Date   
Statement at conference today: the President's budget has money for FIVE states to participate in Phase II of RETAIN

Jennifer Christian
 

You may all already be aware of this.  I had heard rumors, but today it appears to be true.  At the Committee for a Responsible Federal Budget's event entitled "Disability Policy for the 21st Century,"  a speaker commented that there will be FIVE states participating in Phase 2 of RETAIN -- one more than in the original plan.  When I later asked someone from ODEP, they said the money is in the President's budget.

Cordially,

Jennifer Christian, MD, MPH

Moderator, RETAINers List-Serv and Website on Groups.io

(a volunteer activity – not an officially sponsored group)

Chair, 60 Summits Project

(non-profit organization founded in 2006 and mothballed since 2010)

www.60summits.org 

508-358-0169

Just published: our paper with recommendations for implementing a program like RETAIN

Jennifer Christian MD
 

The Committee for a Responsible Federal Budget (CRFB) has just released a follow-up paper that Tom Wickizer, Kim Burton and I wrote on how to implement a Community-Focused Health & Work Service.  Our original proposal to establish the HWS has been credited with inspiring and providing a vision for RETAIN.      The CRFB announcement describes our paper this way:  “A paper entitled “Implementing a Community-Focused Health & Work Service (HWS)” has just been published by the Committee for a Responsible Federal Budget as part of its on-going McCrery-Pomeroy SSDI Solutions Initiative.   This paper serves as a follow up to the authors’ SSDI Solutions proposal for Community-Based Health & Work Centers that provide near-immediate assistance to individuals who experience a work-disrupting health episode, which the Department of Labor (DOL) is currently adapting into a demonstration project. The authors review critical lessons learned from the implementation of similar programs in the United Kingdom and Washington State and present DOL with a series of observations, cautions, and recommendations aimed at ensuring the success of the demonstration.”

 

Our paper is one of 7 commissioned by the CRFB during this phase of the SSDI Solutions Initiative. In writing this second paper, we intend to contribute to the continuing national conversation about the best way to help injured and ill workers avoid needless work disability, and also to assist the 8 states now participating in RETAIN.  Therefore, our follow-up paper begins by providing a vision of the proposed HWS in operation and answers questions about why establishing such a program deserves priority.  We also address some issues that are part of the RETAIN design even though they were not part of our original proposal.    See the abstract pasted below and read the full paper here:  http://www.crfb.org/project/ssdi/implementing-community-focused-health-work-service-hws

 

The paper has three parts because we see three key audiences focused on issues on different planes:     

(a) policymakers because legislation, funding levels, and regulations will influence the design of and context within which a HWS operates,

(b) those accountable for the overall success of the HWS’s implementation at the federal and state level – and for assuring it produces the intended results, and

(c) those responsible for operationalizing the HWS in a way that produces those intended results -- putting all the pieces into place in a specific geographic area and supervising day-to-day operations.  The Technical Appendix has even more detailed and specific information for the operationalizers.

 

CRFB is hosting an event next week (Thursday June 6) entitled Disability Policy for the 21st Century.  It is described as “a conversation with some of the nation’s top disability experts and policymakers, including Senator Bill Cassidy (R-LA).  A panelist discussion will focus on recent legislative and administrative actions along with new proposals to improve disability policy in America.”  CRFB believes that strong labor markets and recent improvements to the finances of the Social Security Disability Insurance (SSDI) program offer a rare opportunity to test or adopt new ideas to improve opportunities for workers with disabilities.  For more information: http://www.crfb.org/events/disability-policy-21st-century

 

Cordially,

Jennifer Christian, MD, MPH

Moderator, RETAINers List-Serv and Website on Groups.io - (a volunteer activity – not an officially sponsored group)

Chair, 60 Summits Project  - (non-profit organization founded in 2006 and mothballed since 2010)

www.60summits.org 

508-358-0169

 

 

 

Implementing a Community-Focused Health & Work Service (HWS)

A Project of the Fiscal Institute at the Committee for a Responsible Federal Budget

Jennifer Christian, Thomas Wickizer, and Kim Burton

May 2019

Abstract

Our original proposal for a Community-Focused Health & Work Service (HWS) was one of 12 included in the McCrery-Pomeroy SSDI Solutions Initiative. We recommended that the Federal government build the capability to deliver services nationwide that will reduce demand for SSDI by helping working people who lose time from work due to the most common musculoskeletal and mental health conditions to stay employed. Nearly 30 percent of people newly awarded SSDI cite back pain, joint pain, anxiety, or depression as their major problem. Research has shown that the best way to improve both health and work outcomes is to act quickly, discern which individuals need extra attention, and then actively intervene to help them get what they need and get back on their feet. The HWS concept is modeled on Washington State’s successful Centers for Occupational Health & Education (COHE) program, which reduced demand for long-term disability pensions and SSDI by 30 percent. It is also grounded in more than 20 years of disability prevention research, policy, and program innovations in both the UK and the US. As designed, the HWS is an addition to a community’s social fabric and serves a target population whose unmet needs create demand for disability programs but have been largely overlooked until now.

