Chapter 16: Integration of Occupational Health Services in the Federal Sector

Abstract

Federal Occupational Health (FOH) is a federal sector model of the integration and collaboration of occupational health (OH) programs that includes on-site health clinics, and environmental health as well as EAP, work-life, and wellness/fitness programs. This article reviews several aspects of integration at various levels of this public health organization.

The broad objectives of occupational health programs are to promote, support, and provide a healthy and productive, highly functioning workforce to the employer. FOH staff has special expertise and knowledge related to federal procedures, regulations and agency culture, as well as the OH disciplines. With its mission to provide occupational health services to federal agencies and federal employees, FOH has the unique opportunity to provide integrated OH services, thereby providing a more comprehensive approach to the occupational health care of the individual employee, as well as a more comprehensive approach to the health and productivity efforts of the federal agencies.

Although we have made strides and engage in continuing efforts to promote integrated programs and care, a number of additional program enhancements are in discussion and/or in process. FOH is a unique entity and the largest provider of comprehensive OH services within the federal government. It has achieved some notable success with the integration of its services across various levels of the organization with different federal organizations. Efforts have been particularly successful in bringing a coordinated response to various crises and emergency situations. With increasing knowledge and data on the benefits of integration, FOH is working to reduce both internal and external organizational barriers to bring integration of services to their maximum potential.     

Chapter 14: Fairview Alive—An Integrated Strategy for Enhancing the Health and Well-Being of Employees

Abstract

This article describes the successful integration between EAP and wellness programs at Fairview Health Services-a program called Fairview Alive.A brief history of integration between EAP and wellness at Fairview is provided including the shared mission these two programs serve at Fairview. Next, this article outlines the Population Health Model on which Fairview Alivewas built, and the specific programs and services provided under each segment of this model. This article then focuses on how Fairview addresses depressionone of their largest cost drivers-in a coordinated effort. Finally, preliminary outcomes from a comprehensive program evaluation, including the impact on medical costs, workers compensation costs and absenteeism costs, are discussed.     

Chemical Sensitivity in the Workplace

Abstract

The debate continues to rage in the medical community and amongst policy makers. This debate centers on a new disease mechanism commonly known as Multiple Chemical Sensitivity (MCS). Magill and Suruda (1998) grouped the theories of etiology of MCS into four broad categories: physical, stress, misdiagnosis, and illness belief. A new name for this illness has recently been advanced as well, toxin-induced loss of tolerance (TILT). Problems with chemical sensitivity are especially troubling for workers and their employers. Employees seeking relief under the Americans With Disabilities Act of 1990 (ADA) are requesting accommodations based on their reactions to chemicals. Employers are beset with claims for accommodations in the workplace, disability claims, and worker's compensation claims. Courts are trying to make sense of chemical sensitivity with respect to accommodations in the workplace. Court decisions regarding MCS issues are varied and oftentimes highly controversial. Primary social problems and mental health issues associated with chemical sensitivities are economic costs and loss of enjoyment of life by MCS sufferers. Economic costs are spread throughout the system; however, their major manifestations are lost worker production, increased demands on services, and the long-term costs associated with supporting a growing disabled subset of the population comprised of chemically injured workers. Social and mental health costs are seen in escalating cases of depression, divorces, behavioral acting out, isolation, anxiety attacks, and chronic medical problems.

Social workers are particularly well suited to advocate for accommodations in the workplace and for social policy change on behalf of those suffering from chemical sensitivity. Their training in systems and ecosystems theory makes them well aware of the importance of the environment on the individual. That training includes knowledge of utilizing strengths based approach to problem solving, and clinical training in mental health, which leads to empowerment for the client.     

Student Bodies,Past and Present

Abstract

This article examines how the field of college health has evolved over time to address the needs of an increasingly diverse student population. The central argument is that college and university health programs developed in conjunction with shifting standards of medical care and public health practices in the United States. The author reviews the role of college health programs as public health agencies for campus communities, and describes contemporary public health challenges facing college campuses. She shows how the history of college health is intertwined with the history of diversity in higher education. In particular, the author outlines how the growth of health services made higher education accessible to women, racial minorities, veterans, and persons with disabilities.     

