Disability Management and Rehabilitation Counseling: Present and Future Opportunities.

The emerging importance of disability management within vocational rehabilitation and rehabilitation counseling has been recognized for over a decade (Bruyere & Shrey, 1991; Crystal, 1987; Gilbride, Stensrude, & Johnson, 1994; Habeck, Kress, Scully, & Kirchner, 1994; Kilbury, Benshoff, & Riggar, 1990; Matkin, 1987; McMahon & Matkin, 1983; Olsheski, 1996; Riggar, Crimando, Bordieri & Phillips, 1988; Rosenthal, 1997; Shrey & Mitchell, 1986). However, the degree of progress made in convincing employers that they are the most appropriate professionals to help manage disability at the work place remains debatable and difficult to quantify. The following discussion highlights some of the concerns that affect the potential employment of rehabilitation counseling professionals in employer-based disability management programs.

Concern one: The nature and quality of disability management programs among employers are highly variable. Consequently, employers may not have consistent conceptualizations of the responsibilities and job requirements of a disability management specialist.

A primary concern within rehabilitation counseling has been an increasing emphasis on meeting employer needs in preventing and managing employees' disabilities. However, the connection between the rehabilitation counselor's skills and the disability management needs of the employer has not been made as directly or expeditiously as anticipated.

For a variety of reasons, employers have been slow to recognize the value rehabilitation counselors can add to the disability management process. One factor may be that disability management practices among employers vary in terms of quality, philosophical orientation, scope, support services, return to work methods, etc. (Habeck, Leahy, Hunt, Chan, & Welch, 1991). Due to the diversity of disability management programs in the employer community, it is difficult to find consensus regarding the essential job functions of the disability management professional.

It may also be that the medical model of disability continues to influence employers' attitudes and responses to disability-related issues. Operating from a medical orientation, employers often view disability primarily as a medical problem that should be treated by medical professionals, e.g., nurses, physical therapists, physicians (Habeck, et al., 1991). Employers may also operate on the assumption that rehabilitation counselors lack expertise in medical issues and medical case management. Thus, it is more common to find occupational health nurses employed at the work setting than rehabilitation counselors (Olsheski & Breslin, 1996).

As a preliminary method of examining these issues, a survey was conducted using a convenience sample of 60 large Midwestern businesses (more than 100 employers). Employers participating in the survey represented the following: manufacturing (n=20); heavy manufacturing (n=15); food production (n=7); transportation services (n=5); banking and financial (n=3); and others (n=2). Eight of the 60 employers refused to provide any information.

Employers were requested to provide their companies' job descriptions of individuals who provide in-house disability management services. Fifty-two percent (n=27) of the employers stated that they had no such job title and that the responsibilities for managing disability were absorbed by employees in human resources/personnel and/or benefits/workers' compensation departments. Forty-six percent (n=24) of the job descriptions emphasized medical management; 15% (n=8) of the responses emphasized understanding the complexity of the interactions of disability and work. Only one respondent (2%) mentioned organizational consultation, program development, systems analysis, or mediation.

The results of this limited survey seem to support the observation that disability management functions exist in various departments within businesses. This may be a source of variability that contributes to the lack of agreement concerning the role of the disability management specialist and the most appropriate professional to best perform this role. Survey results revealed that 10% (n=5) of the disability management programs stand alone; 50% (n=26) are housed in benefits (workers' compensation) departments; and 35% percent (n=18) are housed in personnel/human resources departments. Six percent (n=3) of the programs are housed within safety and/or risk management departments. Job descriptions from the stand alone programs and from safety/risk management departments emphasized an understanding of potential liabilities, organizational structure, and ergonomics, while human resources and benefits areas tended to emphasize health promotion, employee assistance programs (EAP's), and return-to-work case management.

To explore employers' awareness of the rehabilitation professionals' emerging roles within disability management, employers were provided with the following description regarding responsibilities associated with disability management positions: To develop and coordinate cost-effective strategies within the workplace that are targeted to prevent disability and/or workplace injury from occurring. This includes EAPS, safety and risk management programs, wellness initiatives, and ergonomics or, in the case of disability and/or injury, to provide early intervention using effective case management and return-to-work strategies. Employers were then asked: What type of professional do you feel would best be able to provide these described services?

