U.S. Department of Health and Human Services
Screening and Assessment in TANF/Welfare-to-Work: Ten Important Questions TANF Agencies and Their Partners Should Consider
Executive Summary
Terri S. Thompson and Kelly S. Mikelson
The Urban Institute
March 2001
This report was prepared under contract #HHS-100-99-0003 between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and the Urban Institute. The HHS Administration for Children and Families also provided funding for this project. For additional information about the study, you may visit the DALTCP home page at http://aspe.hhs.gov/daltcp/home.shtml or contact the ASPE Project Officer, William Marton, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. His e-mail address is: William.Marton@osaspe.dhhs.gov.
The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.
Changes to the welfare system brought about by the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), and state and local welfare reform efforts, carry serious implications for Temporary Assistance to Needy Families (TANF) recipients with disabilities and barriers to employment. Specifically, work participation and time limit requirements are two key provisions of the federal welfare law which provide a new sense of urgency encouraging states to develop strategies to assist clients with their transitions from welfare to work. As a first step in this process, TANF agencies are considering strategies to identify the barriers that are inhibiting or prohibiting this transition. PRWORA offers unprecedented flexibility to develop such strategies and design programs and services to assist with the transition from welfare to work.
As caseloads have declined, there is general agreement among TANF agencies that larger proportions of remaining clients are "hard-to-serve." Often this means clients are believed to have substance abuse or mental health problems or learning disabilities, or to be in domestic violence situations referred to collectively in this paper as "unobserved" barriers to employment. Given the employment focus and time-limited nature of TANF, there is increased interest in screening and assessment approaches that can be used to identify these barriers to employment.
In response to this increased interest, the U.S. Department of Health and Human Services asked The Urban Institute to explore the issues and challenges related to screening and assessment within the TANF context. This paper represents the earliest work under this effort. It identifies ten of the important questions that should be considered by TANF agencies and their partners as they develop approaches to screening and assessing for barriers to employment. By posing these questions, we hope to further the thinking about options for developing approaches to screening and assessment. However, answers to these questions must be developed by TANF agencies and their partners in order to best meet state and local needs and fit within state and local policy guidelines.
This paper is merely a first step in considering some of the many challenges associated with identifying unobserved barriers to employment. In the second phase of this study, we will conduct case studies to further explore how these issues are addressed in a select number of localities. The report based on the case studies will focus specifically on how those localities have answered the questions posed in this report. Regional meetings intended to facilitate discussion among states and localities facing these challenges will also be convened.
DEFINITIONS AND CONTEXT (QUESTIONS 1-3)
Before moving to the questions of how, when, and by whom TANF clients can be screened or assessed, there are important questions that must be asked that set screening/assessment in its appropriate context. This context is particularly important for TANF agencies just beginning to consider the challenges associated with identifying "unobserved" barriers to employment, and for partner agencies who may not be familiar with the details of TANF policy. There are a wide range of barriers faced by TANF clients that generally fall under the heading of "hard-to-serve." Examining issues related to identifying barriers to employment is complicated by the lack of common terminology. TANF agencies and their partners should take care to ensure they are using terms in the same way to lessen this complication, and in this spirit, Question One notes how terms are used for the purpose of this paper.
Many TANF agencies are already tackling the challenges associated with identifying barriers to employment and need no convincing of the importance of this issue. However, some staff or partner agencies may be less familiar with the objectives of TANF or prevalence of barriers such as substance abuse and mental health problems, domestic violence situations, and learning disabilities. Question Two provides an overview of incentives to screen or assess clients within TANF as well as a review of prevalence estimates for these barriers. Question Three builds on this discussion, outlining key aspects of TANF policy that provide TANF agencies flexibility in how they meet the needs of TANF clients, while also pointing out the requirements that TANF agencies and their partners must consider when developing screening, assessment, and service approaches.
APPROACHES TO SCREENING/ASSESSMENT -- HOW, WHEN, AND BY WHOM? (QUESTIONS 4-7)
Approaches to screening and assessment are largely defined by how the case management process contributes to identification of barriers, the use of screening or assessment instruments, the timing of identification efforts, and the staffing arrangements used to carry out screening and assessment. Questions Four through Seven address these approaches.
