Survey Design for TANF Caseload Project
Summary Report and Recommendations

IV.  PERSONAL BARRIERS

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Contents

1. PRIOR WORK EXPERIENCE, KNOWLEDGE OF WORKPLACE NORMS, BASIC JOB SKILLS, AND PERCEIVED DISCRIMINATION ON THE JOB
   1. Rational for Why the Topic Was Chosen
   2. Common Measures Used, Pros and Cons
   3. Recommended Measures
2. LEARNING DISABILITIES, LIMITED ENGLISH PROFICIENCY, AND ILLITERACY
   1. Rational for Why the Topic Was Chosen
   2. Common Measures Used, Pros and Cons
   3. Recommended Measures
3. PHYSICAL HEALTH PROBLEMS, LIMITATIONS, AND DISABILITIES
   1. Rational for Why the Topic Was Chosen
   2. Common Measures Used, Pros and Cons
   3. Recommended Measures
4. MENTAL HEALTH CONDITIONS
   1. Rational for Why the Topic Was Chosen
   2. Common Measures Used, Pros and Cons
   3. Recommended Measures
5. ALCOHOL AND SUBSTANCE ABUSE DEPENDENCY
   1. Rational for Why the Topic Was Chosen
   2. Common Measures Used, Pros and Cons
   3. Recommended Measures
6. PRIOR CRIMINAL INVOLVEMENT
   1. Rational for Why the Topic Was Chosen
   2. Common Measures Used, Pros and Cons
   3. Recommended Measures

In this chapter, we turn to the personal-level characteristics of TANF recipients that could potentially function as barriers to employment and self-sufficiency. These characteristics have to do with the individual capacities and readiness for work that arise from the mental, physical, emotional, and social domains of personal functioning. Specifically, in the area of personal barriers, we include the subtopics of prior work history, work orientation norms, ability to perform basic job skills and perceptions of discrimination; learning problems; limited English proficiency and literacy; physical health and disability status; mental health diagnoses; substance abuse and dependency; and criminal involvement.

Table IV.1 summarizes our recommendations and priorities for measuring personal barriers in the survey of TANF recipients. The estimate of the total time needed to administer all the “A”-rated items in the personal barriers domain, as indicated in Table IV.1, is 18.5 minutes.

A. PRIOR WORK EXPERIENCE, KNOWLEDGE OF WORKPLACE NORMS, BASIC JOB SKILLS, AND PERCEIVED DISCRIMINATION ON THE JOB

1. Rationale for Why the Topic was Chosen

Some barriers to employment are directly related to job skills and past work experience. Work history has been found to be a strong predictor of whether or not a welfare recipient can obtain and keep employment. Among those with work experience, some may have limited understanding of basic work-orientation norms, such as dress, grooming, attendance, punctuality, and interpersonal behavior. Others have few basic job skills, which can greatly limit their work opportunities. To be employed, even low-wage workers must have some minimum skills — for example, the ability to do arithmetic, make change, fill out forms, talk with customers, and write letters and memos. Finally, some individuals have a history of experiencing racial, ethnic, or sex discrimination or harassment in the workplace. Welfare recipients also may feel that they have been stigmatized by coworkers or employers because of their use of public assistance. Such past experiences can contribute to an overall reluctance to return to the workplace.

2. Common Measures Used, Pros and Cons

Limited Work Experience. To identify individuals with a limited work history, the CalWORKS Prevalence Project asked respondents how long it had been since they last worked for pay (part-time or full-time). Because some survey respondents will be young at the time of the interview, an alternative measure of work history is to ask how many years the respondent worked for pay since turning 18. The WES considers a respondent to have low work experience if he or she worked in less than 20 percent of the years since he or she turned 18.

Knowledge of Workplace Norms, or “Soft Skills.” To what degree welfare recipients lack “soft skills,” and whether this matters, remains the subject of controversy (Conrad and Leigh 1999; and Eberts and Hollsenbeck 2001). The Denver Workforce Initiative has developed an in-depth assessment of work-readiness skills that includes basic work habits and behaviors, work attitudes and values, interpersonal relations skills, and personal and environmental coping skills. The measure was validated with a study of 500 entry-level employees but is not necessarily intended for use in surveys. It is used to identify a jobseeker’s strengths and weaknesses and to help job coaches understand the areas that may require improvement. The Work Readiness Index requires a half-day of training to administer, and the cost is $1,650 per organization, plus travel costs for training. The results for how the measure is performing in the Jobs Initiative sites are not yet available.