Of the 52 employers responding to the survey, 42% (n=22) indicated an occupational health nurse or rehabilitation nurse; 27% (n=14) indicated human resources personnel; 15% (n=8) indicated a physical therapist; and 12% (n=6) indicated a rehabilitation counselor or vocational rehabilitation professional. Two of the respondents answered that they did not know. These results tend to confirm the observation that many employers primarily view disability as a medical problem that is best addressed by medical personnel. Furthermore, almost half (n=24) of the employers surveyed reported some discomfort in choosing one type of professional to address disability prevention as well as react to the disability (i.e., manage return-to-work programs). This attitude reflects the fragmented approach that characterizes many disability management programs. Rehabilitation counselors can demonstrate that they have competencies that are applicable to both preventive and remedial interventions, and that they can help the organization integrate these disability management functions.

Occupational health nurses (OHNs), rehabilitation nurses, physical therapists (PTs), occupational therapists (OTs), and human resource personnel within businesses appear to have the inside track when employers respond to disability management issues. There are presently more than 5,000 certified occupational health nurses within the United States. Martin (1995) stated that OHNs are the most visible and approachable health-related professionals within the disability management arena. Also, physical therapists are considered to be key personnel in work site rehabilitation and transitional work return programs (Olsheski & Breslin, 1996). The rehabilitation counseling profession must develop strategies to make employers aware of the value they can add to the prevention and management of disability at the workplace.

Concern two: The widespread use of the concept of disability management in the rehabilitation services marketplace has made it difficult for employers and employees to understand how disability management actually differs from mainstream private sector rehabilitation interventions.

Although a fairly consistent and comprehensive model of disability management has emerged in the literature over the past 15 years, it does not appear that this model has been sufficiently operationalized at the service delivery level. Due to the increased popularity of the disability management concept, many service providers have indiscriminately labeled their services as "disability management" interventions without changing the quality or substance of these interventions.

Disability management is used to describe both private sector vendored services (e.g., case management, medical management, claims auditing) and employer-based (e.g., company-based, internal program coordinator) approaches. This liberal application of disability management has resulted in confusion and disillusionment among employers and their employees since many vendors are peddling the "same old services" under a new label. These marketing tactics make it difficult for employers to know what provider they should turn to for disability management services. Upon closer examination, it is clear that there are important differences between disability management and mainstream, vendored, rehabilitation services.

Habeck (1996) commented that the most important quality of disability management is that it is an employer-directed process involving a systems approach to managing disability at the organizational level. According to the author, disability management and individually-oriented rehabilitation services are not equivalent in terms of the goals, measured outcomes, and types of interventions used to achieve goals and outcomes.

In one of the first comprehensive texts on the topic, Akabas, Gates, and Galvin (1992) also emphasized the employer-based, organizational character of disability management by defining it as:

   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, quality
   rehabilitation service that reflects an organizational commitment to
   continued employment of those experiencing functional work limitations (p.
   2).

Several of the key elements contained within this definition suggest that the goals of disability management are not incompatible with, but are broader in scope than, individual rehabilitation services. The workplace is considered the locus of all disability management interventions that are coordinated and directed from within the organization. Disability management requires the active participation of the employer (organizational commitment) in prevention, rehabilitation, and return to work. Disability management programs involve strategies at the workplace that aim at both the prevention of disability as well as early intervention in the management of disability. These features of disability management significantly contrast with third-party vendored rehabilitation services that are typically initiated long after the onset of disability. Habeck (1996) referred to the traditional model of rehabilitation as the "reactive, provider-based, clinical model," describing the externally driven services approach as the "broken paradigm" in that it failed to address the root causes of work disabilities that arise from internal organizational relationships, practices, and behaviors (Habeck, 1993).

Shrey (1995) also viewed disability management as a process that is set within the employer's environment. The author outlined three basic principles of disability management: (1) it is proactive; (2) it is a collaboration between labor and management; and (3) it promotes disability prevention strategies, as well as safe and cost-effective return-to-work programs.

