This Series is worth four (4) Credit Hours for CRCC, CDMSC and CCMC. Each article has corresponding questions that can be found be clicking on the Questions link.
The Origins of Occupational Disability, a Formulation of Disability Management, and the Need for Good Public Policy
Fred Heffner, Ed.D., and Jasen Walker, Ed.D., C.R.C., C.C.M.
Corporate Education and Consultation Associates Incorporated
It is a fact in the world of work that some employers are sensitive to the need to plan and conduct Disability Management Programs (DMPs), while other employers are either not aware of the benefits of such programming or have chosen not to implement one. This article is written for both of these entities.
For those employers who already do sponsor DMPs, even exemplary programs, there is at least one highly significant innovation in the occupational disability realm that will, in most cases, be new information. That innovation is the application of Adverse Childhood Experiences (ACE) findings to disability management in the workplace.
To those employers who have not yet come to understand how valuable a quality DMP can be for the bottom line and the valuation of skilled and loyal employees, this article should serve as a blueprint for developing one.
The article is divided into three sections:
I. Introduction to the Biopsychosocial Model of Illness/Injury and Its Effect on Productivity in the Workplace
II. The "Psychosocial Constructs"
III. What We Think Needs to be Done and How to Do It
I. Introduction to the Biopsychosocial Model of Illness/Injury and Its Effects on Productivity in the Workplace
Historically, there have been two approaches to understanding disease and illness and their effects on job productivity: the biomedical approach and the biopsychosocial approach. The biomedical model posits that every disease process can be explained in medical terms. Therefore, if the symptoms are simply biomedical, the employer’s response is medical treatment and the application of the Family and Medical Leave Act, the Americans with Disabilities Act (ADA), an appropriate company-sponsored short-term/long-term disability program, or a jurisdictional workers’ compensation program. Regardless, the biomedical outcome is generally lost time.
However, Engel, a research professor at the University of Rochester, discredited the usefulness of the biomedical model in an article published in Science (1977). He put forth the idea that a combination of biological, psychological, and social factors play a dominant role in how humans function in the context of disease/illness, and that these factors are more significant than biomedical issues alone in terms of disease/illness consequences, including workplace disability.
The biopsychosocial explanation is steadily becoming, or has become, the basic model used by enlightened employers in terms of their DMPs. The key concept in this approach is that healthcare professionals diagnose the disease and designate the degree of impairment and associated levels of functionality, but the employer, along with the employee, determines whether or not the employee is disabled from performing the essential functions of an existing job in the work organization.
In other words, physicians have the education, training, and experience to identify a disorder or disease and describe what, if any, impairment follows. Only the employer, or an employer in the process of hiring a new employee, can determine whether or not the given impairment and its functional consequences disable the employee or job candidate from performing the essential functions of a well-defined job. Walker (1993) distinguishes between medical impairment and vocational disability in the context of a well-constructed DMP.
At Corporate Education and Consultation (CEC) Associates, Inc., we have been privileged to gather the medical and social histories and assess the psychodynamics of thousands of individuals who have experienced trauma said to affect their physical and/or mental capacities to work. These vocational-disability assessments have consistently shown that the biopsychosocial constructs of disease and disability have far more descriptive power and ecological validity than what is conveyed by the biomedical principle alone, and because they do, biopsychosocial frameworks should hold more value to the employer trying to prevent and manage occupational disability and associated lost time.
It is important that employers understand the significant difference between relying solely on the biomedical model of disease and disability versus taking the more informed approach of considering how biological, psychological, and social factors influence mental and/or physical trauma and ultimately result in occupational disability and productivity disruption. We assert that it is crucial that all three of these factors are considered in the organizational decisions leading to the re-employment of workers who have lost time secondary to injury and/or illness.
Once this basic concept of the primacy of the biopsychosocial model is accepted by employers, other contemporary constructs and theories begin to play a significant role in the development and maintenance of a quality DMP. The DMP is the effective integration of human resource strategies intended to prevent occupationally significant impairment, reduce lost time, and increase productivity. Specific biopsychosocial constructs (selected here) include:
- Adverse Childhood Experiences (Anda, Felitti, et al., 2004)
- Work Dysfunctions (Lowman, 1993)
- Disability without Disease (Behan & Hirschfeld, 1966)
- The Disability Process (Weinstein, 1978)
- Disability Proneness (Walker, 1990)
- Learned Helplessness (Seligman, 1992)
- Injured Worker Helplessness (Walker, 1992)
- Positive Psychology (Peterson & Seligman, 2004)
This article defines these and other relevant constructs in an attempt to specify the various human problems that precipitate occupational disability and, also, to provide an outline for disability management rationale, delineating methods and tools that employers can immediately consider for implementation. We stress the importance of guidance from choosing the biopsychosocial model of disability over the biomedical paradigm.
Finally, we call for cooperation among private sector business leaders and public policy makers in reducing the psychosocial antecedents and economic consequences of vocational disability and decreased job productivity. Some observers with different disciplines would implicate poor diet and nutrition or the existence of labor unions as the potential cause for this nation’s problems with work productivity and economic success. We neither deceive ourselves by pretending to know all the ills and cures of workplace productivity, nor do we suggest that occupational disability is a major reason for our nation’s economic struggles. We respectfully offer what we believe is an improved way of perceiving, preventing, and managing occupational disability. This article focuses on these matters and what employers and public policy makers might do to prevent and manage lost time resulting from individual developmental issues, injury, and illness. We argue that employers would be wise to bring together their human resources to prevent and manage lost time and productivity, while at the same time, leaders in the private and public sectors must endeavor to combine their efforts to eliminate the causes of biological, psychological, and social disorders that ultimately manifest as occupational disability.
Lost Time Issues in the Workplace:
American employers have a collective responsibility to pay heed to public policy and to share in the shaping of it. At the same time, it is important for employers to start with a full understanding of where and how absenteeism issues in the workplace start. That is, to be effective in the public advocacy process and to change the quality of the work experience, employers will need to recognize the root causes of occupational dysfunctions and disabilities (i.e., injuries and absenteeism) in their companies.
The overriding reality in terms of absenteeism in the workplace is that essentially all injuries and illnesses derive from some form of aberration on the part of the employee or as a result of counterproductive employer-employee interaction.