An alternative (and more behaviorally based) measure of workplace norms is included in the second wave of the WES. The eight questions were adapted from a previous study of the causes of rapid job loss among welfare recipients (Berg, Olson, and Conrad 1991). Respondents are asked whether in the past four weeks they were late for work, lost their temper, took a longer break than scheduled, failed to correct a problem that a supervisor pointed out, had problems getting along with a supervisor, left work earlier than scheduled, refused to do tasks that were part of the job description, or missed a day of work for any reason.

Basic Job Skills. The WES adapted a series of questions about basic job skills from Holzer (1996) and administered the measure in Waves I and II. The questions ask about the performance of nine basic skills on a daily, weekly, or monthly basis in previous jobs. The CalWORKS Prevalence Project fielded the same measure in their study of welfare recipients in Kern and Stanislaus counties, but asked only if respondents had performed each task at least once a month. The questions ask respondents about writing letters or memos, talking with customers face to face, talking with customers on the phone, reading instructions, working with a computer, filling out forms, doing arithmetic, working with electronic machines and watching gauges. Respondents who report having performed less than four of these tasks are classified as having low basic job skills.

Perceived Discrimination on the Job. Adapting items from a 1995 Los Angeles household survey by Lawrence Bobo and a Detroit area study by Jackson and Williams, the WES asked respondents 16 questions about discrimination. Included in the questions were whether respondents’ current or most recent supervisor made insulting comments about women, welfare recipients, or people of color. Respondents were also asked whether they thought they had experienced discrimination because of race, gender, or welfare status and whether they had been sexually harassed on the job. Four or more instances of these experiences are considered indicative of perceived discrimination. An alternative measure of discrimination was used in the CalWORKS Prevalence project; a single item asked respondents whether they were ever discriminated against for any reason on any job. This measure does not permit disaggregating discrimination on the basis of gender, race, or welfare status. Further, the findings from this measure appear to be unexpectedly low, suggesting that perhaps some recipients did not understand the question or interpreted “discrimination” in various ways.

3. Recommended Measures

After weighing the trade-offs associated with the various measures described above, we recommend the questions from the WES that relate to this topical area, as follows: (1) Limited Work Experience: Ever worked for pay, number of years worked for pay since age 18; (2) Knowledge of Workplace Norms: Series of nine workplace behaviors in the past month; (3) Basic Job Skills: Experience with nine basic skills; (4) Perceived Discrimination: 16 questions on racial, sex, and welfare status discrimination. Although these measures have not been fielded in a telephone survey format, almost all of them require only a simple yes/no response and should be readily adapted for that mode of administration.

B. LEARNING DISABILITIES, LIMITED ENGLISH PROFICIENCY, AND ILLITERACY

1. Rationale for Why the Topic was Chosen

Although they are derived from different sources, the presence of such language and learning problems as learning disabilities, limited English proficiency, and illiteracy can present serious obstacles to finding and keeping employment. Written and oral communication skills are often named by employers as some of the most desired job skills.

A learning disability is a neurobiological disorder that can affect a person’s ability to read, listen, speak, write, spell, reason, recall, organize information, and do mathematics. It is not the result of low intelligence; in fact, comprehensive assessment typically shows a significant discrepancy between the learning disabled person’s cognitive ability and his or her actual achievement. Learning disabilities can lead to frequent job changes, problems on the job, and underemployment and unemployment. Evidence is building that a substantial proportion of welfare recipients may have such a condition. Using screening and assessment, the states of Kansas and Washington have estimated that between one-quarter and one-third of their TANF populations have learning disabilities.