How can the case management process aid in identifying unobserved barriers to employment?
Case management is an ongoing, multi-faceted process of staff interacting with clients, determining needs, establishing goals, addressing barriers, and monitoring compliance with program requirements. Within the case management context, staff may rely on self-disclosure of a barrier or the observation of behaviors that might be indicative of barriers ("red flags") -- for example, bruises or a client who smells of alcohol -- as methods of identifying barriers to employment. Although inexpensive to implement, and likely already occurring at some level in most TANF agencies, these approaches may be imperfect if they are the only identification strategies undertaken.
The effectiveness of self-disclosure and behavioral indicators as methods of identifying barriers depends heavily on staffs abilities to make clients comfortable disclosing or eliciting disclosure, as well as staffs understandings of different barriers and the behaviors that are indicative of those barriers. In some locations, these less formal methods of identifying barriers are combined with the administration of screening or assessment tools. However, little is known among the TANF community about the tools that are available and their appropriateness for this population.
Are there tools that can be used to identify barriers to employment?
There are several state- and professionally-developed tools being used by TANF agencies (or recommended for use) to identify substance abuse and mental health problems, learning disabilities and domestic violence situations. Tools vary widely with some screening for multiple barriers while also collecting general background information, and others screening for a single barrier. Tools also vary considerably in length, complexity, and cost.
Experts caution that TANF agencies should be careful when selecting or developing tools to ensure that the instrument is methodologically sound. For example, there are a number of tools that have been developed to screen for substance abuse problems, but we were unable to identify such a tool that was designed specifically for use with TANF clients. In contrast, there are two learning disability screening tools that were designed specifically for use with TANF recipients.
When selecting or developing tools, TANF agencies may consider seeking guidance from partner agencies or community-based organizations with experience identifying or addressing a particular barrier. When selecting tools, TANF agencies must not only consider methodological aspects of the instrument but also the cost of the tool and the staff skills necessary to implement the tool and utilize information obtained.
When should screening or assessment occur?
TANF agency administrators interviewed generally considered efforts to identify barriers to employment to be an on-going, dynamic process, noting that there is no singular point in the TANF process when they believe screening or assessment should be carried out. Although the TANF client flow offers a number of opportunities to screen or assess for barriers, staff with whom we spoke noted that they utilize many of these opportunities to further their efforts to identify barriers. For example, TANF program orientations may offer an early opportunity to screen a client for barriers to employment. However, this early screening is often used to determine if a client is eligible for an exemption from participation requirements. The employability planning process offers additional opportunities to uncover barriers and is a common point where formal screening or assessment tools are utilized. As clients participate in work and self-sufficiency activities, re-planning sessions offer further chances to explore the reasons a client has not successfully made the transition from welfare to work.
In some locations, clients are referred to partner agencies for additional services. In some cases, the service received is additional assessment by a subject matter expert or trained clinician. In other situations, clients are referred for work-related services but may receive additional assessment as a part of this process. Finally, some TANF agencies use opportunities presented by non-compliance or lack of success in activities to conduct further assessment. Each of these points in the client flow offer opportunities to further explore barriers to employment. However, there is little information indicating if screening or assessing at any particular point in time yields more accurate information.
Although time limits and work participation requirements provide incentives to conduct screening or assessment early in a clients experience, TANF agencies repeatedly note that they are only concerned with a barrier in so far as it prohibits the client from obtaining or retaining employment. Therefore, even screening or assessment efforts that are conducted "up front" are conducted within the context of determining services to assist the client with her quest for employment, not based in the belief that the existence of such a challenge necessarily presents a barrier to employment. In some states with a strict "work first" approach, there is little formal screening or assessment conducted early on and, instead, the labor market is used as the up-front screen to determine job readiness or the existence of a barrier to work.
Who should conduct screening and assessment?
