Ancillary Services to Support Welfare to Work

Authors:

Amy Johnson

Alicia Meckstroth

---

Submitted to: U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation 200 Independence Ave., SW Washington, DC 20201 Project Officer: Richard Silva

Submitted by: Mathematica Policy Research, Inc. P.O. Box 2393 Princeton, NJ 08543-2393 (609) 799-3535 Project Director: Stuart Kerachsky

"

Acknowledgments

This document was prepared by Mathematica Policy Research, Inc. (MPR) under a contract with the Assistant Secretary for Planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services. The authors wish to thank the many people who contributed to its successful completion. First and foremost was the original project officer, Steve Bartolomei-Hill, whose vision of what state and local welfare agency staff need--and would be likely to use--in this time of critical program review provided invaluable direction to the document's content and overall design. Richard Silva, upon Steve's departure from ASPE, continued to provide helpful guidance and suggestions.

At the state and local level, many agency and program staff provided us with national, state, and local data; discussed program operations and implementation issues with us; pointed us toward additional sources of information; and agreed to help in the dissemination of this document. In particular, directors and staff from the programs described at the end of each of the ten sections in this document gave generously of their time in conversation, sending us materials, reviewing our brief descriptions, and agreeing to be listed as contacts for those interested in additional information. Staff from both ASPE and the Administration for Children and Families reviewed portions of the document and provided us with constructive suggestions regarding both design and content. Catherine Runyan, from Ohio Family and Children First, and David Gruenenfelder, from the Illinois Department of Human Services, also reviewed the document and helped shape the final version.

Staff at MPR also played an important role in the completion of this report. Pamela Jones, who was responsible for a large portion of the initial identification of data sources and programs, talked at length with the many people we consulted to gather much of the information for the report and wrote early drafts of numerous program descriptions. Walter Brower and Patricia Ciaccio carefully edited the document. Monica Capizzi and Cathy Harper provided exemplary production support. Jan Watterworth assisted with identifying and obtaining many of the referenced documents. LaDonna Pavetti carefully reviewed the document and gave constructive feedback and suggestions. Stuart Kerachsky, the project director, provided invaluable guidance and support throughout all phases of our work.

We gratefully acknowledge these many contributions and accept sole responsibility for any errors that may remain.

INTRODUCTION: USING THIS DOCUMENT

The replacement of the Aid to Families with Dependent Children program with Temporary Assistance for Needy Families (TANF) block grants heightens the importance of designing services that will enhance the employment outcomes of today's welfare participants. One of the major consequences of the new legislation is that states must now prepare for employment a much larger--and far needier--segment of the population than before. Many in this group will have low skills and will face a number of barriers. Estimates of the percentage of the welfare caseload with at least one barrier to employment range from 54 to 89 percent, depending on the level of severity of the barrier (Olson and Pavetti 1996). Although states may still exempt a portion of the caseload, many who were formerly exempt from employment are now required to comply with work participation requirements and are subject to the five-year lifetime limit on public assistance. The new legislation, designed to provide federal block grants to each state, gives states wide latitude in creating local programs that will support these needs but, as of now, little guidance in how to do so. This document takes an important step toward filling this gap.

The document is organized around ten "barriers to employment" faced by welfare recipients who are struggling to make the transition from welfare to work: lack of specialized child care; disability; domestic violence; financial emergencies; housing instability; lack of health insurance; mental illness; substance abuse; inadequate transportation; and, simply, "multiple barriers," for those who face not just one but a combination of difficulties concurrently. Some portion of the welfare population undoubtedly faces other barriers to employment, but we think this set covers the areas in which welfare agencies should consider developing programmatic responses.

Each of the following ten chapters discusses all aspects of a single barrier. In each chapter and for each barrier, we present information in the four areas described below. A closing chapter discusses several overarching issues critical to future efforts to address these service barriers. Appendix A contains tables that present detailed estimates from the research literature of the percentage of the population facing each respective barrier to employment.

Need for Services

In this section, we discuss how the barrier is defined, present the range in estimates of those facing the barrier (the low- and high-end estimates), and discuss what accounts for some of the differences in estimated figures. The research available to estimate the percentage of the welfare population facing each of these barriers is diverse. Data sources, sample definitions, sample sizes, and research methods vary among studies. Some estimates are clearly more representative of a national welfare sample than are others, and we recognize that the current figures contain deficiencies. We present the range so that welfare agency staff have some initial means of thinking about the percentage of their own population likely to face each barrier. It is important, however, to consider the reasons that estimates vary and to refer to the tables in Appendix A, which provide detailed information on the population and barrier definitions from which the full range of estimates were derived. We conclude this section with a review of what is known from the research about the relationship between the barrier and both welfare receipt and employment status.

Welfare Agency Approaches

Current agency programs to address each barrier encompass a broad range of goals--from improving the identification of clients in need of services to expanding service capacity. In this section, we categorize the numerous strategies that agencies have undertaken, not to suggest that programs ought to be designed around a single strategy, such as client identification, but in an effort to help agencies (1) think about programmatic objectives, (2) define their service needs, and (3) contact other programs whose strategies are relevant to agency objectives.

Where information is available, we discuss the effectiveness of a program or treatment effort at reducing welfare receipt and increasing the likelihood of employment, and we note program costs. There is very little information in these areas, however. Most programs have not included a rigorous evaluation component, nor is detailed cost information usually available. Even when it is, comparing program costs is often impossible.