People who are illiterate may experience difficulty obtaining and keeping employment because they are unable to complete application forms, understand written directions, and read important information. Like people who have limited proficiency in English because it is not their native language, they may be restricted to jobs that require minimal communication, such as manual labor, housekeeping, or meat-packing jobs, which tend to be low-wage, seasonal, or physically demanding. In addition, foreign-born individuals are more likely to be in poorer health, which can affect their employability and make them less likely to have jobs that offer health insurance, compared to the native population. Finally, cultural attitudes about work can sometimes restrict work opportunities for non-native women.

2. Common Measures Used, Pros and Cons

Learning Disabilities. Many nationally representative surveys attempt to identify those with learning disabilities by directly asking whether they have such a disability. For example, the SPD asks whether respondents have any problems on a list of different types of learning problems. However, it is known that the vast majority of learning disabled adults have never been tested or diagnosed and thus do not know whether they have a learning disability. A lengthy assessment, usually conducted by a specialist or licensed psychologist, is required to definitively diagnose learning disabilities. Such an assessment is not within the scope of the telephone survey we are planning.

That said, the Washington State Learning Needs Screening Tool, a brief and easily administered screening instrument, was recently developed and tested to identify the likelihood that an adult may have learning disabilities and require further assessment. The screening tool has been administered to recipients in welfare offices in Minnesota, Utah, and Washington. Emerging results suggest that the measure is reasonably predictive, valid, and reliable when compared to actual assessments. The Nebraska survey and Wave IV of the WES are also fielding the screener in their work with TANF clients.

Limited English Proficiency and Literacy. English proficiency has been measured in numerous surveys by first identifying those respondents whose native language is other than English, then inquiring about their comfort level with reading, writing, or speaking English. In contrast, we found few instruments that measure illiteracy directly. One exception is the third wave of the WES, which includes the Wide Range Achievement Test III (WRAT-III). The WRAT-III requires the respondent to read a list of words while the interviewer scores whether the word was read correctly. Obviously, this measure would not be feasible in a telephone survey without pre-mailing materials, which would add time and expense. An alternative that might serve as a proxy for identifying individuals who are illiterate would be to ask respondents who are native English speakers and not learning disabled about the degree and comfort with which they read to themselves, go to the library, or subscribe to newspapers or magazines. The later questions have been administered in several welfare studies as part of a measure originally designed to get at the extent of cognitive stimulation available in the home environment; but these questions have not yet been used as an indicator of literacy in adults.

3. Recommended Measures

To estimate the number of TANF recipients who are at risk of a learning disability, we recommend the 12-item Washington State Learning Needs Screening Tool. We also recommend including two yes/no items that ask about other types of learning problems: one to determine whether or not individuals have been told they have Attention Deficit Disorder (ADD), and one to determine the presence of diagnosed mental retardation.

To measure limited English proficiency, we recommend an item that identifies respondents who are non-native English speakers. We have less confidence that illiteracy can be reliably measured in this telephone survey, and thus recommend only the proxy measure (reading to self, going to the library, and so on), in the event that time remains after higher-priority measures are included.

C. PHYSICAL HEALTH PROBLEMS, LIMITATIONS, AND DISABILITIES

1. Rationale for Why the Topic was Chosen

A recent report from the NSAF indicates that 13 percent of the sample reported that their physical health limits their ability to work. Other state studies suggest that at least one-fifth, but possibly as many as one-half, of TANF recipients who are not working have health problems which, they believe, prevent them from working. Many parents who are no longer receiving TANF due to sanctions report being unable to comply with the rules because of a health condition, illness, or disability (Sweeney 2000). Evidence from studies of welfare recipients is beginning to show that health problems may present an important barrier, not only for obtaining and keeping employment but also for participating in programs meant to improve recipients’ employability. Although individuals with severe health problems can be exempted from work-activity requirements, most have not been evaluated for disability. Understanding the prevalence and severity of such problems could be useful in guiding states’ policies and procedures.

