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Deborah Jacobs' persistent dream is to get to people before they "flip."

The director of Southern California Edison's disability unit says that at present she almost always learns too late after an employee's performance "flips and she or he goes onto disability." Keeping people out of disability means clueing into turbulence at home or work before it begins to overwhelm the employee, an arduous task at the least, she says with a veteran's perspective.

Jacobs has worked at the company for 17 years, much of those years invested in guiding people back to work. Reality to her is a work force of 17,000, one-tenth of which is out on medical or other leave at any given time.

Beyond her employer is her professional world, where behavioral science intersects with corporate America. It is peopled by teams of disability managers, employee assistance programs, mental health professionals and claims adjusters--and especially midlevel corporate managers who run part of or, as Jacobs does, an entire integrated disability management program.

Jacobs stands in the midst of a vastly growing professional field as represented by the phenomenal growth of the professional association in which she is an active member, the Disability Management Employer Coalition. In the last 12 years, DMEC's membership has gone from 35 to 1,500 members. Jacobs has been president of its Southern California chapter for several years and might arguably serve as the organization's role model.

Employers, especially large ones like SCE, are driven by a sense of urgency to address employee behavioral problems and are nailing together planks for a new foundation for worker productivity. Listening to Jacobs, one can imagine her hammering away, nails clenched between her teeth, as she recounts an episode that opened her eyes.

"In about 2004, a man made some threats toward his supervisor and went out on disability," recalls Jacobs. "He got a certificate for stress, but not a proper mental health diagnosis. When I got this case, wow--he and his supervisor had had a falling out, and here it was a year and a half later. He was capable of doing his job. What a waste. I worked with the EAP to talk with him and the supervisor separately to ask can he go with a clean slate going forward.

"A month after he came back, he called to thank me for getting him back to work and asked me to lunch," she says.

That's basically what she and her crew of 13 do, handling all leaves from work except workers' compensation. They operate out of a first-floor suite in a SCE office park located in Rosemead, Calif., a culturally diverse city of 50,000 east of Los Angeles. She has been managing the unit for seven years.

In the same office complex is Jacobs' boss, Susan Heller, a physician and corporate medical director with an M.B.A. and engineering degrees. "We're both working moms," says Jacobs proudly. Jacobs is married with two young children; they live a mile from Disneyland. Heller runs occupational health clinics, fitness centers and preventive health programs, and oversees Jacobs' operation. Jacobs also reports to the corporate benefits department.

SCE's investment in what could be called employee behavioral risk management is complicated, perhaps inevitably as the field is changing rapidly. It retains Sedgwick CMS, the third-party administrator, to manage disability claims. The Horizon Health Employee Assistance Program was engaged a few years ago to deliver EAP services. Horizon Health's counselors are all offsite except for a part-time counselor at an SCE nuclear facility to meet, according to Jacobs, nuclear regulatory standards.

Jacobs' unit collaborates with both Sedgwick and Horizon, but the arrangement, when she talks about it, seems a very provisional work in progress.

For one, Horizon is delivering both a classic EAP service and a boatload of other helping tools for families.

This, according to Jacobs, is in contrast with a more traditional EAP model delivered internally before SCE outsourced the function earlier in this decade.

According to the traditional model, an EAP concentrates on mental health and substance-abuse problems, primarily for the employee. Because of that, says Jacobs, the company's EAP had a stigmatizing image that kept utilization down.

The EAP now offers financial counseling, legal services, life-care planning and disease management services for all family members, including an elderly parent living remote from their adult children who are SCE employees.

Also, Sedgwick's role as claims manager for short- and long-term disability claims has at least one abnormal feature. When it estimates that a claimant is approaching return-to-work status--usually one month from rejoining the work force--Sedgwick alerts the EAP, which then contacts the employee and the supervisor to address any issues.

In this capacity, the EAP is acting, to use Jacobs' term, as return-to-work coach. This is a pilot program. She says it appears to be working, but it remains unclear who will be in charge of return-to-work coaches in the future. "We have not found the right model yet," she says.

SCE launched the pilot to address a difficult problem that Jacobs says crops up as the return-to-work date approaches.

She explains that "after an employee has been off a long time, two or three days before the scheduled return date, they get a huge anxiety about going back to work. They get anxious and stressed. All of a sudden, you get an extension note from the doctor."

As if that weren't enough to deal with, Jacobs says the supervisor needs to be coached. They have a risk of getting "foot-in-mouth disease" and "saying judgmental things to the returning worker."

Jacobs was educated as a psychologist with a master's degree in organizational psychology from the California School of Professional Psychology. Her internship as a graduate student was at the entry level of the human resources department of SCE. She stayed on after earning her degree and has been with the company ever since.

In her undergraduate days at the University of California at Irvine, one psychology professor told her class that, unless they wanted to provide therapy to patients they wouldn't much like, they might wish to look into organizational psychology.

At graduate school, many of her teachers were adjunct faculty working full-time for Fortune 500 companies.

Jacob's wish to be able to help workers before their performance flips and disability looms is thus an outgrowth of an adulthood entirely devoted to untangling the mysteries of employee performance.

If only she could coach the supervisors.

"One thing that I see as a common denominator is that the employees' supervisors don't always have the best skills for coaching their employees," she says.

Perhaps that's another pilot project in the making.

PETER ROUSMANIERE is a Vermont-based writer and columnist for Risk & Insurance®.

May 1, 2007

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