Workplace Disability Management

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Workplace Disability Management. Steven R. Pruett, Ph.D, CRC SERNRA Conference May 16, 2005. Private Sector Rehabilitation. Rehabilitation Counselors have been employed in the private sector performing rehabilitation services for various insurance related settings since the 1970’s. - PowerPoint PPT Presentation

Transcript of Workplace Disability Management

  • Workplace Disability ManagementSteven R. Pruett, Ph.D, CRCSERNRA ConferenceMay 16, 2005

  • Private Sector RehabilitationRehabilitation Counselors have been employed in the private sector performing rehabilitation services for various insurance related settings since the 1970s.Workers CompensationManaged Care

  • Private Insurance Rehabilitation Economic RationaleFor 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 ManagementThe 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 ManagementDisability 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 employees 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 1970s and early 1980s Burlington IndustriesAT&T 3M CorporationSearsGoals: Humanitarian & Economic

  • Evolution of Disability ManagementDuring 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 professionsRehabilitation counselorsOccupational health nursesOther occupational health professionals

  • Scope of Practice in Disability ManagementCommission on Disability Management Specialist Certification (CDMSC)1991 Essential work role & function categoriesCase management & human disabilitiesjob placement & vocational assessmentrehabilitation services & caredisability legislation & forensic rehabilitationHabecks (1996) two-level concept of disability managers (DM & dm)

  • Scope of PracticeDM (Level I)System, administrative orientedPractice & knowledge domains are predominately managerial and (level II)Service orientedIn 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 PracticeChan et al. (2001)sole focus on practice & knowledge domains of level II disability managersPractice domainsManagerial/Consultative Vocational Counseling, Assessment, and Job Placement/Job Development Disability Case Management Early Return-to-Work Intervention

  • Scope of PracticeChan et al. (2001) continuedmajor knowledge domainscase management techniquespsychosocial intervention skillsvocational aspects of disabilitymanaged caremanaged disabilityhuman resources

  • Scope of PracticeNew study (2003) by CDMSC12 experts in the field of DM3 day exploratory fact-finding meeting on current status of DMEducators, employers, practitioners & adminstratorsconsensus based modelCurrent practice based on 3 primary domainsDisability case managementDisability prevention & workplace interventionProgram development, management & evaluation

  • Scope of Practice (A sample CDMSC finding)

    Disability Case Management





    Perform comprehensive individual case analysis & benefits assessment using accepted practices in order to develop appropriate interventions

    Implement disability prevention practices (i.e., risk mitigation procedures such as job analysis, job accommodation, ergonomic evaluation, health & wellness initiatives, etc.) through training, education, and collaboration in order to change organizational behavior and integrate prevention as an essential component of organizational culture

    Analyze workplace practices (e.g., benefit design; policies and procedures; regulatory and compliance requirements; employee demographics; labor relations) using a needs assessment to establish baselines and design effective interventions

  • Scope of Practice (A sample CDMSC finding)

    Disability Case Management





    Review disability case management intervention protocol using standards of care to promote quality care, recovery, and cost effectiveness

    Develop a comprehensive transitional work program through consultation with all relevant stakeholders in order to facilitate optimal productivity and value in the workplace

    Present the business rationale for a comprehensive disability management program using baseline data, best practices, evidence-based research, and benchmarks and cultural and environmental factors to secure stakeholder investment and commitment.

  • DM Core CompetenciesCase 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 competenciesCase managementHaw (1996) found that only 4% of nursing programs provide coursework in case managementChan, 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.

  • DM Core competenciesHabeck 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 employersRCs in DM expressed frustration with inadequate pre-service training to meet work demands

  • DM Core competenciesShrey (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 competenciesVery few academic programs provide a comprehensive DM curricula.Only a few CORE accredited masters degree programs offer an emphasis in DMGenerally 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 competenciesCDMSC requirements are changing due to changes in the profession of DMEmphases 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 DMChanging DemographicsHursch (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 DMChanging 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 heterogeneousdiffering in health, financial and career needsLonger 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 DMChanging Demographics Recent census data indicate African Americans, Hispanic Americans and Asian Americans comprise approximately 33% of the US population.By 2010 it is estimated tha