Although there has been a tendency to define disability management within the traditional parameters of private sector rehabilitation, the evidence that a growing number of employers are implementing disability management programs at the workplace continues to accumulate (Breslin & Olsheski, 1996; Habeck, Leahy, Hunt, Chan, & Welch, 1991; Olsheski, 1996; Shrey, 1995; Shrey & Olsheski, 1992). As employers become better educated about the advantages of workplace disability management programs, rehabilitation counselors may find increasing opportunities to serve within these settings. The roles of rehabilitation counselors in workplace disability management programs are beginning to receive more attention in the rehabilitation literature (Habeck, Kress, Scully, & Kirchner, 1994; Olsheski & Breslin, 1996; Shrey, 1995). Habeck (1996), for example, found that rehabilitation professionals who work inside the company placed more emphasis on services designed to impact organizational factors (e.g., return to work policies, job accommodations, communication among key stakeholders) than direct services to employees. Olsheski and Breslin (1996) described the role of the rehabilitation counselor in workaday rehabilitation and disability management programs as one that requires a balanced focus on the functional capacities of the employee and the functional capacities of the work environment in responding to job accommodation and retention issues.

At the present time, the role of the rehabilitation counselor in disability management continues to evolve along with the many other professional groups who also claim to be disability management professionals. Different components or functions of the disability management process have been emphasized by these various professional groups. Some within the vocational rehabilitation profession, for example, postulate that disability managers are still within the counseling domain, with the primary responsibility of providing counseling services to consumers. This view also emphasizes using counseling and communication skills in order to develop partnerships with employers and work effectively with them (Scully, Kosciulek, Rosenthal, & Strauser, 1997). Another conceptualization of disability management emphasizes effective case management skills, which is comparable to the return-to-work emphases found in private sector rehabilitation. This model is the basis for the competencies required for the Certified Disability Management Specialist Certification (CDMS) (Currier, Chan, Taylor, & Wood, 1997). Finally, other models of disability management emphasize organizational consultation, program development, and restructuring business systems to prevent and respond to disability (Shrey, 1995).

Rehabilitation counselors may be in the best professional position to resolve the fragmentation problems of disability management functions at the service delivery level and offer employers assistance with developing integrated programs. However, one may ask, how well prepared are they in assuming this role? A discussion of the competencies required of rehabilitation counselors in disability management programs follows.

Concern three: Rehabilitation counselors demonstrate both competencies and deficiencies when working as disability managers.

Research indicates that rehabilitation counselors possess many of the competencies to work effectively as disability managers in several capacities. In a study conducted by Habeck et al. (1994), some support for a "natural fit" was found for the background and skills that rehabilitation counselors bring into practice in regard to disability management work environments. However, employers within such environments noted that rehabilitation counselors had necessary, but not sufficient, knowledge and skills to work effectively with disability management programs and employers. Additionally, rehabilitation counseling practitioners entering disability management expressed frustration with inadequate levels of preservice training to meet work demands (Habeck et al., 1994).

Tate, Habeck, and Galvin (1986) concluded that rehabilitation counselors cannot rely on clinical skills alone in the disability management practice arena. In addition to the skills related to the clinical and case management practices of rehabilitation, they also need to develop skills in organizational interventions, including the abilities to negotiate cooperation among the many stake-holders within the company. Habeck and Manroot (1987) summarized the knowledge and skill competencies needed by rehabilitation counselors within disability management to include: (a) clinical and other direct service needs; (b) administrative skills; and (c) organizational skills. The authors concluded that some of the administrative and organizational skills required in disability management may extend beyond the traditional competencies of the professional rehabilitation counselor.

Rehabilitation counselors may be well prepared in delivering specific services to clients, but are typically deficient in their knowledge of organizational factors that impact disability in the workplace and how these factors relate to the business aspects and operations of the firm. Habeck, Kress, Scully, and Kirchner (1994) noted that rehabilitation counselors need to supplement their clinical skills with organizational competencies. Specific deficiencies noted are: process management; systems analysis; written and verbal presentation skills; organizational change strategies; and negotiation, mediation, and conflict resolution. Olsheski (1993) emphasizes that vocational rehabilitation counselors must possess skills specific to fundamentals of organizational behavior, labor relations, ergonomics, rehabilitation engineering, and human resource management.

Furthermore, an understanding of legal systems, litigation processes, insurance regulations, workers' compensation laws, and legislative initiatives such as the Americans With Disabilities Act (ADA) and the Family Medical Leave Act (FMLA) is crucial if rehabilitation professionals are to effectively assist employers in complying with legal mandates and reducing disability-related litigation activity. Awareness of laws and legislative initiatives is also essential if rehabilitation counselors are to effectively conduct marketing, job development, and return to work activities in the business world (Kilbury, Benshoff, & Riggar, 1990).

