We are going to present the progress reports from RETAIN, the state early return to work programs. And I'm here with Laura Brear from Minnesota, Shirley Crone from Kentucky, I'm from Vermont, and then Jennifer Christian is here by phone and video. She wasn't able to come. And the way we're going to structure this is to give you a little bit of background about the national RETAIN program, and then do a brief comparison of the five states that have these programs, and then Jennifer is going to talk about the program that she's building in Rhode Island that's outside, does not have RETAIN funding, but is a RETAIN-like program. And we packed a lot into the comparison slides because this is really the first time, it is the first time that the cross-comparison of the states has been presented. And so we are not going to read every cell of the tables, but it's really meant to go back to refer to. The approach we're going to take is if you were starting a program or considering a program, some of the things you might want to consider, and we'll point out some of the key differences between the programs, and then Jennifer will talk about really starting from scratch with a program and how to build that. So you'll notice in the tables that they're not all standardized, and that was intentional. We asked each of the states to, we gave the categories and asked each of the states to fill in their responses, and so it was really meant to be their description of their program and not meant to be standardized way of presenting each category by state. So future work will present it in a more standardized way, but for now what we really wanted is just to get that description directly from the state. So with that in mind, we do not have disclosures other than Jennifer Christian's disclosures, which you can see here. She's the chair of the Alliance for Bridging Work and Health, which is a nonprofit for early return to work programs, and the president of Webility, and a medical advisor for Figure 8. And then we also have a disclaimer from our federal funders. The retained programs are funded by the U.S. Department of Labor and the Social Security Administration under some grant awards per state, and this presentation does not reflect the views of the U.S. government or our federal funders, and we aren't going to be mentioning any commercial products, trade names, or endorsements. So I thought we'd start out with some Slido polls just because they're fun, and wanted to get a sense of who you all are. If you're up for it this early in the morning, feel free, otherwise if you want to just let us know your background and if you have any particular points you'd like us to cover during the talk, and we will try and get through this pretty quickly since the slides will be available afterwards so we can get to some questions and answers that you all might have. Is that working for you? We have some people typing. So just for our panel here, I'm going to read them. Occupational medicine physician specializing in VA disability exams, OCMED, and we might have some more people, OccHealth, and we have two people still typing. Does anyone have any topics you can just shout out that you're particularly interested in us covering? Okay, we have OEM at StateGov, and a resident physician in New Mexico regularly sending people to the state for disability claims. Awesome. That's great. Thank you for doing that. The next slide is whether you're interested, if you're here because you're interested in starting a stay-at-work, return-to-work program in your organization, it can be on any level, it doesn't have to be at the state level, in your organization or community. Great. So that's, everyone said yes. Oh, wait, no, 50 percent, no, we're not quite there yet, 50 percent yes, 50 percent no. Does anyone need me to leave this up for longer? I think we have, oh, two-thirds yes, one-third no, and we might have one more coming in, 60 percent yes, 40 percent no. I think we got everyone, did we? Nope, one more. Okay, we're back at 50-50. All right, awesome. So next, so RETAIN stands for Retaining Employment and Talent After Injury Illness Network. We already talked about the funding. In addition to the federal funders, we do have an independent technical assistance group with AIR, American Institutes for Research, an independent evaluation by Mathematica for all the states, and they will be doing the final evaluations of the RETAIN studies. So we didn't get into the study aspect of the program in this talk because we really wanted to compare the states, but there will be some data in terms of employment and SSDI claims at one year post-program. The whole national RETAIN focuses on building state capacity and stay-at-work return-to-work strategies, and those strategies were based on a successful program out of Washington State that you all may be familiar with called the Centers for Occupational Health and Education through their workers' compensation division that reduced Social Security disability claims by a relative third. And as you'll see when we get into the state programs, the RETAIN program did not remain focused in workers' comp, but allowed for these strategies to be applied outside of the workers' compensation setting, and each state developed their program independently, which is why, again, for people who just came in, you'll see that the way the state information is presented is not all the same. Each state did develop theirs independently, and really, the development involved exploring ways to help people remain in the workforce. And a critical component of RETAIN is early intervention, so these programs were based on the, you know, the return-to-work curve that we all know in occupational health, which is the longer someone's out of work, the harder to return, and the critical window is in the first 12 months, sorry, 12 weeks of being out of work. And this slide lists the seven required strategies that RETAIN states were to use, and the focus was really on the return-to-work coordination, as well as education on best practices for stay-at-work and return-to-work, and then all the things that coordination entails, such as early communication and tracking progress, and also focusing on workplace interventions and vocational retraining and rehabilitation when appropriate if someone's not able to return to their job. And this map shows the five RETAIN states, which are Minnesota, Kansas, Kentucky, Ohio, and Vermont. Our Kansas and Ohio colleagues were not here, but they did provide information, and if you have questions about their programs, we don't want to answer for them, so we