Massachusetts Medical Society: Work is Medicine: The Impact of Childhood Trauma on Adult Work Experience

Work is Medicine: The Impact of Childhood Trauma on Adult Work Experience

Work is Medicine - The Impact of Childhood Trauma on Adult Work Experience

Promoting safe work and continuation of work despite chronic stable health conditions is key to economic survival for many minority populations, who are at higher risk for having experienced childhood trauma. The COVID-19 pandemic has contributed to this disparate risk, with increased risk of COVID-19 death as well as economic impact and associated negative mental health outcomes. In this webinar recorded March 22, 2021, Dr. Marianne Cloeren reviews how Adverse Childhood Experiences (ACE) impact future work outcomes. This has implications for physicians caring for patients of all ages - with primary prevention opportunities for those working with children; secondary prevention opportunities when working with adults whose health conditions risk leading toward work disability if not carefully managed; and tertiary prevention opportunities for those working with adults who are not working, due to disabling health conditions. She explains the rationale for considering preventable work disability as a negative patient health outcome.  She reviews the  physical, psychological, and socioeconomic benefits of work and proposes approaches for using work prescriptions as part of a patient-centered treatment plan.





Marianne Cloeren, MD, MPH, FACP, FACOEM 
Dr. Marianne Cloeren, Associate Professor of Medicine at the University of Maryland School of Medicine is an international leader in work disability prevention. Her work in this area has included publications, teaching and research. She recently completed a project funded by the Centers for Disease Control and Prevention (CDC) via the Maryland Department of Health to create a training module about the Maryland Prescription Drug Monitoring Program (PDMP) and evaluate its impact on opioid-prescribing providers’ attitudes and behaviors. Before joining the faculty at the University of Maryland School of Medicine in 2017, her decades of work with patients recovering from work injuries highlighted the important role of opioid use as a risk for long-term work disability. Joining forces with Dr. Jodi Jacobson Frey in the School of Social Work in 2019, this interprofessional team launched “Operation PROSPER – Peer Reintegration and Other Services Promoting Employment in Recovery,” a multiphase project to study the impact of interventions delivered primarily by peer specialists to increase work participation of patients in treatment for opioid use disorder. In 2020, this team began work for the Maryland Department of Health on a project called “Workplace PROSPER – Partnering to Reduce Opioid Stigma and Promote Employment in Recovery” to develop a Maryland toolkit for management of opioids in the workplace. She is an online instructional designer who has authored numerous online training courses for clinicians.

Janet Limke

Janet Limke, MD
Janet Limke, MD, is board certified in Physical Medicine and Rehabilitation. A member of the Massachusetts Medical Society since 2004, Dr. Limke also serves as District President and Alternate Trustee representing the Norfolk South District Medical Society. She recently was elected as Alternate Delegate to the AMA (American Medical Association) representing the MMS. She also serves as a member of the Committee on Occupational and Environmental Health to the MMS.  She is a clinical instructor at Harvard Medical School and a diplomat with AANEM (American Association of Neuromuscular and Electrodiagnostic Medicine.) She received her medical degree from University of Cincinnati College of Medicine; and completed residency in Physical Medicine and Rehabilitation at Tufts Medical Center. After completing her residency, she joined the faculty at the University of Cincinnati, dept of PM&R for 9 years.  In 1999, she returned to New England to work at Eastern Maine Medical Center, followed by New England Baptist Hospital Spine Center in Boston before moving her practice to South Shore Health.  From 2012-2020 she served as Medical Director of the Spine Center at South Shore Health located at 2 Pond Park, Hingham MA at the Center for Orthopedics, Spine and Sports Medicine.   She is a proponent of efficient, intensive exercise to treat many spinal disorders.  She enjoys assisting patients with achieving their best function and preventing avoidable work disability despite chronic pain or physical impairments. Furthermore, she promotes the use of positive language and cognitive behavioral strategies as powerful tools for treatment.  

Intended Audience
All primary care physicians, specialists, and other clinicians who treat patients of working age. Content will also be relevant to those who treat children and adolescents..

Course Objectives

  • State the physical, psychological, and socioeconomic benefits of work.
  • Describe how Adverse Childhood Experiences impact future work disability. 
  • Recognize when work disability is a harmful patient outcome.

Course Fees
Massachusetts Medical Society (MMS) Physician Member: $40.00
MMS Resident/Student Member: $ Free
Non-Member Physician: $90.00
Non-Members Resident/Student: $20.00
Allied Health Professional/Other: $32.00

Format & Estimated Time to Complete: Video, 1 hour

Accreditation and Credit Information
Accreditation Statement
The Massachusetts Medical Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMA Credit Designation Statement
The Massachusetts Medical Society designates this internet enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity meets the criteria for the Massachusetts Board of Registration in Medicine for risk management study.  

MOC Approval Statement
Through the American Board of Medical Specialties (“ABMS”) ongoing commitment to increase access to practice relevant Continuing Certification Activities through the ABMS Continuing Certification Directory, this activity has met the requirements as a MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards: 

Allergy and Immunology
Colon and Rectal Surgery
Family Medicine
Medical Genetics and Genomics
Nuclear Medicine
Physical Medicine and Rehabilitation
Plastic Surgery
Preventive Medicine
Psychiatry and Neurology
Thoracic Surgery

National Commission on Certification of Physicians Assistant (NCCPA)
Physician Assistants may claim a maximum of 1.00 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society.

Exam/Assessment: A score of 70% or higher is required to receive AMA PRA Category 1 Credit™.

Activity Term
Original Release Date: May 5, 2021
Review Date (s): N/A
Termination Date: May 5, 2024

Course Developers, Reviewers & Web Producer:
Danna G. Muir, MBA, Director, Accreditation & Recognition, NEJM Group Education  
Jane E. Gagne, Manager, Accreditation and Education Compliance, NEJM Group Education
Jessica L. Vautour, Product Manager, MMS Education Programs, NEJM Group Education
Thelma J. Tatten, Web Content Production Specialist, NEJM Group Education

System Requirements

Windows 10
Mac OSX 10.6 higher

Most modern browsers including:
IE 11+
Firefox 18.0+
Chrome latest version
Safari 12+

iOS devices beginning with OS version 10 or higher (includes, iPhone, ipad and iTouch devices)

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