Shrey (1992) stated that traditional rehabilitation counseling paradigms tend to overemphasize the characteristics of the individual (injured worker) while ignoring the significance of environmental factors. According to Shrey,

traditional rehabilitation paradigms have focused upon reactive, provider-based clinical models.

Some researchers have attempted to identify the competencies, skills, and roles of the disability management practitioner. Habeck, Kress, Scully, and Kirchner (1994) surveyed a sample of disability management practitioners who attended a national conference on disability management. The sample consisted of internal providers who are employed within the company, insurance-based providers who work for insurance companies or third party administrators, and external providers who provide services on a contractual basis. In contrast to the other groups, the internal providers rated interventions that focus on the organization as the target of intervention as the most important knowledge area.

In general, most of the quantitative research has not identified a set of competencies and skills that are unique to the practice of disability management. One factor that has limited empirical investigations of disability management roles and functions may be the small number of rehabilitation counselors employed directly in employer-based disability management programs. For purposes of this article, a survey was conducted in which 20 (two from each of the ten Rehabilitation Services Administration [RSA] regions) master's level rehabilitation counseling programs accredited by the Council on Rehabilitation Education (CORE) were contacted and asked to provide a percentage of graduates working within disability management. Results of this limited survey indicated that, across the 20 programs, an average of 5-6% of graduates are accessing jobs as employer-based disability managers (this statistic rises to 15-20% when the definition of disability management includes outsourced, insurance-based, private rehabilitation services).

One recent study sponsored by the Certification of Disability Management Specialists Commission (CDMSC) used a panel of well-known disability management consultants to more accurately identify actual disability management practitioners (Currier, Chan, Taylor, & Wood, 1997). The survey instrument used in this study contained items that reflected two levels of practice within disability management. Level one was referred to as the "big DM" and contained knowledge items related to practice interventions at the organizational level, including policy development, program evaluation, management information, and other management functions. Level two was referred to as the "little dm" and assessed knowledge areas related to direct services to clients, including case management, job analysis, and return to work coordination. Results indicated that there is a clear difference of functions and knowledge areas by level of practice. Practitioners who rated organizational functions (DM) as more important knowledge areas intervened at the organizational level, prioritizing knowledge areas concerning program development, policy development, program design, and overall organizational interventions. Conversely, practitioners who rated the individually-oriented interventions (dm) as more important areas of knowledge were those that provided more clinically-oriented services directly to clients such as counseling, case management, and job placement. These researchers tentatively concluded that there appears to be a continuum of practice domains within the field of disability management. One end of the continuum is the individually-oriented rehabilitation services (dm) and at the other end of the continuum the practice is focused at the organizational and systems levels (DM) and is more consistent with the definition of disability management that has been established in the literature.

Another interesting finding in this study was that 77% of the sample indicated that rehabilitation counseling was the most appropriate educational requirement for level one (DM) practice, while 86% of the sample endorsed rehabilitation counseling as the appropriate educational background for level two (dm) practice as well. This information indicates that the master's degree in rehabilitation is perceived as providing a solid educational foundation for various levels of practice in the disability management field.

In order to further clarify the disability management practice domains of the rehabilitation counselors, the next section of this article provides the vocational profiles of three rehabilitation counselors working in employer-based disability management programs. These rehabilitation counselors were interviewed for the purpose of obtaining information about their company, the organizational context of their job (i.e., how they fit into the structure of the company), their key job functions, and the value they felt they contributed to the organization.

Interviews

Barry Brown, M.Ed., CRC, Disability Manager - Techneglas, Columbus, OH

Background Information

Techneglas is one of the leading manufacturers of television picture tubes. Approximately 1700 production workers are employed at the Columbus facility. The employees are organized by the Glass, Molders, Pottery, and Plastics Allied Workers International Union (GMP).