2. Common Measures Used, Pros and Cons

Physical Health and Functional Limitations. The SF-36 Health Survey (Ware et al. 1993) is a widely used and well-validated survey measure of general health and physical functioning.⁽²⁾ One of its advantages is that scores can be compared to age-specific national norms. An abbreviated version of the measure, the SF-12, was used in the Healthcare for Communities Survey and in the CalWORKS Prevalence Project. Several of the items in the SF-12 ask about limitations with respect to vigorous and moderate physical activities, such as lifting heavy objects or moving a table. Respondents are asked to indicate the degree to which they have difficulty with bathing or dressing themselves, walking over one mile, walking several blocks, and walking one block. Other items are brief indicators of emotional or mental health distress.

Several surveys that do not use the full SF-12 include its first item, which asks respondents to rate their overall physical health (see Nebraska, the SPD, NSAF, Iowa, and Alameda). This single item has repeatedly been shown to have very good predictive validity for mortality and disability. The item is frequently supplemented by other questions aimed more closely at the population targeted by the survey. For example, the Nebraska survey used three items to measure physical health: the self-rating of overall health, and two questions about whether the respondent’s health had interfered with his or her ability to work or attend training in the past 12 months. The Alameda survey of welfare recipients asks about medical problems in the past month, as well as such health behaviors as the frequency of check-ups and cigarette smoking.

An alternative measure of functional limitations that may be especially useful for a study of welfare recipients was developed by the NHIS. It asks the number of days in the previous months that the respondent was unable to function at work or school, as well as the number of days on which he or she went to work or school but was less productive because of poor health.

Disabilities or Chronic Conditions. The SPD goes beyond the measure of health and general functioning to ask about such disabilities as limitations in vision and hearing and the need for special aids, such as a wheelchair. It also asks whether the respondent has difficulty walking or carrying things, and whether any chronic condition limits their daily activities. In the 1999 SPD, the respondent is not asked to name the specific limiting condition. In contrast, the WES and the Healthcare for Communities Survey include a question asking the respondent to name any chronic health or medical condition he or she may have; the WES explicitly asks the respondent to name only those conditions that prevent or interfere with working or doing regular activities (for example, diabetes, asthma, and cancer). The open-ended responses are then coded into categories. The Alameda survey uses a lengthy list asking respondents about the presence of each disabling or chronic condition. Respondents are then asked whether each of the problems interfered with the respondent’s ability to work, look for work, or participate in job training.

Access to Health Care. Almost all surveys of welfare recipients include questions about whether the respondent has any health insurance, including Medicaid or employer-provided coverage. Health care is likely to be an important factor in determining whether health problems interfere with participating in employment and employment activities.

3. Recommended Measures

To assess the respondent’s health and whether it interferes with his or her ability to work or participate in training, we recommend using the items in the Nebraska survey: rating of overall health, and whether it has interfered with the respondent’s ability to work or attend training. To assess the presence of chronic conditions or disabilities, we recommend the WES measure because, in this version, the respondent is asked only about conditions that prevent or interfere with work or training. Finally, we recommend the two items from the Nebraska survey that ask about the respondent’s access to health insurance (whether the respondent is covered and, if so, the type of coverage).

D. MENTAL HEALTH CONDITIONS

1. Rationale for Why the Topic was Chosen

Researchers have found that mental health conditions can limit or prevent employment. Lower rates of labor force participation, reduced work hours, and lower earnings have been found to be associated with mental illness. In many cases, attendance is affected; for example, individuals with depression have been found to use as many as four times the number of sick days used by individuals who are not depressed (Broadhead et al. 1990; and Wells et al. 1989). Moreover, some behaviors associated with a mental illness are not conducive to working, including problems with social functioning and coping with day-to-day stress. Added to these difficulties, people with mental health conditions may face stigma and potential discrimination by employers. Gaining the support of the employer can be critical to the success of the mentally ill person in the workplace; yet many affected individuals fear that employers will be reluctant to accommodate their needs.

Mental health problems, especially depression, are considered more prevalent among low-income and welfare recipients than in the general population. For example, more than one-quarter of the sample of welfare recipients in the WES suffered from a major depressive disorder, compared with 13 percent nationally. Moreover, in the WES, major depression was found to be significantly associated with employment. Using the same diagnostic measure of depression, the CalWORKS Prevalence Project found that 22 percent of recipients in Kern County and 36 percent of applicants in Stanislaus County could be classified as having major depression.

