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Specialised training in return to work for case managers is valuable

At a glance:
Case managers find good training helpful. This report evaluates a training program for return to work case managers.
Perspectives:
Employee
Managing complex return to work cases can be difficult and emotionally draining. Case managers need to deal with medical issues and communicate with a wide variety of people. They need to deal with people effectively during times of distress
distress
Severe suffering, pain, anxiety or sorrow
 and they need to be supportive while at the same time achieving outcomes.

A case manager will generally be more positive about working with and helping you if you have a positive approach. This can be difficult when you are in pain or feeling poorly, however the person you are dealing with may also have a challenging role and trying to understand the other person's perspective can make a big difference to the outcome.
Employer
Managing return to work is challenging. The workload can be large, and the job taxing. The skills and knowledge of people managing return to work need to be substantial.

Understand the needs of the people on your staff responsible for managing return to work. Provide the appropriate training and backup support. It will make a positive difference to the outcomes achieved.
Treater
Understanding the skills, background, and experience of case managers can improve the service provided. Case managers come from varied backgrounds including health, payroll, and claims management. Most are keen to help and achieve good outcomes. Most understand that supporting the person is an integral part of good management.

If they don't, it is worthwhile sharing your own experiences. This study shows that case managers are receptive to helpful new information. Positive reinforcement of quality case management is also useful.
Insurer
Managing return to work is challenging. It involves dealing with medical conditions, people who may be distressed, complex organisational issues, ergonomics, while helping people through a difficult time of their life.

The knowledge and skills of good case management should not be underestimated. These skills can be taught and enhanced through training. Case managers in this study appreciated and valued what they learnt.
Original Article, Authors & Publication Details:
W. S. Shaw1, M. Feuerstein2,3, A. E. Lincoln4, V. I. Miller5 and P. M. Wood6 (2001).

Case management services for work related upper extremity
extremity
arm (upper extremity) or leg (lower extremity)
 disorders. Integrating workplace accommodation and problem solving
. AAOHN Journal; 49(8):378-389.

1Liberty Mutual Center for Disability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 Research, Hopkinton, MA.
2Georgetown University Medical Center, Washington DC.
3The Uniformed Services University of the Health Sciences, Bethesda, MD.
4John Hopkins School of Hygiene and Public Health, Baltimore, MD.
5Department of Labor, Office of Workers' Compensation Programs, Washington DC.
Background, Study Objectives, How It Was Done:
The management of return to work by a person experienced and focused on return to work coordination is called ‘case management.'

In this study, the researchers note that the traditional model of claims and medical management does not properly address psychological,
psychological
Refers to a person's perceptions, thought processes, emotions, personality and behaviour. Psychologists can treat mental health problems.
 social, or ergonomic
ergonomic
Designing activities and the workplace in a way to minimize discomfort. i.e. Adapting work tasks, hours, or workstation to accommodate people. An ergonomic computer workstation allows the person to work in the best position to relieve load on the muscles of the neck and arms.
 factors.

The authors note that for people returning to work, a number of problems can occur. These include:

Recurrent symptoms
Confusion due to multiple treatment providers and treatments
Side-effects or negative impacts of medical care
Limitation of the person's abilities due to their condition
Unmodified work duties
Difficulty obtaining ergonomic changes and workplace modifications.

The researchers in this study assessed the value of a two-day professional education program for nurse case managers, and the potential benefits to management of return to work for upper limb
upper limb
arm
 problems. This training program was the first step in a three-year investigation of the extent to which case management can improve return to work outcomes for people with upper limb conditions.

The nurse case managers who participated provided services to government workers with an accepted workers compensation claim. 92 randomly selected nurse case managers were invited to participate in the training program. 70% accepted.

The nurse case managers were registered nurses, had at least two years medical or surgical nursing experience and at least two years experience providing case management services.

Training seminars were run in 1999, over a period of two days (sixteen hours in total). At the conclusion of the workshop, case managers rated their level of confidence from one to ten according to their ability to use the two major components of the program - ergonomics management and problem solving.

The training program covered the following topics

1. Quality medical case management: Guidelines from the American College of Occupational and Environmental Medicine were used to look at appropriate management of spinal and upper limb conditions.
2. A comprehensive initial interview: Case managers were taught how to complete a supportive, interactive interview in order to understand the patient's situation.
3. Developing a case management plan: An inclusive approach was taught, with input from the employee and the supervisor.
4. Applying problem solving processes: A six step process of problem solving was taught, including two simulated cases.
5. Worksite ergonomic assessment: Nurses were trained in how to conduct a worksite analysis including use of a standard protocol and checklist, and basic ergonomic principals.
6. Modifying worksite ergonomics
7. Preventing re-injury: Nurses were taught how to prevent re-injury. This included identifying potential causes, recognising that temporary setbacks may occur, and developing strategies for coping with pain in the short term.
8. Follow-up: A follow up assessment was conducted at 60 days, to ensure that all modifications had been made, and that supervisors and managers were continuing to support the employee.
Study Findings:
Those who participated in the training program reported positively on the experience.

Ratings of the extent to which the training program assisted employees to learn problems solving skills, and facilitated ergonomic modification were moderate. Case managers had some reservations about teaching problem-solving skills to claimants due to concern that workers would fear being blamed for their injuries. These issues were addressed by explaining that problem-solving is a technique used by many business managers to resolve workplace difficulties. Following this explanation, case managers were more confident about embarking on problem-solving training.
Conclusions:
Managing return to work is complex. It involves dealing with workplace modifications, ergonomics, psychological, social and organisational issues. These are all challenging areas.

This is one of the few formal evaluations of a training program for case managers. It shows that case management skills can be taught, and that nurse case managers value the education.
References:
PubMed Abstract
Total Votes for this Article: 8 Average Rating: 3.1
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