Effects of Global Democracy on Women's Reproductive Health: 1970–2005, Cross-World Analysis

ABSTRACT

Despite many trends that have been commonly assumed to enrich societal well-being, this article posits that in addition to benefits there are also costs associated with democratization. This article comparatively analyzes the effects of democratic transition on women's health in democratizing well-developed as compared with developing countries across the world. Considering the junction of positive and negative outcomes of democratization, the author argues that to women the costs of democratization are much more substantial than to men because their societal roles are less valued and life for most women is centered at home and, hence, is not considered to be of public concern. Thus far, democratization's costs to women have been largely overlooked, not only in terms of economic opportunities but also in terms of their impact on women's health. These costs cannot be ignored as they limit women's empowerment and endanger national health.     

Lessons on social and health disparities from older lesbians with alcoholism and the role of interventions to promote culturally competent services

ABSTRACT

Older adults who are lesbian, gay, bisexual, or transgender (LGBT) face greater health risks and possibly more costly care because of their reluctance to seek out health and long-term care services because of limited cultural sensitivity of service providers. This is particularly evident in older lesbians who face substantial risk of health problems associated with alcoholism and are less likely to be open with health care providers because of stigma combined with feelings of alienation, stress, and depression. An estimated 4.4 million older adults are predicted to have problems with alcohol by 2020, and the rates of alcohol-related hospitalizations are similar to those for heart attacks, creating exorbitant medical costs. More culturally competent health and long-term care may reduce health care costs by effectively addressing the dynamics of alcoholism, aging, and lesbian culture. Training initiatives such as those developed by the National Resource Center on LGBT Aging have begun to address the need of a more culturally competent aging services network. This article provides exemplars from empirical data on older lesbians with alcoholism to highlight some of the health, economic, and social disparities experienced in the aging LGBT community. Current interventions in the form of cultural competence training for service providers are presented as a potential step toward addressing health disparities among LGBT older adults.     

Implementation of a Mental Health Task Force in a collegiate-based emergency medical services organization

Abstract

Objective: A Mental Health Task Force (MHTF) was implemented in 2016 by a collegiate-based emergency medical services (CBEMS) organization to (1) improve mental health emergency response and to (2) address concerns for the mental health of CBEMS providers. Participants: Skidmore College EMS is a Basic Life Support First Response service staffed by volunteer undergraduate students. Methods: In coordination with faculty and staff, students in the MHTF developed trainings, peer support structures, community events, policies, and informational resources. Results: Sixteen students joined the MHTF within 1 year. Over 35 Skidmore College EMS members received training on mental health emergency response, peer-support, and self-care. Debriefing programs, mindfulness-based events, shift-length limitations, and access to informational resources promoted the mental health of Skidmore College EMS members. Conclusions: Implementing an MHTF is an innovative, student-led approach to coupling education on emergency response with programming that supports the mental health of CBEMS providers.     

Aligning research and practice: The role of academic-community partnerships for improving measurement and process

ObjectiveCommunity programs addressing social determinants of health are growing in prominence and are increasingly expected to provide metrics of success. Our objective is to assess the role of an academic-community partnership for a community health worker program targeting social and medical needs, and determine factors impacting its effectiveness.MethodsWe draw on a 4.5-year partnership that includes both quantitative and qualitative data collection and analysis. Quantitative data collection mechanisms evolved as a result of the partnership. Qualitative interviews were conducted with community health workers and leadership.ResultsTo align medical and social support services in a sustainable and measurable manner, our academic-community partnership found that creating and maintaining a mutually beneficial space through small wins enabled us to then address larger problems and needs. Ongoing self-study and process evaluation allowed quick adjustments. Unique partnership elements such as having consistent funding and flexible timelines and objectives were essential.ConclusionsWhen integrating health and social services, academic-community partnerships create pathways for bidirectional learning than can quickly turn research into practice and support sustainability, especially when based on incrementally built trust and a history of small wins.     