 

This concept is new and quite different from other disability-related programs, so implementing it will be a challenge. Part 1 of this paper is aimed at policymakers. It asks and answers fundamental questions in order to garner support for implementing a HWS. Part 2 alerts those who will guide or run the program at the national or state level to some critical issues that will lead to success or failure of the operationalization effort – and influence the outcomes produced. It also addresses some little details that could derail the program unless noticed and well managed by those responsible for delivering services in individual cases. For one example, this includes allocating substantial resources to marketing and community relationship building in order to assure a sufficient and on-going volume of referrals. Part 3 considers the interaction of program design and development challenges with the imperative to objectively evaluate program effectiveness. The Technical Appendix provides even more practical advice on key topics for local operators, such as suggested hiring criteria, training requirements, details concerning the referral process, eligibility screening, behavioral incentives, information management during start-up, and so on.

 

Permanent Link: http://www.crfb.org/project/ssdi/implementing-community-focused-health-work-service-hws

 

Author Affiliation

Jennifer Christian                    Thomas Wickizer                               Kim Burton

Webility Corporation              The Ohio State University                  University of Huddersfield

 

The McCrery-Pomeroy SSDI Solutions Initiative

This paper has been published as part of the McCrery-Pomeroy SSDI Solutions Initiative, a project dedicated to identifying practical policy changes to improve the Social Security Disability Insurance (SSDI) program and other policies for people with disabilities. More information about the SSDI Solutions Initiative is

available at http://www.SSDISolutions.org/.

 

The SSDI Solution Initiative is a project of the Fiscal Institute at the Committee for a Responsible Federal Budget. The views expressed in this paper represent those of its authors and not organizations or individuals affiliated with the authors, the McCrery-Pomeroy SSDI Solutions Initiative, or the Committee for a Responsible Federal Budget.

 

Re: No recording of Urban Briefing: Supporting Employment for Newly Ill and Injured Workers through Early Intervention

Jack Smalligan
 

We arranged to do the briefing in a Senate office building to maximize the attendance by Congressional staff. 
Unfortunately, that has meant we won’t be recording the briefing the way would if we were hosting it at Urban’s office.

 

 

 

 

 

Re: Live with Urban - Briefing: Supporting Employment for Newly Ill and Injured Workers through Early Intervention

Jason Parker
 

HI,

 

Thanks for this.  Will there be a video recording available for those that can’t attend?

 

Cheers

​​​​​

Jason Parker, B.HK

Work Disability Consultant

 

PH: 604.521.3526

www.centrixdm.com

 

Re: Live with Urban - Briefing: Supporting Employment for Newly Ill and Injured Workers through Early Intervention

Forst, Linda S
 

 
Jack, will this event be recorded?

On May 28, 2019, at 5:31 PM, Jack Smalligan <jsmalligan@...> wrote:

Colleagues,

 

Next week Tuesday, June 4th, we have a panel for Congressional staff focused on early intervention for newly ill and injured workers.  Jennifer Christian and Gary Franklin, experts familiar to everyone following the RETAIN effort, will both be sharing their perspectives.  While our target audience is Hill staff, others are welcome. 

 

Live with Urban - Briefing: Supporting Employment for Newly Ill and Injured Workers through Early Intervention

Jack Smalligan
 

Colleagues,

 

Next week Tuesday, June 4th, we have a panel for Congressional staff focused on early intervention for newly ill and injured workers.  Jennifer Christian and Gary Franklin, experts familiar to everyone following the RETAIN effort, will both be sharing their perspectives.  While our target audience is Hill staff, others are welcome. 

 

Let me know if have any questions.

 

Jack Smalligan

Senior Policy Fellow

202-261-5423

 


U R B A N  
I N S T I T U T E

Income and Benefits Policy Center

www.urban.org

 

 

From: Urban Institute :: Events [mailto:Events@...]
Sent: Wednesday, May 22, 2019 5:24 PM
To: Smalligan, Jack <JSmalligan@...>
Subject: Live with Urban - Briefing: Supporting Employment for Newly Ill and Injured Workers through Early Intervention

 

Elevate The Debate

 

Urban Institute Events

Supporting Employment for Newly Ill and Injured
Workers through Early Intervention

 

Tuesday, June 4, 2019, 12:30 p.m. to 1:30 p.m.
Check-in begins at 12:00 p.m.

 

Russell Senate Office Building, SR-188
Washington, DC 20510

 


 

Join us for an insightful discussion on early intervention to prevent work disability. Panelists will explore how early intervention programs help workers stay in the labor force after experiencing a new illness or injury, where critical gaps in access to these services exist, the consequences of needless job loss and withdrawal from the workforce for workers and society, and implications for federal policy. The discussion will draw on lessons learned from Washington State’s Centers for Occupational Health and Education intervention strategy, which reduced the rate at which injured workers left the labor force and became eligible for Social Security Disability Insurance benefits by 30 percent. The panel will discuss the effectiveness of early intervention in improving employment and health outcomes for workers with a range of conditions, including mental health, musculoskeletal, and pain-related conditions, and how early intervention can help combat the opioid epidemic.
 

 

 

 

 

REGISTER HERE

 

 


Registration is required to attend the event.

