- [Narrator] Welcome to the RETAIN Kentucky, Retaining Employment Talent after Injury/Illness Network HealthCare Training. I'm Kathy Sheppard-Jones and today I'm gonna talk with you about the possibilities and resources that are available to your patients and about helping those patients retain employment after an illness or injury. In this training, we'll first discuss the impact of how disability is defined and why that's important across systems including healthcare and employment, particularly now that we consider the COVID-19 environment and how it affects how work is done. We know people exit work for a variety of reasons related to illness and injuries, we'll also recognize the role of universal design and accommodations and employment. We'll talk about return to work/stay at work strategies that are related to non-occupational injury and illness that are used by the RETAIN Kentucky program and show you some ways that you can support your patients to access retain solutions such as referrals, case management and support options so let's go ahead and dive in. From a legal perspective, the Americans with Disabilities Act of 1990 or the ADA gives us good underpinning of disability when we're thinking about the reasons why employees may exit the workforce. The ADA defines disability as a physical or mental impairment that substantially limits one or more major life activities or bodily functions, a person with a record or a history of such an impairment or someone who is regarded as having an impairment. Now, major life activities include things like caring for oneself, performing manual tasks, seeing, hearing, breathing, eating, sleeping, walking, standing, lifting, bending, speaking, learning, reading, concentrating, thinking, communicating and walking. Bodily functions include the major systems within the body. Now the ADA is sweeping legislation that protects people with disabilities from discrimination and a particular interest to us and this presentation is the protections that are around employment under the ADA. Now we're gonna talk about reasonable accommodations shortly and it's important to know that to be covered by the ADA in the area of employment, a person with a disability must be considered to be qualified. Now a qualified person is one who meets the requirements of a job in terms of having the required training, education and experience that are required in that job position and someone who can perform the essential functions of the position either with or without reasonable accommodations. The World Health Organization or WHO further expanded on the defined elements of disability. The WHO definition includes impairment and activity limitation, remember how the ADA refers to life activities but the WHO definition adds in another important element and that is participation restriction. And this is really about restriction in different environments that are found in daily activities like working in the community, to engage in social and recreation activities and getting health care. This means that we now have included a social component of disability because we're talking about participation restriction and the person's ability or inability to participate in society. Therefore, I want to suggest that when we think about stay at work and return to work issues, that it gives us an opportunity to think about disability from a social model. Now, in this model, disability only occurs within the context of society and environments. Disability is considered a collection of conditions that are in fact created by the social environment. For certain people still experience impairments but they're only disabled when the environment is not accessible to them so here's an example, a person they have a mobility impairment and that person doesn't walk but that in and of itself isn't disabling because the person uses a wheelchair to get around. Now, if the person is able to do all of the things that they need and want to do in the day, sure, they still have an impairment but may not consider themselves to be disabled. Now, if that person couldn't get to their job because there are stairs and no elevators to get into a building or if there's no accessible transportation, perhaps the workstation is inaccessible to them, well that's when the impairment becomes a disability so let's consider that for a moment. The social model of disability is both contextual and environmental. It puts the onus or responsibility on the environment and not the person. Now in the picture on this slide is a van with a ramp that is extended out into an access aisle that another car is parked in. Now, this removes access to the vehicle for a person who is needing to use that ramp to get in and out of their car. Now, I'm highlighting this point to get us thinking about those things that disable employees from being able to successfully stay at or return to work. The impact of COVID gives us another way to consider disability and work. When we talk about the barriers that workers are facing right now because of COVID, many of them revolve around isolation and loneliness that many of us are feeling through the disruptions to routine, concerns about access to health care, quality education for our kids and employment and the subsequent ability to be economically self-sufficient, right? So if we assess each of these areas individually, well, they also happen to represent historic and long-lived disparities that are experienced by people with disabilities. We know that employment, education and health outcomes for people with disabilities have lagged behind people without disabilities for generations. Quality of Life indicators in general show that people with disabilities are more lonely and less satisfied with life than those without disabilities. I mentioned this because right now, these concerns are being experienced by people who would not have previously been considered as having a disability but who are wholly disabled by our environment. While there are some devastating experiences that people are going through right now, for certain, we're also in a time where we can truly reassess what it means to have an inclusive workforce because people are experiencing employment-related issues now that may lead to their subsequent disengagement from the workforce, therefore understanding stay at work and return to work strategies are more important now than ever. So let's talk about this. Each year, millions of workers experience on and off