When a robbery occurs, the employer calls CCN, a crisis support service based in Grandville, Michigan. For on-site services, CCN has a nationwide network of 5,000 behavioral health professionals specially trained to deliver psychological first aid to the workplace. Most Family Dollar employees are served by CCN telephonically through their TeleReach support service. CCN places a proactive phone call to identified employees on behalf of Family Dollar, acknowledging the incident, expressing concern, providing an opportunity to talk (or not), normalizing traumatic stress reactions, and providing psycho-educational self-care information – including return-to-work strategies. Employees are encouraged to call back anytime during the next 10 days for support. On the 10th day a follow-up call is made to strategize additional self-care, affirm progress, and ascertain work status.

If an employee is still experiencing symptoms at a level that prevents them from returning to work after 10 days, CCN calls the employer to inform them. BMI provides the next level of support to facilitate return to work. In case of severe initial trauma, BMI is immediately involved. Headquartered in Minneapolis, BMI maintains a panel of more than 125 actively practicing physicians and psychologists across the U.S. and Canada to provide clinical expertise on complex medical and behavioral health issues, including trauma recovery. The employer/representative calls BMI, discusses services needed and the current status of the employee, and if agreed that BMI will provide services, calls their employee to let them know BMI will be calling them.

BMI conducts an initial assessment telephonically with the employee within one business day. The BMI psychologist identifies the nature and severity of reported symptoms, ability to conduct activities of daily living (ADLs), past history of trauma, severity of current incident, relationship between the employee and employer and other factors that are impacting return to work. The psychologist determines if it is appropriate for BMI to work with the employee telephonically or if face-to-face services are warranted in addition to telephonic intervention. 

When telephonic support only is warranted, BMI will provide strategies for the employee to use that are successful in reducing symptoms. Follow up occurs as needed, usually initially every other day the first week and less often thereafter, until the employee successfully returns to work. Calls are brief; lasting 15-20 minutes. During the process, if any work-related issues surface that are barriers to return to work, discussions are held with the employer to discuss possible solutions.

If face-to-face services are needed, BMI facilitates the referral to a qualified provider who has competency in working with trauma. The nature of services requested and a fixed timeline for service provision are agreed upon between BMI and the provider in advance of making the referral. Once the referral has been made, BMI calls the employee to ensure the employee attends sessions and the BMI clinician provides ongoing telephonic support until case resolution. Five therapy sessions are authorized with symptom reduction as the primary goal. A return-to-work (RTW) date no later than the second session is the typical expectation.

Throughout this process, calls are placed to the employer’s representative at each decision point. At the conclusion of the assessment and monthly thereafter, a brief written report summarizing activity is submitted by the BMI psychologist. 

Generally, most employees regain function and return to work in less than thirty days. The average time a BMI psychologist spends on a case is three to four hours. Most employees recover and are at baseline functioning within five sessions. 

Outcomes: If team members receive professional support within 2-24 hours after a traumatic incident, the company experiences 86% retention, and only 6% of cases progress to a worker’s compensation claim. For retained team members, work comp claims are 15% less costly. Projected year one return-on-investment (ROI) is in the high 6 figures in work comp disability claims savings plus indirect costs, which according to the American Society of Safety Engineer’s (ASSE) Council of Practices and Standards may run as much as 20 times the direct costs.

Total BMI cases for 2008 to August 2009 = 35

Outcomes:
 16 returned to work, were at maximum medical improvement (MMI), or voluntarily quit at closure
  8 were closed for non-compliance

  Positive/conclusive resolution= 69%

Average cost for BMI cases to date (excluding one outlier) =$758.86

Case Studies:

CASE ONE
In this case, an employee was robbed for the second time in their retail career. CCN had provided initial services for 10 days telephonically after the first robbery and the employee was able to return to work without additional intervention. After the second robbery, the employee was not able to return to work after CCN’s telephonic intervention was completed. It was recommended that the employee receive additional services and support to recover and return to work.

BMI contacted the employee and completed the initial assessment. That information indicated the employee had also experienced several other major life events in the past two years including surviving a major hurricane. Additionally, there were other significant family pressures adding to this employee’s stress.

Face-to-face sessions were arranged in addition to telephonic intervention. The employee saw the counselor and within three sessions had resolved the life stressors to the point that the employee was stable, functioning well and able to work again. Conversations were held about where the employee would return to work as the employee felt very uncomfortable returning to the same store. Another store was found for the employee returned to work without further difficulty.

The process with this employee was completed in six week and no WC case was filed. The cost was $925.00 for services provided.

CASE TWO
CCN provided initial services and the employee stated they still felt unable to return to work. BMI was contacted and completed an initial assessment with the employee. That information indicated the employee was self-reporting symptoms at a level that made the employee reluctant to leave home, the employee was anxious and nauseous and could only go out if accompanied by a family member.

Face-to-face services were recommended. The employee agreed to attend sessions. The employee attended the first session but failed to attend the second scheduled session. In the telephonic follow up the employee said the first session was helpful, but didn’t think it would help in getting back to work. The BMI clinician explained that the goal of sessions was to help the employee with going out alone again and generally reduce the employee’s anxiety. First-discussions about work would occur in context of the employee’s progress. After agreeing to attend another session, a session was scheduled but the employee did not attend.

A letter was sent to the employee requesting a call and if no call was received by a specified date, it would be the conclusion of the clinician that the employee had recovered to the point where these services were no longer needed. The employee did not make any additional contact with the BMI clinician. The case was closed for non-compliance. A few months later, the employee attempted to litigate a WC claim in court. The employee was not successful in obtaining WC benefits as it was clearly documented that services were provided but the employee was not compliant. The process was completed in four weeks and the cost was $590.00 for services provided.

For more information contact:  Kate Harri, MA LP, Vice President, Workplace Interventions – Behavioral Medical Interventions, KateH@behavioralmedical.com or by phone at (952) 927-0184