Using the telephone to improve the quality of return-to-work programs for employees with psychiatric problems may be a good way to help the employers you serve cut their group disability claims costs.

Employers rank psychiatric conditions as the disabilities that concern them most.

Since 1985 the incidence of psychiatric disabilities has grown more than 3 times as fast as the incidence of medical and surgical disabilities. Depression alone causes an estimated 200 million lost workdays and $44 billion in lost productivity in the United States each year.

Although companies have come up with many return-to-work programs for group disability claimants with physical disabilities, the same is not true for claimants with psychiatric conditions or for claimants with physical conditions with a psychiatric component.

Typically, a psychiatric return-to-work program consists of routine sessions with a psychotherapist and medication management by a psychiatrist. Often the primary objective of this treatment is focused on things other than returning the employee to the workplace.

Studies have shown that bringing psychiatrically disabled employees together in a group setting that focuses on improving work-related coping skills can expedite their return to work. Groups are more efficient vehicles for delivering skills training, and they also offer a level of peer support which is not available with individual counseling.

However, the group approach has limitations. Group programs can be expensive to develop and maintain. They depend upon a critical mass of enrollees to survive. In addition to requiring a large, concentrated cluster of disabled employees, a successful group program needs highly trained facilitators. Those facilitators may be in short supply in some regions of the county.

One new approach to improving return-to-work preparation programs is to use teleconferencing technology to bring workers with disabilities into a virtual classroom in which participants learn and practice a set of coping skills that prepare them for timely workplace re-entry. These skills are designed to address the claimants’ psychological stress.

Because teleconferencing is relatively inexpensive and makes efficient use of a counselor’s time, it is a promising vehicle for delivering group return-to-work counseling.

A virtual classroom can reach workers in remote locations and workers who have a hard time getting out of their homes because of mobility problems or other obstacles.

Teleconferencing also might be a sensible way to interact with severely disabled employees who may ultimately end up having to telecommute, or at least take desk jobs that involve heavy use of telephones.

Moreover, workers are still more likely to have telephone access than they are to have the kinds of computers and high-speed Internet connections that could allow for high-quality videoconferencing.

Finally, the teleconferencing approach can offer anonymity to program participants. By eliminating the distraction of self-consciousness, group members can more freely disclose personal challenges and make better use of the program content.

The implementation of a virtual return-to-work program can be a fairly straightforward process. A disability care manager or claims adjuster selects candidates for tele-classes by reviewing a set of selection criteria.

For example, is the worker able to interact with peers? Does a worker have issues that may impede the timeliness of returning to work? At least one study has found that up to 43% of workers on psychiatric disability have documented performance problems that predate the disability. While the relationship of prior performance to disability may be unclear, it is clear that these workers may benefit from a variety of skills training efforts, particularly those that relate to workplace performance.

Essentially, the best candidates for such a program are individuals who are able to interact with others in a classroom-discussion format. Therefore, workers with extremely severe psychiatric conditions are not appropriate for the program until their symptoms have stabilized.

An effective return-to-work program for a psychiatric population, or a physically disabled population with behavioral health issues, needs to include some essential content areas.

The areas include learning effective communication and problem-solving skills, relaxation training to manage anxiety, lifestyle management in all areas of the worker’s life, correcting faulty thinking patterns, as well as a plethora of other educational topics. These topics are covered in a combination of lecture and discussion formats and at the end of each session, which lasts approximately 1.5 hours, each participant will have a homework assignment based upon the topic of the day. A group consisting of about 6 sessions (2 sessions per week) gives participants ample time to practice the skills they learn in the virtual classroom. At the beginning of each group the homework from the previous session is reviewed and group members can hold each other accountable for completing assignments.

Assessing the effectiveness of a virtual return-to-work program can be quite straightforward. The key question is, “What is the impact on the length of disability?” In addition to examining claims costs, an effective program is expected to improve work performance and satisfaction upon successful re-entry into the workplace. These workers now have an enriched coping skill set which assists them not only at work but also throughout their lives. Further, a host of other metrics can be examined from the employer side of the equation such as absenteeism, productivity and procedural compliance.

Early, informal studies of a vendor providing a return-to-work program in a teleconference format indicate that this program shows considerable promise, not only for employees with psychiatric disabilities but also for those individuals with non-resolving physical complaints for which underlying psychological factors are likely to exist. In addition to a more timely return to work, program participants reported that they actually preferred the telephonic venue over a face-to-face format.

Teleconference-based return-to-work programs can use a variety of rate structures, and those structures leave ample opportunity for program vendors to make arrangements for broker compensation. Setting up the programs also can help benefits advisors show clients that they are adding value to group disability programs.

Stephen E. Dannenbaum, Ph.D., is national director for clinical programs at Managed Health Network, Point Richmond, Calif., a mental and behavioral health company. He can be reached at stephen.dannenbaum@mhn.com. Ian A. Shaffer, MD, MMM, is chief medical officer at MHN. He can be reached at ian.shaffer@mhn.com.

The technology brings workers with disabilities into a virtual classroom in which they learn and practice a set of coping skills that prepare them for timely workplace re-entry