the job injuries or illnesses and while there is rightly a strong emphasis on occupational injuries, non-occupational injuries and illnesses are eight times more frequent than those that occur on the job. Now, regardless of the cause, research tells us that if a worker leaves their job due to illness or injury, the odds of that employee ever returning to the workforce drop 50% by the 12th week after injury or illness onset and after a year, the chance of that person ever returning to work decreases to almost zero. Well, in these situations, workers may actually be moving from short-term to long-term disability benefits and then winding up at the federal disability, Social Security Disability Insurance rolls, SSDI, often never returning to the workforce at all. So this has a negative impact on the economic outlook for states, for employers and employers are faced with employee turnover that comes from those vacant positions that results in lost productivity and resulting decreased output. The main driver of the cost of disability to employers in fact and society as a whole are those numbers of days, weeks, months and years that are lost to disability. Well, what this means for Kentucky really is a public health crisis and that arises from household economic instability and disparities across life outcomes that include health. In fact, Kentucky has over 30% of adults with a disability. As I mentioned, there's a significant disparities that exist and there's also a significant gap and workforce participation between people with and without disabilities. Over the last decade, it's remained relatively unchanging at roughly 40%, this is startling but it also reflects those other disparities experienced by people with disabilities both in Kentucky and across the country, where people with disabilities have poor health outcomes including obese, inactivity, smoking and high blood pressure. People with disabilities also earn less, they exit the educational system earlier and are more like to live in poverty. So, we're setting the stage right? Think about that delicate balance, if you're off work for injury or illness, life is disrupted. In Kentucky, we see issues that revolve around community resources that people have and need. What we're finding is it so often it's not necessarily that impairment, it's the social and environmental factors around the impairment that become the most disabling. If you have to be off work for surgery and you're in a no pay status, well, then you can't afford child care, you can't afford your groceries, you may be having difficulty with transportation, you may not be able to make your rent payment. A paycheck to paycheck existence is really like a delicate cake and it's gonna crumble if one of the ingredients is missing. We certainly know the patients who participate and stay at work/return to work programs benefit by keeping their worker identity and everything that goes along with it and that includes the ability to continue to pay the bills and maintain that economic self sufficiency and keep those jobs skills. There's also improved health outcomes, a reduce risk of relapse and reinjury and of developing those secondary conditions that can be more impairing than the initial injury or illness itself. And we can see things like mental health and depression issues, potential substance use disorders and just a downward spiral that can really become hard to stop. Patients having enhanced physical conditioning in mental health and alertness is gonna happen with less relapse and reinjury because you're managing the illness and maintaining routine and therefore keeping some level of physical activity. You also have improved satisfaction with healthcare, with quality of life all the way around and satisfaction is really considered one of those key indicators of quality of life. And by keeping daily routines, patients can keep those social connections, social support networks intact. Research shows that most people are happier when they're working. People have a need to feel productive, be valuable and to be valued. Of course, there's also gonna be reduced overall stress on the family of your patients. Healthcare is another primary beneficiary of stay at work/return to work, if we use a mindset of keeping the patient employed and connected to the job, research tells us that there's a faster patient recovery. Stay at work/return to work focus also means that healthcare providers are gonna have more access to a patient's job functions. The emphasis gives healthcare providers alternate treatment options to consider in the plan of care and it embeds health care in the development and success of stay at work/return to work program development. Stay at work/return to work also emphasizes those all important social determinants of health and lets us make gains in this public health crisis. Keeping patients connected to employment isn't a healthcare issue, it isn't a workforce issue, it's both and therefore it requires a multi-systems approach to be successful. Now, I think we all know that employers experience benefits with stay at work/return to work and that includes reducing staff turnover which is widely acknowledged as the most costly personal expense for employers. And avoidable turnover, in fact, can cost employers from one third up to 100% of the annual salary of that worker to hire and train a replacement. In addition, employers benefit from the improved productivity, processes, morale and profits that go along with a fully staffed organization. Here in Kentucky, we found universal design to be a strategy that can be extremely beneficial in stay at work/return to work and I'll speak to that a little bit more in a moment. Employers are also potentially spending less on workers compensation benefits and premiums for private disability insurance. It really sounds like a win, win, win because also the state benefits, Kentucky benefits, what does it mean? Well, again, research indicates that with modest assistance many employees who left the workforce could have returned to work. State and federal governments benefit from a strong workforce in so many ways, state economy expand, fiscal health improves through increase in tax revenues from wage earners and having lower liabilities for state and federal social and social security programs and that includes state workers compensation programs, SSDI that I mentioned before, Supplemental Security Income or SSI, Medicare and Medicaid. In fact, there are a variety