Generalized Anxiety Disorder (GAD) is estimated to be present in about 4 percent of women in the general population, according to the National Co-Morbidity Study (NCS), the largest nationally representative epidemiological study of mental health in the United States. Recent studies of welfare recipients find higher rates of this disorder: about 7 percent in both the WES and a study of welfare recipients in Utah, and 9 to 10 percent in the CalWORKS Prevalence Project. GAD often coexists with other mental health conditions.

Many welfare recipients experience such traumas as domestic violence and rape, which put them at high risk of Post-Traumatic Stress Disorder (PTSD); see Curcio (1996). The rate of 12-month PTSD in the WES was more than 14 percent; the rate was 13 percent in each site of the CalWORKS Prevalence Project. The rate of PTSD in the NCS was 3.9 percent; this figure, however, includes men, who have a lower prevalence rate than women. The CalWORKS Prevalence Project found that more than 80 percent of women with PTSD had another mental health diagnosis as well.

Among other mental health diagnoses that could interfere with employment are such forms of depression as dysthymia and manic-depression, as well as several forms of anxiety disorders, including specific phobias, social phobias, panic disorders, and agoraphobia. When combined, the prevalence of specific anxiety disorders among welfare recipients in the CalWORKS Prevalence Project was 35 percent in Kern County and 23 percent among applicants in Stanislaus County. Women may also suffer from adjustment problems, such as eating and sleep disorders. With the exception of the anxiety disorders listed above, most studies of welfare recipients have not attempted to measure the prevalence of these other disorders.

Dimensional scales are measures that assess the severity of symptoms associated with a mental health diagnosis (The Center for Epidemiologic Studies Depression Scale (CES-D) is a good example). They differ from diagnostic assessments, which result in a report of the proportion of individuals with a positive diagnosis of a specific condition. Dimensional scales have often been used as screening measures in the past. Although they do not constitute an assessment, they are considered useful because they provide more information than a dichotomous classification of diagnostic prevalence.

2. Common Measures Used, Pros and Cons

General Screening Instruments for Global Mental Health

The NSAF administered a brief, general measure of parental mental health intended to cover four broad dimensions. Five questions ask about anxiety, depression, psychological well-being, and loss of behavioral or emotional control. These questions were adapted from the five-item Mental Health Inventory scale (MHI-5), used in the Medical Outcomes Study (MOS). The measure was developed by selecting the five items that best predicted summary scores on the longer 38-item version of the MHI scale. The MOS sample was drawn from patients waiting in doctors’ offices, rather than from the general population. It is important to note that general measures such as the MHI-5 can only suggest the respondent’s perception of his or her mental health, rather than determine the presence of any actual mental health conditions. In addition, general measures are not informative with respect to specific disorders, their severity, or whether they interfere with daily functioning and employment. Research that attempts to use the MHI-5 to distinguish between respondents who have clinical conditions and those who do not, does not have a track record as strong as other measures that focus on individual conditions.

The Alameda survey included 53 questions selected from the 90-item Symptom Checklist-90, a measure developed in the early 1970s to gauge symptoms of mental distress: depression, interpersonal sensitivity, obsessive-compulsive behavior, paranoia, hostility, anxiety, phobic anxiety, somatization, and psychotic thoughts. Although this measure covers symptoms and distress in many different areas, it is important to note that it cannot suggest the presence or absence of particular mental health conditions. A recent report on this study (Driscoll, Speiglman, and Norris 2000) indicated that the measure failed to predict employment at the multivariate level, unlike results from other studies that use diagnostic assessments, such as the WES and the CalWORKS Prevalence Project.

A short, dimensional measure of nonspecific psychological distress was recently developed by Ronald Kessler at the Department of Health Care Policy at Harvard Medical School (documentation currently under review for publication). The measure captures the severity of symptoms associated with a broad range of mental disorders. The scale includes questions about cognitive, behavioral, emotional, and psycho-physiological symptoms that have been found to be elevated among people with mental health diagnoses. Six- and 10-item versions were carefully developed from a larger set of items, and extensive tests have demonstrated their reliability and validity. The 6-item measure is currently being used in the NHIS, and the 10-item measure is being used in the annual SAMSHA National Household Survey of Drug Abuse and the World Health Organization’s (WHO) World Mental Health 2000 surveys (a set of representative community surveys being administered in 25 countries).

