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- 1. Dyann M.Matson Koffman, DrPH, MPH, CHES Health Scientist CDC Office of the Associate Director for Science Jason E.Lang MPH,MS Team Lead for Worksite Health Programs CDC National Center for Chronic Disease Prevention and Health Promotion L.Casey Chosewood, MD National Institute for Occupational Safety and Health Centers for Disease Control and Prevention AJHP Webinar Series November 26,2013 CDC Resources,Tools,and Programs for Health Promotion in the Worksite Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Disclaimer: The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention
- 2. Agenda CDC Worksite Health Promotion Initiatives & Resources The CDC Worksite Health ScoreCard (HSC) The Total Worker Health™ Approach Discussion
- 3. CDC Worksite Health Promotion Initiatives & Resources Jason E.Lang,MPH,MS Team Lead,Workplace Health Programs National Center for Chronic Disease Prevention and Health Promotion AJHP Webinar Series November 26,2013 National Center for Chronic Disease Prevention and Health Promotion Division of Population Health
- 4. Timeline 1999 2013 NHWP Work@Health Diabetes@Work 2011 Business Cooperative Agreement 2002 Healthier Worksite Initiative 2006 The Purchaser’s Guide 2005 NIOSH WorkLife Initiative NIOSH Total Worker Health 2010 Workplace Health Toolkit 2012 Worksite Health ScoreCard
- 5. CDC Healthier Worksite Initiative • Goals – For worksite health promotion to become a part of CDC culture – Increase“healthy days”among CDC employees • Strategies – Formative research – Collaboration – Physical Environment modifications – Policy modifications http://www.cdc.gov/hwi
- 6. CDC Healthier Worksite Initiative Garden Market
- 7. CDC Healthier Worksite Initiative StairWELL to Better Health Project Before After
- 8. CDC Healthier Worksite Initiative Food at Meetings Guidance
- 9. Tobacco Free Campus • Significant policy change in 2005 • Completely smoke free campuses, indoors and out • Collaboration of health promotion, clinical,EAP staff and“quit-lines” • Personal quit plan,free nicotine replacement • Support for multiple quit attempts • Link annually with the Great American Smokeout®
- 11. An Employer’s Guide to Clinical Preventive Services: Moving Science into Action NBGH product developed with CDC and AHRQ Recommended clinical preventive services for health benefits design Comprehensive:46 conditions, 50% address chronic diseases Targeted to all health care purchasers (public and private) Written with contract language (Summary Plan Description – SPD) http://www.businessgrouphealth.org/preventive
- 13. Assessment Planning/ Implementation Evaluation Individual (e.g. demographics, health risks, use of services) Organizational (e.g. current practices, work environment, infrastructure) Community (e.g. transportation, food and retail, parks and recreation) Contextual Factors (e.g. company size, company sector, capacity, geography) Programs (e.g. education and counseling) Policies (e.g. organizational rules) Health Benefits (e.g. insurance, incentives) Environmental Support (e.g. access, opportunity, physical/social) Worker Productivity (e.g. absenteeism, presenteeism) Healthcare Costs (e.g. quality of care, performance standards) Improved Health Outcomes (e.g. reduced disease and disability) Organizational Change “Culture of Health” (e.g. morale, recruitment/retention, alignment of health and business objectives) Workplace Governance (e.g. leadership support, dedicated resources, health improvement plan, staffing, partners/vendors, communications, informatics) Workplace Health Model
- 14. CDC Workplace Health Promotion Toolkit www.cdc.gov/whp
- 15. CDC Workplace Tools and Resources
- 16. The National Healthy Worksite Program (NHWP) is designed to assist employers in implementing science and practice-based prevention and health promotion strategies that will lead to specific,measureable health outcomes to reduce chronic disease rates.The NHWP seeks to promote good health through prevention,reduce chronic illness and disability,and improve productivity outcomes that contribute to employers’competitiveness.