are happy to connect you with anyone in Ohio and Kansas if you have questions related to their programs. And you'll see that Ohio has some features that are different from the other programs and may be of particular interest because they did, and then there's also a program that focuses more on workers' compensation. So we started out with the similarities across the states. One of the requirements of the grant was the return-to-work coordination could only be provided for six months. We all incorporated best practice training for clinicians and employers, and then to set this up at the state level required coordination of services between a lot of state agencies, both on the healthcare and workforce side, as well as community organizations and other constituents that were relevant to the individual state environment. So we started with key features at the program level, and you will see there's a big difference in state population across the states, and so therefore, while we presented the number of participants enrolled, which was a very huge undertaking for all of the states, you can consider it in the context of the state population, and one point to note is that Ohio focused in three metro areas, Toledo, Cincinnati, and Youngstown, and those three urban areas had a population of about 4 million. And so the big picture message, you'll see each of us had a different lead grant recipient in the state employment sector, different healthcare partners, and different employment partners, and really the message is figure out what's going on in your state or in your organization or wherever you're starting this up, get connected, and leverage the existing efforts and resources, and understand where the gaps are that your new program can fill. Anything from our panel on that? I'll just add to the slide for the Minnesota Retain Program, I think that we were thinking that this was the lead healthcare partner that we put, so Mayo Clinic acted as the lead for our state, but we did have four sub-recipient healthcare partners that made up a network of retained healthcare throughout the state. Yeah, and that's a really important point because you do need a healthcare partner to coordinate the health part of work health coordination, and then where the patients come from or identified from in terms of their injuries and illnesses can be different organizations. And so you'll see both of those reflected in that row. Anything from Kentucky? We did partner with two academic healthcare systems within Kentucky, and also a healthcare system that was located in one of the larger counties. In Kentucky we have 120 counties. What I'm proud to tell you is that we enrolled participants in 113 of those 120 counties, so I think that's pretty impressive. And we also did partner very heavily with our lead grant recipient was Office of Vocational Rehabilitation, and we'll say more about that. Yes, great. And so then our next table is some of the key differences by participant and the type of participant we were enrolling into our programs. And so some of the big differences that you'll see is that Ohio focused on musculoskeletal cardiology, surgery, and some mental health diagnoses, and the diagnoses of the participants varied by program. In Vermont we focused on mental health because that is the most, we have one of the highest rates of young people receiving social security disability benefits, and the most common diagnosis is mental health. We unfortunately are one of the leaders in the nation for work disability in those areas, and I think globally across the program what advice we would give you is just, of course, what you're seeing in your practice as well is after COVID, just really make sure that you're incorporating mental health into your return to work coordination and programming. One of the things I wanted the panelists to talk about is, and one of the things we didn't put into the table, is the most fruitful recruitment strategies because, of course, starting this up, we tried a lot of different ways to identify people, and as we know, there's generally not a universal screening for work disability. Work often gets left out of social determinant of health screens that may be routine in your healthcare systems, and so we all, I think, had different experiences with what was productive and always happy to help if you are starting up and want some suggestions, but one of the most powerful tools is, of course, the EMR, and I'm going to let Minnesota and Kentucky talk about that because they both had different but fruitful ways of using the EMR. That's good. So in Minnesota, we, I think, like many of the programs, we thought, this is a wonderful program. It's really breaking down silos between healthcare, state government, workforce development, and other partners. We thought, kind of, if we build it, people will refer, and in phase one, we found that it was really hard to get providers to refer for patients to self-refer, so we ended up implementing some systematic ways to get patients to our program. One thing we did at Mayo Clinic was we got approval to add employment into our social determinants of health questionnaire, so now every time a patient fills out that questionnaire, in addition to saying how many glasses of alcohol they drink a week and do they smoke and do they have dental care and do they have food insecurity, we ask them a standardized question about employment. They answer in one of eight categories, and if they answer in a way where it indicates that they're kind of recently impacted at work by an injury or illness, we ask them what the last date was that they worked, and then that information populates. We created an employment registry in EPIC, so our retained return to work case managers, each week, they can screen that registry and see, kind of, we've coded it, anyone who uses EPIC, and I think many of the EMRs, the social determinants of health wheel, it's coded as, like, red, yellow, or green. We coded them that same way, so anything that's red means, like, call this person, we might be able to intervene early and help them get back to work. It's someone who's completely off work, they last worked eight weeks ago, they're still employed and they're not working because of their injury or illness, so we're proactively calling them. About halfway through, we also implemented an EPIC campaign off of that registry, where it would take those individuals that we were wanting to call, and it was automatically, every day, the next morning, sending them a message, either in their patient portal, or we would send it by snail mail if they didn't have