We conclude this section on current welfare agency approaches with a synthesis of key implementation issues for agencies to consider as they design services. This synthesis is based on information we obtained from agency staff and from research and policy documents providing in-depth analysis of the barrier. The challenges in implementing a program will vary from agency to agency because of the unique circumstances each agency faces. Local implementation issues in need of consideration will, therefore, encompass more than this synthesis provides. Our conclusion, however, is that implementing a program for any of these barriers should not exclude consideration of these issues. They are, as noted above, the key elements that agencies should address to avoid jeopardizing successful provision of services.

Program Models

Brief descriptions of programs--some still in the planning stage but most currently in operation--are provided. Our intent was not to include an exhaustive review of all efforts under way to address each barrier, but rather to provide the reader with a look at the kinds of approaches agencies are taking and to supply enough information so that those interested can explore further. Contact information is included. The programs presented are a sample for which we were able to get reasonable descriptions, which constitute an interesting cross-section of approaches, and which operate in both urban and rural areas. These are not necessarily "model programs," and most have not been evaluated for effectiveness. We do not endorse these programs, but present them simply to help agencies think about the variety of creative approaches that are possible and to stimulate communication between those who share the ultimate goal of assisting clients in the transition from welfare to work.

Further Information

For those who want further information on addressing each barrier, we include very brief descriptions of key agencies (along with their telephone numbers), as well as brief summaries of significant policy or research documents in the area.

Closing Chapter: A Summary of Overarching Issues

The closing chapter highlights three critical areas that span efforts to address each of the individual barriers to employment: (1) interagency coordination, (2) infrastructure, and (3) additional research needs. Though they are briefly addressed in many of the individual chapters pertaining to a particular barrier to employment, they recur with sufficient frequency and are of such importance that they merit special attention and greater detail. The enactment of legislation that mandates increased work participation rates among current welfare recipients and emphasizes greater personal responsibility has stretched the boundaries of what welfare agencies need to provide in preparing clients for employment. In response, social service and governmental agencies alike need to acknowledge and devote resources toward, in particular, the first two: interagency coordination and development of the infrastructure to support service delivery. In addition, future decisions about effective program design and implementation will depend upon a broader base of research knowledge than is currently available. This document not only provides a useful organizational framework for much of the available information and research across a broad spectrum of issues related to service delivery, but also reveals some important gaps that must be filled. This closing chapter discusses each of the three issues above and provides some direction for future action.

Appendix A: Estimation of Need

Tables that summarize the research estimates on the percentage of the population facing each barrier are provided in Appendix A. These tables include the full range of estimates, their source, the population under analysis, the barrier definition used in each case, and the corresponding percentages. Usually there are two tables: one that summarizes the available estimates for a national sample of welfare recipients and one that summarizes the available estimates for state or local samples. Where another way of organizing the data seemed more useful, the tables are presented differently. We recognize that our review may have omitted additional research that contains other estimates. However, we feel fairly certain that the estimates presented cover a reasonable and useful range that will give welfare agency staff an idea of the magnitude of the problem and help them to gauge the percentage of their own clients likely to need additional services.

Individual state welfare policies continue to change. This report does not review them or address the implications of differences between them (for example, varying time limits, the provision or exclusion of services for convicted drug offenders, or the exemption from work requirements for certain populations). Therefore, some approaches discussed may be relevant within the context of one state's policies but not another's. In addition, the profile of the welfare population is changing daily in response to work requirements and time limits. Estimates of the percentage of this population in need of supplemental services to address each of our ten barriers are changing equally fast; in response, so too will the intensity and design of services to address these needs.

Despite the many unknowns, this document--designed as a resource guide--should help to define the barriers and design solutions toward assisting clients in the transition from welfare to work. It is intended to help welfare agencies understand the barriers to employment their clients face, begin to think about ways to address these, locate information that will facilitate next steps, and begin the coordination of effort that is so needed in response to welfare reform. By synthesizing a large amount of historically diffuse information, we hope that this document assists agencies in their efforts to design promising programs and implement effective practices that improve the employment opportunities of today's welfare clients.

Specialized Child Care

INTRODUCTION

There are currently few providers for those in need of specialized child care: care during nonstandard hours, sick-child care, and special-needs care. The employment opportunities of many welfare recipients are jeopardized not only by this shortage, but also by two emerging forces: the rise in welfare work participation rates from 25 to 35 to 50 percent, and the relative increase in job opportunities during nonstandard hours. It is projected that even less of the need for child care can be met as more welfare recipients enter the workforce and that there will be an even greater demand than at present for specialized care, particularly during nonstandard hours. Unless welfare agencies and others develop approaches that ensure the availability of child care, particularly specialized child care, welfare recipients cannot be expected to meet work participation requirements.

This section provides information on and addresses the following questions related to the need for specialized child care among welfare recipients:

NEED FOR SERVICES:

• How is specialized child care defined?
• What percentage of the welfare population faces this as a barrier to employment?
• What relationship does the need for specialized child care have to welfare dependency and employment?

Definition

The scarcity of child care is rapidly gaining national attention, though it has long been recognized as a significant obstacle for people trying to enter the labor force. Put quite simply, without someone to watch the child, a parent cannot be expected to work. The barrier that child care poses to employment is proportionate to the size of the gap between supply and demand. This gap comprises several dimensions, including affordability, quality, and access.

A comprehensive review of these issues, however, goes well beyond the scope of this document. We focus instead on the gap between the need for and supply of three particular types of care that are seldom addressed but that pose serious barriers to employment for those making the transition from welfare to work: (1) nonstandard-hours care, (2) sick-child care, and (3) special-needs care.