We adopt and endorse the biopsychosocial descriptor because we believe that many of the causes of disability before and after the onset of medical impairment have psychological and social origins, and we do not advocate complete separation from the biological influences that sustain disability. Relevant biopsychosocial constructs are listed above. In Part II, we will endeavor to list and define the specific constructs that will be of value in understanding the origins of and potential remedies to occupational disability and other issues affecting workplace performance. Those constructs that will be of value in understanding the origins of occupational disability include:
- ACE Scores
- Work Dysfunction
- Disability without Disease
- The Disability Process
- Disability Proneness
- Injured Worker Helplessness
- Anger, Conflict, and Emotional Contagion
- The Effects of Depression and Substance Abuse
In addition, we reference what we believe are potential remedies to acquired occupational disability. They are:
- Positive Psychology
- Resilience Work for the U.S. Army (Seligman)
- Work and Flow (Wrzesniewski and Csikszentmihalyi)
- Private Sector Effects on Social and Public Policy
- Sanctuary Model (Bloom, 2001)
- Transition-to-Work Programs
II. The "Psychosocial Constructs"
Following a seminal study, and reporting under the aegis of the Centers for Disease Control and Prevention (CDC), Anda, et al., wrote an article titled "Childhood Abuse, Household Dysfunction, and Indicators of Impaired Adult Worker Performance" (2004). Significant quotations from the report include the following:
Because child abuse and household dysfunction are common and have long-term effects that are highly disruptive to workers' health and well-being, these adverse childhood experiences merit serious attention from the business community, labor leaders, the everyday practitioners of medicine, and government agencies.
Traditionally, maintaining a healthy and productive workforce has centered on job training, technologic improvement in production, and medical treatment for occupational injury or illness. Instead, however, our data indicate the need to adopt the World Health Organization (WHO) definition of health. To do so would necessitate a paradigm shift, in which the disease-oriented biomedical approach is replaced by a biopsychosocial approach in which child abuse and household dysfunction are understood in terms of their long-term effects on worker health and well-being [emphases added]. (Anda, Felitti, et al., 2004, p. 35)
To give a meaningful perspective to these serious declarations, it will be useful to revisit the basic constructs of occupational disability. We set the stage by reviewing these biopsychosocial constructs that seem to predict or describe occupational disability. This conceptual review will lead to an analysis of how organizations can better manage and even prevent workplace disability. Both public and private entities, even in these austere economic times, must collaborate to financially support prevention and early intervention through psychoeducational and social programs if we are to recover and maintain economic prosperity through work productivity.
1. Adverse Childhood Experiences (ACE) Scores:
The acronym ACE stands for Adverse Childhood Experiences. ACE as a phenomenon in adult medical conditions and work behaviors constitutes a relatively new framework, which affords us a potentially useful perspective to more fully understand occupational dysfunction and disability proneness.
The key findings were first reported by Anda and Felitti, et al. (Anda is with the National Center for Chronic Disease Prevention and Health Promotion, a sub-group of the CDC, and Felitti is with Kaiser Permanente). In their paper, Anda and Felitti make the critically significant assertion that "Job performance can be affected by personal factors other than knowledge and skills." Of course, employers in general have had considerable experience with the relationship between employees’ personal issues and job performance, but this research sheds light on the origins of that relationship and may finally give both employers and public policy makers some rationale for privately supporting a social system that includes primary prevention strategies.
Adverse Childhood Experiences are defined as pertaining to (and deriving from) "eight phenomena experienced by respondents during their first 18 years of life." These experiences are said to be:
1. Emotional Abuse
2. Physical Abuse
3. Sexual Abuse
4. Battered Mother
5. Household Substance Abuse
6. Mental Illness in Household
7. Parental Separation or Divorce
8. Incarcerated Household Member
To "assess the cumulative effect of adverse childhood experiences," Anda and his colleagues "calculated for each respondent a score ranging from 0 to 8 (the ACE score), which represented the total number of [these] categories to which the respondent had been exposed." The number of exposures is said to be the "ACE Score." To have been physically abused and to have had mental illness in the family, for example, would generate an ACE score of 2.
The paper is even more specific in terms of "Worker Performance." It lists "three indicators of impaired worker performance" as:
1. Job problems
2. Financial problems
Respondents in the CDC/Kaiser Permanente (CDC/KP) research were identified as having impaired worker performance if they answered "yes" to any of the following questions:
1. Are you currently having serious problems with your job?
2. Are you currently having serious problems with your finances?
The study drew the following conclusions:
1. The long-term effects of adverse childhood experiences on the workforce impose major human and economic costs that are preventable.
2. These costs merit attention from the business community in conjunction with specialists in occupational medicine and public health.
The important conclusion of ACE research is that "employers [and the relevant public health entities] have both the need and the opportunity to work together against the long-term effects of childhood abuse and household dysfunction." The article presents the fact that, "Exposure to such adverse circumstances is likely to lead to massive financial expenditures for health care as well as to economic losses attributable to poor work performance" [emphasis added].
The article concludes:
If even a small fraction of the economic and human resources currently spent on these conventional approaches was used to identify and address the root origins of these problems in the workforce, we could reasonably expect to find more effective ways to improve worker health, well-being, and performance. (Anda, et al., 2004, p. 37)
We believe that the ACE research establishes a foundation for better understanding the theories of disability proneness, disability without disease, work dysfunction, and the disability process as it often unfolds in the workplace. Before taking a look at corporate strategies that can prevent and interrupt the disability process, we briefly review these concepts and other occupational disability phenomena below, beginning with work dysfunction.
2. Work Dysfunction (Lowman):
Lowman’s 1993 book, Counseling and Psychotherapy of Work Dysfunctions, is an early look at individual problems in the workplace from a psychodynamic perspective. Lowman recognized that "work is a natural part of living, and the issues it raises are important parts of character." Lowman itemized work dysfunction as including:
- over-commitment and burnout
- under-commitment and fear of success and failure
- work-related anxiety and depression
- personality disorders in the workplace
Although these aspects of work dysfunction are almost too broad to be useful in terms of workplace planning, they do serve as a starting point for many of the psychological issues that manifest in the workplace.
Lowman defined work dysfunction as a psychological condition in which there exists a significant impairment in the capacity to work caused by either the personal characteristics of the employee or by an interaction between those characteristics and the working conditions. Organizations vary in the extent that they create or ameliorate stress. Jobs can be poorly designed. Supervisors can be ogres or behave very aggressively in an attempt to meet their own needs. Co-workers can be petty, vindictive, and antagonistic. Work conditions, particularly those characterized by high levels of responsibility with limited opportunities for control, can have demonstrable effects on an individual employee’s health and well-being.
On the other hand, dysfunctional workers themselves may not be aware of, or accept responsibility for, the extent to which their own shortcomings and personal characteristics contribute to problems on the job. Work dysfunction is often a precursor to what Walker (1990) termed "disability proneness," which will be reviewed below. Well-planned and implemented DMPs within companies can be instrumental in identifying work dysfunction and in assisting those individuals so identified with specifically designed strategies.