- 17. Each employer will build a core workplace health program including the following components: Assessment of employer and employee needs,interests,health risks and existing capacity A planning process resulting in a workplace health improvement plan to guide the worksite through program development Implementation of programs,policies, and practices to address employee lifestyle risk factors related to physical activity,nutrition, and tobacco use Building a program infrastructure within each worksite for long-term sustainability including evaluation, wellness committees, program champions, and leadership (CEO/C-Suite) support Participation in programmatic activities, training, and technical assistance An evaluation of individual employee and organizational changes NHWP Program Components
- 18. NHWP WH 101 Training Manual http://www.cdc.gov/nationalhealthyworksite/join/Training-materials.html
- 19. Overview • Work@HealthTM is an employer based training program • The Work@HealthTM Program will build employer knowledge and skill as well as capacity to implement, grow and sustain effective workplace health promotion and protection strategies. • The program will enroll 600 employers and other organizations across the country to participate in trainings beginning in 2014.
- 20. Program Structure • Professional Training to build knowledge and skill will be delivered through one of the following models. – ONLINE MODEL,involving seminars, case studies and practical demonstrations delivered through distance-based mechanisms such as webinars. – HANDS-ON MODEL, in which employers participate in interactive workshops that provide content through a variety of approaches including lectures and case studies. – BLENDED MODEL, involving a combination of distance-based or e-learning (online model) and in-person classroom sessions (hands-on model). – TRAIN-THE-TRAINER MODEL is designed to prepare qualified individuals to acquire the knowledge and skills needed to train other employers and organizations using the Work@HealthTM Curriculum. • Training to 600 employers and other organizations through 1 of 4 training models • Four Regional Training Locations: – Baltimore, MD -- Atlanta, GA – Chicago, IL -- Oakland, CA.
- 21. Additional Benefits • A complete health and safety assessment of their organization • Technical assistance and community support resources over 12 months • Seed funding to help take action – Up to $5,000 for employers to implement interventions – Up to $2,500 for trainers to train others • On-going networking opportunities
- 22. CDC Worksite Health Promotion Programs www.cdc.gov/nhwpwww.cdc.gov/workathealth
- 23. The CDC Worksite Health ScoreCard http://www.cdc.gov/dhdsp/pubs/worksite_scorecard.htm Dyann M. Matson Koffman,DrPH,MPH, CHES
- 24. The United States - chronic disease epidemic Represents 75% of the nation’s about $2.6 trillion medical care costs Comprehensive worksite health promotion works Individual risk reduction Environmental supports Policy and wellness activities Only 6.9 percent of employers offer a comprehensive worksite health promotion program Linnan L,et al.Results of the 2004 National Worksite Health Promotion Survey. Am J Public Health 2008;98(8):1. Few validated worksite tools Why develop the CDC Worksite Health ScoreCard?
- 25. What is The CDC Worksite Health ScoreCard? A 100 item tool designed to help employers assess evidence-based health promotion interventions in their worksites to prevent heart disease, stroke,and related chronic conditions. Available at: http://www.cdc.gov/dhdsp/pubs/worksite_scorecard.htm http://www.cdc.gov/workplacehealthpromotion http://www.cdc.gov/nationalhealthyworksite
- 26. How is the HSC Organized? Organizational supports Tobacco control Nutrition Physical activity Weight management Stress management Depression Assesses best practice health promotion interventions (policies, programs,environmental supports) High blood pressure High cholesterol Diabetes Signs and symptoms of heart attack and stroke Emergency response to heart attack and stroke
- 28. What will the HSC Show?