of programs that can be used by states and these include return to work programs such as modified duty, part time work or alternative work and disability benefits programs such as paying out a proportion of disability benefits while an employee may be returning to work and earning less while making that transition, along with actions taken by states to subsidize employers for getting employees back on the job. Those are things like tax credits for job modifications, discounts on insurance and the like. And there are programs also that exist for state employees and of course, state vocational rehabilitation programs and wellness and injury prevention programs that can be, you know, ultimately employer-driven. We know that states vary in their approaches and again, this re-emphasizes that idea that for an employee who hasn't worked disability, there are often multiple systems that are involved and that play a major role in the work outcome. Ultimately, this means that working works, it works for patients, it works for healthcare, it works for employers and it works for states and just society as a whole. All right, now let's talk for a moment about universal design. Universal design is an area we focus on in retain and that has even broader implications for all workers who have shifted to a remote work focus as a result of COVID. We define universal design as a set of strategies around making environments, products and policies that are usable to the broadest array of people. Universal design has been around for decades, really but it's expanded its meaning and when we talk about universal design, what we really are saying is that we consider spaces to include physical and virtual environments. We are including people with disabilities as beneficiaries of universal design but also people across the lifespan who have different styles of learning, different preferences and different needs. When we think about using universal design at the outset, we in fact, may eliminate the need for accommodations because if a space is created with accessibility in mind right from the start, it's less likely to require retrofitting after the fact. I'm not saying that we don't need to provide accommodations for qualified employees who need them that's of course we do. We'll talk more about accommodations in a few minutes but we really have two sets of strategies to use to maximize someone's ability to be successful in a given environment. We have accommodations that are used for an individual and we have universal design that can benefit all people and when we use them both to promote the full participation of everyone, we have inclusion. So really, just remember, universal design is a broad set of strategies around the design of spaces, products and policies that are usable to the broadest array of people, it's really pretty exciting when you think about it. So these universal design principles can be used in building products or environments so that they're accessible to everyone regardless of disability or not and I wanna just talk really briefly about seven principles of universal design. Principle one is equitable use and that means that the design is marketable to people with diverse abilities. An example of this would be incorporating a ramp front entrance for everyone to use. Now principle two shows this flexibility in use and this really reveals that universal design is able to accommodate a wide range of individual preferences and abilities. An example of the second principle would be a deck of playing cards that indicate the number and the suit whether it's being held in the person's right hand or left hand. Principle three is simple and intuitive use. This is really user friendly design, because it's simple and intuitive and the use is easy to understand regardless of the person's experience, knowledge, language skills or concentration level. I think smartphones are a really good example of this, to sell as many phones as possible you want people not to need to take a class to be able to use them. Principle four talks about perceptible information. So basically, the design communicates information that's necessary for that individual, regardless of their ambient conditions or their sensory abilities and what this means is that information is provided in different ways. Like at a crosswalk, there is a person on the display that lights up when it's safe to cross but there's also an audible signal or a chirp for someone who may not see the display. Principle five is tolerance for error so it minimizes the hazards or the adverse consequences of accidental or unintended actions. An example of this would be a ramp that includes railing or is extra wide so if a person gets off course, it minimizes those hazards or the potential for bad results. Now, when I saw negative six, low physical effort, my favorite example is the magic dispensers of things, right? So that could be paper towels, it could be hand sanitizer that we're all using like everywhere or those magic hand dryers that turn on when you wave your hand in front of them. Another example would be the presence of a shower bench in a shower. Principle seven, size and space for approach and use. We see that the size and space that's allowed for is regardless of a person's body size or posture or their mobility, it provides ample room to do what is meant to be done in that space. And so that gives us a quick look at universal design principles and it's something that if we start with that approach can really help us in creating that culture of inclusivity. I wanna talk on this next slide here about some of the categories that the United States Equal Employment Opportunity Commission recommends when considering reasonable accommodations. Now universal design I just talked about it and now you look, it's the first one and restructuring of existing facilities is one that I wanna give some some examples around. This can be things like curb cuts or elevators, accessible restrooms, it's pretty straightforward physical accessibility. Now another category for reasonable accommodations are those things around restructuring of the job itself. Now those could be things that might result in changing some of the duties as long as they're not the essential functions of the job. Change your work location is another category and this would be if we're doing something like telecommuting or home-based work that we're all familiar with at this point, it could be around changing the environment