Disability Management Across Three Domains

The heart of disability management continues to be providing services to ill and injured employees as well as those with disabilities. Disability management, however, does not end there. In addition to the traditional role of the disability case manager, who works one-on-one with ill/injured employees and those with disabilities, there are new knowledge areas and skills sets required of professionals today.

Increasingly, disability management specialists are involved in tasks and responsibilities such as prevention, workplace intervention, and program design and evaluation. The catalyst behind this evolution has been employer demands for integrated programs to improve employee health and productivity. The result is the practice of disability management across three separate areas of responsibility, or domains, as identified by the most recent Role and Function study sponsored by the Certification of Disability Management Specialist Commission (CDMSC).

The three domains identified by the study of current practice in the field are:

- Disability Case Management, in which the practitioner works on-on-one with ill and injured employees

- Disability Prevention and Workplace Intervention, which involves a more proactive approach to reduce workers' compensation claims and disability cases through early intervention and remediation.

- Program Development, Management, and Evaluation, which requires disability management specialists to use their expertise as part of broader absence management and health and productivity initiatives

For many disability management practitioners, the first two domains are the most familiar and the areas in which they have the most experience. The third domain may be the newest and require additional skills and experience. Nonetheless, disability management today is defined by all three domains—from the traditional return-to-work (RTW) approach to collaboration with other professionals to design and implement health and productivity programs.

Although these three domains are distinct, they have an important commonality. Each relates directly to the purpose of disability management, which is to assist ill/injured employees and those with disabilities to resume working and to minimize the impact on employers. As the CDMSC, the only nationally accredited organization that certifies disability managers, states: “Disability management specialists analyze, prevent and mitigate the human and economic impact of disability for employees and employers.” 1

Domain 1: The One-on-One Approach

One way to look at the evolution of disability management is to see how one domain builds upon another. From this perspective, the foundation is Disability Case Management, which is identified as Domain I. Often this involves taking a RTW approach with ill/injured employees, with job modifications or a temporary assignment elsewhere in the company that will allow workers to become productive again, even though they have not recovered to the point of resuming their regular job duties and responsibilities.

This aspect of disability management requires practitioners to be aware of the demands of an employee's job—physical as well as cognitive—in order to determine whether the individual is capable of performing these duties. For example, an employee may be able to perform her regular job functions, but for fewer hours each day. Another worker may be unable to stand for prolonged periods of time or to lift a certain amount of weight as required by his regular duties, but can perform other necessary duties associated with a different job. In these situations, the RTW placement matches the employee's abilities with meaningful work that must get done.

Domain II: Preventing Injuries and Reducing Absences

Activities associated with Domain I respond to an injury, illness, or disability. Once the incident has occurred, whether occupational or non-occupational, the disability management specialist develops a plan to help bring the person back to work as soon as medically feasible.

Domain II of Disability Prevention and Workplace Intervention is the next step, focusing on how to prevent illness, injury, disability, or other incidents that result in unplanned absences. Activities within Domain II often involve activities such as job analyses, job accommodations, ergonomic evaluations, and safety. The disability management practitioner may also be engaged in evaluating outcome data related to lost time and the occurrence of employee absences.

In Domain II, disability management specialists are looking at the aggregate of occurrences of illnesses, injuries, and disabilities. Knowing, for example, that a particular job type has a higher than average incidence of a certain type of injury, the disability management specialist can contribute to prevention strategies that may involve a change in workstations, more frequent breaks for employees, and/or increased education about health and safety for workers and supervisors.

Domain III: The Bigger Picture

With their expertise dealing one-on-one with employees and their knowledge of the causes of workplace absences, disability management practitioners can contribute to the design, implementation, and evaluation of health and productivity initiatives. Admittedly, this is a new area for many professionals in the field, but it is a vitally important one. Here disability management specialists collaborate with others, both inside and outside the employer, to develop, measure, and modify workplace programs.

Specific tasks within Domain III may include analyzing workplace practices, presenting the business rationale for various programs and initiatives to top management, developing and managing disability management programs collaboratively, and championing individual and organizational behavioral changes. Other tasks may be procuring internal and external services, managing service providers using performance standards, facilitating the exchange of data and metrics, and conducting ongoing program evaluations using qualitative and quantitative methods.

Undoubtedly there are professionals who would consider themselves primarily disability case managers, practicing almost exclusively in Domain I, as well as those who have some involvement in prevention but not in more advanced practice areas such as program design and evaluation. To rise to the challenge of Domain III may require additional education, as well as the purposeful pursuit of practical experience. Domain III will also require disability management specialists to become more involved in evidencebased practice, drawing upon the latest research.

Rather than let the challenge become an impediment to practice, disability management practitioners should recognize that the duties and responsibilities associated with Domain III are a natural progression from the knowledge and skill sets of the first two domains. The heart of disability management practice remains serving the needs of employees. The response, however, takes many forms across a continuum, from one domain to the next, building upon experience and tapping into the disability management specialist's expertise.