who are unwilling to participate in such examinations. Many corporations have also followed such an approach.
General guidelines for behavioral interventions that are consistently applied are required to effectively realize the goal of mandatory referral. While some discretion should rest with the manager or other appropriate official to make referrals, there is a real need for consistency. A lack of consistency will lead to potential problems down the road although it is likely that an imperfect approach is more desirable than ignoring problems. Naturally, managers who have carefully observed employees over a long period of time may have intuitive feelings or anxieties about employees that should be considered. They, after all, are exposed to these problems on a daily basis.
There are also a number of medical/psychiatric disorders that increase threat potential. These symptoms should be considered during an evaluation of an employee’s fitness-for-duty when certain disorders or behaviors have been exhibited, or threats communicated, consistent with symptoms that are associated with the disorder. In some cases, medical interventions including pharmacology or vitamin therapy may be effective in medicating the disorder leading to a restoration of job duties by the employee. A list of the medical/psychiatric disorders increasing threat potential is shown on the next page.
MEDICAL/PSYCHIATRIC DISORDERS INCREASING THREAT POTENTIAL
Disorder Possible Symptom(s)
Brain Tumor or Infection Emotional dyscontrol; extreme irritability
Hypertension (high blood pressure) Fatigue, moodiness, concentration problems
Hyperthyroidism (overactive thyroid gland) Hyperactive, "manic," anger, irritability
Sleep Disorders (i.e. insomnia) Fatigue, extreme irritability, confusion
Bipolar Disorder (Manic Depressive Illness) Extreme mood swings, problems with impulse control; hyperactivity and inappropriate
behavior
Major Depression Suicidal thoughts; hopelessness; confusion
Alcohol and Substance Abuse Paranoid thoughts; confusion/disorientation; withdrawal symptoms (hallucinations, delusions, hyperactivity and aggressiveness)
Paranoid Disorders Homicidal thoughts, extreme anger, blaming others; "rage" attacks
Anxiety Disorders Sleeplessness; extreme irritability, poor attention and concentration
Source: DR. JAMES CAVANNAUGH, M.D., ISAAC RAY CENTER, CHICAGO.
RELATED ISSUES
There are a number other related issues that should be considered in the context of a program of behavioral risk management. These issues and concepts are integral to developing and maintaining a sound problem.
Incident & Behavior Documentation:
Prudence suggests that employers document safety-related behaviors and threats more comprehensively than is currently the case. Documentation will tend will record what specific managers believed to be the case rather than to leave such issues for future debate and Monday quarterbacking. This is sound administrative procedure and should be seen as such.
Ideally, managers should document unacceptable behaviors and communications as quickly as possible. In some cases, organizations utilize what is called a Behavior Observation Program (BOP) for subsequent documentation. It would make sense for such documents to be reviewed by a human resources manager early in the process in order to ensure that information is being properly recorded.
Referral Coordination:
Employers typically use psychologists and other mental health consultants to conduct such examinations or to supervise such evaluations. These individuals will consult with employers on issues concerning employee behavior.
The idea of centralizing the referral process through a mental health consultant is both professionally and legally sound. A mental health consultant can consult with managers about the appropriateness of a referral and, perhaps, help monitor clinical treatment of the employee.
Likewise, such consultants can be helpful in terms of developing guidelines on when to refer an employee for evaluation. They also can be useful in helping to develop incidental documentation procedures and for evaluating when proper documentation has been prepared. From a legal perspective, it is important that medical methods be used to meet ADA standards. Also, a mental health consultant may be helpful in managing the sensitive return-to-work process.
Predicting Violence
While the mental health profession strives to improve methods and procedures, there is evidence that fitness-for-duty evaluations have failed on occasion to predict the possibility of violence in employees. Indeed, experts such as Dr. John Monahan, Ph.D., a psychologist on the faculty of the University of Virginia School of Law, suggest that there are limitations in predicting violent behavior in individuals. However, Dr. Monahan and others believe that dangerousness assessments have helped to identify dangerous people and should be used in the future where appropriate.
Essentially, behavioral risk management concerns (1) methods to identify problems and (2) how to best use available capabilities. Appropriate methods are available to employers for the purpose of identifying, with as much validity as possible, potentially dangerous employees as part of the course of protecting the employee, the employer’s workforce, and the public. There are legitimate disagreements on which instruments, psychometric tests, and diagnostic procedures are the most valid. Research hopefully will help us gain insight into these important questions. In the meantime, employers must rely on professional practitioners to conduct such reviews. The utilization of a consultant can help with such determinations.
Finally, we should consider what happens to an employee after an outside professional has evaluated them. Once again, this is the most rational and thoughtful way of understanding the consequences of a mandatory referral policy. As one can see from the following table, management has a large number of options that it can consider. Obviously, these options should be considered in consultation with a professional mental health provider, human resources managers, security professionals, and other appropriate individuals.
OPTIONS AFTER EVALUATION OF EMPLOYEE
1. Refer for medical examination.
2. Place individual on medical leave. Re-evaluate after treatment.
3. Mandatory counseling with treatment monitoring.
4. Opportunity to resign without prejudice.
5. Discipline.
6. Voluntary counseling.
7. Restraining order.
8. Law enforcement criminally charges suspect.
9. Warn targets of threats.
10. Provide security during interviews (if necessary).
©Joseph A. Kinney
Suscribirse a:
Comentarios (Atom)