3. Disability without Disease (Behan and Hirschfeld):
Behan and Hirschfeld (1966), occupational medicine professionals, analyzed the disabilities and lost time of employees in the automobile manufacturing business in Detroit, Michigan. Behan and Hirschfeld started by examining employee accidents. They found that most often, the disability did not match up to the severity of the accident. They were puzzled about the relationships between the accident and the outcome. How did one lead to the other?
In contrast to their predecessors, Behan and Hirschfeld attempted to answer this question by first looking at events preceding the accident and then at the larger human and social context in which the accident occurred. They then searched for ways to understand the problem of chronicity through the assumption that a life of disability or invalidism, with its constricted activity and reduced autonomy, would be chosen and maintained by the employee only if it resolved some extremely powerful and disturbing conflicts within the individual.
These researchers concluded that particular employees, under certain stressful conditions, could manifest "disability without disease." From hundreds of case studies, these physicians concluded that unacceptable disability required an accident, or explanatory event, in order to be acceptable, even though the occupational dysfunction (disability) began well before the identification of an injury (disease).
Behan and Hirschfeld went on to demonstrate that many of the most perplexing and resistant examples of chronic disability in the wake of industrial injuries were actually the late stages in a sequence they termed "the accident process." The four key features of this process were thought to be:
a. Tension and stress: In almost every instance, the accident is preceded by the development (not necessarily in the working area of the patient’s life) of tension and stress, leading to feelings of inadequacy and depression. These unwelcome dysphoric states are often associated with a powerful sense of being insufficiently appreciated, having too much demanded or expected of one, and/or disappointments and frustrations about promotion, security, advancement, and competence.
b. Dependency denial: Essential to the initiation of the accident process is a personality configuration that makes the patient unusually sensitive to perceptions of increased expectations and of reduced support and approval. This personality configuration also makes it very difficult for the patient to acknowledge or to directly and explicitly ask for help for the tension-depression state he/she is experiencing. The personality styles of these people (mostly men in the Behan-Hirschfeld series) have prominent dependent and passive qualities, along with an inability to accept or acknowledge such dependent wishes or passive strivings – a complex commonly found in the working blue-collar population of our industrial centers and which is still (but of recent date less strenuously) widely considered to be normal or even ideal for American men in general.
c. The injury: The coupling of increasing subjective distress with an attitude that makes it difficult to ask for help sets the stage for the next phase of the accident process: the occurrence of an injury that transforms the employee into someone whose distress and impaired performance can be understood by him and others as the result of an externally generated event, something that "could happen to anyone," understandable to all, and generally compatible with an image of tough self-sufficiency. In brief, the accident transforms an "unacceptable disability," equated with weakness and failure, into an "acceptable disability," neither dishonorable nor shameful. None of this requires us to assume that the accident happens because of the need for an acceptable disability; but, of course, the concept of the accident-prone person is an old and recurrent one and would seem to have one of its bases here.
d. Disability as a way of life: The remainder of the accident process has to do with the crystallization and stabilization of disability as a way of life, energized by the patient’s ongoing personality characteristics, by the rapid accumulation of reinforcing social and financial responses to the initial disability, and sometimes, unfortunately, by the consequences of diagnostic and therapeutic interventions of physicians and health-care agencies.
4. The Disability Process (Weinstein):
At CEC Associates, Inc., our concern has been with the contributions of social agencies and social systems (including medicine) to the stabilization phase of the accident (and lost time) process. We found considerable relevancy and value in the work of Weinstein (1978) in what he called "The Disability Process." From Weinstein’s work, we realized that the initiating event could be a non-industrial illness rather than a work-related accident, and that led us to publish papers of our own, extending Behan and Hirschfeld’s concepts.
First, we came to realize that work disability is commonly the end result of a complex process rather than the direct consequence of a discrete accident or illness. This realization helped us to predict and to appreciate the tenacity with which some disabilities may actually be sought out and maintained over time. Whenever self-esteem is elevated, change is difficult and unlikely; when it is low, change is actively sought by the patient and can be facilitated by others.
Second, our contemporary cultural valuations of depression and anxiety as being unworthy, shameful, and unacceptable – valuations that often seem to actually initiate the disability process – appear to be changing. To the extent that we can further soften the cultural polarization of some kinds of suffering as honorable and other kinds as unacceptable, we will reduce the energy that makes the disability process operate.
Third, in view of their prominence as ingredients of the disability process, we could re-examine some of the social and programmatic reinforcements and supports for ongoing disability; we can slow the crystallization and stabilization phases of the disability process by promoting public policies that reduce the reinforcement of disability by monetary and other rewards. Finally, we can re-examine our own activities as rehabilitation professionals to see whether our diagnostic efforts, treatment intervention, participation in the establishment of awards, and even our covert messages about hopelessness or the rightness of the patient’s "claim" against society, contribute to the disability process.
The task of inducing changes in cultural values and societal patterns is enormous, but the disability process is, after all, only a statement of what our society believes to be good and what it holds to be bad about people and their behavior. In the final analysis, the disability process is not likely to change unless the values that energize it are themselves changed.
Retrospectively, we have learned from our experiences of evaluating injured and ill workers, for the purposes of either forensic disability assessment or occupational rehabilitation, that an employee’s personal difficulties, coupled with a troubled life situation, can produce an "unacceptable disability." An unacceptable disability may be defined as a vocational maladjustment (or dysfunction), with or without lost time, that is difficult to explain from a biomedical perspective alone and is nearly always tension-producing for both the employer and employee. Unacceptable disability often reveals itself in an employee’s lack of productivity, increased unhappiness, interpersonal conflicts manifested in the workplace, and/or absenteeism.
When unacceptable disability is followed by an accident or diagnosable illness, the so-called "explanatory event" (e.g., a work-related slip-and-fall accident), unacceptable disability can be transformed into an acceptable disability for the employee. With resultant lost work time sanctioned by various benefits systems (including healthcare) and paid for by the employer, the pre-accident occupational maladjustment is no longer the focus of concern. Instead, the accident or explanatory event, not necessarily the beginning of, but the tangible evidence of disability, serves to justify lost time and absenteeism.
For many years, Behan and Hirschfeld, as well as others including Weinstein, proposed that unresolved anger, particularly among men who struggled with verbally expressing their frustrations, was an identifiable precursor to the so-called explanatory event(s) that made lost time following occupational injury or disease tangible and acceptable. Four decades after the Behan/Hirschfeld proposal, Vinson and his research colleagues (2006) found that higher levels of anger increase the risk of injury, especially among men.