• Nonstandard-hours care is care needed during early mornings, evenings, nights, and weekends, as well as shifts longer than eight hours (GAO 1995).
• Sick-child care, or care for "mildly ill children," is care for children who are too sick to attend school or child care (National Association for Sick Child Daycare 1997).
• Special-needs care is care for children with physical, emotional, or mental disabilities (GAO 1995). Disabilities range from cerebral palsy and autism to attention deficit and speech disorders and hearing and vision problems.

ESTIMATION OF NEED:

• Nonstandard-Hours

  NEED estimates: 10 to 72 percent

  SUPPLY estimates: 12 to 41 percent

  Sick-Child

  NEED estimates: 29 to 65 percent

  SUPPLY estimates: 3 to 50 percent

  Special-Needs

  NEED estimates: 13 to 36 percent

  SUPPLY estimates: 13 to 74 percent

  Table 1 in Appendix A provides estimates of the need for child care in each of the three specialized areas. Table 2 in Appendix A then provides estimates of what is known about the supply. Ranges are presented in the box above. In no case are these estimates based on a single study that has analyzed both issues simultaneously. The primary difficulty even in estimating the proportion of the welfare population needing specialized child care in order to work is that studies do not examine both need and supply together. So while anywhere from 10 to 72 percent need child care during nonstandard hours, it isn't clear if the 72 percent are located in an area with 12 percent of the supply (and the 10 percent located in areas with 41 percent of the supply), or vice versa. Lack of information about the supply of unregulated care further complicates the issue of estimating who faces a barrier to employment as a result of the need for specialized child care. Some people who live in areas and work under conditions that theoretically pose the greatest challenge to sustaining employment (for example, working nonstandard hours where there are very few care providers during these times) may have an extensive network of informal support to compensate.

  The following factors contribute to the ranges in estimates above:

  • Barrier Definition. On the supply side, the range of estimates is wide, depending upon the type of care provider. For sick-child care, centers are much less likely to provide care than are regulated or nonregulated family day care providers. The opposite is true for special-needs child care, however, for which centers are most likely to provide care.
  • Study Sample. Some estimates are based on a sample that is unrelated to the supply of care--for example, the percentage of those who work nonstandard hours or have special-needs children. Other estimates, however, are based on a sample more closely related to the supply of care--for example, those who request specialized care or who have had a problem finding care. These estimates will vary, and it is certainly much less clear to what extent there is a barrier to employment for samples defined in a way that is unrelated to supply of care.
  • Demographic Characteristics. Certain demographic characteristics also affect the estimation of the barrier to employment posed by the need for specialized child care. As is true for any child care, amount and source of income play a large role in determining the extent of a problem affording and obtaining acceptable specialized care. The age of the child also is a factor in the availability of child care. One study, though not based on specialized child care, found that the supply of care in Chicago for preschool children could meet 75 percent of demand, whereas the supply of infant care could meet only 16 percent of demand (GAO 1997).
  • Employment Profile. The extent to which the need for specialized child care poses a barrier to employment is also a function of work characteristics: the number of hours worked, flexibility in hours worked, and benefits provided (such as paid sick leave). One study that has looked at the employment profiles of those who move from welfare to work estimates that the number of former welfare recipients whose jobs grant paid sick leave is less than 30 percent (Rangarajan 1996). As the number of hours worked increases, the percentage of those who rely on formal care (center-based care or nonrelative family care) also increases (Smith 1995). While formal care is more likely to cover children with special needs, it is least likely to cover sick children or be available during nontraditional hours.
  • Geographic Location. Geographic location affects the gap between supply of and demand for care, specialized or otherwise. Poor areas often have a limited supply. For example, though the current supply of infant child care in Chicago can meet 16 percent of demand, as noted above, the current supply of infant care in poor areas in Chicago can meet only 11 percent of demand (GAO 1997). Welfare recipients in rural areas also frequently face both supply and accessibility difficulties, as a result of the greater constraints posed by inadequate transportation systems. Finally, there are differences in how states have earmarked and allocated funding for child care, which will contribute to differences in the local supply of care that is affordable and available to welfare recipients.

  Relationship to Welfare Receipt and Employment Status

  The following information pertains to general child care issues, rather than our three specialized areas. In all likelihood, however, the relationship to welfare receipt or employment status highlighted below is similar to or more extreme for those with specialized child care needs.

  • More than 40 percent of all poor nonworking mothers with infants report child care problems as the primary reason for not being in the labor force (Kisker and Ross 1997).
  • Researchers have found that high day care costs discourage women's entry into the labor force (Smith 1995).
  • Sixty percent of participants in welfare-to-work programs in 38 states reported lack of child care as a barrier to work (GAO 1997).
  • An evaluation of GAIN, the job-training program for welfare recipients in California, found that welfare mothers who were concerned about their children's safety and did not trust their providers were twice as likely to drop out of the program as were mothers satisfied with their child care arrangements (Gilbert et al. 1992).
  • In a 1990 study, nearly one out of every six mothers employed outside the home reported losing some time from work in the previous month because of a problem with child care arrangements (New York City Department of Business Services 1991).

  Welfare Agency Approaches

  What can welfare agencies do to assist clients who face the need for specialized child care as a barrier to employment?

  • What does the evidence suggest about the effectiveness of addressing this barrier?
  • What do we know about program costs?
  • What do we know about program implementation?

  Client Identification

  Identification of clients in need of specialized child care--nonstandard-hours, sick-child, and special-needs care--is usually far less complex than identification of clients with other barriers to employment. However, because resources are limited, it is often quite difficult for agencies to meet clients' needs. Generally, a designated caseworker will meet with each client to assess needs and develop a list of accessible and acceptable child care providers. Clients make the final decision as to which provider to use, but they usually have few options available to them. Transportation barriers may further reduce the number of options. Back-up care, for times when a child is sick, is rarely addressed. When clients' circumstances change (as they move from subsidized employment to unsubsidized employment, change jobs, or change the number of hours worked), caseworkers must repeat this process based on a new needs assessment.

