Total Worker Health in Action

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Volume 9 Number 2  June 2020

Update on the Coronavirus Disease 2019 (COVID-19) Response
While the NIOSH Total Worker Health (TWH) Program will continue to share important updates about TWH research and activities in our quarterly TWH in Action! eNewsletter, you can stay up to date on the COVID-19 response in real time on the COVID-19 webpage or sign up for the COVID-19 newsletter.

Director’s Buzz


In an effort to continue providing you, our readers, with valuable health and safety information, we are sharing this month’s newsletter with an added note. CDC is aggressively responding to the global outbreak of Coronavirus Disease 2019 (COVID-19) and community spread in the United States. The COVID-19 pandemic has touched all aspects of society, including how we work. Emergency responders, healthcare workers, and others providing essential services to the community have been especially stretched thin, working longer hours than usual, working more shifts and days on end, often leaving less time to sleep and recharge. CDC, with strong NIOSH support, recently released resources for worker safety and support to assist workers and workplaces with coping and resilience, workplace guidance, and health and safety steps for specific industries and occupations. You can count on this to be your latest and best source for evidence-based guidance.

Business Open

CDC also updated the Interim Guidance for Businesses and Employers Responding to COVID-19, which includes strategies that may help prevent workplace exposures to COVID-19 in nonhealthcare settings. CDC will continue to update recommendations for employers responding to COVID-19, including those seeking to resume normal or phased business operations. Additionally, CDC has provided answers to frequently asked questions (FAQs) that build on the Interim Guidance for Businesses and Employers, as well as the Guidance for Critical Infrastructure Workers. Answers address suspected or confirmed cases of COVID-19; reducing the spread of COVID-19 in the workplace; healthy business operations; cleaning and disinfection; and critical infrastructure. CDC has also published Reopening Guidance for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools, and Homes. Reducing the risk of exposure to COVID-19 by cleaning and disinfecting is an important part of reopening public spaces and will require careful planning.

For more frequent updates on the response to COVID-19, we would like to draw your attention to NIOSH eNews Flashes. If you aren’t already a subscriber, sign up for NIOSH eNews to receive weekly updates throughout the COVID-19 response, in addition to the monthly eNewsletter.

For the latest Total Worker Health news, research, and events, follow us on Twitter at @NIOSH_TWH,  join our NIOSH Total Worker Health LinkedIn Group, or send us an email at

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Total Worker Health Exclusive

Preparing the Future TWH Workforce: New Framework and Curriculum to Build Capacity

The NIOSH Total Worker Health program recently published an educational framework to speed the training and development of the next generation of Total Worker Health (TWH) professionals. This new publication proposes a standardized TWH core curriculum and educational approach to inform traditional occupational safety and health professionals, key non–safety and health professionals, and key intermediaries.

Workers Different Occupations

The NIOSH Total Worker Health Workforce Development (WFD) Program was established in 2015 to help meet the growing demand for professionals with a broad skill set in worker safety, health, and well-being, including the ability to apply integrated and transdisciplinary concepts and principles.  The skills needed reach across a wide range of subject matter areas, including occupational safety; occupational psychology; public health; chronic disease management; traditional health promotion domains like nutrition and physical activity; supervisory and workforce development; and human resources management.

Working with partners in both the public and private sectors, this Total Worker Health team seeks to build additional capacity in our field. In addition, it seeks to equip existing and future occupational safety and health (OSH) and allied health professionals with the knowledge, skills, and training to (1) prevent worker injury and illness and (2) advance health and well-being among workers, their families, and the community. This comprehensive approach to critical workplace issues has remained pertinent as workplaces and workers face rapidly expanding challenges and technologic demands, emerging public health threats, and dramatic changes in work arrangements, work organization, and worker demographics.

To develop the new educational framework, key stakeholders and partners from diverse, multidisciplinary fields with experience in education and training have deliberated at international symposia, regular WFD workgroup meetings, and a WFD roundtable. These opportunities provided a platform for exploring approaches to building capacity and for identifying competencies and trainings in the integrated approaches that workplace health professionals will need for today’s diverse workforce.

The compilation of these joint efforts is presented in a recent publication, Education and Training to Build Capacity in Total Worker Health®: Proposed Competencies for an Emerging Fieldexternal icon. This seminal article explores the need for a transdisciplinary approach to worker safety and health and puts forward an educational framework that includes the following:

  • A summary of TWH core competencies
  • Identification of priority audiences for education and training
  • Strategies for delivering education and training (such as graduate certificates, continuing education, and professional degree programs)
  • Practical examples of current, successful programs.