where the temperature or the lighting may be improved or enhanced or different in some way. The next category is around modification of work schedules and the ability to utilize flex time and or have reduced hours. The next category is reassignment to another position. Now, in this case, there must be a vacant position available and it must not violate rules around seniority or union rules and truly, reassignment is often considered a last resort. There can also be modification of equipment that happens and that could be using lifting hook on an assembly line, it could also mean something around the use of just using apps to be able to access the equipment so you may not be using the same switch if it's inaccessible but you certainly could turn on a light through a smartphone application. The next category is installation of new equipment. Now this would be things such as incorporating cognitive support apps, voice activation software, using a large monitor, those kinds of things that are going to enable the worker to access all parts of what needs to be done on the job through that reasonable accommodation. Another category of reasonable accommodation is the provision of technical support such as through using software or again apps like Adobe Read Aloud or having a qualified reader or interpreter available. Alright, so I've talked a lot about ideas and principles of things but let's get to examples of reasonable accommodations and this is where we show the connection between the functions of a job, the disability factor that's involved and a possible accommodation solution. Now here in this first example, a person worked for utility company and this person was a lineman and you can imagine, you know, going up and down those utility poles and he had a torn ACL and a subsequent repair so as far as that accommodation goes, that employee had a bucket truck to be able to elevate to whatever the needed level was on the pole that he had to reach instead of having to manually go up and down the pole. In some situations, when the utility lines weren't on the street, for example, if they were behind the house or out in a field and couldn't access it by the bucket truck, the combination also made sure to include that he had a co-worker that was partnered with him so that that co-worker would have the ability to climb the poles when necessary so that's one accommodation. Now this next example of accommodation is we're looking at the job function of healthcare worker who is required to move a patient in a hospital setting from the bed to the chair and this employee had a lumbar/strain sprain and the accommodation was twofold, right? So additional training was done to show that employee how to do a two person lift but what makes this even more interesting is that in this particular job at the health care facility, there was a Hoyer lift and it had been purchased and was sitting in a closet and the lift was located and some additional training was done and on review of the use of the Hoyer lifts and that was used as an accommodation by this employee as well. But in a sense, the use of that lift was also a universal design feature because it could benefit a variety of employees in that health care facility so it's almost like the best of all where we're having an accommodation, it's helping the individual but universal design that is accessible to a broad array of employees and making it easier for them to do their jobs. So a current model for implementation of stay at work/return to work is the retaining employment and talent after injury or illness network demonstration projects. This effort is funded by the US Department of Labor Office of Office of Disability Employment Policy in collaboration with the Employment and Training Administration in the Social Security Administration. Through RETAIN, state teams that include multiple system partners like I've been talking about are implementing and evaluating early intervention strategies. Remember how early intervention is the key to keeping those employees in the workforce, right? And these strategies are designed to help injured or ill employees return to their jobs. So let's talk about RETAIN in Kentucky. The Kentucky Department of Workforce Investment was awarded three and a half million dollars for this multi-systems change demonstration grant. University of Kentucky and the Council for State Governments are part of Kentucky's efforts. The project is working across healthcare employers in public health that provide supports to people who experience an off the job injury or illness. Here in Kentucky we're focusing on non-related work injuries and illnesses because as I mentioned earlier, they're eight times more common than those that occur on job. And in a state with a large proportion of people with disabilities as I also mentioned, we need to remember a disability represents a characteristic of workforce but that disability isn't the outcome. So in order to make some sustainable change, we know that it's not just about helping individual employees, it's also about shifting our frame of reference and what it means to work and have a disability and that has to happen across sectors, it has to happen across systems. So we're fortunate to have partners that represent these systems and in different sectors of state government across different agencies and cabinets and we have strong connections and leaders that realize that this work is truly transformational for the Commonwealth of Kentucky and that we're gonna succeed if we're able to have successful partnerships. We talked about the reduced likelihood of a person returning to full employment and how it drops significantly the longer they're off work. With a really easy referral process, our return to work coordinators engage and connect patients through responsive and personalized contact and usually it's really short, it's within two days of referral and we work with your patients to coordinate and navigate resources. And what we found to be most successful in RETAIN Kentucky is the use of occupational health best practices for worker health care. We're using early intervention strategies that emphasize vocational case management, peer support, assistive technology and universal design and training. Training, training, training and the training is aimed at employers, the training is aimed at healthcare all around helping to educate people, systems, individuals about stay at work/return to work. We use a team approach