  Program Strategies

  The barrier that lack of child care options poses for welfare recipients who work nonstandard hours, who have a sick child, or who have a child with special needs has received little direct attention. The larger issues of the general need for affordable, accessible, high-quality care have largely overshadowed this issue, though responses to this general need may ultimately benefit those in need of specialized child care as well. For example, the need for specialized child care will naturally be served by initiatives that include federal and state funding efforts, employer programs designed to meet employee child care needs, incentive programs for child care providers, and welfare agency efforts that earmark additional funds for child care and that develop expedited systems for assisting clients in finding this care.⁽¹⁾ What we review here are only those efforts that welfare agencies are undertaking to address the need for specialized child care directly. This review does not extend to the full range of the other responses above or to efforts that address issues related to child care policy. We categorize these strategies below. The distinctions drawn are not intended to suggest that agencies design programs around a single strategy or that these strategies are necessarily mutually exclusive. They are provided instead to foster thinking about the range of programmatic objectives possible, to help agencies define their own service needs, and to classify the programs described at the end of this section for agencies interested in pursuing further information. Our review of these programs suggests that there are at least three broad program strategies to address the barrier found by the need for specialized child care:

  Service Coordination. Programs with this strategy aim to institute improved coordination systems or procedures between welfare agencies and other social service agencies in order to help clients obtain specialized child care. One example is the coordination that occurs frequently between welfare agencies and Child Care Resource and Referral agencies (CCR&Rs). Some CCR&Rs pay particular attention to specialized child care needs. CCR&Rs are a natural choice for service collaboration because they are a central structure that provides access for a range of stakeholders. Other forms of service coordination can include computer-based information systems, formal cross-agency advisory groups, or contractual arrangements for child care service provision or provider training.

  Increased Service Capacity. Programs with this strategy aim to expand the supply of specialized child care. Included are those that offer incentives for existing providers to increase their hours of operation or that attempt to identify new providers.

  Employment Integration. Programs with this strategy include a focus on employment in their efforts at addressing child care needs. Just as some welfare agencies are training clients to operate their own transportation services, some are training clients to become child care providers. Agency efforts could tailor these programs to address the need for specialized child care, though the program we reviewed that trains welfare clients does not (Job Opportunities for Low-Income Individuals, in Lincoln, Nebraska, described later in this section under Program models). The intent of these efforts, in addition to providing employment training for welfare recipients, is also to increase service capacity.

  Program Outcomes

  Under the new welfare work requirements, large numbers of welfare recipients are likely to need specialized child care, particularly care during nonstandard hours. In 1991, 7.2 million mothers in the labor force worked nonstandard hours, and this number is expected to rise (Bureau of Labor Statistics 1992). Because formal child care arrangements are necessary for parents to work (in the absence of informal care), the logical assumption is that systems that improve coordination of service providers or increase the supply of providers will remove the barrier to employment that lack of child care poses and help some portion of the welfare population become and stay employed.

  However, we know nothing about the comparative effectiveness of these efforts. With efforts that seek to expand the supply of specialized child care providers, it would be useful to know the comparative effectiveness of offering direct incentives to providers that train welfare clients themselves to become providers. With efforts that seek to coordinate services, it would be useful to know the comparative effectiveness of relying on external resource and referral agencies to help clients locate acceptable and stable providers versus relying on designated in-house caseworkers. Because the focus to date has largely--and appropriately--been on service provision itself rather than on assessment of service provision, research has not yet included this kind of comparative analysis.

  Program Costs

  Welfare agency efforts based on coordination of services with existing resource and referral agencies, employers, or other community-based organizations are relatively inexpensive. Because the agency is not providing direct services, most of the cost is for the coordination itself. Some of the expense will be one-time initial costs (for example, for developing relationships and establishing procedures), and some will be ongoing costs (for example, for monitoring client needs and arrangements).

  The cost of efforts based on enhanced service capacity--on increasing the actual supply of providers--will depend on the magnitude of effort. The program model that we reviewed, the Centerville Cluster Day Care Diversion Project in Des Moines, Iowa, awarded grants of $20,000 each to two service providers to expand their hours of operation and cover nonstandard hours.

  Employment integration efforts, because they increase the supply of child care providers at the same time that they provide training and employment opportunity for welfare recipients, have higher costs. The program model that we reviewed, the Job Opportunities for Low-Income Individuals Project, was funded for $500,000 over three years to train approximately 125 clients. Both employment integration and enhanced service capacity efforts, however, could lead to the creation of enough new child care slots to be cost-effective.

  One immediate cost to welfare agencies, however, not exclusive to any particular type of program, is for additional staff resources to serve a growing number of welfare clients who need child care as they enter the workforce. The level of additional resources needed for new staff will depend upon current staffing resources, how operations are organized, and the local supply and demand for child care services. These costs will be incurred whether families need specialized child care or not.

  Program Implementation

  The summary below discusses implementation issues and approaches that those operating child care programs have faced--and those planning to operate child care programs will likely face--in two key areas: (1) program staff, and (2) local needs assessment.

  Program Staff

  If program implementation is to be successful, welfare agencies should carefully assess several staffing issues to handle clients' child care needs adequately. Agencies should address at least three implementation issues related to child care staffing. As noted earlier, inadequate attention to the number of staff needed, particularly over time as the number of clients making the transition from welfare to work continues to grow, could cause delays in services, poor matches between providers and clients, or lack of attention to the need for back-up care arrangements. These deficiencies, in turn, place additional demands on staff when clients return for services as current arrangements fail. These demands are likely to be exacerbated when clients need specialized child care.