 


Speakers:

  • Jennifer Christian, President and Chief Medical Officer, Webility Corporation; Chair, Work Fitness and Disability Section, American College of Occupational and Environmental Medicine
  • Gary Franklin, Medical Director, Washington State Department of Labor and Industries; Research Professor, University of Washington
  • Andy Imparato, Executive Director, Association of University Centers on Disabilities; Former Disability Policy Director, US Senate Committee on Health, Education, Labor and Pensions
  • Jack Smalligan, Senior Policy Fellow, Income and Benefits Policy Center, Urban Institute
  • Chantel Boyens, Principal Policy Associate, Income and Benefits Policy Center, Urban Institute (moderator)

 

Send any inquiries regarding this event to events@....

Support for this event is provided by Arnold Ventures. For more information on the Urban Institute’s funding principles, go to www.urban.org/fundingprinciples.


 

 


 

Facebook    LinkedIn  YouTube


This email was sent by:
Urban Institute
500 L’Enfant Plaza SW
Washington, DC 20024

Privacy Policy

Unsubscribe
Update Profile      Manage Subscriptions      

Re: You're Invited: Disability Policy for the 21st Century (6/6/2019)

Jason Turner
 

Thanks Marc, I will be out of town. Is it on webinar or recorded?

Jason Turner, Executive Director
Secretaries' Innovation Group
Cell:  414-839-6671

On May 26, 2019, at 4:17 PM, Marc Goldwein <goldwein@...> wrote:

HI folks,

 

I wanted to make sure you were all aware of the event we’ll be holding on June 6th here in Washington, DC.  (See below.) Among the speakers include Jamie Wilson – who is OMB’s point person on the RETAIN project – as well as Senator Bill Cassidy, TJ Sutcliffe from the Ways & Means Committee, and some top experts in disability policy. Chairman Larson is also likely to make an appearance by video.

 

Please RSVP if you can make it, and tell you friends!

 

Thanks,

Marc

 

From: SSDI Solutions Initiative <bounce@...> On Behalf Of SSDI Solutions Initiative
Sent: Thursday, May 16, 2019 12:27 PM
To: Marc Goldwein <goldwein@...>
Subject: You're Invited: Disability Policy for the 21st Century (6/6/2019)

 

_______________________________________________________________________________________________

You're invited! Please join us for:

Disability Policy for the 21st Century

 
Strong labor markets and recent improvements to the finances of the Social Security Disability Insurance (SSDI) program offer a rare opportunity to test or adopt new ideas to improve opportunities for workers with disabilities.

Please join the McCrery-Pomeroy SSDI Solutions Initiative for a conversation with some of the nation’s top disability experts and policymakers, including Senator Bill Cassidy (R-LA). The discussion will focus on recent legislative and administrative actions along with new proposals to improve disability policy in America.

Please register now as space is limited. Breakfast will be served.
 

Click here to register

Featured Speakers:

  • Senator Bill Cassidy (R-LA)
  • Former Congressman Jim McCrey (R-LA), SSDI Solutions Initiative Co-Chair
  • Former Congressman Earl Pomeroy (D-ND), SSDI Solutions Initiative Co-Chair

Panelists:

  • Jason Fichtner, Johns Hopkins University
  • David Stapleton, Independent Consultant
  • T.J. Sutcliffe, House Committee on Ways and Means
  • Jamie Wilson, Office of Management and Budget
  • Marc Goldwein (Moderator), Committee for a Responsible Federal Budget

Where and When:

  • Date: Thursday, June 6, 2019
  • Time: 9:00 am to 11:00 am
  • Location: TBD (Capitol Hill)

Click here to register

 

For more information, please contact events@....

 

 

Committee for a Responsible Federal Budget
1900 M Street, NW
Suite 850
Washington DC 20036 United States

If you believe you received this message in error or wish to no longer receive email from us, please unsubscribe.

 

 

You're Invited: Disability Policy for the 21st Century (6/6/2019)

Marc Goldwein
 

HI folks,

 

I wanted to make sure you were all aware of the event we’ll be holding on June 6th here in Washington, DC.  (See below.) Among the speakers include Jamie Wilson – who is OMB’s point person on the RETAIN project – as well as Senator Bill Cassidy, TJ Sutcliffe from the Ways & Means Committee, and some top experts in disability policy. Chairman Larson is also likely to make an appearance by video.

 

Please RSVP if you can make it, and tell you friends!

 

Thanks,

Marc

 

From: SSDI Solutions Initiative <bounce@...> On Behalf Of SSDI Solutions Initiative
Sent: Thursday, May 16, 2019 12:27 PM
To: Marc Goldwein <goldwein@...>
Subject: You're Invited: Disability Policy for the 21st Century (6/6/2019)

 

_______________________________________________________________________________________________

You're invited! Please join us for:

Disability Policy for the 21st Century

 
Strong labor markets and recent improvements to the finances of the Social Security Disability Insurance (SSDI) program offer a rare opportunity to test or adopt new ideas to improve opportunities for workers with disabilities.

Please join the McCrery-Pomeroy SSDI Solutions Initiative for a conversation with some of the nation’s top disability experts and policymakers, including Senator Bill Cassidy (R-LA). The discussion will focus on recent legislative and administrative actions along with new proposals to improve disability policy in America.

Please register now as space is limited. Breakfast will be served.
 