Our experiences have led us to believe that ignored or poorly managed anger, frustration, resentment, and/or unrecognized depression in the individual employee, and resultant interpersonal conflict, often sabotage work/business productivity. These human experiences frequently manifest as a disability proneness that actually "seeks" an accident or injury to justify and explain inevitable lost time, or what most professionals think of as vocational disability.
It has become evident in our thousands of case histories that disability proneness is a significant dynamic during the antecedents of lost work time. Employee disability proneness not only reduces organizational productivity, but also drives disability costs. More importantly, we have come to believe that disability proneness can be recognized by well-oriented front-line supervisors, co-workers, employee assistance personnel, and occupational health professionals in companies committed to proactive disability management.
In addition, disability proneness can be a target of human capital strategies and workplace interventions, such as employee assistance and managerial mediation programs in a comprehensive, integrated DMP. In pursuit of this conclusion, we begin by looking at corporate/workplace strategies that can prevent and interrupt the dynamics of disability proneness and its consequences of lost time and productivity.
5. Injured Worker Helplessness:
After years of research, Seligman, a psychologist at the University of Pennsylvania, discovered that when an individual believes he or she has no control over life’s events, he/she is likely to demonstrate helplessness, to give up, and to experience depression. Learned helplessness may become chronic and refractory (hard/impossible to manage) depending on what Seligman terms is the individual’s "attributional style." Attributional style is how one has learned to perceive and explain life events.
Building on the Seligman model, in 1992, we described in detail the debilitating effects of injured worker helplessness and the importance of work organizations endeavoring to keep injured employees productive and in control of their work and personal lives, as opposed to separating them through the so-called benefits system, e.g., workers’ compensation. We have shown that "benefits" programs designed to aid injured or sick employees actually engender helplessness (or laziness) in them. Productive, meaningful work is more therapeutic and empowering than the receipt of disability benefits while the individual remains idle and lost in the health care system.
As an aside, since formulating his theory of Learned Helplessness, Seligman has realized the more beneficial aspects of focusing on learning optimism. Human capital workplace strategies and proactive DMP administrators would be wise to adopt Seligman’s concepts of Positive Psychology (reviewed below) for application in their DMPs.
It becomes very evident that work organizations, workplace relationships, and injury compensation programs can create situations that set the stage for an employee to learn helplessness. Moreover, for particular individuals who tend to believe that personal control and job outcomes are beyond them (an attributional style), the lost time system becomes fertile ground for "injured worker helplessness." Depending on the workplace dynamics and the individual’s attributional style, the employee can learn helplessness that will, in turn, make him or her more vulnerable to permanent disability and unending lost time. Once the lost time process begins, the workers’ compensation or other disability systems only add fuel to the process of learning helplessness.
Not incidentally, research has also shown that "non-contingent reward" or benefits programs can produce a phenomenon known as "learned laziness" (Walker, 1992). Together, lost time systems that engender a loss of control and reward money noncontingently are gateways for learned helplessness and laziness.
The lesson here – keep people productive in meaningful jobs in which they perceive control over outcomes! Do not create punitive "light duty" assignments that only add to individuals’ perceptions of no control. Resist releasing them into the lost time system that engenders helplessness, and avoid making them recipients of "benefits" when they can indeed remain productive in alternative employment.
6. Anger in the Workplace, Workplace Conflict, and Emotional Contagion:
Anger in the workplace is a problem, and there is evidence that workplace anger is common. Nearly 25% of respondents to a 1996 Gallup survey said they were "generally at least somewhat angry at work." Anger is a strong emotion that is often misdirected. Workplace anger is commonplace enough that we sometimes conceive of the significantly frustrated employee as potentially "going postal." According to the National Institute for Occupational Safety and Health (NIOSH), the Bureau of Justice Statistics reported that an average of 1.7 million people were victims of violent crimes while working or on duty in the United States each year from 1993 through 1999. An estimated 1.3 million (75%) of these incidents were simple assaults, while an additional 19% were aggravated assaults.
While estimating over 111,000 violent incidents annually, NIOSH introduced a 1993 study showing that workplace violence costs $4.2 billion each year. Although anger does not always result in workplace violence, it serves as a form of control over others, or it lingers as a personal preoccupation, causing employees to be tense and at risk for accident and injury. Furthermore, workplace bullying, a form of chronic anger, is a significant problem that has led to proposals for federal legislation to prevent it.
After analyzing data from more than 2,500 injured patients, Vinson found that anger was significantly associated with increased injury risk among men and women combined. Of course, it is difficult for the purpose of research to define anger, but it is evident in retrospective analyses that employee tension build-up and anger are frequently antecedents to, if not causes of, workplace injury.
People do not always get along in the workplace, and workplace conflict is inevitable. And, while it is costly, it is also reducible. According to Dana, a management consultant, over 65% of performance problems result from strained relationships between employees – not from deficits in the individual employee’s skills or motivation. Value differences, racial and gender prejudices, personal needs and emotional issues, perspective, role conflicts, and power struggles are but a few of the reasons that interpersonal conflict is common in the workplace and why these issues become a major focus of attention for managers. Most organizations spend little time training people how to communicate, cooperate, and solve interpersonal conflict. Yet, a classic study found in the Academy of Management Journal (1966) determined that 25% of the typical manager’s time is spent responding to conflict; that figure rises to 30% for first-line supervisors.
Ignoring interpersonal conflict at work has even greater consequences. Some results of unresolved conflict in the workplace are injury and accidents, lost productivity, increased client complaints, absenteeism, sabotage, increased use of sick leave, and "presenteeism." Presenteeism, as opposed to absenteeism, is the phenomenon of lost productivity of employees who have a high intent to turnover but who do not leave the organization. This situation is sometimes referred to as "retired on the job."
A highly effective process for dealing with anger and conflict in the workplace is called "Managerial Mediation." Every workplace has some moments of contention between and among employees and/or employees and their supervisors. In the world at large, these moments are addressed with some form of conflict resolution. In the world of work, the methodology is a separate and unique process called Managerial Mediation; that is, managers are taught the unique and specific methods needed to resolve conflicts in the workforce. Employers who do not avail themselves of opportunities to train their supervisors in Managerial Mediation skills are avoiding opportunities to save money and improve the quality of work life for all employees.
