Retaining Employment

Michele Clopper, MS, OTR/LSenior Disability Case Manager

This presentation will review the current resources including federal laws to offer a process to assist employers and employees with psychiatric disabilities to stay at work (SAW) or return to work (RTW).

Gain knowledge of key legislation and employer benefits to support employees with functional limitations/impairments related to their disability

Identify the necessary components to facilitate the reasonable accommodation process

Gain an understanding of the interface of job analysis and functional limitations

Articulate the importance of the interactive process

Reflect on the value of developing a SAW/RTW program for individuals with disabilities

Objectives

According to the Society for Human Resource Management (SHRM) many employers do not have a well defined return to work philosophy.

Depression costs employers in the United States over $44 billion annually

55% of this is from reduced productivity ($12.1 b) and absenteeism ($11.7b).

Psychosocial Issues and the Return to Work Process by Miller in 2004

$83.1 b annually with $51.5 b in workplace costs for depression alone

The economic burden of depression in the United States: How did it change between 1990- 2000? By Greenberg…

Costs

ADA- Americans with Disabilities Act signed July 26, 1990

ADAAA- “The Amendments Act”of 2008- lower the threshold to define disability

FMLA- Family Medical Leave Act- 1993 State disability laws

◦ May have a higher threshold than the ADA◦ Provision of state vocational rehabilitation

services

Key legislation

Equal Employment Opportunity Commission (EEOC)

Prohibits discrimination in all areas of employment including the application process, hiring, firing, advancement, compensation, training and all other terms of employment.

Individuals must be qualified- having the skills, education, and experience- to perform the job with or without reasonable accommodation

American with Disabilities Act (ADA)

Does not include a diagnosis but a general definition

“A person has a disability if he/she has a physical/mental impairment that substantially limits 1 or more major life activity, a record of such impairment, or is regarded as having such an impairment.

ADA

Anyone who engages in the use of illegal drugs is not protected by the ADA

An individual who is an alcoholic is protected under the ADA but they must be able to perform the essential job functions

Additionally, the individual can be terminated if alcohol adversely affects job performance

ADA & Addictive Disorders

Broadens the definition of disability Reading Thinking communicating Concentrating Communicating Working Breathing Major bodily functions Walking Bending…

Amendment Act of 2008

Employers with 50+ employees or more Employee must have worked a minimum of 1

year (1250 hours) to be eligible With medical certification, employee entitled to

job protection for up 12 weeks per rolling year for time out of work◦ Medical information can not exceed what is contained in

the DOL form Can be continuous or intermittent leave Employer cannot declare hardship Re-instatement to the same or equivalent

position

Family Medical Leave

20% of the US populations is affected in a any given year using DSM criteria

~ 44- 57.7 million individuals or 1 in 4 19% diagnosed with a mental disorder

alone 3% diagnosed with an addictive and mental

disorder 6% addictive disorders alone

Prevalence

Excessive absenteeism Poor work habits Reduced productivity Stress- complicating variable

Effect on the workplace

Refers collectively to all diagnosable mental disorders characterized by alterations in mood, thinking, behavior, or a combination

Psychiatric Impairments

Concentration Fatigue Memory Organization Multi-tasking Attendance

Functional Impairments Inability to screen

out environmental stimuli

Stress Interactive abilities Dealing with

change Responding to

feedback

Stigma & discrimination◦ Does not self identify

Invisible disability Disclose after a crisis Reputation

Additional Factors

Short term disability plans Long term disability plans Employee Assistance Plans (EAP)

Employer Benefits

STD is mandated in some states- NY, NJ,RI◦ Provides up to 26 weeks of income protection◦ Can be a salary %

LTD is usually offered by a vendor◦ Can have pre-existing condition clauses

Reasonable accommodation benefits◦ Flexible scheduling◦ Job coaches◦ Case management

Vocational rehabilitation services Retraining

Employer Disability Plans

Unum a LTD carrier 3 out of 10 employees between the ages of

25-65 will be out of work for three plus months at some time due to disability

Commonly outsourced benefit Offers a wide variety resources Referrals which address insurance and

geographic needs Wellness component Coaching

EAP

Wellness and Prevention Programs Benefits

Cultural Support

ADA & ADAAA- Civil Rights Laws

FML- job protection

STD, EAP, LTD- employer benefits

Need a way to coordinate and provide a program which coordinates/interfaces

Proactive employer who places value on SAW & RTW

Recap

Employee

NothingSAW

Accommodation

SAW (FML?)

