Advice I gave to state labor secretaries at SIG meeting yesterday

Jennifer Christian MD

The Secretaries’ Innovation Group had a conference yesterday with representatives from the state departments of workforce development and human services from roughly 20 states in the room.   During their working session on RETAIN, I made the following remarks (via phone).  Jennifer Sheehy, Deputy Asst US Secretary of Labor spoke after me, encouraging the states to apply for RETAIN, and reminding them that there is funding to hire whatever helper organizations / staff that is needed to carry out the demonstration project:   In Phase I it is $2.5 million, and Phase II it is almost $20 million.


  • Why I was asked to speak:  Staff from the US Office of Management & Budget have confirmed that a proposal my colleagues and I made for a Community-Focused Health & Work Service as part of the SSDI Solutions Initiative inspired and has provided vision for the RETAIN project – which is incredibly gratifying.   Now, my personal and professional goal is to encourage and support as many states as possible to put in high quality bids to be a site for RETAIN.   And I am deeply committed to having ALL of the RETAIN demonstration projects succeed – so that:

                                                               i.      More workers whose lives have been recently disrupted by new injuries and illnesses get appropriate and TIMELY guidance along with some simple and low cost services that have been shown to increase the chances they will make the fullest possible functional recovery, minimize life and economic disruption, AND keep their livelihoods.

                                                             ii.      The US Congress  and state legislatures can feel confident that this strategy of investing resources at the front end of medical episodes in order to reduce failed recoveries and workforce withdrawal will make a sound investment going forward. 

Here is my personal advice for State Secretaries of Labor (the agency required to lead the bid/project):

  • Most likely, the RETAIN project does not look like it’s in your wheelhouse or existing areas of interest /authority / capability.  That’s because the target population --working people whose ability to work has just recently been disrupted by a common everyday musculoskeletal injury -- has been in NO-ONE’s wheelhouse until now.  

  • A major purpose of RETAIN is to get the needs of this target population onto your agency’s radar.   That’s because making the right things happen early in their recovery can help them keep their jobs.  If not, some will leave the workforce forever, believing themselves to be “too disabled to work” -- and end up on tax-payer funded programs.   So, Phase I of RETAIN is designed to start the collaboration between the healthcare and employment sectors that is necessary to promptly mitigate the impact of new injuries and illnesses on the lives and livelihoods of people who are employed at the time their health condition begins to disrupt their work.

  • The main service focus of RETAIN is to increase the number of workers for whom the right things do happen – by taking a public health /community-wide approach to the issue.   The main idea is to recruit as many community physicians to participate in the program as possible – the ones who provide initial care for new medical conditions.    Then, pay them to perform some simple best practices that have been shown to improve SAW/RTW outcomes.  Then, deploy care coordinators paid by RETAIN to serve as communications liaison between the doctor, the worker, the employer with a strong focus on facilitating SAW/RTW as soon as possible during recovery – which will usually be to temporarily adjusted work to keep the worker productive until their recovery is complete.  If significant obstacles to full recovery are identified – in any life domain -- or if the condition is likely to result in long-lasting impairments, then get specialists with more expertise at the SAW/RTW interface involved very early, and consider subsidizing the workers’ wages for a temporary period --- while they are incapable of working at full productivity.

  • The most important things for the leadership team that I recommend you begin with are:
    1. To decide whether you DO want to meet this population’s needs.
    2. If so, to educate yourselves about COHE and the basic precepts of the work disability prevention model.  Get clear about what needs to happen -- what the “right things” are -- that will enable more workers at risk of prolonged disability to beat the odds – and INSTEAD to have the best possible outcome which includes a rapid and successful SAW/RTW?  
    3. Then figure out how could you meet their urgent needs– with the resources you already have AND with resources that the RETAIN funding will enable you to buy.   That will be the heart of your project design. 

  • To help you design your project, you will need medical expertise, specifically from physicians who are familiar with the everyday realities of the SAW/RTW process in BOTH the medical office and the employer’s workplace.  The COHE model was acknowledged by its designers to be an “occupational health” approach.  The team that came up with the original concept of the program included a physician – the agency’s medical director himself -- and occupationally-oriented physicians were intimately involved in its detailed design.  Thus  we strongly recommend that all state’s RETAIN projects have initial and on-going input from experts in occupational medicine.  Our specialty is uniquely focused on ensuring that employed people get the kind of medical care and other supports that enable them to return to FUNCTION, and especially to WORK.  
    1. In the project design phase
    2. At the overall project leadership level to ensure that the model is operating as designed /intended, and the expertise required to modify it as necessary based on learnings during the mini-pilot.
    3. Within the COHE organization, to serve as an expert resource to the (i) community physician members of the COHE as well as the (ii) healthcare service coordinators who work for the COHE – as they care for individual patients and intervene when necessary in order to try to drive the SAW/RTW process in a good direction.

  • The American College of Occupational & Environmental Medicine (ACOEM) is reaching out to our state and regional component societies to inform them of this opportunity and the important role they can play in assuring the success of RETAIN.  We are asking that they contact their State Leaders/Job Labor Agencies.   YOU CAN REACH OUT TO ACOEM and ask them to help you find the occupational physicians in your state.   847-818-1800

  • Also, I have created a free list-serv for ANYONE – agencies like yours, healthcare delivery organizations, other organizations or individuals in the public, non-profit or private sector who would like to find a way to contribute or participate in RETAIN.  Please join us.  The group’s name is RETAINers.   On the list-serv, we have already shared some key documents and raised some important issues.  Your questions and contributions will be most welcome.   The list-serv is sponsored by the non-profit 60 Summits Project which was founded to propagate the work disability prevention model across North America.  Send me an email at jhchristian@... or jennifer.christian@....