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Michele Clopper, MS, OTR/L Senior 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 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… 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 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 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. 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 Broadens the definition of disability Reading Thinking communicating Concentrating Communicating Working Breathing Major bodily functions Walking Bending… 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 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 Excessive absenteeism Poor work habits Reduced productivity Stress- complicating variable Refers collectively to all diagnosable mental disorders characterized by alterations in mood, thinking, behavior, or a combination Concentration Fatigue Memory Organization Multi-tasking Attendance 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 Short term disability plans Long term disability plans Employee Assistance Plans (EAP) 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 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 Wellness and Prevention Programs Benefits 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 Employee Nothing SAW Accommodation SAW (FML?) EAP SAW Accommodation SAW FML STD Out of Work FML RTW With or Without Accommodation 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 Identify stakeholders Identify essential job duties Obtain information: functional abilities & limitations Job analysis Maintain confidentiality 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 Documentation of disability Be careful as only need the scope to establish need and functional limitations and abilities Implement reasonable accommodations 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 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 Psychological considerations Environmental considerations Cognitive considerations Distractions (number of alternating tasks) Interpersonal demands Attention to detail Accuracy Stress level Complexity Critical reasoning Risk (effect on end result) Employee Employer- Supervisor, Human Resources, Benefits Provider Union Council Others 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? 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 What response can the employer make to keep the employee at work or to facilitate their successful return? Journal of Occupational Medicine- Flexible schedules Office/workstation location Lighting Job restructuring Head phones To do lists Job coaches Additional time to learn new responsibilities Tape recording Prevention Model from Michael Melnick, OTR/L, President of Prevention Plus, Inc. Accountability Commitment Communication Consistency Flexibility Inclusion Respect Fun Lab employee ◦ Research ◦ Animal care Office worker Accountant/Customer Service Representative Faculty Assistant Librarian 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. 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/19972007/Features/2004/f-020904.aspx US Department of Labor. http://www.dol.gov/