Emotional contagion is another significant factor in terms of workplace dynamics. Awareness of the concept of "emotional contagion" goes back to at least the early 1990s. It has been defined as signifying the tendency to express and feel emotions similar to, and influenced by, those of others. In human development, emotional contagion is frequently looked at as a cause of dysfunctional dynamics in families, especially affecting children.
Emotional contagion can, of course, be a critical factor in the workplace. To understand employee behavior in the workplace, employers need to be aware of the phenomenon and take measures to counteract it. While the most prevalent situation is that of the interaction between and among employees, the contagion is also cited as a condition sometimes present in the employee-customer relationship.
Barsade is considered the most knowledgeable researcher on this phenomenon. In Barsade’s paper, "The Ripple Effect: Emotional Contagion and Its Influence on Group Behavior," he wrote:
The results of this research confirm that people do not live on emotional islands, but, rather, that group members experience moods at work, these moods ripple out and, in the process, influence not only other group members’ emotions but their group dynamics and individual cognitions, attitudes, and behaviors as well. Thus, emotional contagion, through its direct and indirect influence on employees’ and work teams’ emotions, judgments, and behaviors, can lead to subtle but important ripple effects in groups and organizations. (Barsade, 2002, p. 670)
Barsade concludes, "Emotional contagion has been shown here to play a significant role in work-group dynamics. A better understanding of the conditions and concepts of emotional contagion can lead to greater insight into and understanding of employees’ workplace behavior."
7. The Effects of Depression and Substance Abuse:
Depression: Another very common human experience, often described as "anger turned inward," that can be linked to workplace dysfunction and disability proneness is depression. According to the National Institute of Mental Health, "in any given 1-year period, 9.5% of the population, or about 20.9 million American adults, suffer from a depressive illness." The economic cost of depression is estimated to be in the tens of billions of dollars. Left untreated, depression is as costly to the U.S. economy as heart disease or AIDS, costing over $43.7 billion in absenteeism from work with over 200 million days lost from work each year. Depression has also been shown to directly contribute to lost productivity, while at the same time, increasing treatment costs. Depression ranks among the top three workplace problems for employee assistance professionals, following only family crises and stress.
The Behan and Hirschfeld formulations of more than 40 years ago (1966) and Weinstein’s subsequent construct (1978) hold true today: the build-up stage of the disability process, before an explanatory event (such as a workplace accident), which can be observed as increased depression, increased irritability, increased blaming, and decreased productivity, becomes the seed for "unacceptable disability." Employee depression need not go unrecognized and untreated. Competent and sensitive supervisors, leaders of health and wellness programs, and active employee assistance intervention can interrupt the disability process precipitated by depression.
Substance Abuse: The vast majority of drug users are employed. Unfortunately, when they come to work, they do not leave their substance abuse and related problems at the workplace door. According to a national survey from the Substance Abuse and Mental Health Services Administration, of the 20.2 million illicit drug users aged 18 or older in 2010, 31.3 million (65.9%) were employed either full or part time.
Research from the Occupational Safety and Health Administration indicates that between 10% and 20% of the nation’s workers who die on the job test positive for alcohol or other drugs. In fact, industries with the highest rates of drug use are the same as those at a high risk for occupational injury, such as construction, mining, and manufacturing. The National Institute on Drug Abuse has estimated that employed drug-abusers cost their employers about twice as much in medical and workers’ compensation claims as their drug-free coworkers.
The term "self-medicate" can be defined as the process by which some individuals may abuse substances while attempting to relieve other problems such as depression, anxiety, pain, sleeplessness, or other symptoms of illness. Therefore, substance abuse can be a symptom of an underlying problem, and individuals experiencing job stress (from promotion, demotion, failure, reduced seniority or status, or other changes) and/or family tension may be inclined to self-medicate.
Employees self-medicate with prescribed medications, illicit drugs, and/or alcohol. Substance abuse is an international problem, and it most certainly finds its way into the workplace. Historically, Occupational Assistant Programs (OAPs) have focused on substance abuse, and with their development, OAPs have evolved into more comprehensive Employee Assistance Programs (EAPs) with "broader brush" concerns and targets, including family stressors.
At this point, the problem identification process leads to potential solutions. Workplace disability having its origins in the biopsychosocial dynamics of human development and adult behaviors requires new remedies as we accept a broader definition of workplace disability than the traditional biomedical model affords us.
III. What We Think Needs to be Done and How to Do It
Positive Psychology (Seligman and Peterson):
"Positive Psychology" is a recently developed (1998) branch of psychology that shifts the focus from the traditional functions of identifying disease and treating dysfunction to a concerted effort to teach positive approaches to life. Positive Psychology is posited as a complement, not a replacement, of traditional psychology. It is defined in some quarters as a proactive process to make normal life more fulfilling and not simply a process to treat mental illness. The original developers of Positive Psychology are two university professors, Seligman and Peterson.
The primary development tool of Positive Psychology is a set of 24 "character strengths" that Seligman and Peterson said are found (or should be found) in mentally healthy individuals. To measure the presence or absence of these important values, they devised Character Strengths and Virtues: A Handbook and Classification. The classification is divided into six virtues, each with subsets of specific strengths:
1. Wisdom and Knowledge: Creativity, Curiosity, Open-Mindedness, Love of Learning, and Perspective
2. Courage: Bravery, Persistence, Integrity, and Vitality
3. Humanity: Love, Kindness, and Social Intelligence
4. Justice: Citizenship, Fairness, and Leadership
5. Temperance: Forgiveness and Mercy, Humility and Modesty, Prudence, and Self-Regulation
6. Transcendence: Appreciation of Beauty and Excellence, Gratitude, Hope, Humor, and Spirituality
These composite "strengths" are sometimes referred to as "Values in Action."
Positive Psychology endeavors to elucidate the human factors (including virtues and character strengths) that lead to the "good life." In its work with employers developing and evaluating DMPs, CEC Associates has written that individuals with occupationally significant impairments, mental and/or physical, still have the right to pursue such a life. Company leaders, human resource managers, and DMP directors can significantly enrich their organizations and enhance their human capital strategies by integrating positive psychology concepts into their methods of human resource development and disability management.
Resilience and Seligman’s Work for the U.S. Army:
Members of CEC Associates have spoken to the importance of "resilience" as a crucial trait in employee success. The questions are:
- Can mental toughness be taught?
- Can individuals learn how to be more resilient?
