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RETAIN-CT History 

The following is a historical review of the RETAIN-CT grant pilot program and research study. The purpose of this program archive is to help those who are interested in Stay-at-Work and Return-to-Work (SAW/RTW) research, programming and implementation. 

Modeled after Washington state’s Centers of Occupational Health and Education (COHE) program, RETAIN-CT (Retaining Employment and Talent after Injury/Illness Network) was a U.S. Department of Labor (DOL) federally-funded quality improvement project across multiple states. RETAIN-CT was conducted in the Hartford region of Connecticut from September 2018 to March 2022. The RETAIN-CT team, consisted of CT DOL, UConn Health, Division of Occupational and Environmental Medicine (DOEM), along with collaborators from the American Job Center’s (AJCs) Capitol Workforce Partners (CWP), Community Health Center Association of CT (CHCACT), and Department of Aging and Disability Services (ADS) and other stakeholders.  

The grant was administered by the CT DOL. Karen Quesnel and Kathy Marioni managed and directed grant activities, partnerships, communications, contracts, reports, budgets and monitoring responsibilities. 

The program implemented early intervention strategies to help workers at risk for disability after an injury or illness by providing support mechanisms to Stay-at-Work (SAW) and Return-to-Work (RTW). The program provided a unique opportunity for the collaboration of clinical providers, insurers, injured workers, employers and state agencies. The RETAIN-CT approach included provider and employer training, and the use of very early RTW coordination by pairing participants with RTW Navigators. 

The research team was led by William Shaw, PhD, UConn Health, Dept of Medicine, Division of Occupational and Environmental Medicine (DOEM). For this study, some participants were paired with a RTW Navigator to help connect them with RTW information, resources and support. A control group of participants, nearly half of all participants, were not paired with a RTW Navigator but continued to receive care by their provider and participated in the surveys. This was a randomized control trial. Participants consented for research during enrollment into the RETAIN-CT program and completed surveys at baseline, 3 and 6-month intervals.  Each participant received $50 for entering the program and for each completed survey. As of this writing, a statistical analysis has not been completed to compare both study groups. 

Attracting workers (study participants), who were on a possible trajectory toward disability, was attempted first through insurance companies for participant enrollment. A second method of patient engagement by a more direct means through health care offices proved to be more successful in reaching the target population.  

Health care providers and their office staff personally helped in the recruitment of workers/patients from Fall 2020 – Spring 2022.

Outreach and Marketing 

Understanding the health care audience was critical for outreach and recruitment of our target participants —patients living with musculoskeletal pain, injuries or illnesses preventing them from staying at work (SAW) or returning to work (RTW). Establishing trust not only included the provider but the office staff who typically served as the liaison with the patient. Targeted clinicians, such as OEM Specialists, Physical Therapists, Occupational Therapists, Pain Specialists and Chiropractors, who treat musculoskeletal disease, pain and injuries were empathic to the work place needs of their patients and often wished they could do more to help them. Finding and educating providers who understood the need for SAW/RTW assistance to help their patients was a win-win for the RETAIN-CT outreach team. Provider training was held in-person (pre-pandemic) to teach RTW concepts then transitioned to video online sessions (Cisco Webex) during the pandemic. Many of these specialists saw patients on a regular basis and formed good patient/provider relationships allowing more opportunities to recommend RETAIN-CT participation. Some of the providers and office managers were more charismatic and the process of recruitment seemed easier for them.  

UConn Health, DOEM research and medical staff took the lead role in provider recruitment and training. Through invitation, interested providers were asked to register online for provider education. Training to both the practitioner and the office staff on patient enrollment techniques commenced during less clinically busy months of the pandemic. Understanding the needs of health care practices was critical to recruitment success and once the offices became busy, it was imperative to have a quick enrollment process established. Janet Caldwell Cover (UConn Health), serving as the RETAIN-CT Outreach and Marketing Coordinator, offered many ways to support the providers with step-by-step guides and upon request offered direct patient enrollment. For providers who enrolled several patients, the enrollment process became systematic. For those with many qualifying regular patients, there was a flurry of activity in the beginning and after a few months a decline, catching only new clients entering clinics. True integration of this RTW practice in the clinical office setting requires time to educate the value and benefits of RTW coordination and time needed to build this practice into their routine. Unfortunately, Phase 1 pilot funding ended after only 12 active clinicians realized the benefits to their patients. Starting from patient enrollment, through RTW navigation, to implementation of a RTW plan with hopefully a positive RTW outcome that was then messaged back to the provider, was the loop of communication needed to established trust and confidence by RETAIN-CT clinicians.