Survey Instruments for Specific Disorders

Depression. Depression, or depressive symptomatology, has been measured in dozens of surveys of welfare recipients. A 20-item measure of depressive symptoms developed by the Center for Epidemiological Studies at the National Institutes of Health (NIH) has repeatedly been shown to be reliable and valid when administered to welfare recipients, including studies in Iowa, Florida, and Minnesota, the New Chance Demonstration, the National Evaluation of Welfare to Work Strategies (NEWWS), and other studies. The CES-D, as it is known, has an established clinical cut-off point, permitting researchers to identify respondents who are at risk for depression versus those who are not (Ensel 1986). Other survey measures of depression include the Beck Depression Inventory (BDI), a list of 21 symptoms and attitudes that can be self-administered or administered by interviewers (Beck, Steer, and Garbin 1988). The major limitation of measures such as the CES-D and BDI is that they provide only screening-type estimates of the risk for clinical depression. Instead of suggesting a probable diagnosis, these measures provide an estimate of the number of depressive symptoms relative to others.

The more recent development of the Composite International Diagnostic Interview (CIDI) permits researchers actually to assign a diagnosis of depression based on the Diagnostic and Statistical Manual of Mental Disorders, version IV (DSM-IV).⁽³⁾ The CIDI was developed by WHO for use in epidemiological surveys around the world, and was administered in the NCS, the largest psychiatric, epidemiological study in the past decade. Since then, the CIDI has been included in hundreds of studies that have documented and confirmed its reliability and validity. Designed for use with trained interviewers (rather than clinicians), the full CIDI was converted to a short form by Ronald Kessler (1998), the lead investigator of the NCS, making it especially useful in brief surveys. The CIDI-SF consists of several different “modules” for various diagnoses, including major depression.⁽⁴⁾ The depression module of the CIDI-SF was used in the WES, the CalWORKS Prevalence Project, and the Healthcare for Communities Survey, among others. MPR also employed the CIDI-SF depression module in the Nebraska survey.

Generalized Anxiety Disorder (GAD). Compared to major depression, the potential presence of GAD has not been frequently measured in studies of welfare recipients, perhaps due to the unavailability (until recently) of a reliable survey instrument. The GAD module of the CIDI-SF was administered in the CalWORKS Prevalence Project, the WES, and the Healthcare for Communities Survey. The Alameda survey screened for GAD but used an instrument other than the CIDI-SF.

Post-Traumatic Stress Disorder (PTSD). The prevalence of PTSD in the past 12 months was measured in two surveys of welfare recipients by using the PTSD module of the CIDI-SF: the WES and the CalWORKS Prevalence Project. To be diagnosed with PTSD, respondents must first have experienced a traumatic event causing helplessness or horror, and then to persistently re-experience the trauma. Recurring symptoms include avoidance of trauma-related stimuli, outbursts of anger, disturbed sleep, and numbing of general responsiveness. Although there are many possible causes of PTSD — such as war trauma, being in a life-threatening accident, or witnessing someone being killed or badly injured — the CalWORKS Prevalence Project abbreviated the PTSD module by asking the respondent the PTSD questions from the CIDI only if he or she had experienced a physical or sexual assault some time in their past (instead of the 10 different events in the PTSD module).

Phobias. The CIDI-SF provides modules for specific phobias, social phobia, panic disorder, and agoraphobia. The CalWORKS Prevalence Project used the CIDI-SF modules to assess each of these conditions among their current welfare recipients and applicants. The major benefit of including measures of phobias is that they can be included in prevalence estimates that reflect all anxiety disorders. Yet all surveys must consider the trade-off between the constructs that should be measured and the survey length. Wave II of the WES included the CIDI-SF eight-item measure of social phobia in place of the GAD module that appeared in Wave I. The Healthcare for Communities Survey, a nonwelfare sample, screened for panic disorder.

