Workplace Disability Management

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Workplace Disability Management

• Steven R. Pruett, Ph.D, CRC
• SERNRA Conference
• May 16, 2005

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Private Sector Rehabilitation

• Rehabilitation Counselors have been employed in
  the private sector performing rehabilitation
  services for various insurance related settings
  since the 1970s.
• Workers Compensation
• Managed Care

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Private Insurance Rehabilitation Economic
Rationale

• For Vocational Rehabilitation services
• Return of the claimant to gainful employment
  thereby reducing payment of lost wages.
• For medical case management
• Facilitate the treatment and recovery of the
  claimant for a quick and safe return to work.
• Reducing costs by curtailing unnecessary or
  unrelated medical treatment and reducing
  compensation for lost wages.

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Disability Management

• The rising cost of health care and disability at
  the work place in conjunction with a competitive
  business economy provided the impetus for cost
  containment strategies with large companies in
  the United States.

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Definitions of Disability Management

• Disability management is a workplace prevention
  and remediation strategy that seeks to prevent
  disability from occurring or, lacking that, to
  intervene early following the onset of
  disability, using coordinated, cost-conscious,
  and quality rehabilitation service that reflects
  and organizational commitment to continued
  employment for those experiencing functional work
  limitations.
• (Akabas, Gates Galvin, 1992, p. 2)

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• Disability Management means using services,
  people and materials to (a) minimize the impact
  and cost of disability to employers and
  employees and (b) encourage return to work for
  employees with disabilities.
• (Schwartz, Watson, Galvin Lipoff, 1989, p.1)

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• A proactive and systematic workplace strategy to
  enhance organizational health and to promote
  employees wellness by providing preventive and
  remedial services to minimize the economic and
  human costs of disability.
• (Lui, 2000, p.5)

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• The first disability management programs appeared
  in late 1970s and early 1980s
• Burlington Industries
• ATT
• 3M Corporation
• Sears
• Goals Humanitarian Economic

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Evolution of Disability Management

• During the 80s and 90s a growing number of
  employers were implementing DM programs in the
  workplace
• (Breslin Olsheski, 1996 Habeck, Leahy, Hunt,
  Chan, Welch, 1991 Shrey, 1995)
• DM programs began hiring many different rehab
  professions
• Rehabilitation counselors
• Occupational health nurses
• Other occupational health professionals

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Scope of Practice in Disability Management

• Commission on Disability Management Specialist
  Certification (CDMSC)
• 1991 Essential work role function categories
• Case management human disabilities
• job placement vocational assessment
• rehabilitation services care
• disability legislation forensic rehabilitation
• Habecks (1996) two-level concept of disability
  managers (DM dm)

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Scope of Practice

• DM (Level I)
• System, administrative oriented
• Practice knowledge domains are predominately
  managerial and fiscal.
• dm (level II)
• Service oriented
• In addition to those cited in the 1991study
  practice knowledge domains include disability
  management concepts, principles of insurance,
  benefit plans, ergonomics, managed care concepts,
  and business practices and operations.
• Currier, Chan, Berven, Habeck Taylor (2001)

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Scope of Practice

• Chan et al. (2001)
• sole focus on practice knowledge domains of
  level II disability managers
• Practice domains
• Managerial/Consultative
• Vocational Counseling, Assessment, and Job
  Placement/Job Development
• Disability Case Management
• Early Return-to-Work Intervention

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Scope of Practice

• Chan et al. (2001) continued
• major knowledge domains
• case management techniques
• psychosocial intervention skills
• vocational aspects of disability
• managed care
• managed disability
• human resources

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Scope of Practice

• New study (2003) by CDMSC
• 12 experts in the field of DM
• 3 day exploratory fact-finding meeting on current
  status of DM
• Educators, employers, practitioners
  adminstrators
• consensus based model
• Current practice based on 3 primary domains
• Disability case management
• Disability prevention workplace intervention
• Program development, management evaluation

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Scope of Practice (A sample CDMSC finding)
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Scope of Practice (A sample CDMSC finding)
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DM Core Competencies

• Case management within DM is an essential element
  for dealing with a workplace disability (Akabas
  et al., 1992).
• In general, rehab nurses and occupational health
  nurses have adequate medical knowledge skills,
  but may lack understanding of the interaction
  between disability and work.
• VR counselors rehab psychologists generally
  have an adequate understanding of disability and
  work, but are likely to have limited knowledge
  specific to medical problems (Rosenthal
  Olsheski, 1999)

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DM Core competencies

• Case management
• Haw (1996) found that only 4 of nursing programs
  provide coursework in case management
• Chan, McMahom, Shaw, Taylor, Wood (1997) found
  only 20 of masters level RC programs had one or
  more course in case management.
• CORE requires some case management courses, but
  rehab case management is related, but is not
  equivalent to disability case management.