their patient portal, saying, like, at a recent visit, based on, you know, some answers to your questionnaire, we thought that you may need help staying at work or getting back to work. These are some of the resources in the community, so we added the career force sites for American job centers, VA sites, and then we also added information about our Minnesota Retained Program for people that live and work in Minnesota. And that helped legitimize the program, so that when people, when our staff called, they were like, oh yeah, I got a message about this retained thing, and they were less likely to think that it was a scam call, which we got a lot of early on. And then the third thing that we did with the EMR, most recently, is we sent out blast emails to every patient that was seen at Mayo Clinic in the last six months that matched the demographic. So basically, anyone over 18, I think we did 18 to either 65 or 70, granted there are absolutely patients that are working beyond that. And then they had to live in Minnesota, so they, part of our criteria was that they had to work in Minnesota, we might not know that until they called us, but we got quite a few people calling us based on those blast emails that went out. And that was really effective. All those three things were how we got the majority of our participants in the program. Shirley, anything to add to that? Thank you. Well, we are on a relentless pursuit of solutions, as you can tell, because she mentioned very clearly that it was a lot of challenges in phase one, number one in the just priorities that physicians and providers had. Right in the middle of the pandemic, it was difficult to really get them to think about employment needs. So the EMR, we did embed that within three of the healthcare systems in Kentucky. And what we found to be most productive was really getting the information to the individual patient, really putting that individual in the lead role of making that decision that they felt that they were impaired and needed assistance to stay in the workforce. So we did the QR code that everyone became familiar with during the pandemic. As Minnesota did, we did include the criteria within that QR code. We messaged in a variety of ways. We did target certain diagnosis. That was not really as effective as sending retained messages to anyone who, say, for instance, was receiving physical therapy for some sort of a pain, diagnostic, scheduled for surgery, MRI, CT scan. We had an influx of what we called self-referrals come in from that strategy. And we knew when they came through our intake team that they had already determined to be eligible for the program. They lived in Kentucky. They were currently working or had worked within the last 12 months. They had some sort of a medical condition or impairment that they felt put them at risk of leaving that job or difficulty staying at that job. And lastly, it was that they could not have even applied or received SSI or Social Security Disability within the last three years. So that was our eligibility. We also did digital marketing that was outside that EMR that was very successful as well. But the EMR allowed us at discharge for also case managers, nurses to give that retained information to a patient at discharge. And then that person made the decision to mobile device, call us, queue our code. And that also generated a lot. Great. And that was a great segue to our next slide. I think just one more point on the participants. Initially, we started this before the pandemic. And at Vermont, we partnered. Our program was embedded into primary care. And we really wanted it. And Vermont has a care coordination program that's a state-funded program. And so we didn't want to be providing care coordination in a separate parallel program. So we embedded into primary care. We ultimately worked with 120 primary care practices. We said at the beginning, do you want a poster with a QR code where patients can self-screen? And everyone said, our patients won't know what to do with a QR code. And then the pandemic happened and everyone was ordering their French fries with their QR code. So the practices quickly shifted to saying they did want posters with QR codes. And so for us, we were across every health system in Vermont, we're a tiny state, so we had that luxury. Every healthcare system ended up participating. Everyone has a different EMR. So we really focused on communities around the primary care area and those community health teams that were already existing in the primary care medical home. So in terms of eligibility, Shirley already did a great job describing. There were core eligibility requirements from the state, and then, which is the, being active in the workforce, not applying for or receiving SSDI benefits and having an injury or illness that's impacting work and being within that 12-week window. And then other states added on. So you'll see that a couple of key features was in Minnesota. I'm just gonna say this for you, Lara, just because I wanna make sure we have time for Jennifer, that no legal representation or litigation related to the medical condition. In Ohio, the person enrolling needed to agree that the employer would be contacted to discuss the return-to-work strategy. In Vermont, we didn't do that because we had higher ability and other very, very strong workforce programs that really had the employer communication piece. So we didn't require that for participants because it may be happening through a voc rehab counselor. And then I think, was there one other? For Vermont, we excluded anyone who had an active untreated substance use disorder because there's a lot of substance use disorder in Vermont, and people who are actively using aren't ready for the workforce, but we would connect them with treatment, and if they did get into a treatment program, they could re-screen and join if appropriate. And was, is there one program, you guys, was there one program that was just work comp claims only, or no? I don't think, I don't think so, okay. So next slide, we wanted to, there's two slides on the return-to-work coordinator role comparison. What I would say is that this is where the intersection of services already existing in your institution or state becomes very important, and where to put these coordinators and what their role is is really defined by the circumstances and the environment. So Laura and Shirley, do you wanna talk about where your return-to-work coordinators were placed? Absolutely, so we made a decision very early on in phase one to embed the return-to-work, we call them return-to-work case managers