Training slides
121 clinical providers received in-person or online program orientation training.

RETAIN-CT 2.0 provider training slides
RETAIN-office staff training

Enrollment forms (three, each in English and Spanish languages) were submitted by the clinics to UConn Health by fax or email. The patient/worker consented for the research study and enrolled into the program by completing the following forms.

Consent Form
Patient Cover Letter
Participant Enrollment Information Form: Part Two
Participant Enrollment Information Form: Part One
Consent Form - Spanish
Worker Form Part 1 - Spanish
Provider Form Part 2 - Spanish

Marketing Materials

To keep providers engaged and to continue to attract new providers, regular communication material was distributed by email and in person.   

Newsletter
A monthly e-newsletter gave providers and office staff more information on featured topics such as the RTW Coordinator process, vocational training and ergonomic services. It served to encourage enrollments, continue RTW education and to report on RTW success stories. It allowed our medical and research team to share topical research publications and links to our providers and it helped to promote RETAIN-CT Project ECHO RTW Healthcare Provider Trainings.

Newsletter samples
Issue 1 E-Newsletter
Issue 2 E-Newsletter
Issue 3 E-Newsletter
Issue 4 E-Newsletter
Issue 5 E-Newsletter
Issue 6 E-Newsletter
Issue 7 E-newsletter
Issue 8 E-Newsletter
Issue 9 E-Newsletter
Issue 10 E-Newsletter

Marketing communications pieces were developed by professional service providers to brand RETAIN-CT, add colorful graphics and photographs depicting workers from all walks of life, to communicate and visually illustrate the credibility of the program.

  • A two-pocket style marketing folder was used to:

  • contain information presented to the provider

  • house information specific for office staff recruitment training or

  • hold enrollment forms, a flyer and a letter to hand to participants

Also, other materials included:

  • RETAIN-CT business cards for outreach staff

  • Tri-fold color brochures for program invitation

  • Post-it-Notes with RETAIN-CT imprinting served as a leave-behind at provider’s offices.

  • RETAIN-CT masthead used for print and email communications

Consumer based videos
As part of the legacy of the RETAIN-CT pilot project, a YouTube video series was developed to simulate the Return-to-Work Navigators/Coordinators role. A virtual Jill avatar offers advisement including CT state resources to support a worker as they are facing hard workplace questions and assessing their own ability to return to work. Some person-to-person assistance may be available, post RETAIN-CT, depending on the CT state assistance needed. The 12-part video series offers many of the free resources recommended during RTW Navigator-to-participant sessions. A RTW resource guide, developed in March 2022 is a comprehensive list of services suggested in the YouTube videos and accessible in the link below.

Return to Work After an Injury or Illness Video Series

Connecticut Return to Work Resources
A guide to help injured or ill workers manage available services and supports in CT. This information is useful for the provider and employer as well.

RTW Coordination
Participants received RTW coordination services from RETAIN CT Work Navigators, Kate Hayden (UCONN Health) and Jill Larmett (Capital Workforce Partners). In addition to return to work/stay at work strategy implementation, the RTW Navigators assisted participants with accessing other necessities such as food, energy assistance, affordable housing, assistive technology, ergonomic equipment, and referrals to additional resources. They also implemented Integrated Resource Teams with RETAIN’s partnering agencies, the Department of Aging and Disability Services, Bureau of Rehabilitation Services and Workers’ Rehabilitation Services coupled with the American Job Centers, for participants that needed training and job placement assistance in a new field. RTW Navigators received guidance from the RETAIN team experts via weekly case conferences.

Our approach to return-to-work coordination in RETAIN-CT was an individualized, worker-centered approach that applied problem-solving principles to encourage a safe and sustainable return to work. The goal of this approach was to understand from the worker perspective their job demands, workstyle and work habits, pain coping strategies, organizational and financial constraints, and other psychosocial or workplace circumstances that may need to be considered in planning an effective return-to-work plan. In addition to a worker receiving quality, evidence-based health care treatment and evaluation for a musculoskeletal disorder, they may also benefit from a facilitated analysis with solution-based brainstorming, along with coaching, support, and workplace communication and outreach, uniquely tailored to their specific situation.