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DM Core competencies

• Habeck et al. (1994) found some evidence for a
  natural fit between the background skills of
  RCs and DM work practice.
• Employers found RC had necessary but insufficient
  knowledge skills to work effectively with DM
  programs and employers
• RCs in DM expressed frustration with inadequate
  pre-service training to meet work demands

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DM Core competencies

• Shrey (1992) noted traditional RC paradigms
  overemphasize characteristics of injured worker
  while ignoring significance of the environmental
  factors.
• Traditional rehab programs have focused too much
  on reactive, provider-based clinical models.
• RCs in DM must be able to develop active
  partnerships with employers to enhance employment
  of injured workers while advocating for
  interventions in the workplace.
• RCs must be able to conduct ergonomic and
  disability prevention programs, including
  workplace safety programs EAPs

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DM Core competencies

• Very few academic programs provide a
  comprehensive DM curricula.
• Only a few CORE accredited masters degree
  programs offer an emphasis in DM
• Generally CORE programs train students to provide
  counseling and support to individuals with
  disabilities using private non-profit and public
  VR systems as models.
• Concepts necessary to DM have not been emphasized
  in these models.

22
DM Core competencies

• CDMSC requirements are changing due to changes in
  the profession of DM
• Emphases on prevention has made job analysis,
  reasonable accommodation and ergonomics into the
  mainstream of practice.
• Early intervention has brought greater focus on
  medical management and requires knowledge of high
  quality medical care with an occupational
  perspective.
• Additional changes will most likely be in work
  organization and management structure
• (Caulkins, Lui, Wood, 2000)

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Emerging Practices in DM

• Changing Demographics
• Hursch (2003) projects
• Number of older workers will increase
  substantially over next couple of decades. 18.4
  million workers over 55 in 2000 will reach 31.9
  million by 2015 (US GAO, 2001).
• Proportion of older workers will increase from
  13 to 20 by 2020 (Purcell, 2000). Fewer
  younger workers entering workforce to replace
  positions vacated by retired workers.
• In 2000 30 of the older population was in the
  work force. By 2015 this will increase to 37.
  (Purcell, 2000)

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Emerging practices in DM

• Changing Demographics
• Older workers are needing health insurance and
  additional finances to support desired
  lifestyles.
• Holistic approaches needed for work and life
  planning.
• Older workers are heterogeneous
• differing in health, financial and career needs
• Longer healing times may be needed, but many
  older workers are loyal, skilled and careful
  workers, who have fewer work-related injuries.
  They are also less likely to have family
  problems. (Douglas, 2000)

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Emerging practices in DM

• Changing Demographics
• Recent census data indicate African Americans,
  Hispanic Americans and Asian Americans comprise
  approximately 33 of the US population.
• By 2010 it is estimated that European Americans
  will be a distinct numerical minority.
• Workplace will be even more diverse requiring
  greater cultural sensitivity.

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Emerging practices in DM

• Outcome orientation
• Accountability and accuracy driven by business
  competition and rising disability costs.
• Many companies lack tools for effective outcome
  measurement.
• Employer Measures of Productivity, Absence and
  Quality (EMPAQ) (in development by WBGH)
• Industry-wide, consensus-based standardized
  health related lost-time measure
• Comparative predicative analyses
• Establishment of meaningful goals, measurement
  criteria, and evaluation of outcomes that cover
  the overall benefits of DM.

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Emerging practices in DM

• Prevention
• DMs work closely with occupational health teams
  ergonomics, risk management, EAPs
• Optimization of communication across corporate
  silos
• understanding of differences in expertise
• Job Analysis, job accommodation, job modification
  ergonomics
• Assistive Technology
• EAPs

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Emerging practices in DM

• Response how to avoid employee absences.
• Too frequently a referral for VR does not occur
  until MMI is reached and claimant cannot RTW
• Catastrophic injuries ? immediate referral
• injury that has potential to limit RTW should
  result in a expedited referral.
• In-house monitoring of claims can promote this
  type of referral.

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Emerging practices in DM

• Transitional Work Programs (TWP)
• involve a combination of purposeful and
  productive job duties, tasks, functions
  therapeutic activities for a worker with
  functional restrictions.