Due to rising costs and increasing disability-related work disruptions, the company decided to employ a disability management consulting firm to assist in the development of a transitional work-return program and on-site physical therapy services. The consultants worked with a joint union/management steering committee, composed of equal numbers of management and union members, in designing the program and the related operational policies and procedures. The transitional work program was implemented in 1993, and a rehabilitation counselor was hired as a disability manager to coordinate the program as well as perform other disability management functions at the workplace. Later, a well-equipped physical therapy clinic and conditioning center was opened in order to provide on-site rehabilitation services and clinical support to the transitional work return program.

In 1996 the original counselor left Techneglas and Brown was hired to fill the position. Brown became interested in employer-based disability management while fulfilling the internship requirements for his master's program in rehabilitation counseling at Ohio University. He completed his internship in the Human Resources Department at Ohio University and coordinated the transitional work return program that was designed for university employees who were injured on the job. When he learned of the opening at Techneglas, he felt it was the perfect employment opportunity.

Organizational Context

Brown's job as the Disability Manager is located in the Human Resources Department. His immediate supervisor is the Director of Industrial Relations. Brown works closely with a team of human resource professionals including workers' compensation claims managers, union officials, benefit technicians, safety directors and technicians, occupational health nurses, physical therapists, and the plant physician. He also interacts with external providers including the company's third party administrator, physicians, EAP providers, and other health care specialists.

Brown noted that he has important working relationships that extend beyond the human resources umbrella. He cited his relationship with union officials and production supervisors as essential to his success in getting workers back on the job. As an internal employee, his direct communication with the production side of the business allows him the opportunity to influence and negotiate job accommodations and transitional work opportunities that are the least disruptive to production requirements. According to Brown, there are a number of advantages that arise from being inside the corporation. He states that his direct access to the work environment allows him to deal with issues on an immediate basis. Frequently, he is able to prevent a situation from resulting in a work disruption or lost time. He feels that his role has strengthened the value of disability management principles at all levels of the company.

Key Job Functions

Brown outlined a number of essential functions that he performs in his role as the disability manager at Techneglas, including: coordinating the employee's participation in transitional work; developing transitional work plans and monitoring the employee's progression back to full-duty status; and coordinating work-site rehabilitation services by maintaining effective communication between the physician, on-site physical therapist, union representative, work supervisors, co-workers, and the employee.

He also is involved in working with the production supervisor and therapist in the identification of transitional work assignments and job accommodations; assessing work performance problems and providing interventions designed to prevent lost time; facilitating compliance with ADA; and developing policies and procedures by participating on various joint union/management safety and health committees. Further, his duties include serving as a clinical resource by assisting in the mediation process when personality conflicts or threatening situations occur between co-workers; performing staff development functions by educating employees, supervisors, labor and management officials about the goals and value of disability management interventions; and maintaining a program evaluation system to report outcomes of disability management interventions.

Value to the Organization

In his role as a disability manager, Brown views his greatest contribution to the company as making the work environment more flexible and capable of providing work-related accommodations. His role is valued by the company because he is perceived as the "internal expert" when it comes to rehabilitation and return-to-work issues. He feels that his counseling skills are a definite advantage in resolving organizational conflicts and removing attitudinal and physical barriers that hinder return-to-work. He influences organizational policies and procedures and helps the company sustain a return-to-work philosophy.

Brown also emphasized that his goal is to ensure that the disability management program remains a win-win situation for the company and its employees. In terms of the economic impact of Techneglas' on-site rehabilitation and transitional work return programs, the company has experienced substantial reductions in lost time days, workers' compensation costs, rehabilitation expenses, insurance reserves, and litigation costs.

Marybeth Stevens, M.S., CRC, CCM, CDMS, NCC, Program Manager, Health Advocacy and Disability Management - GE Power Systems, Schenectady, NY

Background Information

GE Power Systems is a division of the General Electric Corporation that manufactures power generation equipment. GE Power systems employs a total of 15,000 workers in six domestic manufacturing plants, 41 service centers, and 36 international operations. Approximately 4,500 employees work at the Schenectady facility. Most of the production employees are organized by the International Union of Electrical Workers (IUE). A smaller number of employees are represented by the Teamsters, and Pipefitters Union. The most common types of occupations are related to heavy manufacturing, metal fabrication, machining, and engineering.

