The Retaining Employment and Talent after Injury/Illness Network (RETAIN) demonstration is a collaborative effort between the U.S. Department of Labor (DOL) and the Social Security Administration (SSA) to improve employment outcomes for individuals who experience injuries or illnesses that put them at risk of exiting the labor force and relying on disability programs and other public supports in the long term. RETAIN projects include a combination of medical provider services, stay-at-work/return-to-work (SAW/RTW) coordination services, and other SAW/RTW services. This evaluation will focus on the Vermont Department of Labor's implementation of "Vermont RETAIN" statewide. The evaluation will document how the project is implemented, describe enrollees, estimate the project's impacts on enrollees' outcomes, and assess whether the benefits outweigh the costs.

The Vermont Department of Labor is partnering with health care, employment, and other entities to implement "Vermont RETAIN." SSA contracted with Mathematica to conduct an independent evaluation of the program. Under the RETAIN model medical providers receive training and incentives to use occupational health best practices. The state agency also coordinates SAW/RTW services for the enrollee, fosters communication among Vermont RETAIN stakeholders about the treatment enrollee returning to work, and monitors the enrollee's medical and employment progress. Providers at participating practices are trained in the Vermont Best Practice Resources and Training, which explains how to identify early and then manage the risk of work disability to help prevent long-term unemployment. Participants undergo a systematic assessment of barriers to work, work goals, and function in order to create a personalized RTW plan; RTW coordinators use a strength-based coaching model and provide care coordination through a customized mobile health app.

Vermont plans to work with 68 primary care practices across the state and enrolls clusters of medical practices to participate in the study. The evaluation team randomly assigns each cluster to either a treatment or control group. Mathematica conducts random assignment of clusters on a rolling basis as Vermont enrolls clusters. Vermont invites eligible individuals who see a medical provider in either the treatment or control group to enroll in the study. Individuals who see a provider that has been randomly assigned to the treatment group and who enroll in the study are considered "treatment group enrollees" and are eligible for Vermont RETAIN services. Individuals who see a provider in the control group and enroll in the study are considered "control group enrollees" and are not eligible for Vermont RETAIN services.

The evaluation team then compares the outcomes of the treatment and control groups and gathers evidence on how RETAIN shaped the outcomes of enrollees who were eligible for its services, regardless of whether they participated in those services. Data sources include enrollment data, surveys, administrative records, program data, and qualitative data.

Inclusion Criteria:

• 18 years or older
• Live or work in Vermont (or if out of work, lives in a border state and plan to work in Vermont)
• Currently employed or actively looking for a job
• Have an injury or illness that is limiting or could limit ability to stay at or return to work
• The injury or illness occurred, flared, or worsened within the past 6 months

Exclusion Criteria:

• Has received care of coordination services from RETAIN before
• Has an active SUD that is currently untreated
• Has been out of work for more than 12 weeks due to injury, illness, or flare
• Currently applying for or receiving disability benefits from Social Security Administration