  Determination of the most efficient and effective role for those handling clients' child care needs is also important and will depend upon whether the agency relies on external resources such as a hotline or CCR&R or handles identification of providers and client referrals in-house. Agencies will need to train staff adequately for whichever roles and responsibilities they are expected to assume.

  Local Needs Assessment

  If programs are to be effective, they should address the specific child care needs that clients face. Effective implementation is dependent upon a clear understanding of what clients need and an inventory of local child care resources. Many of the independent efforts, for example employers' efforts to address their employees' child care needs, begin with some form of local survey. Without clear information about both sides of this issue--client needs and existing resources--it will be harder to develop an appropriate response to address the gap. Some form of local needs assessment will help agencies determine whether they are more in need of coordinated services to make the referral process more efficient (because existing providers meet clients' needs) or more in need of expanded services (because existing providers do not meet client needs). This may be the case, for example, in an area with very few providers offering care during nonstandard hours and a client population in need of this form of care. Because there are few providers and potentially many clients in need of specialized child care, this form of needs assessment must focus on identifying these potential gaps. An initial needs assessment, perhaps conducted in coordination with other local stakeholders, should be done before an agency designs a service response.

  Program Models⁽²⁾

  • What are welfare agencies doing to address this issue?
  • Whom can I contact?

  The following programs are presented alphabetically by state. The reader can determine the relevance of a program by noting its primary program strategy and geographic location and then refer to the brief descriptions and contact information on the subsequent pages. We have used primary objective(s) to assign program strategies, though a program may have many objectives.

  Child Care Support Center

  Child Care Solutions

  Atlanta, Georgia

  Program strategy: Service coordination

  Location: One urban site

  ---

  Iowa Division of Economic Assistance

  Centerville Cluster Day Care Diversion Project

  Des Moines, Iowa

  Program strategy: Enhanced service capacity

  Location: Two rural sites

  ---

  Lincoln Action Program

  Job Opportunities for Low-Income Individuals (JOLI) Project

  Lincoln, Nebraska

  Program strategy: Employment integration

  Location: One urban site

  ---

  Program Name/Contact

  Child Care Support Center Child Care Solutions Atlanta, Georgia

  Pam Runkel, Director Projects of Child Care Solutions 404-479-4233

  Program strategy: Service coordination Location: One urban site

  Brief Program Description

  The Child Care Support Center in Atlanta, Georgia, designed Child Care Solutions (CCS) to help parents find child care in the metropolitan Atlanta area. Although the service is available to any parent in need of assistance, the Child Care Support Center familiar with the unique needs of the welfare-to-work population and seeks to address those needs through specialized programs and through coordination with the Atlanta Department of Family and Children's Services. The center has two goals: (1) to strengthen the ability of families, caregivers, and communities to nurture, support, and educate all children; and (2) to build a supply of affordable, high-quality child care in 16 metropolitan Atlanta counties.

  The center operates three programs that affect people moving from welfare to work: CCS, the Lawrenceville Project, and Purchase of Care.

  CCS is a child care resource and referral service that provides information, assistance, and training to caregivers and educates parents and the community about the importance of expanding affordable, high-quality child care (with special attention given to nonstandard-hours care, sick-child care, and special-needs child care). CCS notes that the parents' requests for referrals to nonstandard-hours care are outstripping the supply, and the Child Care Support Center has sought to increase the number of caregivers who offer nontraditional care. In addition, CCS maintains data on child care facilities and family child care homes that can offer specialized care for children with disabilities. The cost for referral is determined on a sliding fee scale, according to the person's level of income. While CCS is provided to all residents of Greater Atlanta, its counselors spend substantial time providing child care counseling to the growing number of welfare recipients making the transition to work.

  The Lawrenceville Project targets residents of the housing authority for training as child care providers. Project administrators estimate that 95 percent of the program's participants are welfare recipients.

  Purchase of Care buys child care for families with children under three at a price of $65 a week. It is funded at $50,000 a year by the Georgia Child Care Council. Families can receive assistance for up to one year. Project administrators estimate that 50 percent of the project's participants are welfare recipients.

  Evaluation

  This program has not been formally evaluated.

  Program Name/Contact

  Iowa Department of Human Services Community Self-Sufficiency Grant Centerville Cluster Day Care Diversion Project Des Moines, Iowa

  David Perret, Coordinator Community Self-Sufficiency Grant Iowa Department of Human Services (515) 281-4187

  Program strategy: Enhanced service capacity Location: Two rural sites

  Brief Program Description

  The Division of Economic Assistance of the Iowa Department of Human Services and the Iowa Workforce Development Department approved the Community Self-Sufficiency Grant Centerville Cluster Day Care Diversion Project to respond to an identified need for nonstandard-hours child care in the rural counties of Appanoose, Davis, Monroe, and Lucas. The program's goal is to remove the employment barrier of nonstandard-hours care for TANF participants who are participants in PROMISE JOBS, Iowa's work and training program.

  The Centerville Cluster Day Care Diversion Project has two main objectives: (1) to expand the number of facilities that provide care during nonstandard hours and (2) to assist TANF/PROMISE JOBS participants in securing nonstandard-hours care. Because of the lack of available nonstandard-hours care, a grant of $20,000 was awarded to Kid's World in Centerville for them to extend their day care hours from 6:00 a.m. to 10:30 p.m. Monday through Friday. Another facility, the Davis County Day Care and Preschool, was awarded a $20,000 grant to provide care from 5:30 a.m. to 10:30 p.m. Monday through Friday. The Davis County Day Care and Preschool has also received $5,000 for open day care during June, July, and August. So that participants can secure nonstandard-hours care, they are advised of the availability of such care at the time of assessment, at the Job Club, and at the negotiation of their Family Investment Agreement. Participants are apprized of the service and its benefits. If a person expresses a need, a formal referral is made to a local area facility that offers nonstandard-hours care.