In 1995, GE began an integrated disability management process. An on-site occupational health and physical therapy clinic is currently in operation at the Schenectady facility. A return-to-work program was developed in collaboration with the IUE. Stevens, who earned her master's degree in rehabilitation counseling at Mankato State University, was also hired by GE in 1995. She related that she was contacted by a recruiter concerning the position at GE. She noted that she was the only rehabilitation counselor among the four final candidates. The other three candidates were certified occupational health nurses.

Organizational Context

Steven's disability management position is located in the Human Resources Department. Her immediate supervisor is a physician who serves as the Medical Director of the company. The Human Resources Department is responsible for the management of all health claims including short-term and long-term disability insurance, workers' compensation, disability pensions, and health care plans. Stevens works closely with members of the health care team and other union and management representatives that are involved in disability management issues. She supervises 12 "care managers," composed of both rehabilitation counselors and nurses, located throughout the Power Systems Division.

Key Job Functions

Stevens indicated that many of her functions occur at the systems and organizational level of operations within the company. She identified the following key job functions: oversees the financial management of the disability management budget; evaluates the effectiveness of disability management services; and monitors the service delivery for daily operations of the on-site health clinics, extended occupational health network, and other disability management interventions.

She also oversees the operations of return-to-work programs; consults with environmental health and safety representatives regarding disability prevention; maintains close communication with manufacturing managers; attends production meetings; consults with care staff regarding strategies to resolve special cases; consults with legal managers regarding ADA compliance issues; maintains a close relationship with union leadership regarding return-to-work program, job accommodations, and other disability management issues; and supervises staff of on-site care managers who deliver direct services to employees.

Value to the Organization

Stevens indicates that her value to the company lies in her commitment to provide comprehensive, cost-effective disability management to employees through high quality care. This mission is accomplished by maintaining employees' satisfaction with disability management services. Working within the corporation, she is able to influence change and bypass bureaucratic issues to achieve what is right for the employee and the business.

As a member of corporate management, Stevens collaborates with representatives from union and management in designing policies and programs that prevent disability and promote return-to-work. She uses her counseling skills in the supervision of case management activities and as a resource in conflict resolution among the stakeholders who manage disability at the workplace. Stevens has earned the trust of labor and management and is viewed as an integral member of the corporate disability management team.

David Campbell, M.A., CRC, Supervisor of Disability Management Services - Steelcase Inc, Grand Rapids, MI

Background Information

Steelcase Inc. manufactures office furniture and employs around 8,500 workers in the Grand Rapids area. The employees are not represented by a union. The most common occupations include assembly, packing, welding, shipping, skilled trades, electricians, and machinists.

Steelcase initiated disability management services in the late 1980s by creating a transitional work center for employees who could not perform the full range of duties required by their original jobs. Disability management programs at Steelcase have continued to expand and improve since the initiation of the transitional work center. The company has now integrated all disability management functions by merging workers' compensation, short-term disability, long-term disability, permanent total disability, and FMLA administration into a single department of Managed Claims Services. Steelcase offers a variety of disability management services for its employees including internal case coordination, redirected work center, temporary alternative work, career counseling, vocational services, on-site physical and occupational therapy, and medical case management.

In 1994, Campbell became involved with Steelcase's disability management program as an intern from the rehabilitation counseling program at Michigan State University. After completing the internship, he was retained by Steelcase on a contractual basis and was later hired by the company.

Organizational Context

Campbell's position, Supervisor of Disability Management Services, is located in the Disability Management Department, a component of the company's Human Resources Division. Campbell's immediate supervisor is Manager of the Disability Management Department and Managed Claims Services. Campbell indicated that his job requires him to have a close working relationship with clinical staff as well as non-clinical manufacturing supervisors who have key roles in disability management and return-to-work. He supervises an on-site disability management team consisting of physical therapists, occupational health nurses, rehabilitation counselors, and case managers. He frequently interacts with representatives from Managed Claims Services who provide integrated claims management services for all types of disability insurance and the FMLA.

Key Job Functions

Campbell outlined the following key job functions of his disability management position: supervises on-site disability management team consisting of physical therapist, occupational health nurse, rehabilitation counselor, and case manager; and consults with staff concerning case management, counseling, accommodations, and return to work concerns.

He provides conflict resolution interventions for problematic and complicated cases and situations; monitors the progress of disability management services including case management, physical therapy and work conditioning, vocational services, and modified duty; and provides training for staff and conducts staff development activities to implement disability management services throughout the company. He also collects data to evaluate the effectiveness and cost-savings of disability management interventions; provides input and develops policies pertaining to disability prevention, management, and return-to-work; and facilitates communication among various internal departments and external parties involved in disability management.