Click here to register

Featured Speakers:

  • Senator Bill Cassidy (R-LA)
  • Former Congressman Jim McCrey (R-LA), SSDI Solutions Initiative Co-Chair
  • Former Congressman Earl Pomeroy (D-ND), SSDI Solutions Initiative Co-Chair

Panelists:

  • Jason Fichtner, Johns Hopkins University
  • David Stapleton, Independent Consultant
  • T.J. Sutcliffe, House Committee on Ways and Means
  • Jamie Wilson, Office of Management and Budget
  • Marc Goldwein (Moderator), Committee for a Responsible Federal Budget

Where and When:

  • Date: Thursday, June 6, 2019
  • Time: 9:00 am to 11:00 am
  • Location: TBD (Capitol Hill)

Click here to register

 

For more information, please contact events@....

 

 

Committee for a Responsible Federal Budget
1900 M Street, NW
Suite 850
Washington DC 20036 United States

If you believe you received this message in error or wish to no longer receive email from us, please unsubscribe.

 

 

Helpful detailed info: How to recruit, train and deliver brief services to workers

Jennifer Christian MD
 

Hello, RETAINers –

 

Here are two documents that should be very helpful for those who are responsible for planning, training, and supervising the delivery of one-on-one SAW/RTW interventions with workers, either as part of a RETAIN program or in another similar effort.   

  1. First is “Effectiveness and costs of a vocational advice service to improve work outcomes in patients with musculoskeletal pain in primary care: a cluster randomised trial (SWAP trial ISRCTN 52269669).   It describes the Study of Work and Pain (SWAP) trial in the UK which enriched the services available in primary care medical clinics by adding the option of brief consultations with “Vocational Advisors” to workers who were either (a) still at work but struggling due to the effects of illness/injury or (b) had been out of work for LESS than 6 months.   

 

The vocational advice was a very modest intervention (most frequently a single telephone conversation) yet it successfully and significantly reduced days away from work – and at a favorable cost-effectiveness ratio.   The study was a randomized controlled trial (RCT)  involving 6 general practices.  Three practices were randomly selected to deliver the intervention; the physicians in those practices could refer their patients for vocational advice.   The other three practices served as controls and did NOT have that service available.     

 

THINGS TO NOTICE:

    • The difference in outcomes between the two groups was not due to the physician’s awareness of how to provide best current work-focused primary care.  The physicians in ALL SIX practices had previously received one hour of education on.  The education emphasized four key messages:  (1) work is usually good for people with musculoskeletal pain, (2) long periods of absence are generally harmful, (3) musculoskeletal pain can generally be accommodated at work, and (4) planning and supporting return to work are important aspects of clinical management. 
    • The fact that the physician REFERRED the patient for VA should be considered part of the intervention because it established a POSITIVE CONTEXT for the VA.  The referral signaled to the patients that the doctor thought VA was needed or might be helpful, which probably enhanced the intervention’s “legitimacy” and thus its impact.   Remember this about advice or instruction:  it isn’t the words that are spoken which makes the difference ---  it is what is HEARD and TAKEN TO HEART and then APPLIED.   Thus, context/relationship/credibility is critical.

  1. Next is “The Development and Content of the Vocational Advice Intervention and Training Package for the Study of Work and Pain (SWAP) Trial”.   This article describes in detail how the intervention was designed and carried out, and how the Vocational Advisors were selected and trained.   The article includes a lot of practical details, including for example Table 1 “Common Obstacles to SAW/RTW and the actions VA’s were to take to overcome them,”  and Table 2 which describes the sequence of three potential steps in the Vocational Advice intervention.

 

Here’s the abstract:  

Purpose     There are substantial costs associated with sickness absence and struggling at work however existing services in the UK are largely restricted to those absent from work for greater than 6 months. This paper details the development of an early Vocational Advice Intervention (VAI) for adult primary care consulters who were struggling at work or absent due to musculoskeletal pain, and the structure and content of the training and mentoring package developed to equip the Vocational Advisors (VAs) to deliver the VAI, as part of the Study of Work and Pain (SWAP) cluster randomised trial.

Methods     In order to develop the intervention, we conducted a best-evidence literature review, summarised evidence from developmental studies and consulted with stakeholders.

Results     A novel early access, brief VAI was developed consisting of case management and stepped care (three steps), using the Psychosocial Flags Framework to identify and overcome obstacles associated with the health-work interface. Four healthcare practitioners were recruited to deliver the VAI; three physiotherapists and one nurse (all vocational advice was actually delivered by the three physiotherapists). They received training in the VA role during a 4-day course, with a refresher day 3 months later, along with monthly group mentoring sessions. Conclusions     The process of development was sufficient to develop the VAI and associated training package. The evidence underpinning the VAI was drawn from an international perspective and key components of the VAI have the potential to be applied to other settings or countries, although this has yet to be tested.

 

Cordially,

Jennifer Christian, MD, MPH

Moderator, RETAINers List-Serv and Website on Groups.io

(a volunteer activity – not an officially sponsored group)

Chair, 60 Summits Project

(non-profit organization founded in 2006 and mothballed since 2010)

www.60summits.org 

508-358-0169

 

 

Regional variation in hourly labor costs (pay & benefits)

Jennifer Christian
 

Let’s build our awareness of the economic pressures that employers face – especially the well-meaning ones who want to do “the right thing”.   

 

See data below from the Bureau of Labor Statistics for current hourly labor costs by region of the country.  No wonder companies are eager for AI and automation!  And whoa, baby! Look at the drop in cost per labor hour if you move your New England company to the East South Central region.  