  The program is funded at $50,000 by the Iowa legislature.

  Evaluation

  While an impact evaluation is not scheduled, the project is undergoing a less formal evaluation.

  Program Name/Contact

  Lincoln Action Program (LAP) Job Opportunities for Low-Income Individuals (JOLI) Project Lincoln, Nebraska

  Sue Hinrichs Project Director 402-471-4515

  Program strategy: Employment integration Location: One urban site

  Brief Program Description

  The Lincoln Action Program (LAP), based in Lincoln, Nebraska, has designed the Job Opportunities for Low-Income Individuals (JOLI) Project to address the dual need for employment and child care among welfare recipients and other low-income people. The program's goal is to create 125 new child care or other microenterprise businesses during the program's operational phase (October 1, 1995, to September 30, 1998).

  In addition to providing case management, JOLI offers welfare recipients training and support in establishing an in-home child care business. The program provides, at no cost to the participant, more than 50 hours of training in child care-related skill development as well as business management. Financial assistance with business start-up expenses is available to all participants who complete the training series. Additional support and networking opportunities are also provided through monthly support group and business group meetings, as well as a mentoring component that matches successful JOLI child care providers with participants entering the program. The case management services are provided to reduce any existing barriers to self-sufficiency and successful business operation. Family strengths and barriers are identified through a comprehensive assessment. Goal-setting activities follow.

  The JOLI Project is funded through the Office of Community Services at the U.S. Department of Health and Human Services. For a three-year period, JOLI was funded at $500,000.

  Evaluation

  The Center on Children, Families, and the Law, at the University of Nebraska, is currently evaluating this program. The evaluation is designed to measure the program's impact on participants' self-sufficiency through employment or general nonreliance on public assistance, to assess how adequately project activities are implemented (through a process analysis), and to compare the characteristics of people in the JOLI program with people living in the target communities. JOLI staff members will do the actual data collection through interviews and case record review, and the center will analyze the data.

  Findings

  Results from the final evaluation will be available in October 1988.

  Further Information

  Further information on issues related to child care is available from the following

  Organizations

  Child Care Automation Resource Center

  Washington, DC

  888-821-6997

  The Child Care Automation Resource Center was established by the Child Care Bureau of the Administration for Children and Families at the U.S. Department of Health and Human Services to help states and territories meet their reporting obligations under the new welfare reform legislation. The center also provides workshops and training on developing training materials for state and territorial child care staff.

  National Association of Child Care Resource and Referral Agencies (NACCRA)

  Washington, DC

  (202) 393-5501

  The National Association of Child Care Resource and Referral Agencies (NACCRA) supports state childcare resources and people and programs that care for children. NACCRA gathers, analyzes, and shares information with families and childcare providers, builds connections in states and communities to create policies on childrens' issues and childcare, and aids families in balancing work and home.

  National Association for Sick Child Daycare (NASCD)

  Richmond, Virginia

  1-804-747-0100

  The National Association for Sick Child Daycare supports the establishment of high- quality sick-child daycare programs nationwide, substantiates and quantifies the need for new sick-child programs, promotes the establishment of new sick-child care services by researching and disseminating needed information, and promotes and participates in sick-child care research.

  National Child Care Information Center (NCCIC)

  Vienna, Virginia

  (800) 616-2242

  The National Child Care Information Center disseminates child care information in response to requests, conducts outreach to child care providers to connect other organizations and individuals with child care resources, and publishes the Child Care Bulletin.

  Further information on issues related to child care is available in the following

  Documents

  Fewell, Rebecca R. "Child Care for Children with Special Needs." Pediatrics, vol. 91, no. 1, January 1993.

  This document discusses child care for children with special needs and places the issue in an historical context. The author reviews the characteristics of young children with special needs, reviews barriers that inhibit provision of care for children with special needs, and notes some current models and practices that have proven effective.

  Kamerman, Sheila, and Alfred Kahn. "Child Care In the Context Of Welfare Reform." New York, NY: Columbia University School of Social Work, 1997.

  This report discusses the state of child care within the context of welfare reform. In addition to a review of the child care provisions of the Personal Responsibility and Work Opportunity Reconciliation Act, the report presents policy initiatives aimed at reducing the demand for child care, child care funding structures, ways to expand the supply of care, and selected state child care policies.

  Kaplan, April. "Child Care and Welfare Reform." Washington, DC: Welfare Information Network, 1997.

  This is a fact sheet that provides background information on the child care needs of welfare recipients, as well as on child care publications, resource contacts, and program practices in several states.

  U. S. Department of Labor, Women's Bureau. Care Around the Clock: Developing Child Care Resources Before 9 and After 5. Washington, DC: DOL, April 1995.

  This document, though it does not focus on either the welfare population or efforts by welfare agencies, addresses the mismatch between changing schedules in the workforce at large and available child care services. The report is designed for those who want to address the growing need for nonstandard-hours care and profiles a variety of efforts--chiefly on the part of employers--to develop appropriate responses.

  1. Some states have authorized a higher rate of reimbursement for providers of nonstandard-hours care or have specifically directed resources to these providers (for a discussion of these efforts at differential reimbursement, see Tweedie et al. 1998). These efforts should help to increase specialized care in these states.