Value to the Organization

Campbell indicates that the company's decision to keep many of its disability management functions and return-to-work services in-house is one that continues to pay valuable dividends for the business and employees. As the Supervisor of Disability Management Services, Campbell feels he makes a valuable contribution to the company by combining his clinical and organizational skills to promote the success of the services. His clinically-oriented contributions involve supervising and coordinating a multi-disciplinary rehabilitation team at the workplace. His contributions at the systems level involve the use of organizational development strategies and program administration to promote cooperation and coordination among all key stakeholders within the company.

Discussion

Although the term disability management and the concepts associated with it have been found in rehabilitation literature for more than 15 years, rehabilitation professionals have not yet been recognized as employers' first choice to reduce disability-related costs. The importance of disability management has been recognized within the vocational rehabilitation profession. However, if one is outside looking in, the clamor is but a faint din, undetectable amidst the noise of the many specializations within the profession.

To better understand opportunities and future directions for rehabilitation counselors within disability management, it may be more appropriate to use qualitative research approaches such as in-depth interviews and on-site analyses of employment settings that involve rehabilitation counselors who work in employer-based disability management programs. This qualitative information is necessary to better guide the design of survey instruments and the selection of the samples used in quantitative investigations. The scope of practice within disability management can be further defined by better understanding the roles, functions, and skills of professionals already engaged in it.

Habeck (1997) described the evolution of rehabilitation counselors in new employment settings as a type of "pathfinding" process whereby professionals begin to uncover new opportunities in which to apply their talents and skills. The three case studies of the rehabilitation counselors contained in this article illustrate this pathfinding process. By demonstrating that their talents and skills are making valuable contributions in preventing and managing disability at the workplace, these professionals are paving the way for more career opportunities that involve rehabilitation counselors in corporate disability management programs.

As a profession, rehabilitation counseling must present a unified front regarding the necessity to evolve in response to emerging needs in this area of practice. Following is a list of suggestions to further define and enhance the role of rehabilitation counselors entering into disability management. Rehabilitation counselors should:

1) Articulate how and where they fit into the prevention of, as well as response to, disability.

2) Be able to articulate how and where they fit into occupational health teams and the unique contributions they can add to the disability management process; e.g., applying their combined expertise in counseling and return-to-work in responding to the rising concern among employers regarding the management of employees with mental illness at the workplace (Watson Wyatt, 1997).

3) Be able to develop partnerships with occupational health teams and better understand the roles of OHNs, PTs, OTs, human resource personnel, and physicians.

4) Market the profession by offering a consistent array of services.

5) Increase the profession's exposure to the private sector business and industry; professional associations should take a more aggressive stance on linking the profession to other professional associations including risk management, human resources groups, and labor organizations.

Additionally, CORE accredited program curricula should respond proactively to emerging needs and roles; this includes offering relevant new courses, infusing principles of disability management into existing courses, as well as developing disability management internship sites.

Finally, further research and publications addressing the role and function and best practices within disability management are essential.

Conclusion

Presently, disability management has a very broad and sometimes nebulous definition that can include: providing internal, direct client services; providing internal, organizational services; providing external consultation; or working directly with insurance carriers. The rehabilitation counselors interviewed for this article have demonstrated that the profession can make a valuable contribution in the disability management arena. It is hoped that this type of qualitative data can by used by rehabilitation counselors to enhance their understanding of this area of practice and stimulate their confidence in pursuing this emerging career path. The information contained in the vocational profiles of these disability managers may help rehabilitation counseling professionals more clearly articulate where their competencies and skills fit into the disability management picture, including their role within occupational health teams. As the nature and scope of disability management programs evolve, rehabilitation counselors will have the opportunity to secure their involvement in this exciting area of practice. If the profession responds to this opportunity, success will be based on the ability to convince employers that rehabilitation counselors are the most efficacious professionals to help them prevent and manage disability.

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David A. Rosenthal, Ph.D., CRC, Department of Rehabilitation Counseling, 231 VR Building, University of Wisconsin - Stout, Menomonie, WI 54751. Email: [e-mail]