 

If there are any business people on RETAINers, please correct me if I’ve got this wrong:    It only makes sense to employ people in operations – making things, providing services – if they produce substantially more revenue / save more money for the company than what they cost the company. That’s the “margin” idea.  The margin is used to (a) pay for the administrative costs of being in business including the leadership / management structure – and (b) create the profits.   If the prices the company can charge for its goods / services drop (due to market competition), and the labor costs can’t, the margin disappears.

Therefore, it is reasonable for employers to be uninterested in retaining workers who are less productive than others.   If we want to persuade employers to keep people employed despite a newly acquired impairment (whether temporary or long-lasting) that has altered their ability to perform their regular job tasks in their usual fashion  -- we gotta emphasize these distinctions:

--  There is a big difference between making "temporary adjustments" to a job as an aid to recovery, and making "reasonable accommodation"  under the ADAAA.   Ideally, either technique will make those impairments IRRELEVANT and permit full productivity.  That's what the ADAAA requires.  But it often makes sense for employers to voluntarily go beyond the requirements of the ADAAA when the impairment is likely to be short-lived.  
 
In many cases, especially common everyday musculoskeletal and mental health conditions,  allowing someone to return to work doing tasks or on a schedule that TEMPORARILY reduces performance expectations (tasks, hours worked, etc.) IS NECESSARY (strongly recommended) to speed healing and promote the fullest possible recovery -- and/or avoid over-reliance on or abuse of a benefits program.  

Employers may need help to see that it is usually better from an economic perspective -- and for employee morale -- to have someone who is on the payroll at work and being productive -- contributing SOMETHING -- rather than sitting home getting paid for doing nothing while recuperating.   All but the very smallest employers are driving up the cost of their benefits programs for coming years by using them unnecessarily this year.

When talking about "transitional work" or "modified duty" that DOES reduce productivity, we should always remember to put the word TEMPORARY, and provide an anticipated end date or review date.  Many employers set a limit of 90 days, which can be extended for a clear and reasonable cause.   

Cordially,

Jennifer Christian, MD, MPH

Chair, ACOEM Work Fitness & Disability Section (ACOEM members only)
Moderator, Work Fitness & Disability Roundtable (multi-stakeholder/multi-disciplinary)

Office:  508-358-5218 (preferred)

Mobile:  617-803-9835

Email: jennifer.christian@...

 

Blog: www.jenniferchristian.com

Website:  www.webility.md

 

 

 

 

From: Bureau of Labor Statistics <service@...>
Sent: Monday, January 28, 2019 11:28 AM
To: jhchristian@...
Subject: The Economics Daily

 

Bureau of Labor Statistics

 

The latest Economics Daily article is available here: https://www.bls.gov/opub/ted/2019/private-employer-costs-for-pay-and-benefits-were-42-point-06-in-new-england-in-september-2018.htm. Highlights are below.

Private employer costs for pay and benefits were $42.06 in New England in September 2018

01/28/2019

Employer costs for employee compensation for private industry workers averaged $34.53 per hour worked in September 2018. Employer costs were highest in New England ($42.06), the Middle Atlantic states ($41.95), and the Pacific states ($39.42).

HTML

Re: Supporting Employment for Newly Ill and Injured Workers -- New Urban Brief

Peter Rousmaniere
 

Jack,
 
Thanks for your letter. I am keeping track of your thoughtful papers.
 
One issue I hope you can raise is the need for information about the duration of disability from the date of start of disability. This is not an easy thing to do. In workers’ comp it should not be difficult, as long as one is careful in collecting and interpreting the data. Workers’ comp claims payers record the date of injury and have data on duration of disability payments, and some count the days of disability.  After about a year post injury the data gets complicated.  But it is important to construct the data, due to the importance of early intervention. I have not seen detailed duration of disability data from Washington (per COHE). I have urged the WCRI [Workers' Compensation Research Institute] to focus more attention on this issue (see attached).
 
Regards,
Peter
 
Peter Rousmaniere
129 Freedom Drive.
Montpelier VT 05602
802-291-3843 cell
pfr@...

Twitter @prousmaniere
professional website: www.peterrousmaniere.com
weblog: www.workingimmigrants.com

Doubt is not a pleasant condition, but certainty is absurd. - Voltaire 

Supporting Employment for Newly Ill and Injured Workers -- New Urban Brief

Jack Smalligan
 

Colleagues,

 

We’ve published a brief that has a lot of relevance for the RETAIN effort, especially the second blog described below.  It is the third brief in Urban’s New Direction for Disability Policy series.  In this paper we examine the evidence base for early intervention services for workers at risk of dropping out of the labor force due to a new illness or injury.  The paper provides an overview of how these services are now delivered in the US and promising models that could be used to expand early intervention services for at-risk workers. Our first blog below provides a link to the brief and a high-level overview of the topic.

 

The second link below is a blog that will be familiar to you and is designed to inform a wider policy community about RETAIN.   It is highlighting how states are already starting to develop new models for expanding and delivering early intervention services to workers who do not have access to employer-based services.

 

·         Most employers don’t help workers stay employed after illness or injury.  Early Intervention can help. This blog emphasizes the equity gaps created by the largely voluntary employer-based delivery of early intervention services in the US.  Some workers, typically in higher-wage jobs, already have access these services. By contrast, lower-wage workers have fewer supports when they experience a new illness or injury.