- 29. Who can use the HSC? Employers,human resource managers, health benefit managers, health education staff,occupational nurses, medical directors,wellness directors,or others responsible for worksite health promotion to: Help employees adopt healthy lifestyles Establish benchmarks and track improvements Integrate efforts with business objectives CDC Awardees and State health departments to: Assist employers and business coalitions Monitor and track worksite practices over time Establish best practice benchmarks
- 30. DEVELOPMENT AND VALIDATION OF THE CDC WORKSITE HEALTH SCORECARD
- 31. CDC Partners CDC Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion Workplace Workgroup Emory University Institute for Health and Productivity Studies Dr. Ron Goetzel,Dr. Enid Chung Roemer,and staff Research Triangle Institute (RTI) Expert panel: federal,state,academic,and private sector representatives
- 32. Developing the HSC Examined existing worksite inventories and resources Identified reliable and valid questions from other tools Developed domains and questions Pre-tested the tool with employers and practitioners Revised the HSC tool based on employer feedback Weighted each question: Scientific evidence (1-4) Impact on intended health behavior (1-3) Summed the scores and adjusted/ assigned value: 1=good,2=better,and 3=best evidence/impact
- 33. The CDC Worksite Health ScoreCard Scoring Methodology Describes Rating system Scores for each question Citations and references http://www.cdc.gov/dhdsp/pubs/docs/HSC_Score_Method.pdf
- 34. How was the HSC Validated? Employers recruited nationwide through State Programs National Business Coalition on Health National Safety Council Goal: 30 organizations for each employer size worksite Very small -- 10-99 Small -- 100-249 Medium -- 250-749 Large -- 750+
- 35. …How was the HSC Validated? Field testing 93 worksites in 2011 24 very small,13 small,16 medium, and 40 large Determining content and face validity, inter-rater reliability, and feasibility of adoption 93 employers (2 respondents per site completed online survey) 20 employers (random sample from 93 completed telephone interviews) 9 employers (random sample from 93 completed site visits)
- 36. What did we learn? Employers like the HSC and reported that most interventions are feasible to adopt Linear relationship between employer size and number of interventions in place (215 max score) 129 153 129 112 99 0 50 100 150 200 Average HSC Scores for Study Sample Very small Small Medium Large All Employers Employer Size Groups Very small: 10–99 Small: 100–249 Medium: 250–749 Large: 750+
- 37. How Do You Use the HSC? 1. Complete the CDC Worksite Health ScoreCard Gather a small team of individuals representing different organizational units e.g., Human Resources,Health Benefits,Occupational Health, Worksite Wellness Committee Answer“yes”or“no”for each question consistent with current practices and programs or in place within the last 12 mos. large organizations with multiple worksites, complete HSC for each worksite separately
- 38. How Do You Use the HSC? (cont.) 2. Tally your score for each topic,e.g.,hypertension 3. Review scores; use as a planning tool to identify gaps in your worksite program 4. Identify which of priority strategies are feasible to implement short-term and long-term Strategies that are relevant,feasible,and consistent with your organization and employee needs Highest impact strategies not in place Annual Worksite Health Improvement Plan and Budget
- 39. Health Improvement Plan Template and Sample
- 40. How Do You Use the CDC-HSC? 5. Consult the Resource Links section 6. Contact your State Health Department for technical assistance http://www.cdc.gov/workplacehealthpromotion/organizations/ index.htm http://www.chronicdisease.org/membership/members- directory 7. Benchmark to demonstrate progress over time 8. Inform and educate employees and management
- 41. The Gateway Project- 2010-11 Gateway Employers had twice HSC Score improvement compared to Community Employers More Gateway Employers improved HSC scores that Community Employers 87% GATEWAY EMPLOYERS 50% COMMUNITY EMPLOYERS
- 42. Current Activities Used HSC in CDC National Healthy Worksite Program Published manuscript: Roemer EC,Kent KB,Samoly DK,Gaydos LM,Smith KJ,Agarwal A,Matson-Koffman DM, Goetzel RZ.Reliability and Validity Testing of the CDC Worksite Health ScoreCard: An Assessment Tool to Help Employers to Prevent Heart Disease,Stroke,& Related Health Conditions. JOEM,Volume 55,Number 5,May 2013m pp.520-526. Developed a web application Validated Four New Modules Lactation Support - 6 questions Occupational Health and Safety – 10 questions Vaccine Preventable Diseases - 6 questions Community Resources and Partnerships – 3 questions (not scored)