Six broad domains of competencies are proposed:

  1. Cross-disciplinary subject matter expertise
  2. Advocacy and engagement
  3. Program planning, implementation, and evaluation
  4. Communication and dissemination
  5. Leadership and management
  6. Partnership building and coordination.

An additional goal of this publication is to encourage input on a proposed standardized TWH core curriculum and to continue the conversation surrounding proposed competencies for an emerging field that will lead to a greater number of trained TWH professionals. This information will be useful for existing academic institutions, professional societies, and others who are developing and augmenting degrees, certificates, and other continuing education and training programs in OSH. To share your thoughts, contact the TWH team.

Promising Practice

Dartmouth-Hitchcock Health: Helping Employers Navigate New Challenges through the Project ECHO Model

Editor’s note: The NIOSH Office for Total Worker Health developed this feature with co-authors Robert McLellan, Sally Kraft, Megan Colgan, and Seddon Savage.

Since 2017, Dartmouth-Hitchcock Health’s Department of Population Health has been working across the health system and with community partners to improve the health of patients, employees, and communities. The organization has consistently been heralded as a leader in health care and was one of the first Total Worker Health Affiliates.

Program Development and Description

In early 2019, Dartmouth-Hitchcock Health (D-HH) Population Health established a Project ECHO hub as a learning infrastructure for clinicians and community organizations to share knowledge and improve clinical and non-clinical determinants of health. Originally created by Dr. Sanjeev Arora of the University of New Mexico Health Sciences Center, Project ECHO® (Extension for Community Healthcare Outcomes) was a telementoring model. Using video-conferencing technology, the program connected primary care providers in rural communities with specialists in a no-cost mentoring model to expand access to expertise. Since then, the Project Echo model has grown throughout the world as an effective, low-cost model to improve clinical practice and outcomes.

D-HH launched an employer-focused Project Echo as a learning platform to link relevant experts with employers to address critical behavioral health issues affecting workers and employers. The need for employer-specific guidance to assist employee recovery and other behavioral health issues became evident after a highly attended in-person conference for employers highlighting the impact of the opioid epidemic on community and workforce health. D-HH ECHO planners brought together experts in behavioral and occupational health and recovery, employers with strong substance use disorders (SUD) supportive practices, and state-wide workforce leaders to pilot a four-session ECHO program for employers focused on supporting employees with SUD. The 26 initial registrants represented a wide range of economic sectors and thousands of employees across New Hampshire, Vermont, and several other states. Participants were encouraged to present issues, solutions, and specific problems during the sessions to learn from both subject matter experts and other participants in a teach-all, learn-all model.


The success of the pilot program generated tremendous enthusiasm for future employer-focused ECHO courses.  A pre/post survey revealed key outcomes, depicted in Table 1. Also, 100% of participants reported feeling less professional isolation and 91% of participants indicated interest in attending future ECHO courses.

Table 1: Percentage of Participants Reporting High or Very High Confidence in Different Aspects of Supporting Employee Recovery





Ability to address SUD in the workplace






Understanding SUD, recovery, and impact of stigma






Awareness of and accessing supportive community resources






Understanding and complying with legal requirements






Designing policies to support a recovery-friendly workplace





DHH Project ECHO

Following the success of this pilot, D-HH has launched a second ECHO program focused on various aspects of the COVID-19 pandemic. This ECHO program will have at least nine sessions and has over 160 registrants from multiple states. These represent a variety of sectors, including large manufacturing facilities and small employers such as retail stores and libraries. Weekly polls of the audience identify common questions and themes, which will become the focus of discussions in following weeks.

Next Steps

Looking to the future, D-HH anticipates additional courses to address employer needs in promoting workforce and community health. The model is scalable and flexible, capable of responding quickly to employers’ needs. Future ECHO courses for employers will help address the many anticipated health impacts of the COVID-19 pandemic, including ongoing courses addressing employee behavioral health needs.

The Project ECHO team faces two significant challenges to sustain and improve its work: funding and measurement of outcomes. To date, the D-HH Department of Population Health has funded the approximate $2,200 cost per each ECHO session, making it possible to provide these courses as a free public service. The department is now looking at a philanthropic business sponsorship model to finance what could continue to be a free public service for employers of every size. The team is also identifying metrics beyond pre- and post-participation surveys to measure the impact of the ECHO courses. Desirable hard outcomes include metrics such as aggregate pre/post group health and workers’ compensation claims, absenteeism, and turnover.

Learn more about Project ECHO at Dartmouth-Hitchcockexternal icon.