·         States are testing innovative strategies to help at-risk workers stay employed.  This blog provides an update on the Retaining Employment and Talent after Injury/Illness Network (RETAIN) demonstration grants that DoL awarded last September and the ideas put forward by the eight states that were each awarded about $2.5 million in planning grants.

Best,

Jack Smalligan

Senior Policy Fellow

202-261-5423

U R B A N   I N S T I T U T E

Income and Benefits Policy Center

www.urban.org

 

Re: A useful analogy for teaching secondary prevention concept

David Duden
 

This is helpful and as I think about the nudge theory, it would appear that there is a role for how education, directional messaging and loss minimization messages are designed and delivered.....think of the directional floor lighting in air planes on the floor....helping folks get to safety, and also to stay low....

David 

 

A useful analogy for teaching secondary prevention concept

Jennifer Christian MD
 

A lot of people with whom you need to collaborate in RETAIN may not be familiar with (or buy into) the concept of secondary prevention of work disability  – or said another way, the techniques that prevent adverse secondary consequences of injuries/illnesses.  This is the generic “active ingredient” of Washington’s COHE, Early RTW, and early Voc Rehab programs, so is a really important for everyone involved to understand. 
 

I thought of a way you might be able to make the concept of secondary prevention come alive for others – by analogy to our country’s efforts to fight building fires.   The fire departments in every community use primary, secondary and tertiary prevention techniques to manage the threat of fire in structures.  The techniques vary in WHEN they are deployed, in WHO does them, and in the LEVEL OF EXPERTISE/EXPENSE involved:  
 

    • PRIMARY PREVENTION approaches are DEPLOYED AHEAD OF TIME.  They include a variety of activities carried out by many different types of professionals:   education on the importance of not smoking in bed, teaching children to “stop drop and roll,” assuring that all electrical wiring is up to code, requiring the use of fire resistant construction materials, etc.
       
    • SECONDARY PREVENTION APPROACHES are put in place by homeowners ahead of time in anticipation of possible fires -- but are DEPLOYED AT THE FIRST SIGN OF TROUBLE:   smoke alarms in every house go off the instant they detect a problem, sprinkler systems and/or hand-held fire extinguishers douse little fires before they can turn into roaring conflagrations. 

    • TERTIARY PREVENTION APPROACHES are DEPLOYED TO DO DAMAGE CONTROL in response to a conflagration:  a full array of complicated, dangerous (and expensive) fire-fighting professionals, equipment, procedures and techniques to save lives, prevent complete destruction of the building or spread to other structures.

Is this helpful? 

Cordially,
Jennifer Christian, MD, MPH
Moderator, RETAINers List-Serv and Website on Groups.io
(a volunteer activity – not an officially sponsored group)
Chair, 60 Summits Project
(non-profit organization founded in 2006 and mothballed since 2010)
www.60summits.org
508-358-0169

 

Significant study strengthens / validates COHE/RETAIN model

Jennifer Christian MD
 

The SWAP study (Study of Work and Pain) in the UK successfully improved work outcomes by embedding vocational advisors in primary care practices who provided guidance [relatively] early in illness/injury episodes.   The vocational services consisted of an initial phone call, one or more face-to-face meetings and contact with employers, and included updating the treating physician on the obstacles to SAW/RTW that had been identified and any progress.  The advisors used the "psychosocial flags framework" to assist patients in identifying and overcoming obstacles to SAW/RTW.   See attached paper, or the abstract and citation below.    I just bought a pdf of Tackling Musculoskeletal Problems: A Guide for Clinic and Workplace - Identifying Obstacles Using the Psychosocial Flags Framework at https://www.tsoshop.co.uk/bookstore.asp?FO=1345766

Cordially,
Jennifer Christian, MD
Moderator, Work Fitness & Disability Roundtable (multi-disciplinary)
Section Chair and Moderator, ACOEM Work Fitness & Disability Section list-serv (ACOEM members only)

ABSTRACT:  Musculoskeletal pain is a common cause of work absence, and early intervention is advocated to prevent the adverse health and economic consequences of longer-term absence. This cluster randomised controlled trial investigated the effect of introducing a vocational advice service into primary care to provide occupational support. Six general practices were randomised; patients were eligible if they were consulting their general practitioner with musculoskeletal pain and were employed and struggling at work or absent from work < 6months. Practices in the intervention arm could refer patients to a vocational advisor embedded within the practice providing a case-managed stepwise intervention addressing obstacles to working. The primary outcome was number of days off work, over 4 months. Participants in the intervention arm (n 5 158) had fewer days work absence compared with the control arm (n 5 180) (mean 9.3 [SD 21·7] vs 14·4 [SD 27·7]) days, incidence rate ratio 0·51 (95% confidence interval 0·26, 0·99),P50·048). The net societal benefit of the intervention compared with best care was £733: £748 gain (work absence) vs £15 loss (health care costs). The addition of a vocational advice service to best current primary care for patients consulting with musculoskeletal pain led to reduced absence and cost savings for society. If a similar early intervention to the one tested in this trial was implemented widely, it could potentially reduce days absent over 12 months by 16%, equating to an overall societal cost saving of approximately £500 million (US $6 billion) and requiring an investment of only £10 million.