  2. For an explanation of how programs were selected, please refer to the discussion included in the Introduction under the paragraph heading "Program Models."

  Disability

  INTRODUCTION:

  Although welfare recipients with physical or learning disabilities have high rates of unemployment, with appropriate workplace accommodations many can become successfully employed. The few research studies available have begun documenting the widespread occurrence of disabilities--particularly learning disabilities--among welfare recipients and the high correlation between disabilities and unsuccessful efforts at employment. If this population of welfare clients is to make a successful transition from welfare to work at a sustaining wage, agencies must accurately diagnose clients' needs and explore opportunities for workplace accommodations.

  This section provides information on and addresses the following questions related to disability among welfare recipients:

  NEED FOR SERVICES:

  • How is disability defined?
  • What percentage of the welfare population faces this barrier to employment?
  • What relationship does disability have to welfare dependency and employment?

  Definition

  There are many different definitions of disability. The Americans with Disabilities Act of 1990 broadly defines it as "a physical or mental impairment that substantially limits one or more of the major life activities." The Vocational Rehabilitation Services Program (VR), a program to help people with physical or mental disabilities become employed, defines disability more narrowly, as a physical or mental impairment that constitutes or results in a substantial impediment to employment (U.S. Department of Health and Human Services 1990). For our analysis, we focus on welfare recipients who face barriers to employment because of two types of disabilities: (1) work-related physical disabilities, and (2) learning disabilities.⁽¹⁾

  Work-related disabilities are defined as self-reported physical or health conditions that limit the ability to work or make a person unable to work. Learning disabilities, often difficult to identify and therefore frequently undetected, are defined as a range of problems manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities or of social skills (Cohen et al. 1994). Learning disabilities, thought to be due to dysfunction of the central nervous system, generally occur among people with average or above-average intelligence and are measured according to differences between expected and actual levels of achievement (Giovengo and Moore 1997). More broadly defined, "special learning needs" may cover learning disabilities, as well as mild mental retardation, slow learning, below-average IQ, or low basic skills (attributed to those with only a grade school education or low scores on tests of basic skills).

  ESTIMATION OF NEED:

  • National estimates: 10 to 20 percent State/local estimates:⁽²⁾ 11 to 31 percent

    Tables 3 and 4 in Appendix A provide the full review of estimates on people with work-related disabilities. Most estimates in this area do not distinguish between SSI and welfare recipients. (Welfare recipients with physical disabilities may or may not qualify for SSI, and little is known about the number and characteristics of low-income, physically disabled people who qualify exclusively for welfare and are not eligible for SSI.) The ranges in estimates, presented in the box above, are due primarily to the following factor:

    • Barrier Definition. Estimates that are based on a narrow definition of work-related disability, such as a health condition that makes a person unable to work, will tend to be much lower than estimates that apply a broader definition, such as a physical disability or health condition that limits the ability to work.

    Learning Disabilities

    National estimates:	25 to 40 percent
    State/local estimates:	36 to 66 percent

    Tables 5 and 6 in Appendix A provide the full review of estimates on those with learning disabilities, including low basic skills. The ranges in these estimates, presented in the box above, are due to the following factors:

    • Barrier Definition. Estimates that are based on a low reading level will vary slightly from those based on results of an IQ test or a measure of basic skills. Clinically diagnosed learning disabilities will yield lower estimates than will those that include more broadly defined "special learning needs."
    • Measurement Method. Differences in measurement methods largely explain differences in estimates of people with learning disabilities. Different measurement methods include a formal learning disability assessment; an assessment based on tests of basic skills; an assessment based on client reading levels; and an estimation of the proportion of welfare recipients with learning disabilities based on a comparison to a similar population that is learning disabled, such as participants in Adult Basic Education. State estimates are often based on the use of formal learning disability assessments of individual welfare recipients, further validated by psychological testing.

    Relationship to Welfare Receipt

    • Female welfare recipients are more than four times as likely as nonrecipients to have very low basic skills (Olson and Pavetti 1996).
    • People receiving welfare five years or longer are almost twice as likely to have very low basic skills than are those receiving welfare less than two years (Olson and Pavetti 1996).
    • Among welfare recipients in a recent study, those with special learning needs received welfare for 79 months, compared to 61 months for those who did not have special learning needs (Giovengo and Moore 1997).

    Relationship to Employment Status

    • People with any level of disability are much less likely to be employed than those without a disability, and they have a greatly reduced earnings capacity (McNeil 1997).
    • People who report having work disabilities are more than twice as likely as other workers to be unemployed but actively seeking work--16 percent versus 7 percent (Mashaw and Reno 1996).
    • Welfare recipients with functional limitations are half as likely to exit welfare for work in a given four-month period than recipients without functional limitations (Acs and Loprest 1995).
    • A large proportion of adults with learning disabilities are thought to drop out of job training efforts because the programs are not designed to meet their learning needs (Gerber and Reiff 1994).

    Welfare Agency Approaches

    • What can welfare agencies do to assist clients who face disability as a barrier to employment?
    • What does the evidence suggest about the effectiveness of addressing this barrier?
    • What do we know about program costs?
    • What do we know about program implementation?

    The two critical program features of an agency's approach to addressing disabilities as a barrier to employment are (1) identifying which clients have physical disabilities, learning disabilities, and other special learning needs; and (2) determining the type of program or service to provide.

    Client Identification

    Accurate identification of clients with disabilities and the correct determination of the type of disability are critical first stages to working with these clients. The identification process applies to physical disabilities, learning disabilities, and other special learning needs; however, the use of formal identification tools and instruments is more relevant for learning disabilities. There are two key steps in this process: screening and assessment.