The answers to these questions may be found in a study that the U.S. Army has initiated under the leadership of Dr. Seligman, who tested cadets at West Point. The preliminary work at West Point was centered on the self-rated "24 Character Strengths" survey created by Seligman and Peterson. The results of the West Point test showed that those cadets who scored highest on such traits as bravery, optimism, persistence, enthusiasm, fairness, and honesty were more likely to stay in the West Point program than those who scored lower on these strengths. Positive Psychology is seen by the Army as being of great value in helping the healthy majority of soldiers to:
- learn to achieve greater satisfaction
- adapt more effectively to novel and challenging situations
- develop the sense of existential meaning that appears to be linked to soldier adaptation
While CEC Associates is not aware of any comparable study of the value of resilience in the workplace, the study of the U.S. Army is encouraging and suggests that what worked in the rigors of cadet training can also work in the demands of the workplace. (At least one major American employer has developed an application process for new hires that tries to determine whether or not an individual displays the desirable characteristic of resilience.)
Positive Psychology is a rich source of methods and material that will benefit employers who are determined to improve the quality of their workforce while at the same time improving the quality of life of their valued employees.
Work and Flow (Wrzesniewski and Csikszentmihalyi):
Employees who see their employment as "work," simply a job and nothing more, have not benefited from the formulations and conclusions that Wrzesniewski and Csikszentmihalyi have provided us.
Wrzesniewski developed the concept that all employment falls into one of three categories from the worker’s perspective. That is, they see themselves having a:
- Job: the individual is primarily concerned with the financial reward of work, or a
- Career: the individual is focused on advancing within the occupational structure, or a
- Calling: the individual works not for financial gain or career advancement but for the sense of fulfillment that work brings.
Csikszentmihalyi developed the concept that when a "task" is totally engrossing, the individual is experiencing "flow." Csikszentmihalyi carefully enumerated the personal experiences that are present when flow is achieved and the individual "acts from a deep but effortless involvement that removes everyday concerns."
These studies have value to management because many workers fail to achieve the desired levels that can lead to quality work and creativity. Employees who resist returning to work after an injury may perceive their employment merely as a "job," and these same employees are not likely to ever experience the satisfaction of "flow," or at least not in their work.
Workplace leaders who recognize the disadvantages of just having a job and never achieving flow have resources available to them if they choose to apply them. Wrzesniewski states:
My work addresses the possibility of finding positive meaning in work through a variety of paths: the work itself, its perceived contribution to the greater good, interactions and relationships with others on the job, and the ability to challenge oneself, to name a few.
In too many instances, employees who see their work as only a job have never been given the opportunity to find a suitable/preferable career through career assessment and counseling. By the same token, employers also frequently see a given job as merely a job, and they are not interested in creating a more stimulating and rewarding work environment. If the employer is not invested in improving the quality of worklife for its employees, it simply will not happen.
What Employers Can Do:
We argue here that employers need to manage their human resources with proactive strategies designed to prevent and lessen the effects of occupationally significant injury or illness. At the same time, employers and employer groups have a responsibility to take an interest in public policy affecting education and social service delivery systems and, further, to take initiatives to effectively change that public policy for the benefit of the workplace, as well as society at large. In this regard, all educated citizens have a responsibility, and employers have an increased responsibility to help create healthy environments in which the future workforce will inevitably develop.
The challenge is that we, as a democracy, need to improve the quality of our workforce, and leading the charge for that change must be this nation’s employers. We need to do everything we can to develop better prepared and more literate adults throughout the nation, and employers are directly accountable creating an organizational culture that promotes growth and learning. This is not socialism; this is good public policy being supported, facilitated, and applied by private sector leadership.
Public policy that recognizes and targets the origins of ACE and other biopsychosocial causes of vocational disability and failed productivity is simply good economic policy. All American employees and employers in this increasingly competitive global economy would benefit from ways of reducing the biological, psychological, and social causes of family disintegration, child abuse, educational underachievement, poor vocational preparedness, and occupational dysfunction in the prospective and current employee populations.
The U.S. Bureau of Labor Statistics reported as of October 7, 2011, that between September 2010 and September 2011:
- the number of employed Americans with a bachelor’s degree or higher grew by 448,000
- the number of employed Americans with only a high school diploma decreased by 772,000
The reality for employers is that the competition for skilled, educated employees makes it harder to find and hire workers with the particular skill-sets needed. At the same time, employers need to do what they can to prevent good employees from leaving the company.
It is also important to note that the issue is not just finding and keeping educated and job-ready employees; it is also important for producers (employers) to have a population sufficiently well educated and affluent to buy the product or service the employer is hoping to sell them. This is not to mention having a society/culture that is amenable to the good life in which the employer and all employees want to live.
The priorities of public policies that need to be addressed include:
- equality in public education
- environmental (climatological and social) threats to our future
- political processes that are cooperative rather than antagonistic
- continuing recognition of how important prevention and early intervention programs are in the long-term health of our citizenry and the commitment to fund these programs.
The imperative to change educational futures is not only for the sake of the children, but also for all present and future members of our society. In the meantime, we must continue efforts to prevent the antecedents of occupational disability and to proactively manage it when it occurs.
The Minimum Requirements of Dealing Effectively with Impaired Worker Performance
The long-term effects of ACE on the workforce impose major human and economic costs on employers that are preventable. When asked in the CDC/KP study how many days of work they had missed in the past 30 days because of poor physical health, stress, or feelings of depression, those reporting having missed two or more days were characterized as having a problem with absenteeism. Regardless the reason for not wanting to return to work after an illness or injury, it must be attended to with state-of-the-art DMP methods.
Particular employees in specific circumstances can be prone to develop disabling disease or injury, that is, infirmity that results in lost time or measurable reduction in productivity. Disability proneness exists in every work population. As summarized in Part II of this article, the ACE research, as well as the theories of Behan, Hirschfeld, Weinstein, etc., all expound upon the biopsychosocial factors that engender disability proneness in the workplace. We advocate that in the context of good public health care policy, human capital strategies in quality DMPs can reduce the effects of disability proneness by being comprehensive, well integrated, and proactive.
Based on anecdotes in the literature and our own observations at CEC Associates in more than 5,000 injury cases, we introduced the concept of "disability proneness" in 1990 and spoke to potential organizational remedies in 2007. Here, we propose corporate methods and strategies on how disability proneness might be proactively managed by the work organization that wishes to reduce absenteeism, curb disability costs, maintain morale, and increase general productivity.
What corporate strategies can prevent and interrupt the biopsychosocial dynamics of disability proneness and the disability process? There are a number of human capital strategies to deal with disability proneness that have been deemed essential to exemplary and truly integrated DMPs. To be "truly integrated," these strategies must not become corporate silos operating independently in a bureaucratic fashion. Most of these programs can be effectively operated by a disability management team, led perhaps by a human resource professional, and integrated not only with each other, but into the very fabric of the workplace.
