What is a PsychoEmotional Cognitive Functional Capacity Evaluation?

Delighted, you asked.

The PsychoEmotional Cognitive Functional Capacity Evaluation has been specifically and systematically designed to address a person’s physical, emotional, and cognitive capacity for functioning following injury. The individual may have PTSD, brain injury, depression, or undiagnosed mental health condition or comorbid conditions (more than one condition co-occurring at the same time). Due to the length of testing involved (3-day evaluation), this evaluation is also applicable when physical, emotional, and cognitive fatigue issues are present. You may even have a few of these clients on your caseload, and have been wondering how to quantify and demonstrate their change in function objectively.

Take the example of my client, Tiffany (name changed to protect her identity), she did not have a significant physical injury following the motor vehicle accident. Yet, she was not able to work productively, she was having extreme difficulty organizing herself to manage her multiple roles and functions which were not an issue pre-injury.

For example, pre-injury, Tiffany was able to work part-time, care for her two preschool aged children, cook, grocery shop, manage household tasks, enjoy her relationship with her husband and friends, was socially active, loved to read, worked out and did crafts and creative projects with her children. She had a full and active life, she reported that she had no difficulties physically, cognitively and emotionally.

After the accident, she was diagnosed with depression, anxiety, and post-traumatic stress disorder due to the severity of the accident, the risk of dying and losing her children in the accident. She became withdrawn, had panic attacks, struggled to work part-time, would often stay in bed and cry, could no longer consistently provide care for her children, could not drive due to trauma and anxiety, relied on her husband to do the grocery shopping, was unable to cook consistently, clean, or take care of the house. Socially and emotionally, she withdrew from her friends, and her marriage deteriorated, she became anxious, and irritable. She could no longer go to the park with her children due to her anxiety, intolerance for noise and being around people. There was a marked change in her emotional and overall functioning.

So how did we evaluate Tiffany’s functioning objectively?

We are delighted to share the successful application of a PsychoEmotional Cognitive Functional Capacity Evaluation to address these types of difficult to quantify limitations or invisible injuries. So what did we do for Tiffany? In this particular case, we undertook a three day evaluation to explore her physical, cognitive and emotional functioning.

On Day One, Tiffany completed various physical testing as that was necessary to determine if she had any lingering physical limitations. Due to the severity of her mental health conditions, she tended to minimize her ongoing back and neck pain, which were causing mild to moderate limitations while she was working as a cashier. For instance, she demonstrated reduced tolerances for prolonged standing, and bending activities, and reduced strength capacity for lifting and carrying. Subjectively, she was surprised to discover that her physical pain was interfering with her daily activities (childcare, housework) and ability to work without pain. Moreover, she reflected that the ongoing lingering pain was also contributing to her chronic pain, fatigue and mood issues. In fact, this is a common finding confirmed in a number of research studies on chronic pain, and depression, and in our clinical experience.

On Day Two, we undertook cognitive testing involving standardized and performance based testing. Tiffany’s test results and performance showed that she had difficulty with multitasking, executive functioning, time management, and meeting productivity standards.

On Day Three, we undertook a combination of physical and cognitive testing, to determine her overall functional tolerances with respect to her physical and cognitive limitations noted thus far. Day Three allowed for fine tuning and testing of further areas that had became apparent over the course of the evaluation.

What about her emotional functioning? Indeed, her emotional functioning was a critical aspect of the comprehensive evaluation. Her emotional functioning was evaluated over the course of the evaluation, through subjective reports and objective findings. Not surprisingly, given Tiffany's mental health conditions and overall complexity arising from the interplay of her cognitive and physical limitations, she demonstrated difficulties with emotional regulation over the course of the three day evaluation. In fact, Tiffany had observed increased levels of anxiety which interfered with task performance over the course of the evaluation and during the next day follow-up cognitive testing completed via Zoom.

In summary, over the course of the PsychoEmotional Cognitive Functional Capacity Evaluation, Tiffany demonstrated a reduced capacity for physical, cognitive and emotional functioning, as noted through the use of objective test findings, which confirmed her reduced capacity for work and daily activities.

What happened then? Upon receiving the expert report, her lawyer was able to conclusively demonstrate the reduced capacity in Tiffany’s physical, cognitive, and emotional functioning, which resulted in a significant settlement and closure of the file.

Final thoughts: as a clinician and evaluator, being able to clearly quantify these unexplored cognitive and emotional/psychological areas of functioning is satisfying. These types of limitations have not been evaluated objectively through Functional Capacity Evaluations, and their resulting impact on daily functioning and work capacity in the past. As we endeavor to continuously fine tune our methodology and expand our battery of tests, increase our knowledge and understanding of complex injury and mental health conditions through research and clinical experience, we are entering a new era of growth and possibility to serve clients who have invisible and hard to quantify injuries and disability.

The PsychoEmotional Cognitive Functional Capacity Evaluation is a comprehensive evaluation that will illuminate the specific areas of difficulties, such as with functional cognition, emotional regulation, and any lingering physical limitations. This three day evaluation will target the specific areas of concern to give you a comprehensive report and expert opinion delineating the client’s level of physical, cognitive, and emotional functioning through use of standardized testing, and performance based testing. This comprehensive report usually exposes a host of unrecognized underlying issues typically relating to cognitive and emotional sequelae arising from the complexity of the individual’s mental health conditions and/or enduring physical limitations.

I imagine it is easy to tell that this is one of our favorite evaluations to undertake, due to the complexity and depth of information that is uncovered in the process.

Feel free to reach out to us, to determine if a specialized PsychoEmotional Cognitive FCE is a good match for your client.