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Workplace Disability Management by wuzhenguang

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									Workplace Disability
Management

     Steven R. Pruett, Ph.D, CRC
        SERNRA Conference
            May 16, 2005
Private Sector Rehabilitation

 RehabilitationCounselors have been
 employed in the private sector
 performing rehabilitation services for
 various insurance related settings since
 the 1970’s.
  –   Workers’ Compensation
  –   Managed Care
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.
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.
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)
“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)
“A proactive and systematic workplace
strategy to enhance organizational health
and to promote employee’s wellness by
providing preventive and remedial services
to minimize the economic and human costs
of disability.”
                (Lui, 2000, p.5)
   The first disability management programs
    appeared in late 1970’s and early 1980’s
    –   Burlington Industries
    –   AT&T
    –   3M Corporation
    –   Sears
   Goals: Humanitarian & Economic
Evolution of Disability
Management
   During the 80’s and 90’s 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
      –Rehabilitationcounselors
      –Occupational health nurses
      –Other occupational health professionals
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

   Habeck’s (1996) two-level concept of
    disability managers (DM & dm)
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)
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
Scope of Practice
 Chan     et al. (2001) continued
  –   major knowledge domains
        casemanagement techniques
        psychosocial intervention skills
        vocational aspects of disability
        managed care
        managed disability
        human resources
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
Scope of Practice (A sample CDMSC finding)
Disability Case             Disability                         Program
Management                  Prevention                         Development
Perform comprehensive       Implement disability               Analyze workplace
individual case analysis    prevention practices (i.e., risk   practices (e.g., benefit
& benefits assessment       mitigation procedures such as      design; policies and
using accepted practices    job analysis, job                  procedures; regulatory
in order to develop         accommodation, ergonomic           and compliance
appropriate interventions   evaluation, health & wellness      requirements; employee
                            initiatives, etc.) through         demographics; labor
                            training, education, and           relations) using a needs
                            collaboration in order to          assessment to establish
                            change organizational              baselines and design
                            behavior and integrate             effective interventions
                            prevention as an essential
                            component of organizational
                            culture
Scope of Practice (A sample CDMSC finding)
Disability Case           Disability                 Program
Management                Prevention                 Development
Review disability case    Develop a                  Present the business
management                comprehensive              rationale for a
intervention protocol     transitional work          comprehensive disability
using standards of        program through            management program
care to promote           consultation with all      using baseline data, best
quality care, recovery,   relevant stakeholders in   practices, evidence-based
and cost effectiveness    order to facilitate        research, and
                          optimal productivity and   benchmarks and cultural
                          value in the workplace     and environmental
                                                     factors to secure
                                                     stakeholder investment
                                                     and commitment.
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)
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 master’s 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.
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
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
DM Core competencies
   Very few academic programs provide a
    comprehensive DM curricula.
   Only a few CORE accredited master’s 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.
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)
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)
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)
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.
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.
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
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.
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.
Emerging practices in DM
(TWP)
   DM coordinator’s 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 worker’s 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.
Emerging practices in DM
(TWP)
   DM coordinator’s 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 worker’s 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 worker’s progress.
Emerging practices in DM
(TWP)
   Post TWP planning
    –   DM case management monitors worker’s
        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
        1990’s 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)
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.
Emerging practices in DM
   Integrated Disability Management (IDM)
    –   Combining all disability related programs
          Worker’s   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.
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)
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,Worker’s comp, disability
          Unauthorized time off, sick pay, FMLA

    –   Still a 24/7 model like IDM.
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 employee’s 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.
Emerging practices in DM
   AM implementation
    –   Specify when COBRA will be offered to employees on
        leave.
    –   Explain whether an employee’s 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)
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).
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)

								
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