- 43. During the past 12 months, did your worksite Yes No 1. Provide employees with health related information,programs,or resources from any of the following organizations (not including your own organization)? (Respond“yes”or“no”to all questions.Answer“yes”if health information,programs,or resources are provided in-person or online;on-site or off-site;or in group or individual settings.) 1A.State/local public health agency 1B.Health insurance plan 1C.Health management program and/or wellness program provider/vendor 1D.Workers compensation provider 1E.Health-related organizations (such as the American Heart Association, American Cancer Society,etc). 1F.Health insurance broker 1G.Hospital 1H.YMCA 1I. Community Organization or Business Group (Wellness Council,Chamber of Commerce or other business group)
- 44. L. Casey Chosewood, MD National Institute for Occupational Safety and Health Centers for Disease Control and Prevention Healthier, Safer and More Engaged Exploring the potential of NIOSH Total Worker HealthTM
- 46. Source: US Bureau Of Labor Statistics, 2011 (Credit: Jess Jiang and Lam Thuy Vo /NPR)
- 47. Extreme environment Extreme aging These Are the Deadliest Threats Facing Many American Workers Extreme convenience
- 48. Isn’t Behavior Change Enough? Sir Michael Marmot “ It is unreasonable to expect people to change their behavior when the social, cultural and physical environments around them fully conspire against them….” Adapted from M. Marmot/Institute of Medicine Report
- 49. Worker Health = Economic Health • Company health & employee health are interdependent • Nearly 2 in 3 Americans get healthcare through employer • Employees: Spend >1/3 of day at work Limited supply Getting older • Employers pay for: 36% of the nation’s healthcare expenditures Workers’ compensation claims
- 50. Group Health Group Health Group Health Occupational Safety and Health Demand and Disease Management Demand and Disease Management Demand and Disease Management
- 51. The Total Worker Health™ Approach Total Worker Health™ is a strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being.
- 52. Integrated Approach to Total Worker Health EAP Group Health Compensation Programs Presenteeism/ Absenteeism Occupational Safety and Health Disability Workers’ Compensation Health Promotion Demand and Disease Management Adapted from: Liberty Mutual, 2010, Webinar, The Wellness-Work Comp Connection. Ron Goetzel, 2011, Examining the Value of Integrating Occupational Health and Safety and Health Promotion Programs in the Workplace, at http://www.cdc.gov/niosh/docs/2012-146/pdfs/2012- 146.pdf.
- 53. Examples of Integration • Respiratory protection programs that address tobacco use and smoking cessation • Ergonomic consultations that include arthritis management strategies • Stress management efforts that first seek to diminish workplace stressors, and only then work on building worker resiliency • Comprehensive screenings for work and non- work risks
- 54. WellWorks-2 Study Results: Tobacco Use Cessation • Rigorous study design • Smoking quit rates among hourly workers receiving occupational safety & health AND worksite health promotion interventions were more than doubled relative to the worksites that received only worksite health promotion interventions (11.8% vs. 5.9%, p = 0.04) Sorensen and Barbeau at http://www.cdc.gov/niosh/docs/2012-146/pdfs/2012-146.pdf
- 55. Engagement Flexibility Part-time Work Shift Work Aging Low-wage work AffordableCareAct Fatigue Stress Skills-mismatch Culture
- 57. Why Integration and Total Worker HealthTM Matter • Improvements in work environments and the conditions of work benefit all workers • Participation increases in both safety and health promotion programming • Injury, illness, disability and absenteeism rates decrease • Overall health-related costs decline o Workers’ compensation o Personal healthcare costs o Absenteeism and presenteeism related costs • Additional productivity gains realized
- 58. Visit The TWH™ Website: http://www.cdc.gov/niosh/TWH/
- 59. Stay Connected to NIOSH Total Worker HealthTM • Follow us on Twitter • Join us on LinkedIn • E-mail www.twitter.com/NIOSH_TWH www.linkedin.com/groups/NIOSH-Total- Worker-Health-4473829/about TWH@cdc.gov
- 60. Contact Information Jason Lang jlang@cdc.gov Dyann M.Matson Koffman Email: dmatsonkoffman@cdc.gov Casey Chosewood Email: ahx6@cdc.gov
- 61. For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta,GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Thank You! National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention