Retaining Employment and Talent After Injury/Illness Network (RETAIN) Evaluation
Objective
The Social Security Administration (SSA) and the Department of Labor (DOL) are jointly conducting the Retaining Employment and Talent After Injury/Illness Network (RETAIN) demonstration, which test promising early intervention approaches to improve the labor force participation and retention of individuals with recently acquired injuries and disabilities and to reduce their future need for Social Security disability benefits.
The demonstration consists of two phases. The first involves cooperative awards to eight states to conduct planning and start-up activities, including the launch of a small pilot, funded by DOL. During Phase 1, SSA provided evaluation-related technical assistance through our contractor, Mathematica, including evaluability assessments assessing which states’ projects would allow for a rigorous evaluation in Phase 2.
Although each state is implementing its own unique model, all RETAIN projects are centered around early coordination of health care and employment-related supports and services for participating workers. The interventions include the following, at minimum:
- Early identification of workers, very soon after the onset of a condition that could affect their ability to work;
- Using specialized Return-to-Work Coordinators to coordinate health and employment service delivery;
- Training health care providers in occupational health best practices;
- Facilitating early communication and return-to-work efforts between workers, their employers, and their health care providers; and
- Partnerships among relevant state agencies and at least one health care system.
Status
In October 2018, SSA awarded a contract to Mathematica Policy Research to evaluate the RETAIN state projects. In April 2021, DOL awarded Phase 2 funds for Kansas, Kentucky, Minnesota, Ohio, and Vermont to build upon their work in RETAIN Phase 1.
Phase 2 projects began enrolling participants on a staggered basis, beginning in October 2021. All state projects are currently in the enrollment and implementation and services delivery phase. The enrollment period ends for all states in May 2024. SSA’s evaluation contract with Mathematica ends in February 2026.
The RETAIN evaluation is a mixed-methods demonstration and both qualitative (i.e., in-depth interview data) and quantitative data (i.e., baseline intake surveys, surveys with RETAIN staff, enrollees, service providers and administrators during and after services conclude, and program services and employment-related data for enrollees in each state) are being collected. SSA’s planned evaluation activities for the demonstration in each of the five states in Phase 2 (i.e., KS, KY, MN, OH and VT) consist of the following components:
- Participation analysis: This analysis will provide insights into which eligible workers choose to enroll in the demonstration and take up the corresponding services.
- Process analysis: This analysis will produce information about operational features that affect service provision; perceptions of the intervention design by service users, providers, administrators, and other stakeholders; the relationships among the partner organizations; each program’s fidelity to the research design; and lessons for future programs with similar objectives.
- Impact analysis: This analysis will produce estimates of the effects of the interventions on primary outcomes, including employment and Social Security disability applications, and secondary outcomes, such as health and service usage. SSA and Mathematica will identify evaluation designs for each state to generate impact estimates. The evaluation design could include experimental or non-experimental designs.
- Benefit-cost analysis: This analysis will present findings on the benefits and costs to workers, state and federal governments, and society.
The final process analysis report is expected in September 2025. The final impact analysis report is expected in November 2025.
Access interim reports, related implementation findings, and special topic reports below.
Information For Phase 2 Participants
This file shows all Phase 2 states, their websites and project logos.
RETAIN Evaluation Design Report
The Retaining Employment and Talent after Injury/Illness Network (RETAIN) demonstration is a collaborative effort between the U.S. Department of Labor and the Social Security Administration to help workers with recently acquired injuries and illnesses remain in the labor force. The goal of RETAIN is to implement and build evidence on the effectiveness of early stay-at-work/return-to-work (SAW/RTW) strategies to help those who develop a potentially disabling condition. The RETAIN demonstration seeks to increase employment retention and labor force participation and reduce long-term work disability among project participants.
The RETAIN demonstration has two phases. In Phase 1, which started in 2018, the Department of Labor awarded nearly $19 million in grants to eight state agencies to develop and pilot projects to help those who experience a potentially disabling condition remain at or return to work. During Phase 1, the state agencies set up pilots to test recruitment, enrollment, and service delivery for a limited sample of participants who could benefit from RETAIN. In Phase 2, the Department of Labor competitively awarded $103 million in grants to five state agencies to continue and expand their RETAIN projects from May 2021 to May 2025. The five states are Kansas, Kentucky, Minnesota, Ohio, and Vermont.
This report summarizes the evaluation design for RETAIN. The primary objective of the report is to serve as a reference for government officials, project staff, service providers, and members of the general public to consult for basic information about RETAIN until reports become available later in the evaluation.
Early Assessment Report
This report assesses the initial implementation of the RETAIN programs in five state-specific chapters (i.e., KS, KY, OH, MN, and VT). Each state began enrollment at a different time between November 2021 and March 2022. This assessment of initial implementation covers the period through June 2022. The findings focus on (1) program partnerships and the environment surrounding RETAIN implementation and service delivery, (2) recruitment and enrollment of eligible workers, and (3) RETAIN implementation and service delivery during the initial months of enrollment and service delivery. It also identifies areas for continued monitoring and evaluation technical assistance.
RETAIN-Process-Report
This report assesses RETAIN program implementation and service delivery in five state-specific chapters and one chapter that describes treatment enrollees’ experiences during Phase 2, which started in 2021. DOL and SSA competitively awarded cooperative agreements to five state agencies to expand programs they began in Phase 1 of RETAIN. Each state began enrollment at a different time between November 2021 and March 2022. This report assesses program implementation and service delivery through June 2023, which was midway through the 48 months of program operations funded under Phase 2 grants. The findings focus on (1) program partnerships and the environment surrounding RETAIN implementation and service delivery, (2) recruitment and enrollment of eligible workers, and (3) RETAIN implementation and service delivery. The narrative also addresses the implications for replicating each state’s program and provides an interpretation of impacts on outcomes.
Success Stories
These RETAIN Success Stories focus on the people and projects that enhance each state’s stay-at-work/return-to-work program. The Success Stories provide insight into the ways RETAIN programs may be used to promote the demonstration and enhance outreach with key audiences.
KS Success Story Phase 2
KY Success Story Phase 2
MN Success Story Phase 2
OH Success Story Phase 2
VT Success Story Phase 2
Special Topic Reports
The RETAIN Demonstration: Practical Implications of State Variation in SSDI Entry in SSDI Entry.
This brief presents findings on state- and county- level SSA administrative data with two goals in mind: (1) to introduce the RETAIN demonstration and its objectives to a broad audience and (2) to support RETAIN states in their planning for Phase 2 of the demonstration. SSDI application rates vary substantially by geography and other characteristics, such as age. This variation underscores that the size and risk profile of the working-age population varies across states. County-level data on SSDI awards also show substantial geographic variation within states. States in RETAIN may wish to adjust their approach to recruiting and screening based on this variation. More broadly, the findings here emphasize the benefits of developing state-based intervention approaches given the large geographic and demographic variation in disability application outcomes by state.
The RETAIN Demonstration: State Programs’ approaches to recruiting potential enrollees.
This report presents information on RETAIN state programs’ approaches to recruiting potential enrollees and implications for the pace of enrollment during the first 11 months of the demonstration. The brief reveals that the five state RETAIN programs (i.e., in Kansas, Kentucky, Minnesota, and Ohio) varied widely in cumulative enrollment during this period. The programs use different types of strategies to recruit potential enrollees. For example, some programs use a relatively direct strategy of relying on their staff to identify potential enrollees by searching medical record data. Other programs use a relatively indirect strategy of relying on referrals from other entities, such as medical providers, to identify potential enrollees. Programs that use relatively direct strategies had more enrollees. The findings here offer considerations for RETAIN and other programs seeking to identify and enroll participants in a relatively short time frame to provide early intervention services.
The RETAIN Demonstration: Comparing RETAIN Enrollees with Other Populations.
This report presents a comparison between the RETAIN enrollees with other populations by assessing the socioeconomic characteristics of adult workers and SSDI/SSI applicants in the five RETAIN program states (i.e., Kansas, Kentucky, Minnesota, Ohio, and Vermont). The comparative characteristics of people who enrolled in RETAIN in 2022 include all workers and applicants for SSDI and SSI in their respective states. The report provides insight into how RETAIN enrollees who might be at risk of leaving the labor force differ from the worker population and whether the RETAIN demonstration is reaching people who look similar to SSDI/SSI applicants. The findings indicate the attributes of RETAIN enrollees differed substantially from those of the two comparison populations and are reaching people who might be at greatest risk of applying for disability benefits.
The RETAIN Demonstration: Stay-at-Work and Return-to-Work Experiences of RETAIN Enrollees with Behavioral Health Conditions In this brief, we investigate how the characteristics, challenges, and experiences of enrollees with behavioral health conditions differ from those of other enrollees. We focus on enrollees assigned to the treatment group who enrolled into RETAIN on or before June 30, 2023. The share of treatment enrollees with behavioral health conditions varied widely across RETAIN programs, likely reflecting the differences in their eligibility criteria and recruitment strategies. We also examined the experiences enrollees with behavioral health conditions had with the RETAIN programs as they worked toward their stay-at-work or return-to-work goals.
The RETAIN Demonstration: A Case Study of Medical Providers’ Experiences in Ohio
In this brief, we describe the experiences of medical providers in Ohio RETAIN, including their characteristics, use of occupational health best practices, experiences working with return-to-work coordinators, and barriers to participating in the program. We focus on Ohio RETAIN because it was run by a single health system with direct access to providers, a relationship that facilitated the program model.
Restricted Access Files and a Public Use File will be generated prior to the end of the project in 2026. The Public Use File will be posted when it becomes available in 2026.