Other Mental Health Conditions. Dysthymia and Lifetime Mania were assessed using the full CIDI in the Healthcare for Communities Survey, but these and other conditions have not typically been measured in studies of welfare recipients.

3. Recommended Measures

Building on what is known at this time about mental health barriers among welfare recipients, we recommend taking a specific, rather than broad and general, approach. Although it is now possible to diagnose many types of mental health conditions within a survey context, we propose to measure the prevalence of disorders that research suggests are more prevalent among low-income women: Major Depression, Generalized Anxiety Disorder (GAD), and Post-Traumatic Stress Disorder (PTSD). Furthermore, because of the high rates of mental health problems in welfare recipients, we recommend assessing the presence of conditions using only the best available measures that can be administered in a brief telephone survey. In particular, we propose the CIDI-SF to diagnose the prevalence of these disorders. The depression module of the CIDI-SF consists of 16 major questions and took only two minutes to administer in the WES. The module for GAD has 17 mostly simple yes/no items. The PTSD module is available in the CIDI and contains 35 items.

E. ALCOHOL AND SUBSTANCE ABUSE DEPENDENCY

1. Rationale for Why the Topic was Chosen

Abuse and dependence on alcohol or other substances is closely linked to problems with finding and keeping a job. Researchers estimate that one in five families on welfare have an adult with an alcohol or drug problem. Employment options are limited for those who cannot pass a drug-screening test as a condition of employment; past drug- or alcohol-related convictions may also restrict opportunities. Moreover, the symptoms associated with chemical addiction can frequently interfere with maintaining employment. Studies have shown that people with such addictions are far less productive at work, are more likely to injure themselves or someone else, and have higher-than-average health care claims, compared to those with no addiction. These problems often result in cycling in and out of jobs — and welfare. Most individuals with a drug or alcohol addiction require intervention before they can maintain steady employment. Chemical addictions sometimes mask psychiatric disorders; while mental health conditions — such as depression, mania, and attention deficit disorder — often coexist with alcoholism or drug dependency.

The DSM-IV makes a clinical-diagnostic distinction between alcohol or substance abuse and alcohol or substance dependence. Dependence is a diagnosis involving a “maladaptive pattern of substance use, leading to clinically significant impairment or distress.” It is considered to be a long-term condition (though responsive to treatment) and is characterized by having at least three symptoms from a list of criteria that includes, among other symptoms, tolerance, withdrawal, taking a substance in larger amounts or over a longer period than was intended. Alcohol or substance abuse, on the other hand, is characterized by having only one or more symptoms, which include problems in performance at work, school, or home; recurrent use when it is physically hazardous; and recurrent substance-related legal problems. If a person meets the criteria for substance dependence, a substance abuse diagnosis is not applicable. Although dependence is the more serious and long-term condition, both dependence and abuse of alcohol or other substances is likely to interfere with the ability to obtain and maintain employment.

2. Common Measures Used, Pros and Cons

The CIDI-SF provides separate diagnostic assessments for abuse and dependence of both drugs and alcohol.⁽⁵⁾ The CalWORKS Prevalence Project, the WES, and SPD used the alcohol and drug modules of the CIDI-SF to assess dependence. The modules are relatively short for a diagnostic assessment (the alcohol component has eight items, and the drug module has nine). Thus, the modules suggest a diagnosis, they are brief, and scores can be compared to national norms from the NCS. These measures have the additional advantage of having been previously OMB-approved for use in a nationally representative survey (the SPD).

The Nebraska survey of welfare recipients used a four-item screener for drug and alcohol use, known as the Drug-CAGE. Adapted from the original CAGE, which is an alcoholism screener used primarily by clinicians, the Drug-CAGE includes “alcohol or drug use” in each item. The measure was supplemented with a small number of other questions asking whether drug or alcohol use interfered with the respondent’s ability to work or attend training activities, as well as questions about service receipt. Though brief, these items do not permit disaggregation of alcohol from drug use; more important for our purposes, the Drug-CAGE does not result in a probable diagnosis of drug or alcohol dependence. Furthermore, although the CAGE has been widely used, it has been found not to be equally sensitive across ethnic and racial groups, and its items are not equally discriminating (Cherpitel 1998; and Volk et al. 1997).

