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



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)






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


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.