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Work: A Social Determinant of Health

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Featured Speaker

Christine A. McKenzie, M.Ed

The Department of Vocational Services is a leader in the field of employment for people with disabilities.

There are only a few hospitals in the US that have this as a service and MMC is the only one in the State. 

It is a unique service and one that allows patients to meet with an Employment Specialist while they are in the hospital to discuss any concerns they may have about returning to their current job or if they are unemployed how the service can assist them in obtaining employment.

Listen in as Christine A. McKenzie, M.Ed discusses how in addition to the work with inpatients, the department also works with individuals in the community and has a statewide presence in the areas of behavioral health, providing vocational assessments for TANF participants providing benefits counseling for individuals on SSI and/or SSDI.

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Melanie Cole (Host):  The Department of Vocational Services is a leader in the field of employment for people with disabilities. There are only a few hospitals in the U.S. that have this as a service and MMC is the only one in the state. My guest today is Kristine McKenzie. She is the Director in the Department of Vocational Services at Maine Medical Center. Welcome to the show, Christine. Tell us about this unique service that the hospital offers and why is it so necessary?

Christine McKenzie (Guest):   I think first and foremost, when we become ill and we’re of working age, our work or employment becomes interrupted. One of the first things people who are working and become ill and enter into the hospital or an out-patient, one of the first things they ask their physician or medical provider is, “When can I go back to work?” They equate being better physically or mentally with returning to work and being able to function at a level that they were able to function before they became ill. Our department helps people assist with getting either back to their original employment, navigating time off, negotiating with employers if they need an accommodation, whether it be in the short term or the long term. In the event that they can’t return to their line of work, then we assist people in defining a new career path and finding out what is available, what training they would need and how they will navigate finding something in that field and returning to work. 

Melanie:  How do you do that, Christine? How do you--if they can’t go back to their original position because it was a very physical or labor demanding job--assess what they can do based on whatever their illness was?

Christine:  I think you are looking at a couple of different things there. One of the things we look at is, what is the person’s desire to return to work? That is a really, really important factor. When people become ill and they are out of work, one of the things that starts to impact them is they can get depressed and they can start to be thinking that they are not able to return to work. In meeting with us and assisting them, it gives them and provides them with some hope that there is more than just what they were doing. If they had been in a career for a long time doing the same type of work, their focus becomes pretty myopic:  “What will I do?”  So, you start to look at what their skills, capabilities and abilities are which people lose sight of after they’ve done the same type of work for a long time. I think a good example of that is, people regain insight into what their interest and skills are when they retire. You talk to someone who is retiring, no longer working in their career and that’s a positive thing, right? Retirement. They can clearly say to you, “Oh, I’ve always been interested in this” or “I’d love to do this.” That desire to do something different and that openness to take that on is really part of what we try to impart with individuals—to say, “If you could do anything that wasn’t what you were doing in the past what would that be like?” But, at the same time work with individuals around the loss of a career or a line of work that they had been used to because when they are not going back to something they know, it produces anxiety because it is an unknown. We assist individuals in navigating what is a normal level of anxiety when you are going through a change. Then, what becomes so much of anxiety that it prevents them from going back to work. We are always assisting individuals to look at a broader perspective of what they can do and what their skills, abilities and education are and then, what is it they can see themselves doing. Then, we start to look at matches with those industries within our own state of Maine. 

Melanie:  In the communities, do you also work with employers to get them to realize that people with disabilities can do jobs for them that may not be what they originally were doing but other jobs and kind of help them reach out to community employers? 

Christine:  Absolutely. That’s a huge part of what we do. Most of the employment specialists that work in our department are in daily contact with employers. I think that brings up a really good point which is there is some education that goes along with that. Educating employers about disabilities or illnesses and how they will or will not impact somebody’s functioning at work. We’re not talking to employers about what a candidate can’t do. We’re talking to employers about in spite of these disabilities, individuals with disabilities can work. I think it’s really important in our own job that we are out in the community connecting with employers, which we do on a daily basis to ensure that they understand that there is a viable workforce. In Maine, we have an aging population and we will have a workforce shortage in which we will have to look at individuals with disabilities and rightfully so, so that they can fill the jobs that people are exiting either because they are retiring or they are aging out of the workforce. 

Melanie:  Do you find that there is a difference in resonance with those community employers if the person has mental illness versus physical disabilities?

Christine:  That’s a good question. Mental illness is, in large part, an invisible illness, right? So there are a lot of myths and unknowns-- 

Melanie:  Stigmas and things.   

Christine:  --to the general public about mental illness. There is, in large part, a stigma associated with that which results when people get anxious when they don’t know what to expect. For us, a large part of what we do is work with individuals with psychiatric or mental illness. They are the largest disability group to get on social security and the least likely to get off social security rolls. That is a shame considering the fact that these illnesses are treatable illnesses. We spend a lot of time working with employers to have a better understanding of, what does it mean when somebody has mental illness in your workplace? For a large part of our group—the group of individuals that we work with – there is the whole issue around disclosure, right? Should I tell somebody that I have a disability or not? Should I tell them that I am struggling with mental illness or not? Those are discussions that we have frequently with individuals because they are thinking about, “What should I say?” There is no hard answer to that. It is an individual decision about what they want to disclose to an employer related to an illness or a disability. One of the rules of thumb is how will this impact that job? If somebody is returning to a job they had before, they are thinking about those kinds of things and, as I mentioned before, they are going to think about whether or not they need an accommodation in the short or the long term. But, there are also individuals who are thinking about, when I read this job description, is it something that I can fully do and my disability will not impact my job functioning? In that case, many people elect not to say anything at all. 

Melanie:  What about where insurance is concerned? What a confusing situation in the best of circumstances but if someone suffers from a disability, whether it’s a mental disability or physical, are employers afraid that now this is going to impact their insurance premiums, their rates? This person is going to need more days off. How do you work with patients about dealing with all of the insurance things? 

Christine:  I think you first have to take a look at how employers, as you mentioned, are looking at the whole aspect of keeping their workforce healthy. That’s the piece where it’s proactive. Here at Maine Medical Center, we have a large wellness program for employees. The whole incentive is that when you are healthier, you contribute more to your workforce. We take the perspective of – when people are returning to work and the individuals that we work with – that they are the healthiest that they can be. The whole piece around “How are you going to impact my insurance rates?” we deal less with because we want people to return to work when they are healthy enough to return to that job. 

Melanie:  It is such great information and so beautifully put, Christine. You are so well spoken and I’m quite sure that you are really great at your job.  In just the last few minutes here, please give us your best advice for people with disabilities on returning to work and how you can help them there at Maine Medical Center.

Christine:  I think in order to have a meaningful conversation and a meaningful discussion with a patient, you have to look at how patients talk about their levels of satisfaction with the services. When providers are talking with patients about what matters to them, which in large part is their work; I mean, work provides us with a sense of purpose every day. So, when medical providers, and we do here at Maine Medical Center, can have conversations with people about their work, then their satisfaction increases overall with the level of service they are having because it is meaningful to them. It says, “Not only did I get better but I was able to return to work. Whether it be in the field I was in or in an exciting new field that I never thought I was able to get into.” I think, in large part, that’s what we aim to do here in in-patient and in out-patient. 

Melanie:  Thank you so much, Christine, for helping us with this today. You’re listening to MMC Radio.  For more information you can go to That’s This is Melanie Cole. Thanks so much for listening.