within the healthcare team. So we actually hired them within our occupational medicine team. They report up through occupational medicine, they have full access to the EMR, they can message providers through the EMR, and they can message patients through the patient portal. So we found that that works incredibly well, and it offloads a lot of the administrative burden from the providers, because they aren't having to fill out a form to tell the case managers what they need to know. You have to be quick, Shirley. In following the COVID pandemic, we all had to go remote, and that was sort of a silver lining for us in Kentucky, because it did allow us to do remote work and reach those 113 counties that I talked about earlier. That's great, and on the Vermont side, one thing I'll say, you'll notice the names of the coordinators are all different across the program. And for those of you who came in before my introduction, these slides were all completed by the state, and so you will notice within the categories, things may be reported slightly differently, that was intentional. And if you have questions about Ohio and Kansas who are not able to be here, we can connect you with them after. I will say on the Vermont side, the reason we chose work health coaches was A, we really wanted to get that, because we were embedded in the primary care, medical home, community health teams, we wanted really to get to that connection with health, but also with the strong hireability and American Job Center's work going on in the state, they considered themselves to be doing return to work coordination, and so to make a distinction between the programs, we took return to work out of the title of our coaches, but they did, and you'll see across the bottom the credentials of the return to work coordinator team, and I think what all of us will say is that having a diversity of disciplines across your coach team is very helpful, and using that multidisciplinary expertise, coaches were frequently talking to each other and supporting each other, so we know a former work comp nurse case manager having a social worker, or a PT, or an ergonomist, or an employment specialist to talk to can be very helpful. This is also about the return to work coordinator role, and you'll see that really we all try to, I think the key here is figuring out a standard early intervention approach, but then customizing it to the circumstances of the participant, because of course most of us, as you can see from the other slides, we're dealing with a wide range of types of injuries and illnesses, so making sure that it was customized in Vermont, we called them work health assessments and plans, based them on the participant's work health goals, and then focusing on reducing the barriers, and then one of the other things is that you will always get participants coming in with something totally new and different that the coach team may not have experience with, and so having continuous education throughout the, for the return to work coordinators is really helpful, so you can pull in topics as needed for them to learn from experts. Anything else you all wanted to say on that slide? And then of course just a lot of communication, communication, communication, a lot of huddles, I think most of the states also had some experts that the coordinators could go to if issues kind of exceeded the typical coaching, coordinating role. In Vermont we have, and kind of we call it our return to work expert team, it's a hub, our coaches are in 10 locations across the state, and we, our experts had just scheduled office hours where coaches could drop in to ask questions throughout the week, and they also met with each other, and I think you all had similar structures to your program. Anything you want to say there, Shirley, that's new or different? Okay. In terms of measures, some states used validated surveys, others did not, and a lot of the measures are diagnosis based, so I think a lot of us took the approach of looking at more the risk factors and barriers for work disability generally, but certainly you can pull in measures for particular diagnoses. Okay, quickly through state dashboards, this is Kansas's dashboard, you can see that they had also enrollment across the state and great return to work rates, we don't have the final numbers because we just ended enrollment this week, but there will be more information on that coming, but again, very high return to work numbers. Shirley, do you want to talk about your state that looks sort of like a fluorescent, like a bench science fluorescent antibody experiment? We have it. That really depicts that we did reach those 113 counties across the state. We did end as of May 17th with 3157, so that's very close to the 3200 for enrollment. We had multiple referral partnerships and surpassed over 11,000 referrals as of this week, and great return to work percentages, 93% of retained Kentucky participants who completed their return to work plan are employed, were employed as they exited that interdisciplinary project, so this intervention works. And this is just, I do want to also mention, you'll see that the numbers, if you look across the slides, the total number of participants per program is different between the tables and the dashboards and the final numbers because, of course, these are active programs still happening, and when the data was pulled were the numbers that we had, but it gives you a sense of the numbers. And also, good return to work rates, and Minnesota dashboard, any points you want to make before we turn it over to Jennifer? Yeah, I'll just point out three quick things on this that stand out. I know this is a lot of data, so one thing is the top industry for participants that enrolled in our state was healthcare. Just under 20% of our participants were from healthcare, which is notable because Mayo Clinic employees actually weren't eligible because we have a preexisting return to work program that we kind of modeled our Minnesota Retained Program after, so these are participants from other healthcare organizations throughout our whole state, and I think that that shows the benefit to a program like this on healthcare and keeping healthcare workers at work. The other couple things are on the bottom right, that's a heat map of where participants came from throughout our state, and we also are very proud that we hit almost every county throughout the state. The ones that we haven't had a participant from are kind of on the edges and extremely rural, likely people that are self-employed farming. And then the last thing is, I think we might have been