By providing face-to-face or telephonic, individualized RTW coordination sessions in a neutral setting, we hoped to establish greater rapport, understand workplace demands in more detail, identify more explicit and solvable problems, and identify and implement more employer accommodations, all under the direction and involvement of the worker and their employer, with oversight from their care provider. The two primary components of the RETAIN-CT RTW coordination efforts were to engage in problem solving skills training with the worker and to orchestrate a work-site walk-through that would enable a more individualized RTW plan between the worker and their employer.

For more information on the RTW Coordination services, please refer to the RETAIN-CT RTW Coordinator manual.

RETAIN-CT Project ECHO Series 

Health care providers including RETAIN-CT provider registrants from multiple disciplines and specialties were invited to be part of this well established and respected, best practice care methodology to promote peer case-based learning. Facilitated by Michael Erdil, MD, FACOEM, eight successive monthly sessions featured subject matter experts.

 

For more information on Project Echo, the topics and references shared at the meetings, please refer to the ECHO RETAIN-CT Series. 

Special Presentations 

In February 2022 Health Resources in Action (HRiA) presented “Preventing Injury, Pain, and Opioid Use in the Workplace Training” to CONN-OSHA, CT’s Occupational Safety and Health Administration Breakfast Roundtable Group. The session was designed to educate and build skills around understanding how workplace conditions may lead to injury, pain, and opioid use; explore strategies to create a work environment that will help prevent opioid use and addiction; and identify workplace strategies that support treatment and recovery. Work plays a central role in the lives of most adults, and can support people in health and recovery, but for some people, is a pathway to addiction. High stress, heavy lifting, repetitive motion, and lack of clear safety protocols are conditions that can cause injury, illness, or pain. Forty-two (42) participants attended this training.

https://www.ctdol.state.ct.us/osha/Breakfast/Archives/02152022/Index.htm 

In March 2022, RETAIN-CT Team members prepared and presented 3 training sessions to American Job Center staff including directors, managers, frontline staff, career advisors and business services representatives on “Return-to-Work Strategies in a COVID-19 World.”  Occupational health experts and a Return-to-Work Navigator 1) discussed what was learned during the RETAIN-CT return to work and stay at work (RTW/SAW) pilot project, 2) provided practical approaches in assisting workers/customers during COVID-19, 3) included education and resources for RTW/SAW, mental health support, and assistance for those suffering from prolonged COVID-19 symptoms or “long-COVID”. Over 200 participants attended these sessions.

Additional resources shared with providers during Project ECHO sessions

CDC’s Post-COVID Conditions: Information for Healthcare Providers
The CDC released interim guidance for the evaluation and treatment of patients with post-acute covid syndrome.

The Back Book  patient advice pamphlet on back pain.
“The Back Book” that was developed in the UK as a simple patient advice pamphlet.  Dr. Shaw finds this to be one of the best brief no-nonsense guides for patients and it is now freely available on the web to be shared with patients.  The document is going on 40 years old but the advice is still good. 

Safely Returning America to Work  – COVID-19 RTW guidance for industry

Special thanks to our supporters and contributors to RETAIN-CT

Connecticut Department of Labor

Karen Quesnel,

RETAIN-CT Project Manager

Kathleen Marioni,

Director

 

UConn Health

Occupational and Environmental Medicine

William S. Shaw,

RETAIN-CT Research Lead

 

Matthew Brennan

Janet Caldwell Cover

Dr. Lenworth Ellis

Dr. Michael Erdil

Brittany Gaines

Jennifer Garza

Katherine Hayden

Dr. George Moore

Sara Namazi

Thomas Varghese

 

Capital Workforce Partners

Jill Larmett

Shelly Henderson

Mohamed Chaouki

 

CT State Dept of Aging and Disability Services

Bilaugn Florius

 

Community Health Center Association of CT

Russell Dexter

Christina Del Vecchio

Kelly Halkyard

Funding Acknowledgement

 

The RETAIN-CT program was fully funded by the United States Department of Labor under Cooperative Agreement No. OD-32541-18-75-4-9, in the amount of $3,110,280. This website does not necessarily reflect the views or policies of the U.S. Department of Labor, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. This program was administered by the CT Department of Labor. © 2022 CT Department of Labor


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