Chapter 2: The Business Case for the Integration of Employee Assistance,Work-Life and Wellness Services

SUMMARY

Employee assistance programs (EAP), work-life programs and wellness programs are three commonly provided kinds of interventions that have the goals of reducing healthcare costs, improving employee performance and fostering a healthier workplace culture. The integration of these kinds of programs is a recent trend that has the potential to offer additional synergistic benefits. New studies have linked comprehensive delivery services that support human capital needs with bottom-line financial success of the company. This evidence can be used to make the business case for offering EAP, work-life and wellness services in an integrated capacity. However, while promising, the scientific evidence thus far in this area has methodological limitations and there are critical aspects that require further study.     

Abortion,Limited Medical Resources,and the Meaning of Health Care

Abstract

Although accidents are the leading cause of death among college students, literature about developing student health safety programs is limited. In this article, we present preliminary recommendations based on literature review, epidemiologic data, and Nominal Group Process (NGP) activities, for developing university student safety programs. Our recommendations include appointing a coordinator to oversee all on-campus safety activities, providing for university-wide education programs dealing with alcohol and drug use, promoting personal safety efforts in areas such as family violence and rape prevention, and encouraging students to use safe transportation alternatives.     

Outcomes Measurement

SUMMARY

Outcomes measurement in health and mental health should be of vital concern to social workers since public support and financing will follow evidence of effectiveness. Social work in health and mental health requires a framework for conceptualizing outcomes measurement so that the profession can focus clearly on the work to be done in outcomes measurement. This framework should distinguish among the various ways that outcomes measurement can be used to advance policy, program and practice. This article discusses two applications of outcomes measurement, namely for improving policies and programs, and, second, for conducting outcomes research. Other dimensions that could be included in an outcomes measurement framework for social work in health and mental health are identified but not elaborated. The author's objective is to make a strong case for the role that outcomes measurement can play in both the improvement of social work policies and programs in health care, through performance measurement, as well as in advancing the healthcare knowledge base, through outcomes research.     

Access to Interprofessional Continuing Education in Integrated Care Through Digital Instructional Technology

ABSTRACT

In preparing the workforce for integrated care, continuing professional education serves a critical role. Within a rapidly changing health care landscape, matriculated students now benefit from pedagogical innovations supporting integrated care, particularly interprofessional education, and working professionals must not be excluded from this transformation. University-based digital instructional programs can support the learning needs of working professionals, providing an alternative and complement to brick-and-mortar classrooms and ad hoc onsite trainings. This paper describes the structure, content, digital approach, and outcomes of a continuing education program in integrated behavioral health and primary care, housed in a school of social work at a major university. The challenges of interprofessional digital education are described and future directions are suggested.     

Maternal Health Care Services in the Himalayas

ABSTRACT

The state of health of the people in developing countries does not show a very good trend. They are faced with the double burden of communicable and noncommunicable diseases as well as other sociocultural factors that need to be addressed, especially in rural areas. The present study was conducted in a rural area with the dual purpose of training the undergraduate medical student in the field and exposing or sensitizing them toward the need of the rural masses and provision of services in the form of medical aid or health education and awareness. It was a camp-based approach where an intense phase was planned for a week and a follow-up phase every month. The present article is the result of the week-long intense phase. The intensive phase is basically the period when this camp was run for 7 days with the involvement of specialists from various departments providing their services. In the next phase there were follow-up activities and services that were provided once a month. The study generated an interest in the students, and they are very keen for the follow-up visits. Because the students were allotted families, the whole village was covered and health awareness was generated, which created demand. This demand was met given the number of patients attending the clinics, of which 57% were females. Furthermore, 77% of the patients reported that they were fully satisfied with the services being provided.     