EAPSAW

Accommodation

SAW FML

STDOut of

Work FML

RTWWith or Without Accommodation

EmployeeReasonable accommodation can occur with any scenario

Facilitates the accommodation process Identifies the employee’s need for support

for success at work Employer must acknowledge the request Act quickly Assign responsibility Conduct trainings

JAN

Interactive Process

Identify stakeholders Identify essential job duties Obtain information: functional abilities &

limitations Job analysis Maintain confidentiality

Responsible Party

Pivotal role in any SAW or RTW process Study –Journal of Occupational

Rehabilitation The supervisor is the key person Being a support Making demands Acknowledging every employee Setting the tone Collaboration & communication

Role of the supervisor/manager

Documentation of disability Be careful as only need the scope to

establish need and functional limitations and abilities

Implement reasonable accommodations

Medical documentation

Jobs have essential and marginal functions/duties Essential duties are the reason a job exists

◦ % of time performing this function◦ If remove this function the job would be significantly

altered◦ What are the consequences of not performing this duty?◦ Can other employees perform this duty, if necessary?

What is the impact?◦ What are the minimal qualifications? Including skills,

training, and experience

Accommodation(s) are given to support the individual in performing the essential duties of the job

Job Descriptions

Observe the physical requirements Force, distance, dimension of tools &

materials necessary to operate the equipment or perform the activities

The frequency to which the activities need to be performed

Number of workers that perform the activities

Amount of time spent on each essential function

Degree of skill, education, specialization Physiological considerations

Job analysis

Psychological considerations Environmental considerations Cognitive considerations

Analysis continued:

Distractions (number of alternating tasks) Interpersonal demands Attention to detail Accuracy Stress level Complexity Critical reasoning Risk (effect on end result)

Cognitive & Psychological Considerations

Employee Employer- Supervisor, Human Resources,

Benefits

Provider Union Council Others

Stakeholders

Triggered by a medical condition

Step 1 Questions requiring answers: What is the individual’s functional capacity? What are the functional limitations/

impairments What are the medical

recommendations/restrictions?

SAW /RTW Process

Step 2 What are the essential duties of the

position?◦ Job Analysis

Comparing the essential duties with the functional abilities and impairments of the individual while incorporating the medical restrictions

SAW/RTW Process

What response can the employer make to keep the employee at work or to facilitate their successful return?

Journal of Occupational Medicine-

SAW/RTW Process

Flexible schedules Office/workstation location Lighting Job restructuring Head phones To do lists Job coaches Additional time to learn new responsibilities Tape recording

Examples of Reasonable Accommodation

Prevention Model from Michael Melnick, OTR/L, President of Prevention Plus, Inc.

Accountability Commitment Communication Consistency Flexibility Inclusion Respect Fun

Model

Lab employee◦ Research◦ Animal care

Office worker Accountant/Customer Service

Representative Faculty Assistant Librarian

Cases

Americans with Disabilities Act. Retrieved from: http://www.ada.gov/

Amendments Act. Retrieved from: http://www.ada.gov/ American College of Occupational and Environmental Medicine.

(2006). Preventing Needless Work Disability by Helping People Stay Employed. Retrieved from: http://www.acoem.org/guidelines.aspx?id=566.

American Occupational Therapy Association. Self Study. American Occupational Therapy Association. Practice Framework Boston University Center for Psychiatric Rehabilitation.

http://www.bu.edu/cpr/ Equal Employment Opportunity Commission. http://www.eeoc.gov/ Family Medical Leave Act. http://www.dol.gov/whd/fmla/ Gray, K. (2005). Evidence-Based Employment Services for Persons

with Serious Mental Health Illness. AOTA Mental Health Special Interest Section Quarterly.

References & Resources

Greenberg, P.E., Kessler, R.C., Birnbaum, H.G., Leong, S.A., et al. (2003). The economic burden of depression in the United States: how did it change between 1990-2000? Journal of Clinical Psychiatry. 64, 1465-1475. doi: 10.4088/JCP.v64n1211.

Holmgren, K. Dahlin Ivanoff, S. (2006). Supervisors views on employer responsibility in the return to work process. A focus group study. Retrieved from: http://www.springerlink.com/content/h858365q4t37838u/fulltext.html

Job Accommodation Network. http://askjan.org/ Miller, D. (2004). Psychosocial Issues and the Return to Work Process. Retrieved from: http://aota.org/Pubs/OTP/1997-2007/Features/2004/f-020904.aspx

US Department of Labor. http://www.dol.gov/

References and Resources