The Comprehensive Multidisciplinary Assessment

In our experience, when a professional undergoes a multidisciplinary assessment, it signals the beginning of a shift in his/her life.  More often than not, an authoritative body is requiring that an objective expert take a close look at a particular concern that has arisen secondary to alleged behavior or conduct.  Often, the professional who is mandated to undergo an assessment feels stuck between a rock and a hard place.  First, he/she is being required to participate in an evaluation process that will take him/her away from family, work and other familiar surroundings.  Second, it involves an unplanned expense.  Third, it can be unsettling to realize that one’s professional, psychological, emotional, interpersonal, cognitive and physical functioning will be open to inquiry and examination.  From a subjective point of view, the prospect of having to undergo an assessment can feel intrusive and evoke a defensive stance.  Drs. Stacy and Graham understand this response, and the dilemma the individual is facing, from our experience evaluating well over 600 professionals in similar situations.  In the end, the best way to approach an assessment process is to be open and honest.

Acumen Assessments conducts multidisciplinary assessments with adherence to a process of forensic inquiry and scrutiny that takes into account multiple levels of analysis.  When a professional comes to Acumen for an assessment, our position is to maintain objectivity by taking into account various forms of bias that could adversely affect our clinical opinions, including our subjective perspective and attributions.  This is why a sound multidisciplinary evaluation includes multiple opinions so as to reduce biases at different levels of analysis (e.g., psychological, psychiatric, medical, social and professional domains of functioning).  In the end, our goal is threefold: 1) to help preserve the safety and integrity of those whom the client serves within his/her profession; 2) to help the client and others involved gain a deeper understanding of his/her predicament; and 3) to make recommendations, if indicated. Utilizing a multidisciplinary assessment increases the validity of the evaluation team’s conclusions and recommendations.

Some of the difficulties that lead to assessment include sexual misconduct, sexual harassment, boundary violations, problems with professional role functioning and disruptive behavior.  Often, these behavioral and interpersonal difficulties are related to professional burnout, midlife crisis and transition difficulties, addiction and recovery problems, or mood, anxiety, adjustment, personality, sexual, attention-deficit/hyperactivity, impulse control and eating disorders.  Challenges related to aging, such as dementia, cognitive decline, and the need for accurate and clear differential diagnosis, may also be involved.  In every case, our goal is to define a causal explanation for the presenting problem that links directly to recommendations for treatment, monitoring and/or rehabilitation if indicated.

The general goals of the assessment are to:

• Identify, if present, any psychiatric, psychological, medical or cognitive impairment, illness or disorder.
• Establish a causal hypothesis to help those involved in the referral to understand the client’s behaviors.  This hypothesis does not excuse the professional’s conduct but may explain, in part, why the behavior being evaluated occurred (e.g., antisocial-like behavior, bipolar illness, cognitive impairment, substance abuse/dependence, sexual addiction/compulsivity, professional burnout resulting in depression and poor judgment, problems associated with personality development).  This understanding can inform treatment and possibly assist in determining the nature of disciplinary action.
• Estimate the client’s rehabilitative potential.
• Render conclusions related to fitness for duty and indicated treatment, if appropriate.

The elements of the assessment include:

• Comprehensive medical evaluation, if indicated, with appropriate laboratory studies, medical history and screening for substances of abuse (e.g., urinalysis, hair test if appropriate, etc)
• Review of collateral information
• Comprehensive psychiatric evaluation
• Alcohol and drug history and diagnostic screening
• Psychosocial/developmental history
• Comprehensive psychological testing and clinical interview following a forensic protocol.  This may include the administration of: 1) at least two valid and reliable objective personality inventories, 2) an objective measure of response style, and/or 3) a widely utilized measure of cognitive functioning or full neuropsychological evaluation if deemed appropriate.
• Standardized administration of projective testing to evaluate perception, problem solving, emotion regulation, and thought organization
• Screening for attention-deficit/hyperactivity symptoms
• Sexual history
• Screening for sexual addiction/compulsivity/paraphilic disorders
• Forensic polygraph examination if indicated (questions need to be clearly focused on past behavior and not intent)
• Multidisciplinary team meeting in which all experts involved in the evaluation present clinical data, review collateral information, explore personal and professional biases, challenge each other’s conceptualizations and arrive at a consensus regarding the client’s psychiatric, psychological, medical, and cognitive disposition
• A report summarizing all the elements of assessment
• A medical/psycho-legal statement regarding the client’s fitness for duty, and rehabilitative potential, if indicated
• Recommendations