CITATION:   Wynne-Jones G, et al. Effectiveness and costs of a vocational advice service to improve work outcomes in patients with MSK pain in primary care: a cluster randomized trial.  Pain 159 (2018) 128-138 - January 2018

Re: New Disability Policy Briefs Relevant to RETAIN Pilots

Peter Rousmaniere
 

Jack,

I am lucky that I got your email, by way of the RETAIN list.

I write on workers compensation and have been for some time. I am probably the only well read columnist in workers comp who pays attention to the broader context of workers comp, such as SSDI and other employee leave/disability programs.

I look forward to reading your two reports.

Regards

Peter Rousmaniere

On Nov 9, 2018, at 10:40 AM, Jack Smalligan <jsmalligan@...> wrote:

Colleagues,
 
I am starting a series of briefs that may be of interest to you as it should help to put the RETAIN pilots into a broader context .  A New Direction for Disability Policyexamines how federal policy could improve the employment of people with disabilities through expanded use of early intervention. 
As some of you know, I served in the Office of Management and Budget within the Executive Office of the President for 27 years, much of that time focused on the Social Security Disability Insurance (SSDI) program.  Jennifer Christian and I met when I went to the Brookings Institution in 2012 for a sabbatical to focus on SSDI.  We have stayed in touch since then and last year, inspired by Jennifer’s paper, I was in the right civil servant position at OMB to be able to recommend to the Trump Administration that they include funds in the DoL budget for what became the RETAIN proposal.
 
I am now at the Urban Institute and continuing to work on disability policy.  Below are links to the first two briefs:
 
·         A Stronger Social Security Disability Insurance Program Opens the Door for Early Intervention – examines the debate around the Social Security Disability Insurance (SSDI) program and finds the program is now much stronger than it has been in many years.  We conclude that while SSDI is stronger, policy makers have missed opportunities to more effectively support the employment of people with disabilities.
 

·         Expanding Early Intervention for Newly Ill and Injured Workers and Connections to Paid Medical Leave – examines why existing federal and state programs fail to intervene early with newly ill or injured workers and identifies an opportunity to pair proposals for universal paid family and medical leave with grants to states to test promising models for early intervention that could be scaled up over time.

We have at least two more briefs in this series.  The third brief will go much more into how this issue area intersects with the health care field. We are also releasing a short blog to give an overview of this project.
Best,
 
Jack Smalligan
Senior Policy Fellow
 

U R B A N   
I N S T I T U T E
Income and Benefits Policy Center
 

Peter Rousmaniere
129 Freedom Drive.
Montpelier VT 05602
802-291-3843 cell
pfr@...

Twitter @prousmaniere

professional website:
www.peterrousmaniere.com
weblog:
www.workingimmigrants.com

Doubt is not a pleasant condition, but certainty is absurd. - Voltaire 

New Disability Policy Briefs Relevant to RETAIN Pilots

Jack Smalligan
 

Colleagues,

 

I am starting a series of briefs that may be of interest to you as it should help to put the RETAIN pilots into a broader context .  A New Direction for Disability Policy examines how federal policy could improve the employment of people with disabilities through expanded use of early intervention. 

As some of you know, I served in the Office of Management and Budget within the Executive Office of the President for 27 years, much of that time focused on the Social Security Disability Insurance (SSDI) program.  Jennifer Christian and I met when I went to the Brookings Institution in 2012 for a sabbatical to focus on SSDI.  We have stayed in touch since then and last year, inspired by Jennifer’s paper, I was in the right civil servant position at OMB to be able to recommend to the Trump Administration that they include funds in the DoL budget for what became the RETAIN proposal.

 

I am now at the Urban Institute and continuing to work on disability policy.  Below are links to the first two briefs:

 

·         A Stronger Social Security Disability Insurance Program Opens the Door for Early Intervention – examines the debate around the Social Security Disability Insurance (SSDI) program and finds the program is now much stronger than it has been in many years.  We conclude that while SSDI is stronger, policy makers have missed opportunities to more effectively support the employment of people with disabilities.

 

·         Expanding Early Intervention for Newly Ill and Injured Workers and Connections to Paid Medical Leave – examines why existing federal and state programs fail to intervene early with newly ill or injured workers and identifies an opportunity to pair proposals for universal paid family and medical leave with grants to states to test promising models for early intervention that could be scaled up over time.

We have at least two more briefs in this series.  The third brief will go much more into how this issue area intersects with the health care field. We are also releasing a short blog to give an overview of this project.

Best,

 

Jack Smalligan

Senior Policy Fellow

202-261-5423

 


U R B A N  
I N S T I T U T E

Income and Benefits Policy Center

www.urban.org

 

This profound paper will help you understand RETAIN

Jennifer Christian MD
 

Hello all –

I really really hope / recommend that you read – and especially that you request (require?) the “system level” agency people involved in your RETAIN group to read -- pages 1-9 of the attached paper.   Please do not dismiss this paper because it concerns workers’ compensation.  Those early pages are an admirable piece of crystal clear policy thinking about strategies to improve outcomes for a POPULATION currently being ill-served by the status quo – and accomplish that goal via a series of programmatic initiatives.   Isn’t that what you want to do with your RETAIN program?  

