5 States are Getting $20 Million Each to Implement a Multi-Sector Return-To-Work Approach. Is Your State One of Them?
Three years after it started, participating states are beginning to take stock of RETAIN, a $180 million, 6.5-year federal program designed to reduce long-term work disability, decrease job loss, work absence and withdrawal from the workforce because of a work-related disability.
RETAIN, which stands for Retaining Employment and Talent After Injury/Illness Network, targets workers with a recent onset of work disability due to new or changed health conditions, especially musculoskeletal conditions.
“Before RETAIN there were no coordinated systems of support broadly available to help workers return to the workforce,” said Savi Swick, research and evaluation director for the U.S. Department of Labor’s Office of Disability Employment Policy.
“The program provides early-intervention stay-at-work/return-to-work services to prevent needless work disability. It is the only federal program of its kind.”
RETAIN’s goal is to provide services to people within 12 weeks of the onset of their condition.
RETAIN was developed after years of research and planning between ODEP, the Social Security Administration and the Department of Labor’s Employment and Training Administration, and included input from disability management experts, employers and industry associations, worker associations, public sector entities, researchers and others.
RETAIN was rolled out in two phases. Eight states (California, Connecticut, Kansas, Kentucky, Minnesota, Ohio, Washington and Vermont,) each received grants $2.5 million grants in 2018 to conduct planning activities, launch a small pilot of services and prepare for evaluation.
Five states, Kansas, Kentucky, Minnesota, Ohio, and Vermont, received Phase Two funds to expand services to a broader population and participate in an evaluation of RETAIN services outcomes.
Phase Two will continue through 2025.
What Does RETAIN Encompass?
RETAIN’S core services include:
- Training in occupational health best practices for participating healthcare providers.
- Active involvement of a Return-to-Work (RTW) Coordinator throughout the medical recovery period to facilitate continued employment.
- Enhanced communication among workers, employers, and healthcare professionals.
- Accommodations and job modifications.
- Retraining and vocational rehabilitation services
“There are differences in how the states are implementing these strategies to account for differences in employment, insurance and healthcare landscapes, but the services and supports central to all the projects include the core services,” Swick said.
“Because the states have unique partners, some of the biggest differences across the programs are in the referral processes and flow of service for participants.”
About 1,000 people participated in Phase One, which was recently completed. Another 16,000 people are expected to take part in Phase Two, with about half receiving the full suite of RETAIN services and the other half receiving a minimal service as part of the comparison group for the independent evaluation.
Swick says RETAIN to date has been focused largely on program development and implementation, but some successes have already been achieved.
“Some of the greatest accomplishments thus far have been improvements in coordination across healthcare and workforce systems,” he said.
“In the past, healthcare and workforce systems did not typically work together to help injured and ill workers regain function and maintain or regain employment.”
Success So Far
Representatives of states involved in RETAIN recently discussed their experiences with the program in a session hosted by the American Occupational Health Conference.
Representatives from participating states said program has enabled them to identify displaced workers earlier than previously. She also said it has prompted healthcare providers to consider how a patient’s job may impact their health.
In Vermont, a RETAIN representative says they kicked off their program by asking stakeholders in a variety of areas what they needed. The response was that they wanted a Functional Restoration Program (FRP), which is a two- to four-week program for chronic pain suffers, and which takes an interdisciplinary approach including a pain management occupational medicine physician, social worker, program coordinator and others.
In rural Vermont, many communities couldn’t support such a program, but could benefit from one, the representative said.
As a result, they created a hub and spoke model for an FRP in which the hub of the program coordinates services, completes testing and provides expertise as needed to satellites in six regions of the state.
A large challenge in Phase One was developing data systems that allow RETAIN staff to share and access participant data in real time.
Additionally, since this is a federal grant, the state programs have to collect information on participants for the independent evaluation. Also, programs had to develop their service flow and figure out how their staff were going to organize themselves to serve participants.
Early in Phase One most states faced recruitment and enrollment challenges.
“Most of the Phase One states took steps to increase their referral pipelines by identifying effective communication approaches,” Swick said. “They developed outreach strategies to support referrals, addressed the concerns of prospective participants who may not want to be part of a federal program with an evaluation, and delineated roles and responsibilities throughout the recruitment and enrollment process.”
As the program continues, Swick expects it to have important implications for other return-to-work efforts.
“Through RETAIN, we intend to learn a great deal about the impact of early intervention services on injured and ill workers, the types of services that are most effective, and ways that state agencies, private organizations or others may coordinate to help these workers,” he said.
The current approach is piecemeal and not effective.
“Currently, workers are at risk of falling through the cracks of the fragmented systems that support them, and too often employment is not viewed as part of a positive health outcome,” he said.
“The lessons and best practices we learn through RETAIN may provide the guidance and evidence some groups need to start developing their own programs. Improving the employment outcomes of injured and ill workers, including those with occupational and non-occupational conditions, is a win-win situation – it benefits all stakeholders involved.”. &