1. Communication Skills Training. It is necessary for all supervisory and front-line management personnel to learn effective communication skills. Whether a supervisor is attempting to teach a concept or intervening in a dispute, how well that supervisor interpersonally communicates is key to continuing productivity and morale. The most vital element in effective management and supervision – communication – must be learned. Unfortunately, most of us are "taught" communication styles from our first supervisors – our parents – and more often than not, these are ineffective in the workplace.
In The Assertive Manager, Zuker (1989) writes, "Communication is the cornerstone of business. Managers use many different channels to communicate with others, and [they] spend between 50% and 90% of their day in communication of one-kind or another. Communication is a set of skills you learn."
Most communication between front-line supervisors and subordinates is verbal. Listening and sending messages are more complex than we realize. Listening is an art that takes some of us many years to learn. When another’s behavior is unacceptable to us, the messages that we send them to change their behavior can be destructive rather than constructive to the relationship. Of course, no one wants to be told that their behavior is unacceptable. Learning to listen is tough and learning to confront appropriately is probably even more difficult. Instead of acquiring and consciously learning listening and confrontation skills, most of us who engage in interpersonal communication at work follow our idiosyncratic styles of relating to others, and whether we want to admit it or not, we probably communicate like our parents communicated with us.
2. Employee Assistance/Safety and Wellness Programs. The EAP is a basic process designed to assist management in identifying and resolving an individual worker’s problem that interferes with work. EAPs are most effective when they can identify and address problems before they manifest themselves. Effective EAPs provide "24/7" access (including telephone access). The functions of an effective EAP in chronological order are supervisory training, assessment, consultation, referral, and crises management. The stages of how these functions develop are: awareness of the problem, predicting consequences, identifying causes, and applying corrective resources. The more effective EAPs are "broad brush" and recognize that personal problems that interfere with work behaviors are highly variable and not limited to substance abuse alone.
Since prevention and early intervention are the objectives, EAPs must be constructed with the philosophy that supervisors are on the front line. Supervisors must receive specialized training in how to recognize potential problems and when, where, and how to refer the worker to the EAP component for services. Training supervisors in smaller companies is as important as training them in larger companies: the difference is in the referral source. Referral sources for small companies are frequently community-based resources. Safety/Wellness and EAP coordinators are responsible for designing the supervisor training, initiating it, and conducting follow-up training in regularly scheduled intervals.
In fact, because many of the causative factors in EAP cases are family-related (including domestic violence), model EAP services are available to family members as well. That is, the family may be a cause of the problem and will have to be treated along with the employee. In all cases, the familial unit will be affected by the employee’s dysfunction and will have to be brought into the referral/treatment process to optimize outcomes.
The objectives for Safety/Wellness programs and EAPs for employers include:
- Fostering improved health outcomes for employees and their families
- Promoting an optimum quality of life for the employee and his or her family
- Increasing workplace productivity
The specific services of the EAP include:
- Professional assessment of issues related to mental health, substance abuse, the workplace environment, and other challenges to major life activities of the employee or family members
- Immediate, personal counseling (for employees and family members)
- Referral to either treatment or support services
- Implementation of pre- and post-stress management assistance
- Application of return-to-work strategies including vocational assessment with Transition-to-Work (TTW) methods
For mid- to large-sized companies, the essential
correctives to injury proneness are aggressive and continuing safety and
wellness programs. (For smaller companies, understanding the basics of what
these formal programs include is the minimum, essential ingredient.)
Ergonomics, smoking cessation, relaxation/meditation methods, stress management
techniques, nutrition classes, and other such prevention strategies are made a
regular part of the operational process. In Pennsylvania, for example, employers receive a 5% discount on their
workers’ compensation premiums if they implement safety programs. If work
organizations maintained the philosophy that all accidents could be prevented,
and successfully acted on that philosophy, significantly fewer employees would
3. Managerial Mediation Training. Since anger plays such a significant role in workplace injuries, the single most productive preventative is managerial mediation. As discussed earlier, strife in the workplace is between co-workers or between an employee and his/her supervisor. This condition is a commonplace event; Managerial Mediation Training will assist supervisors in dealing with it.
The specialized methods and materials for mediation in the workplace are those that were developed in conflicts outside of this environment. There are now mediation (conflict resolution) services available through most court systems; they are available for counselors specializing in marital/divorce conflicts; and mediation methods are even used in nation-to-nation conflicts: President Carter (Nobel Peace Prize recipient in 2002) brought in mediation specialists when he worked on the Middle East conflict.
Workplace supervisors are trained in the specialized methods of mediation and are required to apply the methods to those conflict situations that, if left unaddressed, would likely escalate. The process is designed to bring "mutual acceptance" to the disputants in the conflict. Given that over 65% of work performance problems result from strained relations between employees, unmanaged employee conflict is arguably the largest reducible cost in organizations today.
Federal legislation, notably the Family Medical Leave Act and the ADA, requires disputants, under the direction of the Equal Employment Opportunity Commission and the Department of Justice, to engage in mediation before they will sanction litigation.
4. The Sanctuary Model. Thus far, there appears to be no model that specifically suggests a methodology to cope with ACE scores in the workplace. However, one research article that does address "trauma" in the workplace, which presumably could cover the trauma experienced by individuals with an ACE score, is the work of Bloom, a Drexel University professor and board certified psychiatrist.
Bloom has done extensive work on "the impact of trauma on individuals, families, organizations, and cultures." She is on the staff of Drexel’s Center for Nonviolence and Social Justice, a component of Drexel’s School of Public Health. The Center focuses on trauma as a public health issue and provides a "program of healing." The basis for this work is developed in Bloom’s research, Sanctuary: a Trauma Informed Method. The work postulates a process for creating an organizational culture by which healing from psychological and social traumatic experiences can be addressed.
In an article written for the New York Business Group on Health in 2001, titled "Creating Sanctuary in the Workplace" (www.publichealth.drexel.edu), Dr. Bloom lays out the process. Sections of the program include the following:
- The signs of traumatic stress.
- What does trauma do to a person?
- The most critical psychologically destructive aspect of trauma.
- Who will have the most difficulty feeling normal again?
- Why is it so important to pay attention to all this and not just expect that people should "pull themselves together"?
- What protects against long-term impact? (Resilience factors)
- What are "acute stress disorder" and "posttraumatic stress disorder?"
- With so many traumatized people in the workplace, how will our businesses continue to function?
- Does everyone need therapy?
- How can we promote a workplace environment that promotes recovery and healing?
- What is a "trauma-sensitive workplace culture?"
