Building Claimant Self-Efficacy to Improve Return-to-Work Outcomes

“Whether you think you can, or think you can’t, you’re right.” – Henry Ford

“So, how long do you need to be off work?” This was the question posed to me by the urgent care physician following a brief examination and discussion of my back pain symptoms.

What? Why are you asking me? Aren’t you supposed to know, doc? I informed the doctor that I had a sedentary job and that I had no problem sitting but that walking and standing was quite painful. I explained that I would be able to make accommodations to get myself to and from work, so I didn’t really need any time off. Thankfully, my back healed within a couple of weeks.

This recent experience made me wonder how many of the claimants I had dealt with in my more than 20 years as a disability professional had also been asked this question by their treatment providers. Had I been someone less familiar with disability issues or less confident in my ability to adapt to meet my temporary mobility challenges, I probably would have given the doctor a ballpark figure of, say, two weeks. Chances are, he would’ve written me a note to stay home from work for at least a week. And what good would this have done me? Sure, I could have squeezed a short “staycation” out of the deal and binge-watched Netflix, but I probably would not have recovered as quickly, and I would have fallen far behind in my work and overburdened my co-workers. All these factors would have escalated my trepidation about returning to work.

While some people would have taken advantage of this opportunity, I believe that many questionable disability claim durations are driven by claimant fear and misconceptions. Anxiety, feeling as if they have lost control over their lives, and being unfamiliar with and intimidated by trying to navigate disability and medical systems create needless absences from work. While nobody wants claimants returning to work prematurely and jeopardizing their recovery, which can happen with certain conditions, surgical procedures, or treatments, there are many more nebulous conditions (i.e., back strain, fatigue, and pain) that are primarily self-reported and have no definitive duration guidelines. So is there anything we as claim professionals can do to help such disability claimants take a more empowered role in their recovery and return to work?

Yes, there is! We can build claimant self-efficacy by respectfully challenging their misconceptions and helping them overcome the victim mentality we often see claimants falling into. Simply defined, self-efficacy is what an individual believes he or she can accomplish using his or her skills under certain circumstances. Self-efficacy differs from self-esteem in that it’s a judgment of specific capabilities rather than a general feeling of self-worth.

The theory of self-efficacy was developed by Albert Bandura, an early cognitive psychologist who, along with others in the field, found that an individual’s self-efficacy plays a major role in how he or she approaches goals, tasks and challenges and makes decisions. The theory proposes that individuals are more likely to engage in activities for which they have high self-efficacy and less likely to engage in those they do not – performance and motivation are in part determined by how effective people believe they can be. The amount of research supporting self-efficacy motivation is high, which shows that the theory is not only valid but reliable. Life is full of challenges, so people must have a strong sense of personal efficacy to persevere, especially when faced with recovery from an illness or injury.

Bandura and his colleagues have found that people with a strong sense of self-efficacy:

• View challenging problems as tasks to be mastered;
• Develop deeper interest in the activities in which they participate;
• Form a stronger sense of commitment to their interests and activities; and
• Recover quickly from setbacks and disappointments.

In contrast, people with a weak sense of self-efficacy:

• Avoid challenging tasks;
• Believe that difficult tasks and situations are beyond their capabilities;
• Focus on personal failings and negative outcomes; and
• Quickly lose confidence in personal abilities.

So, who has time to coach claimants? We all do! In the normal course of talking with claimants, we can increase their personal efficacy. It doesn’t take any more time – we just need to be mindful of ways in which we can respectfully challenge claimants to take charge of their lives. Remember, we are not dictating treatment, just advocating for the claimant to challenge the information he or she receives (or doesn’t receive) from the claim stakeholders – information they need to make important decisions in their lives.

What claimants would this strategy be most effective on? There are those claimants who are determined to return to work no matter what, and, on the opposite end of the spectrum, there are those who are determined never to go back to work no matter what. It is those claimants in the middle, the ones who are ambiguous about their return to work, that we have the greatest chance of influencing.

Disability case managers can help to build claimant self-efficacy by incorporating some simple concepts into their normal dialogue: performance outcomes, vicarious experiences and verbal persuasion. By using performance outcomes or past experiences, case managers can compare a current challenge to a similar situation in which the claimant was successful. They can emphasize the similarity of the new task to be learned to something the claimant is already doing. For example, if you know that a claimant has power of attorney for her mother and has been coordinating her mother’s care for some time, you could build self-efficacy by relating the claimant’s past or current success to her current challenge: “You’ve told me how effective you are at managing your mother’s care. You can manage your own care in the same way. Let’s talk about that.”

With regard to vicarious experiences, if a person becomes aware of someone similar to them who has succeeded in a comparable situation, it can increase his or her self-efficacy. This is where a case manager can share claimant success stories (keeping all private information confidential, of course), relating applicable claim situations to the current one and offering examples and strategies for helping the claimant take charge of the situations he or she faces.

Verbal persuasion or encouragement can also positively influence self-efficacy. Using positive verbal persuasion generally leads individuals to put forth more effort; therefore, they have a greater chance at succeeding. The level of credibility directly influences the effectiveness of verbal persuasion – where there is more credibility, there will be a greater influence. Who better to influence the claimant than those of us in the disability insurance industry who are familiar with countless claim scenarios and understand the physical, psychological and social barriers that impede a successful return to work?

To boost self-efficacy, case managers can begin by setting up small, basic goals with the claimant. One aspect of persuasion that is particularly effective is to urge and encourage the claimant to do slightly more than he or she is now doing. Mastery of simple goals develops self-efficacy and leads to overcoming larger, more difficult ones. Case managers should strive to make teaching goals short-term and realistic, and not much beyond what the claimant believes he or she can realistically accomplish. Once the goal is established, be prepared to follow up on the outcome with the claimant and offer additional reassurance.

Here’s an example: You’re talking with a claimant whose doctor has recommended she get out of the house and exercise regularly, but the claimant tells you she is too depressed. During your phone call, you hear a dog barking in the background and the claimant mentions that the dog is “starved for attention,” but she’s too withdrawn to tend to her pet as she should. You could ask the claimant, “What if you took your dog for a short walk around the block? That way, you’re getting out of the house, getting some exercise, and spending time with your dog. Is this something you would be willing to try?” Set a deadline for the claimant to complete the goal and ask her to call you afterward to discuss how it went. Presuming that this results in a good experience for the claimant, the next goal would be to increase the number of times per week she takes the dog for a walk.

And finally, encourage claimants to ask questions and seek information from their employers, care providers, and you! Remind them that they are the ones in control of their lives. Challenge them to not define their lives by their conditions, and help them overcome feeling intimidated to ask questions of their treatment providers – the more they understand about their condition, the more they will take control of their own recovery. Assist them with questioning beliefs and breaking down the barriers that are keeping them from returning to work. Are the barriers self-imposed? Are the perceived barriers based on accurate facts? Could barriers be overcome by asking questions and being more proactive?

As research shows, claimant motivation is the number one driver in getting people back to work. Why not use this fact to everyone’s advantage, build upon it, and empower claimants to be active participants in their recovery and return to work? Everybody wins!