Suggestion for state RETAIN programs--Develop your inventory of specific interventions

Jennifer Christian MD

Here’s what I hope you will be thinking after reading the list shown belowof common non-medical issues that increase the risk of unnecessary work disability in new health-related employment predicaments . 

“If I want our RETAIN service to make a real difference, I gotta make sure that the service developers come up with a set of strategies and tactics (a playbook of specific interventions).  Our goal will be to outperform the status quo with regard to each of the non-medical issues below."

(The list below is an excerpt from Appendix 1 of our original proposal for a Community Focused Health & Work Service.  RETAIN service developers will find a lot of detailed and hopefully practical/useful information in our proposal, especially in the 3 Appendices.  You can find links to all of the pieces here: )

“Non-Medical Issues in Health-Related Employment Predicaments

The predicaments – as well as the opportunities – facing adults with new health problems and/or newly acquired disabilities are quite different from those with longstanding stable disabilities.  The person whose life has recently changed (for the worse) feels like they have experienced a significant loss and their future is in jeopardy. A period of confusion, uncertainty, and adjustment ensues. (Aurbach 2014)  Most have unwillingly entered an unfamiliar and sometimes hostile world.  Individual circumstances vary widely.

Here are some common non-medical issues that may arise in the beginning of new medical episodes, and which can negatively impact the work status of the individual

·       lack of a shared sense of purpose, trust, and open communication among the multiple participants who typically are involved (the individual, healthcare providers, employer, community-based services, insurance company staff, etc.);

·       uncoordinated responses to different aspects of the worker’s situation being made by several professionals in different organizations on different timelines;

·       variability in the quality, expertise, and philosophy of service providers who may be involved;

·       the individual's lack of necessary knowledge about their condition and how to deal with it effectively so that maximal function and employment are retained;

·       the individual’s lack of life skills and ability to cope with the many new, unfamiliar, and complex challenges the situation poses;

·       failure to identify and acknowledge the existence of any obstacles that need to be overcome;

·       and perhaps most importantly, the absence of any professional who is charged and being paid for their efforts to proactively and urgently drive the situation forwards towards the best practicable outcome possible, regardless of the domain any obstacles are in or what type of help is needed.

Evidence shows that many of these issues can be identified and addressed at or near the beginning of episodes at relatively low cost and with reasonable effectiveness.  (Caruso 2010) (Mitchell 2012) (Wickizer 2011), (Burton 2013) It logically requires much more effort and expense , with far lower chance of success, to undo damage already done by the time that late efforts are made to return people to employment.”

Jennifer Christian, MD, MPH
Moderator, RETAINers List-Serv and Website on
(a volunteer activity – not an officially sponsored group)
Chair, 60 Summits Project
(non-profit organization founded in 2006 and mothballed since 2010)