Chapter 11: Motorola Drives Strategic Initiatives Through Collaboration and Interdependence

Abstract

This article describes an integrated approach to implementing a wellness program in a corporate setting. Motorola's wellness program is reviewed, including its history, rationale and strategic focus. Successful integration partners are identified, and strategies for integrated programs are outlined. Education, communication and prevention initiatives and program components are discussed, including recommendations and shared learnings for both small and large-scale wellness programs.     

The Health Education Section: 38 Years of Growth

Abstract

The author traces the growth of ACHA's Health Education Section from its beginnings with a handful of members in the late 1950s to its position of increasing leadership in the organization. She describes the growth of innovative programs the section's more than 300 health educators developed as they expanded the concept of health education and promotion beyond the walls of traditional health centers into the broader university community. College health educators must participate in efforts to establish accountability for prevention and promotion strategies that include community health as well as clinical preventive services.     

A Population-Wide Screening and Tailored Intervention Platform for Eating Disorders on College Campuses: The Healthy Body Image Program

Abstract

Objectives: This article presents a new approach to intervention for eating disorders and body image concerns on college campuses, using a model of integrated eating disorder screening and intervention. Formative data on implementation feasibility are presented. Participants: College students enrolled at 2 universities between 2011 and 2012. Methods: The Healthy Body Image program is an evidence-based screening and intervention platform, enacted via community and online resources. An online screen was used to identify students at varying levels of risk or eating disorder symptom status; responses were used to direct students to universal or targeted online interventions or further evaluation. Universal prevention programs to improve healthy weight regulation and body image culture were offered to all students. Results: Formative data from 1,551 students illustrates the application of this model. Conclusions: The Healthy Body Image program is feasible to deliver and provides a comprehensive system of screening, evidence-based intervention, and community culture change.     

Chapter 10: Ceridian's Experience in the Integration of EAP,Work-Life and Wellness Programs

SUMMARY

This article considers EAP services, work-life and wellness programs and the implications of integrating these services. The concept of how wellness programs enter into this equation is explored as well as how Web-based services have played a significant role. Ceridian's experience in providing these services is explored through a case study, anecdotal information, and other data. This article reviews why integrated EAP services, work-life and wellness programs offer more value when compared to programs that contain individual components. It is concluded that wellness and the Internet continue to play a key role in programs becoming more integrated. It is also suggested that integration is now larger than traditional EAP, work-life, and wellness programs. Other human resource services are becoming more important components of integrated services.     

On the Integration of Science and Practice in College Health

Abstract

College health professionals want to assure the unique healthcare and health education needs of college students will continue to be met under national and state healthcare reform. This may be an “all or nothing” proposition. Either colleges and universities will have exclusive control of healthcare delivery for the college student population or else college health will not be a major force in healthcare reform. If college health is to play a meaningful role in future government-controlled health insurance programs, it must first demonstrate that current health services and insurance financing programs meet minimum quality standards. This proposal calls for expanding existing federal laws to create qualified student health plans and integrating the college health model into a reform package based on employer-sponsored health insurance. The concept of qualified student health plans allows for a high degree of flexibility that can be integrated into the majority of state and federal healthcare reform proposals, including the plan proposed by President Clinton, that are not based on a single-payer system. Ultimately, the authors suggest, their proposed plan would eliminate the current situation, in which large numbers of college students are uninsured or underinsured.     

A Survey of 100 Community Colleges on Student Substance Use,Programming, and Collaborations

Abstract

Objective: The objective was to survey community college personnel about student substance use, and infrastructure (staff and funding), programs, and collaborations dedicated to substance use prevention. Participants: The sample included 100 administrators, faculty, and health services staff at 100 community colleges. Methods: Participants completed a Web-based survey. Results: Participants reported a number of alcohol and other drug (AOD) related concerns. Despite limited staff and funding dedicated to AOD, institutions are implementing a number of programs, although many are not implementing some of the programs popular at traditional 4-year colleges. They are also collaborating with a number of on- and off-campus groups. The availability of staff and funding dedicated to AOD, and the presence of residence halls, is associated with health programming and substance abuse collaborations. Conclusions: Results suggest that there is a need for increased research to understand the most effective AOD prevention strategies for community colleges.