one of the only states that had equity benchmarks, so we included an equity benchmark that we wanted at least 15% of our participants to come from BIPOC communities, and we've consistently exceeded that. We ended just under 25% making sure that we were getting retained to those populations, so we had a outreach specialist that went to a lot of community events and went and spoke at churches and libraries and other community organizations to make sure that everyone knew about retained. Anything you want to say on your second slide? And then I think for the second slide, the one thing I'll point out is on the top right, our workforce development partner provided supportive services to participants, so those were things to help remove kind of temporary barriers to getting back to work, and the biggest one was transportation, so that was giving out gas cards. If gas or a car to get to work was a barrier, they provided that service to participants, and that was very helpful. This is the Ohio dashboard, and again, you'll see in their map, and for those of you who weren't here at the beginning, their program was in the three metro areas shown here. In terms of our map, the majority of people who enrolled had non-work-related illnesses versus injuries. Majority who enrolled were female, which actually is interesting looking at the, I don't know if you all saw the poster showing that women often come at least to work comp services later than men, and our map shows both where our participants enrolled from as well as the 120 primary care clinics that we worked with across the state. At this point, unless you all have anything else to add, I'm going to turn it over to Jennifer. I have to get out of this and to our video. She unfortunately wasn't able to be here, and Laura, you make a great point because we did not include, some of the dashboards have some of the race and other demographic and equity breakdown. We didn't highlight it, but we definitely can comment on that in the Q&A. Let me see if I can get this going. So maybe while you're pulling that up, I'll make one last comment, and that's one of the requirements from RETAIN was to include stakeholders, including from state government and our lead state organization for Minnesota was Department of Employment and Economic Development. As an OCMED physician, I can say, I'm embarrassed the things that I didn't know were going on to support workers. So programs like this that really bring together stakeholders, synergize efforts, and provide a lot of services for workers. I think this should be playing. Hi, I'm so sorry I can't be with you. I have COVID and so do my husband, and we're stuck here in Massachusetts. But I did want to share with you this brief case study starting from nothing in Rhode Island. As you probably know, I've been very involved as a champion for RETAIN from before it was born. My paper, actually my paper that I wrote to other people provided a vision and inspired RETAIN, which was a wonderful experience. And since then, I've gotten interested in whether RETAIN programs can start, or RETAIN-like programs can start spontaneously without a big federal ante. The $20 million price tag on RETAIN means that it might be very hard for other states to get started. So we decided to try and see if we could start from nothing, and it turned out that we decided to start in Rhode Island. And I'm having trouble again. Oh, here we go. Our intentions changed over time in this project. At the start, we were kind of cocky. We had never entered another state cold, and we learned a lot. So, sorry, I'm talking intimately. As I say, we wanted to start small, without a $20 million ante at the front end. We wanted to design a terrific service delivery program and take advantage of the lessons learned by the real RETAIN states during their initial period, and show the rest of the country that it can be done, and pioneer some of the ways for how we do it. Over the period of a year, when we had a planning and design and planning grant, we, at the end of that year, we were sadder, but wiser, and had learned a lot that we wanted to share with you. The money that we had for planning came from a multi-pronged state government grant program, and we were only part of their agenda, so we had to learn how to be a small part of a much larger, broader initiative. And we needed to learn how to speak their language, and then we also needed to learn how to help outside parties discover how our program aligns with their interests, goals, and capabilities, and respect and work around others' constraints. In other words, we had to learn that we were not the center of the world. And because Rhode Island is a small and very tightly knit, actually, some people would say, closed circle of state, we had to earn our way into being a trustable part of the community of Dupuiters, and we had to get on the gossip line, the rape line, because it's alive and well in actually every community. And in order to make our program make sense in the context of the larger budget in the state, we had to make our program affordable and start with a tiny service program. Over the year period, the program got tinier and tinier until we realized that we probably could get started with a solo practice, highly experienced vocational rehabilitation counselor with personal experience with life disruption due to injury and illness, and with some medical backup. So we did have some prior groundwork laid in Rhode Island that Webility, my consulting company, had done several projects with the largest workers' home venture in Rhode Island. We had some familiarity with the system and the players. And in 2018, Rhode Island actually bid to be a part of RETAIN, but was not selected. So there was already at the levels of pretty high management in the Department of Labor and Training in Rhode Island, so sympathy for the idea of RETAIN. And then in 2021, Webility helped design and own the charge work program for the workers' comp rehabilitation facility operated by the Rhode Island Department of Labor and Training, which here and after will be referred to as DLT. So the DLT of COO, Lockley, was a very positive, forward-looking, action-oriented leader. She had supported RETAIN's RETAIN bid, excuse me, reported Rhode Island's RETAIN bid. And during her involvement with the workers' comp early return program we were working on, she had bought into the universality of the work disability prevention model. And happily, she also oversaw the Real Jobs Rhode Island Partnerships program, which is the program where we eventually got our grant. So some favorable features, as