The significance of Bloom’s work, as sketchily outlined here, is that it provides a basis for developing methods and materials for effective Disability Prevention and Management in the workplace. If an ACE score may be considered to be a subset of Bloom’s "trauma," that is, if the ideas she sets forth for trauma also apply to individuals with ACE scores, then those ideas could provide a structure on which DMPs can be modeled.
Although Bloom’s research and writing do specify, at times, a workplace context, her interest is larger than just the workplace. We, at CEC, however, are focused on what employers can do to mitigate dysfunction and disability in the workplace.
5. Transition-to-Work Programs. The primary premise of workplace disability management is that all injured or ill workers must be encouraged to return to appropriate employment as soon as possible. When the job demands substantially exceed the employee’s capacity, modified duty, as guided by an in-place TTW program, is essential. We strongly discourage the use of so-called light duty programs that are generally meaningless and, therefore, sometimes punitive. Vocational assessment as an integral aspect of transition to work and selective internal job placement should be used to replace the traditional outsourcing programs often sponsored by workers’ compensation insurance carriers.
Private Sector Responsibility in Affecting Social and Public Policy
After outlining the various dynamics of occupational dysfunction and vocational disability and current workplace strategies to prevent injury, illness and lost time, we call for a collaborative effort among scientists, educators, and private sector leaders to influence politicians and public policy makers to reduce the causes of Adverse Childhood Experiences and other biopsychosocial factors that lead to occupational disability. With evidence that one out of 50 children is homeless and that 35.8% of all childhood fatalities are linked directly to neglect, we need to come to terms with the fact that our society is failing to protect its human resources and future workforce.
We recognize that there is a substantial portion of the population that believes in the importance of keeping government, particularly the federal government, out of citizens’ lives. Indeed, it may be posited that one of the byproducts of a truly democratic society is the personal choice adults have to create the circumstances for adverse childhood experiences. After all, a free and democratic society allows for a range of personal choices and behaviors, including those that may be irresponsible and aberrant enough to damage youth. But in a truly Democratic society, children should have sufficient protection and ample opportunity to become healthy adults capable of enjoying "life, liberty and the pursuit of happiness." Good public policy recognizes the importance of protecting and educating children just as it has embraced the value of worker health and safety.
Helping to create environments in which families develop healthy children, schools enrich students, and employers maintain skilled employees will require much more dedication, creativity, commitment, and capital expenditure than it takes to change a dietary pyramid into a food plate. But from our vantage point, the work needs to be done.
Only when we fully recognize that our country’s well-being depends on healthy human capital will we approach the guarantees of a free and democratic society, one that can once again prosper in a global economy. Therefore, employer groups, such as manufacturing associations and chambers of commerce, along with educators and health care professionals, would be wise to collaborate and influence public policy makers to ameliorate the effects of poverty, poor education, chemical dependency, unintended parenthood, and child abuse in order to prevent the antecedents to these socially and occupationally destructive biopsychosocial dynamics.
It should be made perfectly clear that the notion that ACE and other factors cause disability proneness should not be misused by employers as a rationale for conducting employee "witch hunts." Employers do not need another reason to discriminate. Suffice it to say that many individuals with ACE and other risk factors for disability are not necessarily susceptible to work dysfunction, poor productivity, and lost time. Resilience can be learned if not inherited. Other employees who have not had psychosocial developmental misfortunes can fail in the workplace for a variety of reasons. What we need is a society that prevents ACE whenever possible. For employers to view a worker’s history of personal adversity and developmental turbulence as a reason to discriminate against him or her constitutes a terrible injustice that is completely contrary to the practice of good human resource management and antithetical to disability management.
The purposes of this paper are to describe the various human situations and workplace dynamics that can lead to occupational dysfunctions and disability proneness, to address the basic elements and methods of an integrated and effective DMP, and to call for a more united effort among social/healthcare professionals and employers to influence and shape public policy. We begin by asserting that the biological, psychological, and social dynamics in people’s lives are predictive of health or dysfunction, and that consideration of the biomedical factors alone is insufficient when attempting to reduce the incidence of vocational disability and lost time secondary to injury and/or illness. We recognize the contribution of the ACE research in this regard.
We emphasize the importance of creating effective disability management, not so much through benefit integration, but through collaboration of effective human resource strategies and empowerment programs. In this paper, we examine the genesis of work dysfunction and posit strategies to prevent causes of disability proneness and ameliorate, if not eliminate, the vocational "disability process," one that begins prior to lost time, injury, or illness, and evidently, in some cases, with Adverse Childhood Experiences. It is hoped that an understanding of disability proneness and a greater appreciation of how truly integrated disability management can prevent and interrupt the process of becoming disabled will assist human resource professionals in designing, implementing, evaluating, and ultimately upgrading DMPs.
We propose that work organizations, preferably under the supervision of a human resources administrator, organize and integrate the various personnel programs that can collectively combat the antecedents and potential causes of disability proneness. By assisting employees at risk with the right services in a timely fashion, disability can be prevented. Integration of disability management is as much an effective combination of employee help programs as it is an integration of benefits programs and insurance plans. With an emphasis on prevention of the antecedents to workplace disability rather than benefit payment for lost time, integrated DMPs can reduce costs by having a significant effect on keeping members of a work organization healthy and productive.
Finally, it is imperative that educators, social scientists, employers, and politicians unite and collaborate to reduce the antecedents and consequences of ACE and other destructive developmental dynamics in our citizenry that biologically, psychologically, and socially result in occupational dysfunction and work disability.
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Useful web sites:
- National Institute for Occupational Safety and Health. www.cdc.gov/injury.
- National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/depression-listing.shtml
- "Fact sheet: alcohol and other drugs in the workplace." National Council on Alcoholism and Drug Dependence. http://www.ncadd.org/facts/workplac.html
- National Health Information Center. www.health.gov/nhic.
- Academy of Management Journal (1966). www.aom.pace.edu/amjnew.
- "Innocent Ones." (Child abuse and neglect statistics). www.innocentones.org.
The Center for Disease Control/Kaiser Permanente study (Robert F. Alda, MD; Vincent J. Felitti, MD.) reports that when individuals have an ACE score of 6 or more, the more likely they will be to have a life span that is up to 20 years shorter than those with smaller scores
CEC Associates publishes the oldest running quarterly newsletter on Occupational Rehabilitation, The New Worker. See www.cecassoc.com for methods and materials.
Note: We want to acknowledge and thank Liz Dolce, Gina Moyer, and Dina McAfee for their assiduous effort and insight demonstrated while editing and proofing this paper.