The Alameda study administered numerous lengthy measures for alcohol and drug use and dependence, making them largely unsuitable for our purposes. The Healthcare for Communities Survey employed a screener for alcoholism (the AUDIT) and included a modified version of the CIDI for drug abuse and dependency.

3. Recommended Measures

Considering the practical implications of drug or alcohol dependency as a barrier to work, it seems important to measure these barriers especially well. Several states are considering, or have already implemented, programs that address alcohol and substance abuse among welfare recipients; yet there is little accurate data on the actual prevalence among this population. Moreover, diagnosing rather than screening for alcohol and drug dependency would be consistent with our approach to the assessment of mental health conditions in this survey. Because mental health conditions and alcohol/drug dependency so often coexist, it is desirable to take a similar approach to their measurement. For these reasons and others, we strongly recommend the two modules of the CIDI-SF for measuring alcohol and drug dependency.

F. PRIOR CRIMINAL INVOLVEMENT

1. Rationale for Why the Topic was Chosen

The employment needs of individuals with prior criminal involvement are somewhat different relative to those of other job-seeking adults. Although ex-offenders may face some challenges in keeping a job, their primary difficulty is obtaining one. Most job applications require prospective employees to report criminal convictions, and employers are cautious about hiring workers who have a past felony conviction because of the added behavioral risk they may bring to the workplace. In the eyes of employers, a criminal background raises the chance that theft, physical endangerment, substance abuse, and related activities will occur in the workplace. In fact, ex-offenders may be categorically barred from certain types of work in some states, including working with vulnerable populations such as children, the elderly, or the ill. In addition to these barriers, many ex-offenders have limited or sporadic work histories, particularly those who have been incarcerated.

Ex-offenders may have some difficulty maintaining employment due to legal issues requiring them to take time off work or issues that arise as they struggle with the transition from structured prison life to the mainstream. It is unclear whether being on probation or parole may interfere with working.

Despite these challenges, some employers — including those in the construction, assembly work, and manufacturing sectors — often are willing to hire ex-offenders and do not perform background checks on applicants. When the supply of labor is limited, other employers who are not legally prohibited from hiring ex-offenders may be persuaded to hire them. In fact, most employment programs that serve this population focus on helping the ex-offender understand the laws that protect him or her and on working with prospective employers to overcome fears and concerns about hiring an individual with a criminal background.

2. Common Measures Used, Pros and Cons

In the Nebraska survey, the respondent is asked whether he or she has a criminal record and, if so, whether it caused the respondent to lose a job or be prevented from working or participating in training. The question is embedded in a longer list of “things that could make it hard to look for a job.” Similarly, the WES asks whether the respondent has a criminal record, in a list of “reasons you think you don’t have a job.” The CalWORKS Prevalence Project and the SPD do not ask about respondents’ potential criminal activity.

Among the surveys of welfare respondents we examined, the Alameda survey includes the most extensive measurement of criminal background. It asks whether and, if so, how many times the respondent was convicted of a crime since reaching age 18. Respondents also are asked about 18 specific crimes they may have committed in the past year, and how many times they committed them. Finally, they are asked whether they have been on probation, bail, in jail/prison, or awaiting charges, trial or sentencing in the past 90 days. These measures do not appear to have national norms against which results could be compared.

3. Recommended Measures

Since there is no standard with respect to measurement of criminal background, little information exists on how welfare recipients compare to non-welfare recipients in this regard. Given the sensitivity of such questions, we recommend keeping measurement of this issue particularly brief. We recommend including the two questions asked in the Nebraska survey, potentially within the context of another measure.

Footnotes

2.  For more information on the the SF-36 and its shorter version, see www.sf36.com.

3.  For more information on the CIDI, see http://www3.who.int/cidi/index.htm.

4.  For complete instructions on coding the various modules of the CIDI-SF, see http://www3.who.int/cidi/cidisf.htm.

5.  For more information on the CIDI, see http://www3.who.int/cidi/index.htm.

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