favorable sort of pre-existing conditions in Rhode Island, was that this Rhode Island Department of Labor and Training oversees workers' comp and operates Rhode Island's Temporary Disability Insurance Company program, one of the first in the nation, by the way, and is the designated workforce system agency for federal funding and programs. For example, the RETAIN programs had to have as the lead agency the designated workforce agency. And DLT runs the grant-funded Real Jobs Rhode Island Partnership program. The Real Jobs Rhode Island Partnership program, which is called RJRI, funds efforts to strengthen Rhode Island's economy and business environment. It is aimed at strengthening Rhode Island's competitiveness as a state and strengthening the quality of Rhode Island and the place to live by partnering with employers to supply them with a high-quality workforce and by increasing workforce participation, especially among historically disadvantaged workers. And that yellow highlight is very intentional. I'm starting to learn that the right terminology will get you further than the wrong terminology. So an RFP came out, a solicitation for new partners in Real Jobs Rhode Island. And part of the RFP said that solutions, meaning proposals, aligned with the following priorities were strongly encouraged. They wanted programming with a focus on diversity and equity and inclusion, especially underserved populations left behind by the traditional workforce system. And they wanted both new hire training that is focused on improving people's careers through advancement and also incumbent worker training for the same thing, career advancement. So they weren't looking to just jam people into jobs. Ideally, they were looking to try and upgrade everybody's life through participation in this program. Now, Real Jobs Rhode Island requires that proposers, applicants, identify a targeted industry sector, region, and or target population. Their favorite proposals are when an employer in the shipbuilding industry or the jet propulsion industry or the manufacturing sector of some sort partners with a training company that's going to provide them with high-quality workers. Because as I said, a real part of the program is to keep high-quality employers in revet. They also, though, are open to proposals for target populations. And they are looking for or are open to adults with demonstrable barriers to employment, including but not limited to individuals with disabilities. You can see the whole list here. Individuals who are older workers, individuals facing behavioral or substance abuse issues. And you do not see newly injured or ill workers on this list. But because we had heard from the COO that she was open to what we were doing in the workers' comp side, it was clear that they would, we got a signal, that they would be open to a quality proposal on our side. So the summary of events to date was that in April of 22, the 60 Summons Project, Doing Business as the Alliance for Virginia Health and Work submitted a competitive bid with a proposed plan for year one. And then in June 22, we were awarded a three-year RGRI partnership. This program is interesting. You're a partner for three years. You bid competitively for the first year. And after the first year, as long as your project makes sense, it will be funded, unless there's not enough money available. And it turned out that that is a big caveat. So our first-year contract was awarded to design and plan the program overall. RGRI in 22 had $50 million requested by partners with $30 million available. And we ended up with a contract, as I say, though, our contract, somebody else set the amount, not me, at a ridiculously small $5,000. But the max we could have gotten would have been $25,000 to design and plan the whole program. So we did it as a pro bono. In September 23, we submitted a proposal to implement the program in year two, a non-competitive bid with the award contingent on funding availability. And it was not funded, because the amount of money available had gone down from $30 million in 22 to $17 million in 23. They said that they hope we will reapply. And they, however, they predict they're going to have even less funding for next year. They did encourage us to obtain partial funding from other grantors. And we're really happy to hear about our plans to start approaching local philanthropic organizations. They said they really bought into our idea. Just to continue here, verbally, the woman who runs the Real Jobs Rhode Island program said that they funded with a combination of federal and state money, and that there is federal money available for historically disadvantaged workers, and that in their view, newly injured or ill workers who are unable to work are historically disadvantaged. And this is the cool sentence she said. They are so disadvantaged, they don't know they're disadvantaged. So they have really gotten our message that people don't realize they're in trouble. And often, it needs active outreach in order for them to be able to accept services. So that's the story. We hope that we will find local philanthropic funding to help us. We've realized, and the state actually did comment, that there is more community development work required than we realized before you open your doors. And then the community development work actually continues after you open your doors. Because in fact, all the people whose cooperation we need are unaware of the existence of this group, or unaware of how hard it is to be in this position, and the preventability of some of the job loss and withdrawal from the workforce and prolonged financial and other kinds of distress. So first, we have to do community education on the existence of the group. Then we have to do community education on the existence of our program. And then thirdly, how specifically we want to work together with people. So we're planning to use the philanthropic funding for the community development position papers, conferences, things like that, and be able to put in a smaller bid to Real Jobs Rhode Island, which is the operational part of the program. Thank you for letting me speak to you today. Boy, I wish I could be there with you. I think the Q&A is going to be fantastic. Bye. We're going to have to switch back to where we are. So our hope is that this gave you a flavor of all of our unique programs with a lot of really great and different features. We left a slide in about some of our sustainability features. All of the programs are now we're in. Retain was a four-year program at Vermont. We call it our freshman, sophomore, junior, senior year. So