The RETAIN Demonstration: Stay-at-Work and Return-to-Work Experiences of RETAIN Enrollees with Behavioral Health Conditions

The Retaining Employment and Talent After Injury/Illness Network (RETAIN) demonstration, a joint initiative of the U.S. Department of Labor and the Social Security Administration, aims to help workers with recently acquired injuries and disabilities remain in the labor force. Following a pilot phase, the U.S. Department of Labor awarded cooperative agreements to state agencies in Kansas, Kentucky, Minnesota, Ohio, and Vermont to fully implement RETAIN services. These five RETAIN programs aim to identify and recruit a subset of workers at risk of exiting the labor force and applying for Social Security Disability Insurance and Supplemental Security Income. All the RETAIN programs serve people with behavioral health conditions, including mental health conditions and substance use disorders, along with other types of health conditions. The Social Security Administration contracted with Mathematica to conduct the RETAIN evaluation. The evaluation relies on a random assignment study design, under which each program randomly assigned enrollees to a treatment group (eligible to receive services through RETAIN) or a control group (ineligible for RETAIN services).

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. Treatment enrollees with behavioral health conditions were more likely to be female and were on average younger than other treatment enrollees. At the time of enrollment in RETAIN, treatment enrollees with behavioral health conditions had lower employment rates and recent earnings, had worked less recently, and had shorter tenures at their current or most recent job compared with other treatment enrollees.

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. RETAIN programs varied in their infrastructure and resources available to support RETAIN staff in serving treatment enrollees with behavioral health conditions. Program staff described several unique challenges that these treatment enrollees faced, including stigma associated with their condition, a more complex pathway to recovery than enrollees with physical diagnoses, inadequate access to needed care, and non-health challenges such as housing insecurity. Despite these challenges, data recorded by the RETAIN projects indicated that treatment enrollees with behavioral health conditions generally used program services to a similar extent as other treatment enrollees. Many treatment enrollees with behavioral health conditions also described the value of the services they received through the RETAIN project.