Spotlight on Opioids in the Workplace

NIOSH Seeks Input on Workplace-Supported Recovery for Substance Use Disorders

Editor’s note: If you or someone you know needs assistance (in English or Spanish) with mental health and/or substance use disorders, prevention, and recovery, please contact SAMHSA’s National Helpline at 1-800-662-HELP (4357) or visit icon.

Now Extended: Contribute Feedback on Workplace-Supported Recovery Programs to Help Workers and Employers

In February, NIOSH began seeking input on Workplace-Supported Recovery Programs (WSRPs) to prevent and offer treatment for workers with substance use disorders through a Request for Information in the Federal Register. NIOSH has posed a series of questions on WSRPs and is interested in responses from a variety of stakeholders. The comment period has been extended to remain open for input until July 27, 2020. Learn more about WSRPs and submit your feedback at icon.

Updates from the NIOSH Centers of Excellence for Total Worker Health

To learn more about how the Centers of Excellence are responding to the emerging public health threat, visit their websites.

These are just a few of the updates from the NIOSH Centers of Excellence for Total Worker Health. To learn more about the program and each of the Centers, visit

News from NIOSH TWH Affiliates and Partners

Expanding Research Partnerships Webinar Series
The 2020 Expanding Research Partnerships Webinar Series is designed to promote the work of innovative and impactful intramural and extramural research partnerships. The next webinar will take place on June 10 at 12 PM ET, as a special collaboration between the NIOSH Office for TWH and the NIOSH Future of Work Initiative. The webinar will feature topics on the future of work and implications for aging workers. Register for the live webinar or access webinar recordings on the webinar series website.

Kentucky Injury Prevention Data
The Kentucky Injury Prevention and Research Center (KIPRC) has released county profiles of work-related injuries leading to emergency department visits, in this interactive tableexternal icon. The Kentucky Fatality Assessment and Control Evaluation (FACE) Program has also released a number of hazard reports and case investigations. Users can navigate to each of the investigations, as well as hazard alerts and toolkits, on the FACE websiteexternal icon.

Shaping the Future to Ensure Worker Health and Well-Being
The Southwest Center for Occupational and Environmental Health (SWCOEH)external icon at The University of Texas Health Science Center (UTHealth) at Houston was awarded a multi-year Cooperative Agreement conference grant (U13), in partnership with CDC/NIOSH, entitled “Shaping the Future to Ensure Worker Health and Well-being: Shifting Paradigms for Research, Training and Policy.”  Over a three-year period, this U13 Cooperative Agreement will contribute to public discourse in a major way through a series of conferences and dissemination activities. The series will bring together a broad, interprofessional audience that includes but goes beyond employers, workers, and the academic community and will focus on the three critical areas of research, training, and policy/application.

Survey Opportunity: How Have You Adapted To Working At Home?
Researchers at CENTIENTS (Center for Intelligent Environments)external icon are conducting a survey about the transition to working from home during the pandemic for office workers who typically spend most of their day working at a desk. Specifically, they are interested in how office workers have adapted to their home office workstations and the impacts on ergonomics and how their perception about technology has changed with this experience.  If you are interested in participating, the survey takes about 10 minutes to complete and all responses are anonymous. Provide your input hereexternal icon.

Welcome New TWH Affiliate UNC Greensboro!
The University of North Carolina Greensboro (UNCG) interdisciplinary Workplace Health Networkexternal icon aims to advance worker health and wellbeing, using a socioecological approach that aligns with the TWH hierarchy of controls. UNCG offers a post-baccalaureate certificate that prepares students and practitioners to lead TWH initiatives and they engage with internal, local, and national partners to conduct practitioner trainings, consultations, and research and evaluation. Examples of topics addressed through training, consultation, and research include quality benchmarks, food environments, work-life balance, flexible work schedules, burn-out and job performance, screening and brief interventions, and opioid misuse prevention.

Welcome New TWH Affiliate NAWHC!
The National Association of Worksite Health Centers (NAWHC)external icon is a 501C3, non-profit organization, focused on assisting public and private employers, unions and other health plan sponsors in learning about, planning and obtaining the greatest return from their onsite, near-site, shared, mobile and virtual health centers, pharmacies, worksite fitness and wellness centers. NAWHC’s mission is to become the premier source of education, information, networking and resources on worksite health centers. NAWHC supports employers and others who wish to integrate or develop worksite clinics into their health care and benefit strategies to serve as the hub of all health care data, health benefit and wellness programs and resources to enable them to manage their population’s health and safety.