TANF agency officials and subject matter experts generally agree that the most appropriate role for TANF agency staff is to screen clients for barriers to employment and facilitate referrals to organizations with expertise diagnosing and addressing barriers. This belief is based in the fact that many TANF caseworkers are former eligibility or income maintenance workers with little experience with case management and barrier identification. To the extent that this is the case, states may need to consider training existing staff on barriers, screening, or assessment, hiring new staff to conduct screening/assessment, or creating partnerships with other agencies to assist with screening or assessment efforts.
TANF agencies generally have many partners in the service delivery process. However, for the purpose of identifying and addressing unobserved barriers to employment, TANF agencies may need to develop new relationships or change the nature of existing partnerships. Although resources in communities will obviously vary, other government agencies and community-based organizations may possess valuable experience identifying and addressing barriers to employment and therefore may be potential partners. Partnerships for the purpose of identifying and addressing barriers to employment faced by TANF clients bring with them many challenges, including understanding respective program philosophies and requirements. For example, partner agencies may not understand the work incentives and work participation rates that exist in PRWORA. In some cases, TANF agencies and their partners may need to consider adaptations in their policies or strategies order to accommodate TANF program requirements such as adapting services to meet shorter time frames or focus more heavily on work-related activities.
ADDITIONAL ISSUES (QUESTIONS 8-10)
Pervading the questions of how, when, and by whom screening and assessment should be conducted are questions relating to staff training and privacy and confidentiality. Although these are two important additional questions, these are merely some of the many questions TANF agencies and their partners must answer.
What training issues are related to screening and assessment?
Regardless of decisions related to the use of tools or informal identification methods, the timing of identification efforts, staffing arrangements and partnerships, it is likely that some training will be necessary. Training may need to be conducted on a wide range of topics including: general awareness of the characteristics of particular barriers, the details of how to administer specific assessment tools, how to determine appropriate services to address barriers once identified, and how to facilitate referrals to partner agencies. Training may also need to be conducted on broader issues of TANF and other program policies as they affect allowable services and the timing of different activities.
Additional training considerations include who to train (including the importance of cross training of partners) and the costs of training (including materials, trainers, and staff time required to attend training). However, there are costs associated with not conducting, or not training, the appropriate staff. Such costs may include inconsistent implementation of screening and assessment approaches, inconsistent information provided to clients by program staff unfamiliar with the program rules or requirements of partner agencies, and unsuccessful program initiatives.
What issues related to privacy and confidentiality should be considered?
Fundamental to the issues of obtaining information about barriers to employment faced by TANF clients and sharing this information with partner agencies in efforts to remove or mitigate such barriers are questions related to privacy and confidentiality. These issues are affected by a variety of laws, perceptions, and individual fears too complex to discuss fully in this report. However, the potential negative consequences of not seriously confronting the importance of these provisions makes the issues worth raising, even briefly. Examples of negative consequences include, but are not limited to: the fear of social stigma, the inability to obtain health insurance, and physical harm (or even death, particularly in the case of sharing information about domestic violence situations). Despite the challenges presented by privacy and confidentiality provisions, states have found ways to address these requirements and meet clients needs.
What other questions should be asked?
Questions One through Nine address some of the common issues that arose during the background research for this paper. However, there are numerous other questions that states and localities should consider. Examples of other important questions include: Should drug testing be used to identify substance use among TANF recipients? What can be done to help medical professionals understand the implications of their assessment or diagnostic findings? Is gaming the system a problem?
FUTURE DIRECTIONS
The issues raised in this paper suggest that states and localities face a number of decisions in selecting an approach to screening and assessing TANF clients for unobserved barriers to employment. The paper also offers examples of how some states and localities have answered questions related to screening and assessment. However, the issues and discussion presented here generate a number of questions that require additional information to fully address. This suggests that, regardless of the chosen strategy, states, localities, and the federal government should consider incorporating data collection into approaches implemented and plan future research related to strategies for identifying barriers to employment. Perhaps most important among future research questions are those that shed light on the effectiveness of different approaches to screening or assessment of TANF clients for barriers to employment. Additionally, many questions remain regarding the factors that may influence the effectiveness of different approaches.