we're all going into our senior year and looking ahead to ways to fund it. And some of the things we collectively, as a group of five states, are hoping to do that we weren't able to do in this initial startup and dissemination phase is, as Jennifer pointed out, funding sources going forward, expanding into the chronic work disability population, being able to provide return to work coordination services beyond six months, and really matching it to the participant need. This particular program from the US Department of Labor was looking at employment outcomes. We're also, of course, from the social drivers of health side, very interested in the health benefits of this program. How can we provide all of the state programs now have return to work training and competencies across the constituents of return to work? How can we make sure that education is out there? Is there a consensus training across the retained states? And then to Laura's point, and to all of us just making sure that we're reaching both current and historically underrepresented, underserved, under-resourced, under-recognized worker populations. In the retained program, workers had to have social security numbers. That limited us in our ability to reach migrant workers and other people without social security numbers or who did not want to share their social security numbers. And just really increasing the awareness that work is a really critical driver of health. I know we're preaching to the choir on that here. And then being able to help other states, programs, organizations build their own retained programs. So with that, Jennifer already mentioned this opportunity through Rhode Island. There are federal funds for, in Rhode Island, they call them historically disadvantaged populations. And Rhode Island has now determined that workers with injuries and illnesses who are work-limiting injuries or illnesses fall under that population. So you may be able to find some funding in your states that way. And we are going to open it up now to questions. And again, happy to connect you with the other two states who weren't able to come. And we can, yeah. Yeah, I'm Jim Brew. I'm the medical director for Bon Secours Mercy Health, occupational services in the Toledo region. Just to let you know where I'm coming from. And I'm sorry Christina couldn't be here today. Although I really have appreciated her keeping us informed, even though technically workers' comp is excluded from retained. But first off, I also want to make sure to wish Jennifer a rapid recovery. I don't know how many of you know how many decades, and I mean decades, that she has committed her life to the stay at work, return to work programs and how much work she's done in the state of Washington and so forth. So I really, really want to say, first off, I've appreciated everything that Jennifer has done. And I wish you to get well. So my question is, have you guys looked at differences between the different diagnoses? Almost everybody had some version of mental health, which is probably one of the most difficult diagnoses that are to get people back to work, versus musculoskeletal, which is sometimes a little easier because those tend to heal. So have you looked at that difference? And are you considering adding any other potential difficult return to work, such as TBI? So thank you so much. What's not on? So thank you so much. Jennifer, I don't know if you heard, but you got big kudos for all the work you've done getting us here. She's on my phone. And yes, so in Vermont, we're lucky to have a state employee assistance program called Invest EAP. And so they are one of our partners. And we have a retained funded EAP mental health counselor. And we offer all participants who come in universal brief screening and intervention survey, and the option to then, based on that screening, do the intervention part of the brief screening and intervention. And she also is able to connect patients. She has a great algorithm for, are they connected to the right services? Is it working? Do we need to add on or get people connected? I could go on about this for a while. One of the features of Vermont, we actually have, we rank fifth highest in access to mental health services. And we are the absolute lowest state in individuals taking advantage of mental health services. So we had huge barriers, just kind of that help rejecting behavior. So yes, it's a very different approach. And the state has a statewide initiative integrating mental health into health care. So it's really just for us about, again, just what is the barrier? What is the need? And knowing all the resources available. It is a lot more. And that's part of my, the six months was really a barrier in that with mental health, because it's a much longer timeline. And I'll just piggyback on that. I think right now, we have the opportunity amongst our states to do a sustainability pilot, where we kind of make a pivot and we think about possibly a different population or different interventions. One thing that we're doing in Minnesota is we're thinking about partnering with specialties where they do serve a lot of patients that have kind of acute onset injuries or illnesses, like TBI clinic, cardiology, where people have heart attacks, even the ICU. Any patient that ends up in the ICU that was working before is going to have a hard time getting back to work. So we're thinking about partnering with those groups to help their patients and hopefully help the providers and care teams to offload some of the administrative burden. Hi there. My name is Stephanie Smith. I do a lot of work for the VA for their disability assessments. And I just have, veterans were mentioned once. I was just curious if y'all have looked at that data in terms of, or collaborated with the VA in terms of vets who are receiving disability compensation payment and motivation for those folks to return to work. Just personally, I have some concerns about the chronic disabled identity and motivations to return to work. So I didn't know if that was discussed amongst you. I know. So veterans were absolutely included and welcome to enroll in RETAIN. We tried really hard to make a connection with the VA at the start of it to have the VA as one of the health care subrecipients and partners. And it was hard figuring out the path of how to do that. So one of our return to work case managers is actually a military vet and went out to several of the VA centers and did individual outreach talking to them. So I think we got a lot of participants that way. But I think that a program like this systematically, maybe when people come