To learn more about the Total Worker Health Affiliate program, visit

New Publications and Resources

From CDC and NIOSH

NIOSH Encourages Worker Well-Being Research

Many Work-related Hazards Affect Construction Apprentices’ Safety and Health

Education and Training to Build Capacity in Total Worker Health: Proposed Competencies for an Emerging Fieldexternal icon

New Publications and Resources from NIOSH Centers of Excellence for Total Worker Health

Associations Among Patient Care Workers’ Schedule Control, Sleep, Job Satisfaction, and Turnover Intentionsexternal icon

Defining “Integration” for Total Worker Health®: A New Proposal (2020) Annals of Work Exposures and Health external icon

Evaluation of an Occupational Safety and Health Training for Cannabis Cultivation Workersexternal icon

Functional Movement Screen (FMS) as a Predictor of Occupational Injury among Denver Firefightersexternal icon

Health Links Employer Toolkit: Eating Disorders in the Workplacepdf icon, Family Friendly Workplacespdf icon, Effective Safety Leadershippdf icon, and Walking Meetings 101pdf icon

How does Organizational Climate Motivate Employee Safe and Healthy Behavior in Small Business? A Self Determination Theory Perspectiveexternal icon

Longitudinal Trends in Renal Function Among First Time Sugarcane Harvesters in Guatemalaexternal icon

Magnitude of Behavioral Deficits Varies with Job-Related Chlorpyrifos Exposure Levels Among Egyptian Pesticide Workersexternal icon

Overtime Work and Work-Family Conflict Among Correctional Supervisorsexternal icon

The Relationship Between Leadership Support and Employee Sleepexternal icon

Total Worker Health: An Emerging Innovation in Workplace Health and Well-Beingexternal icon

Conferences, Webinars, and Training in Support of NIOSH Total Worker Health


8th-12th – The Healthier Workforce Center of the Midwest (HWC) Great Plains Center for Agricultural Health will host Agricultural Safety and Health: The Core Courseexternal icon online this year. The Core Course will be conducted virtually during the regularly scheduled week, June 8-12, 2020. The course will provide an overview of the agricultural industry and the unique health and safety hazards with a focus on prevention. The course is ideal for healthcare providers, safety managers, veterinarians, and anyone interested in the specific health and safety needs of rural and agricultural populations, and continuing education credit is available.

10th – The second installment of the 2020 Expanding Research Partnerships Webinar Series will take place on June 10, 2020 at 12 PM ET. This webinar will feature a special collaboration with the NIOSH Office for TWH and the NIOSH Future of Work Initiative, featuring topics on the future of work and implications for aging workers. Register here.

23rd-25th – Join Center for the Promotion of Health in the New England Workforce (CPH-NEW) Investigator Jennifer Cavallari, ScD as she presents “Using Total Worker Health to Broaden your Safety Program.” Register for the Safety2020 Professional Development Conference and Exposition at the Orange County Convention Center in Orlando, FL and find more information on the Safety2020 websiteexternal icon.

23rd-25th – Associate Director of Harvard T.H. Chan School of Public Health’s Center for Work, Health, & Well-being, Jack Dennerlein, will be presentingexternal icon “Implementing Total Worker Health organizational interventions targeting conditions of work: Common themes across multiple industries” at the Institute of Work Psychology International Conference 2020. This conference was originally going to take place in Sheffield, UK, and will instead be a virtual event, taking place completely online.


14th-16th – The Oregon Healthy Workforce Center (OHWC) Occupational Health Psychology Summer Institute will take place online this year. The theme for the 3-day event is Building a Culture of Health, Safety & Well-being. Learn more and registerexternal icon.

29th – St. Louis Area Business Health Coalition has rescheduled the BHC Spring Forum: Mental Well-being in the Workplaceexternal icon for July 29, 2020 from 8:00 am to 12:00 pm in St. Louis, Missouri.

While many events have transitioned to a virtual format, we encourage you to follow us on social media for live updates regarding conferences, webinars, and trainings!


Editorial Board

L. Casey Chosewood, MD, MPH, Executive Editor

Emily Norton, Managing Editor

Sarah Mitchell, Associate Editor

Seleen Collins, Copy Editor

Margaret Bertsch, NIOSH Web Developer

Steve Leonard, NIOSH Web Publisher

Please send your comments and suggestions to us at

This newsletter is published quarterly via email by the National Institute for Occupational Safety and Health Total Worker Health® Program to inform members of the public health community as well as interested members of the general public of program-related news, new publications, and updates on existing activities and initiatives.