Improving the Return-to-Work Process: A Strong Collaboration between EA Professionals and Occupational Health Physicians Can Result in More Accurate Evaluations of Sick and Injured Workers, Better Medical Outcomes, and Fewer Repeat Injuries or Illnesses

Article excerpt

As a full-time employee assistance professional for the past 15 years, I have been fascinated by the return-to-work process. Problems can arise unexpectedly. Some employees want to get back to the job quickly, perhaps risking further injury in their haste. Others seem to be on a prolonged holiday, with little concern for their future or their job security There is room for controversy if an employee leaves my office disappointed.

I have worked closely with occupational health physicians to evaluate employees' readiness to return to work and have always been impressed by the favorable results that obtain when EA professionals and doctors cooperate with each other. When they jointly focus their efforts on accurately evaluating an employee who is returning to work after an occupational injury or personal illness, they greatly enhance the decision-making process. The employee benefits in the long run, whether he/she agrees at the moment.

On occasion, I conduct return-to-work interviews in partnership with an occupational health physician who works in my building. The physician usually sees the patient first; if he/she detects a need for EAP involvement, the employee walks down the hall to my office. After talking to the employee, I discuss the case with the doctor. These onsite collaborations are extremely productive, since we are able to address both psychological and medical issues with the evaluations fresh in our minds.


Important decision-making protocols have developed from the cooperative evaluation process. The first decision to be made has three possible outcomes:

1. Return the employee to work;

2. Delay the return to duty and seek more information; or

3. Retain the employee on sick leave for a discrete period of time.

Depending on the person and the symptoms he/she displayed, 30 days often are a useful period of time to wait for a re-evaluation.

The second decision to be made focuses on complications that have arisen while the employee has been away from work or were never addressed in the past. These complications can be complex and almost always result in a delay in the employee's return to full duty There are three major issues that fit this description:

1. A new physical injury or illness;

2. Chemical dependency or substance abuse; and

3. Mental health issues that previously existed or have developed in the interim while the employee has been absent from work.

Knowing what to look for in terms of additional symptoms is crucial. I interviewed several physicians with whom I have worked to gather opinions about these complicating factors. Each described unique methods of detection.

Dr. Joseph Pursch is a psychiatrist who specializes in the treatment of chemical addictions. He collaborates with the EAP Committee when he conducts a return-to-work evaluation and calls me prior to assessing an employee to get as much information as possible about the person's behavior in the workplace. If any clinical reports or discharge summaries are available, he wants to see those as well.

Dr. Pursch has evaluated airline employees on behalf of the Federal Aviation Administration for many years. He is one of a select group of mental health professionals who evaluate employees in safety-sensitive positions for chemical dependency issues. Dr. Pursch described "the airline model," a standard used to evaluate airline personnel that consists of the following:

1. Inpatient treatment for at least 30 days;

2. Participation in 12-step meetings on a regular basis, starting with 90 meetings in 90 days as soon as treatment concludes;

3. Weekly participation in an aftercare group at a treatment center for at least two years;

4. A thorough evaluation by a psychiatrist, including a battery of psychological tests; and

5. Face-to-face monitoring by an EAP Committee at least once per month for a period of time that could extend from two to five years. …