back from deployment or ongoing, would be really good to integrate into that population. Thank you. Corey Cronrath, Marshfield Clinic Health System. How you doing, Laura? Thank you so much for bringing this epidemiological study together and doing the hard work to bring it to us. My question is going to go more down the lines of, have you spoke to the health systems within the state that we're participating on if occupation is a required field for registration? And when I say occupation, I'm speaking North American Industrial Classification System, first two digit. So you can identify them by industry. At Marshfield Clinic, we were able to do this. And what it's helped us do is identify, one, social determinants of health, worker, non-worker. Two, we can look by ICD-10 code to industry. And are we having an uptick in pulmonary fibrosis within our manufacturing? And we have a research institute we need to look into that more. And so I would wonder which systems in your area are doing that, because now you can have local data and national data. So we, oh, yes. I just want to pause for one second. So it is 930. So we won't be offended if you transition to the next talk. And we will stay. Just one quick point on the mental health. I do retain to develop a cognitive return to work form that mirrors a physical return to work form. My poster is still up. There's a QR code. You can download it and use it. It's great for TBI, long COVID, and mental health conditions. So just a little, in case anyone's interested. I'll respond quickly to Dr. Conrath's question. So for Minnesota, at Mayo Clinic, we were able to incorporate the BLS, standard occupational classification system, into our EMR as an optional demographic feature. So it's not required at registration, which means we don't have universal data on it. I don't believe any of the other health care systems that we work with have that. But I think that that would be wonderful to standardize within all of the major electronic medical records throughout the US. It would be a great opportunity for research and for helping patients. Carl Auerbach, Albany, New York. First, I want to just flash back to a probably, I think it was a work fitness disability session meeting more years ago than I want to remember, when a young woman by the name of Jennifer something or other worked so diligently and hard on the return to work, stay at work type concept that has increasingly become part of what we as occupational physicians do. Thank you, Jennifer. My clinic takes care of underserved populations in New York. We do actually see some folks from Vermont. I have two terms here that I think are very important in this whole thing. One is mental health. Most of our patients have been out of work for many years. They have either had mental health issues that led to that or have developed mental health issues as a result of being out of work. And that link is important to understand and deal with. The other is motivation. Many of our patients don't care. They don't want to go back to work. They've settled into a pattern of getting their workers comp benefit, and that's all they want. And we try very hard to get them back into the life, at least, if not work. And it's exceedingly difficult. Thank you for the insights that you've had on these points. But I wonder if you could just comment a little further on those situations. The only thing I would say is I agree. Cognitive and mental health issues have really been exacerbated in the COVID pandemic and put a magnifying glass on that. What I think is key about RETAIN is it's early intervention. And you can't overemphasize that. A TBI may not be ready medically, but the hope and the motivation at the point of injury is why it's important to include nurses, first point of contact, your workforce agencies, collaboration among the OVR, the Office of Vocational Rehabilitation, and really tag into that service on an early intervention and your occupational clinics. Now, I worked in occupational medicine for 30-plus years, and it's really based on work best practices, what we're talking about in a non-work-related injury or illness. So I agree. I'll just piggyback on that. Our lead return to work case manager was previously a mental health case manager. And one thing that she mentioned about our population is that the vast majority of our participants have either a diagnosed or sometimes undiagnosed mental health or behavioral disorder that needs support. So one thing that we're thinking about for a future state is incorporating a social worker into our team to help with some of those things. Like, we have a lot of participants who can't maintain housing, who are getting evicted from different living situations that need that help, and then also doing some mental health case management training for all of our staff, even if the diagnosis is not specifically mental health. That's certainly impacting many people's return to work. Great. I think I don't know if there's another group coming in, but yes. And just one more quick point on that beat. When you are working with, no, no, come on up and say, to the, yeah, come on up, to these populations, people with substance use disorder often have felony history. And so it's important to be able to know how to do that and know work partners who can work with employees that have a felony history. Hi, this was a great talk, super interesting. I'm wondering if you guys would take it on the road. You know, we have occupational medicine residents, students in the School of Public Health, I think, in our social determinants of health course. This information is really important. It's a career pathway and a perspective that would be unusual for them. And it's fabulous. Great work. What organization do you work at? University of Illinois at Chicago. I tried to. We would love to. OK. I tried to organize this in Illinois, actually, and went to our Department of Commerce and Economic Opportunities. And I realized pretty quickly that it was an eight-headed monster that would require a lot of coordination. So I kind of backed out of it. But I think it's a really important realm. Thank you. We'll give you our cards. Anyone who wants to will be able to stay. We really appreciate it. We know we had a hot competition this morning, so really appreciate you all coming. And I'm happy to be available to answer more questions. Thank you.

RETAIN program

state early return to work programs

Laura Brear

Shirley Crone

program structure

program comparisons

challenges and opportunities

enrollment criteria

return-to-work coordinator roles

mental health issues