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Emerging practices in DM (TWP)

• DM coordinators involvement
• initiates early contact with injured worker to
  explain program, discuss type of work, review
  benefits, answer questions
• Analyze available job duties physical demands
  consistent with workers residual abilities
• Arrange for an objective worker functional eval
• Reviews TWP program with medical staff or primary
  physician worker, including transitional work
  assignments, clinical supervision, time frames,
  safety precautions, and expectations for RTW.

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Emerging practices in DM (TWP)

• DM coordinators involvement
• Collaborates with treating MD in discussing with
  worker how the TWP involves safe work activities
  and minimizes potential for reinjury
• Discusses modified work duties with work
  supervisor
• Monitors workers progress with clinical
  supervisor during the structured period of
  transitional work keeps medical staff informed
  of progress or changes
• Arranges realistic accommodations/assistive aides
  or modified work if needed.
• Updates stakeholders on the workers progress.

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Emerging practices in DM (TWP)

• Post TWP planning
• DM case management monitors workers performance,
  productivity adjustment following a successful
  RTW.
• If needs are not attended to poor productivity,
  increased absences or job loss can result.
• Medical/disability management programs in the
  1990s returned many workers to work, but 60 of
  those that RTW had one or more injury related
  absences that often resulted in job loss.
• (Butler, Johnson, Baldwin, 1995)

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Emerging practices in DM

• Facilitating Adjustment and Coping
• Psychosocial interventions
• Reduction of stigma for psychiatric disabilities
• Integration of psychosocial interventions
  requires policies procedures that define
  relationship between VR and and mental health
• EAPs have traditionally not been involved in the
  RTW process and may be unfamiliar with vocational
  objectives, operations services in the DM
  program.

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Emerging practices in DM

• Integrated Disability Management (IDM)
• Combining all disability related programs
• Workers comp, group health, short long-term
  disability
• Motivated by pursuit of efficiency at all levels
  this is an attempt to reduce duplication of
  services to reduce benefit costs.
• 24/7 model Regardless of etiology or time of
  occurrence of the health problem, health care and
  RTW services are provided in a consistent and
  coordinated manner.

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Emerging practices in DM

• IDM
• Definitions, interpretations, applications are
  not universal across employers.
• Elements that are consistently rated as the most
  effective in controlling disability costs
• Common case management
• Aggressive RTW policies or practices
• Responsible, internal, and active management of
  disability issues and identifiable, simple and
  coordinated points for intake claims reporting
• (Watson Wyatt Worldwide and WBGH, 1999/2000)

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Emerging practices in DM

• Absence Management (AM)
• Many employers have moved beyond
  integration-of-benefits to overall productivity.
• Combining programs that involve work
  interruptions
• Medical, Workers comp, disability
• Unauthorized time off, sick pay, FMLA
• Still a 24/7 model like IDM.

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Emerging practices in DM

• AM implementation
• Formulate a leave of absence policy delineating
  length of absence by category (e.g., severe
  health, pregnancy, adoption, death in family,
  military)
• Create a same-job protection policy for
  work-related and non-work-related disabilities
• Generate specifications on how an employees
  salary will be replaced while he or she is on
  leave.
• Ascertain how long an employee on leave will be
  treated as an active employee.
• Explain what happens if an employee discontinues
  health insurance or other benefits while on
  leave.

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Emerging practices in DM

• AM implementation
• Specify when COBRA will be offered to employees
  on leave.
• Explain whether an employees work will be
  reassigned while s/he is on leave
• Adopt a leave policy, consistent with workers
  comp law which encourages employees to RTW
• Make revisions to employee handbook that include
  general information about employee rights and
  responsibilities under FMLA/WC and similar laws
  and leave policies.
• Ritter (2000)

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Emerging practices in DM

• Presenteeism
• Shift in focus from absence of employees, to
  present, but lacking productivity due to chronic
  illness, distraction from family care needs,
  personal problems, etc (Stevens, 2003).
• Chronic health problems such as diabetes, asthma,
  depression, pain disorders allergies can have a
  major presenteeism impact.
• Heath Productivity Questionnaire (Harvard Medical
  School WHO)
• Work Limitation Questionnaire (Health Institute,
  Division of Clinical Research at Tufts-New
  England Medical Center).

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Evidence-based DM practice

• Entails
• Integrating DM practice expertise with best
  available observable evidence regarding a
  specific disability obtained by systematic
  research.
• Case manager can then understand the accuracy of
  vocational functional capacity, diagnostic
  evaluations and base recommendations for
  prevention or intervention strategies on
  empirical information reliable research
  findings.
• (Rosenthal, Hursch, Lui, Zimmerman Pruett,
  2005)