Implementing a community-focused health and work service (HWS)

Jennifer Christian, Thomas Wickizer, Anthony Burton

Research output: Book/ReportCommissioned reportpeer-review


Our original proposal for a Community-Focused Health & Work Service (HWS) was one of 12 included in the McCrery-Pomeroy SSDI Solutions Initiative. We recommended that the Federal government build the capability to deliver services nationwide that will reduce demand for SSDI by helping working people who lose time from work due to the most common musculoskeletal and mental health conditions to stay employed. Nearly 30 percent of people newly awarded SSDI cite back pain, joint pain, anxiety, or depression as their major problem. Research has shown that the best way to improve both health and work outcomes is to act quickly, discern which individuals need extra attention, and then actively intervene to help them get what they need and get back on their feet. The HWS concept is modeled on Washington State’s successful Centers for Occupational Health & Education (COHE) program, which reduced demand for long-term disability pensions and SSDI by 30 percent. It is also grounded in more than 20 years of disability prevention research, policy, and program innovations in both the UK and the US. As designed, the HWS is an addition to a community’s social fabric and serves a target population whose unmet needs create demand for disability programs but have been largely overlooked until now. This concept is new and quite different from other disability-related programs, so implementing it will be a challenge. Part 1 of this paper is aimed at policymakers. It asks and answers fundamental questions in order to garner support for implementing a HWS. Part 2 alerts those who will guide or run the program at the national or state level to some critical issues that will lead to success or failure of the operationalization effort – and influence the outcomes produced. It also addresses some little details that could derail the program unless noticed and well managed by those responsible for delivering services in individual cases. For one example, this includes allocating substantial resources to marketing and community relationship building in order to assure a sufficient and on-going volume of referrals. Part 3 considers the interaction of program design and development challenges with the imperative to objectively evaluate program effectiveness. The Technical Appendix provides even more practical advice on key topics for local operators, such as suggested hiring criteria, training requirements, details concerning the referral process, eligibility screening, behavioral incentives, information management during start-up, and so on. Permanent Link: Author Affiliation Jennifer Christian Thomas Wickizer Kim Burton Webility Corporation The Ohio State University University of Huddersfield The McCrery-Pomeroy SSDI Solutions Initiative This paper has been published as part of the McCrery-Pomeroy SSDI Solutions Initiative, a project dedicated to identifying practical policy changes to improve the Social Security Disability Insurance (SSDI) program and other policies for people with disabilities. More information about the SSDI Solutions Initiative is available at The SSDI Solution Initiative is a project of the Fiscal Institute at the Committee for a Responsible Federal Budget. The views expressed in this paper represent those of its authors and not organizations or individuals affiliated with the authors, the McCrery-Pomeroy SSDI Solutions Initiative, or the Committee for a Responsible Federal Budget.
Original languageEnglish
PublisherMcCrery-Pomeroy Social Security Disability Insurance Solutions Initiative
Commissioning bodyCommittee for a Responsible Federal Budget
Number of pages33
Publication statusPublished - 30 May 2019


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