to support people to stay at work or return to work. The team provides coordinated services and supports for early return to work or stay at work problem solving, goal setting, organizing resources, providing referrals to community resources, job counseling, job site analysis and then always being an engaged partner to make community connections. We have assistive technology specialists who provide assessments of work sites and work situations to assess how well the environment fits the needs and preferences of the person and identifies the solutions that are needed to improve that fit. We define assistive technologies as any object, tool or device that makes life easier and the team also includes peer support specialists who provide mentoring and advocacy skills building. Who is eligible? Patients who have an injury or illness that has occurred off the job. This includes people who are currently working but are at risk of not staying at work. They must have been employed within the last 12 months or be employed now. People who may not have applied for or be receiving federal disability benefits including social security disability insurance or supplemental security income. Stay at work/return to work emphasis can make a real difference with your support, this could be you. Any one of us can experience an injury or illness at any time that makes it challenging to stay at work or get back to work. Having a systematic evidence-based and evidence-informed support and resource is essential to help people navigate what can be a complex maze of healthcare and job related options at a time when they're struggling with their healthcare needs. So RETAIN Kentucky gives us a powerful set of tools to keep people employed, productive, contributing and included. So how you engage? Well, your role and the path that healthcare providers take makes a difference. Ultimately, there are many ways you can promote return to work for your patients and stay at work for those who may be at risk of losing due to disability as defined by the ADA or is defined by the social model disability, whichever you like. First, know that you play a part in setting the tone, organizational culture is influenced by the way that we regard disability and the way we assign value or lack of value to those who are labeled as having a disability and as such, consider promoting an inclusive workforce. We've talked about job descriptions and light duty, reassignment or transitional work and how we can utilize these as resources that can help patients stay at or return to work. We model that work is an expectation for everyone, let's not place our own biases and assumptions about who can and cannot work, everyone deserves the right to work and the dignity that it brings. We talked about universal design, it's also important to understand accommodations and what is legally required, hopefully the examples that we shared helped you to do so. So this slide is a list of some of the resources that should be part of your tools. They include RETAIN, also includes the State Vocational Rehabilitation Agency that serves the whole state, in Kentucky that's the Office of Vocational Rehabilitation. And Kentucky OVR helps people with disabilities prepare for, enter or advance in competitive employment and OVR also helps employers with recruiting, retaining and accommodating employees. There are Centers for Independent Living or CILs in Kentucky. These are community based nonprofits that all provide a core set of services and these services also include peer support and referral. Kentucky also hosts a State Assistive Technology Projects known as the KATS Network. Regional Assistive Technology Centers in Kentucky provide assistive technology services that include training and assistive technology learning libraries, pretty cool stuff. I included Job Accommodation Network and it's actually a national resource but it's a really good one to know about because it connects accommodations and employment and services are free and you can access them at askjan.org. The last one that I wanna mention today is University Centers for Excellence in Disability. There are 67 new sets around the country and these organizations are all housed within a university and they have a shared vision that people are fully engaged in society across the lifespan. And while different uses have different strengths, all of them operate with that common goal toward a nation where people with disabilities are full and equal members of their communities. The UCED in Kentucky is housed at the University of Kentucky and it's called the Human Development Institute and HDI hosts over 50 projects, the priority areas in leadership, early childhood education, employment, universal design and assistive technology, health and wellness and research and evaluation. There are also a variety of continuing education programs and pre-professional training opportunities available and one of which includes a certificate in universal design along with a graduate certificate in developmental disabilities. So what you need to know about retain and referring to retain is that the referral process is really easy. It first means thinking about those patients you have that could benefit. To refer patients, providers can share retain information, you can visit kyretain.org to learn more about the work, you can choose the referral option and a team member will follow up. You can call 859 562 3251 or email RETAIN@uky.edu. You can contact us with questions at any time or you can email Shirley Kron, Shirley.Kron@uky.edu if you have other questions. So I wanna thank you and I want you to remember that working works. Recognize that disability is part of the human experience and it's not an outcome. While we work for different reasons, promoting work as an expectation and knowing how you can ensure that supports are in place for success helps all of us to build healthy, inclusive communities. I am Kathy Sheppard-Jones, you can reach out to me about any information in this presentation at kjone@uky.edu and I just need to let you know that RETAIN Kentucky is funded by the US Department of Labor Office of Disability Employment Policy in the amount of $3.5 million under Cooperative Agreement number OD-32548-18-754-21 and this presentation does not necessarily reflect the views or policies of the US Department of Labor nor does mention of trade names, commercial products or organizations imply any endorsement by the US Government. I wish you peace.