Tom Wickizer just sent the paper to me; I had never seen it.  It is dated 2001, before COHE got underway.  Entitled “Improving the Quality of Workers’ Compensation Health Care Delivery: The Washington State Occupational Health Services Project”, it lays out in very clear language the initial rationale for Washington state’s efforts to improve outcomes for injured workers.  It answers the question WHY they undertook COHE, and also explains why some supporting initiatives need to be included.   The short answer appears on page 8:  “These factors argue for adopting a community-based public health approach to quality improvement and injury prevention.”  Because Washington’s thinking has become more refined since 2001, today they would no doubt replace the last term “injury prevention” with this one “secondary prevention of adverse secondary consequences of injuries.”   

This 17 year old paper leaves unstated two significant policy /strategic issues.  Perhaps they weren’t recognized at the time – but they are noticeable now: 

  1. The nation’s healthcare delivery system has proven surprisingly intransigent to efforts to “transform” it – for many reasons laid out in agonizing detail elsewhere.  (Too many features of our healthcare, disability, and workers’ comp systems are being terribly distorted by greedy people whose main aim has become maximizing money.)  The solution Washington came up with is brilliant:  non-combative in tone, admirably limited in size/scope, and thus more likely to succeed than other broader initiatives. 
  2. COHE allows the solution to grow up alongside the status quo – more or less like a better mousetrap with delicious cheese.  Hmmmmm, that analogy is not good because mice get killed.  It’s more accurate to say that COHE creates a positive “brand” in the community and becomes a beacon or outpost of quality in an otherwise cynical system with a lot of negative press.  The twin messages of “best practices” and “better outcomes for workers” that COHE sends appeal to and attracts the “good guys” in all stakeholder groups:  workers, physicians and employers -- and allows them all to thrive and prosper and have good outcomes.   (As an indication of their intention to build buy-in by workers/labor, Washington LNI steadfastly REFUSED to discuss monetary savings as a goal, or even measure them for quite a while.)    When I visited a family practice in Spokane Washington, they had a big placard on their reception desk saying “COHE member physician” or something like that.   

Cordially,
Jennifer Christian, MD, MPH
Moderator, RETAINers List-Serv and Website on Groups.io
(a volunteer activity – not an officially sponsored group)
Chair, 60 Summits Project
(non-profit organization founded in 2006 and mothballed since 2010)
www.60summits.org 
508-358-0169

 

 

Percent of all workers with STD / LTD insurance coverage

Jennifer Christian MD
 

Bottom line:  In 2018,  substantially less than half of private industry workers had access to short-term disability insurance plans -- and only a third to long-term plans.   A quarter of state and local government workers had access to short-term coverage and more than a third to long-term benefits.  See chart below – and a link to the BLS report from which it came further down.

 

 

Here is a report from the Bureau of Labor Statistics with a bit more detail:   https://www.bls.gov/opub/ted/2018/employee-access-to-disability-insurance-plans.htm

 

Bureau of Labor Statistics, U.S. Department of Labor, The Economics Daily, Employee access to disability insurance plans on the Internet at https://www.bls.gov/opub/ted/2018/employee-access-to-disability-insurance-plans.htm (visited October 26, 2018).

 

Cordially,

Jennifer Christian, MD, MPH

Chair, ACOEM Work Fitness & Disability Section (ACOEM members only)
Moderator, Work Fitness & Disability Roundtable (multi-stakeholder/multi-disciplinary)

Moderator, RETAINers List-Serv and Website on Groups.io

 

Office:  508-358-5218 (preferred)

Mobile:  617-803-9835

Email: jennifer.christian@...

Blog: www.jenniferchristian.com

Website:  www.webility.md

 

Basic introduction to work disability prevention

Jennifer Christian MD
 

Dear state RETAIN program people:  

Unless you create a shared vision of what “good” looks like, you may find it difficult to build a common sense of purpose among the participants, collaborators, and contributors to your state’s RETAIN program. 

Attached are two articles I wrote for the IAIABC Journal in the mid-2000’s.   They might serve well (in whole or in part) as basic orientation material for the participants in your RETAIN project – because they DO lay out that vision of “good”. 

  1. A new paradigm – a new way of thinking -- underlies the design of RETAIN.  The “Introduction to the New Work Disability Prevention Paradigm” (fall_2008 Christian_article--attached) will be a good place to get people to understand why and how this approach is different.   It lays out the basic precepts of the paradigm which were first articulated in ACOEM’s report entitled “Preventing Needless Work Disability by Helping People Stay Employed. 
  2. Because RETAIN represents a first bold step in a gradual process of social change, the second article (Opinion-60Summits-Fall 2009--attached) ,“About the 60 Summits Project and Where the Rubber Tree Plant Is Going,” reminds us that cultures evolve and new paradigms emerge through the efforts of committed people who care enough about a particular issue to make new ideas take hold and bear fruit.  This article points out the similarities between the emergence / adoption of the work disability prevention paradigm and other earlier shifts in the way our society has approached issues such as childbirth, drunk driving, and domestic violence.   (Please forgive the constant references to workers’ compensation – which is the IAIAIBC journal’s focus.)

Cordially,

Jennifer Christian, MD, MPH

Moderator, RETAINers List-Serv and Website on Groups.io

(a volunteer activity – not an officially sponsored group)

Chair, 60 Summits Project

(non-profit organization founded in 2006 and mothballed since 2010)

www.60summits.org 

508-358-0169