    Screening refers to determining the probability that a disability exists. The use of formal screening tools is critical for learning disabilities, which are much less apparent than physical disabilities.

    Assessment refers to a process for collecting information to determine which aspects of a client's life are affected and what type of disability exists. Assessments typically take the form of vocational evaluations and/or diagnostic testing.

    A number of instruments are used to screen for learning disabilities. Two states--Washington and Kansas--have developed short screening instruments appropriate for use by welfare caseworkers to identify learning disabilities. In addition, Washington developed a second screening instrument, designed to identify other special learning needs. Both of Washington's instruments are based on the Payne and Associates Special Learning Needs Inventory. The Kansas instrument was developed by the University of Kansas Center for Research on Learning. Research efforts to test and validate these screening tools are ongoing. In addition to these screening instruments, the National Adult Literacy and Learning Disabilities Center acts as an information resource network, providing materials on how to identify and serve adults with literacy needs and learning disabilities. (Additional contact information on these sources is provided under the sections entitled Program Models and Further Information.)

    After initial screening, complete vocational evaluations and/or diagnostic assessments are usually conducted. Vocational counselors typically conduct vocational evaluations to determine how to accommodate individuals with physical disabilities (and, in some cases, learning disabilities) in the workplace. Ideally, clinical psychologists conduct diagnostic assessments to identify learning disabilities. This type of formal (clinical) assessment, in combination with tests to measure ability and achievement, is generally necessary to identify a learning disability and make a complete diagnosis. After this assessment, an accommodation or service plan is developed to help the client manage the effects of the disability, recognize the types of jobs that are suitable given the disability, and identify appropriate and customized adjustments necessary for the client to successfully get and maintain a job.

    Program Strategies

    State and local agencies are enhancing their efforts to better identify and accommodate clients who are limited in their ability to work by physical and learning disabilities. Our review of programs suggests that there are at least four broad program strategies to address these barriers. While some of the programs are operated by welfare agencies, others are either collaborative program efforts between welfare and other agencies, or are programs operated by nonprofit service providers to which welfare agencies refer clients. Lessons from all of these efforts are relevant for welfare agencies interested in developing their own strategies to better serve clients with disabilities. This review is concerned chiefly with examining what welfare agencies can realistically hope to accomplish in response to client needs and does not extend to potential responses that would go well beyond the welfare agency, for example, to address changes in the SSI and SSDI systems.

    We categorize these strategies below. The distinctions drawn are not intended to suggest that agencies design programs around a single strategy or that these strategies are necessarily mutually exclusive. They are provided instead to foster thinking about the range of programmatic objectives possible, to help agencies define their own service needs, and to classify the programs described at the end of this section for agencies interested in pursuing further information. The four program strategies as they relate to serving clients with disabilities are categorized as follows:

    Staff Education and Awareness. Programs with this strategy, by providing training to staff from welfare agencies and other community organizations, aim to increase awareness and understanding of (1) how disabilities can affect clients and their prospects for employment, and (2) what types of special services and accommodations clients need to move from welfare to work.

    Client Identification. Programs with this strategy aim primarily to improve accuracy in identifying clients who have disabilities, particularly learning disabilities. These include programs that offer advanced training to welfare case managers to improve their ability to identify, support, and refer clients with disabilities for further assessment and specialized services. They also include specialized initiatives to develop brief screening tools that welfare staff can use to detect learning disabilities.

    Service Coordination. Programs with this strategy aim to improve coordination between agencies in order to help clients obtain available services. Coordination takes any number of forms, including the provision of user-friendly methods to provide information about available benefits and services and the use of formal referral procedures to allow access to services for clients with disabilities.

    Employment Integration. Programs with this strategy offer services directly related to employment, including vocational assessment, vocational training, remedial education, job training, job search and placement assistance, and transitional employment support. These programs are usually operated by organizations to which welfare agencies make referrals, for example, nonprofit service providers.

    Program Outcomes

    There is minimal evidence of the effectiveness of different types of welfare agency efforts to address barriers to employment that are related to clients' disabilities. Moreover, too few programs outside the welfare system that serve persons with disabilities have been adequately evaluated for a determination of their effectiveness. The research that has been conducted, however, suggests that positive employment and welfare outcomes can result when people with disabilities receive appropriate VR services (GAO 1993; and Dean and Dolan 1991).⁽³⁾ In particular, people with learning disabilities can be productively employed if remedial education and occupational training are successful and if they are helped to compensate for their disability in the workplace (Kohaska and Skolnik 1986).

    A number of studies, most of which are not rigorous evaluations, help to support the benefits of skill remediation and vocational rehabilitation for adults with either disabilities or low basic skills. Further research in this area is warranted for obtaining empirical evidence of program effectiveness and for discerning which program strategies are successful at providing vocational rehabilitation and occupational skills training specifically to welfare recipients with disabilities.

    Effect of Disability Service and Accommodation on EMPLOYMENT

    • A national quasi-experimental evaluation of the VR program for people with disabilities found that participants who were successfully rehabilitated had significant gains in employment and earnings at five-year followup compared with participants who had dropped out of the program (GAO 1993).
    • A quasi-experimental evaluation of the VR program in Virginia compared participants (both successful and unsuccessful rehabilitants) with program dropouts and found that participants with physical disabilities and female participants with mental and emotional disabilities had significantly greater earnings at one-year followup than did dropouts (Dean and Dolan 1991).
    • Descriptive data from an employment integration program showed that over 70 percent of participants who received vocational services (only a small portion of whom were welfare recipients) were placed in private-sector jobs with average starting salaries of $16,000 (National Center for Disability Services 1996).
    • An experimental design evaluation of the National Supported Work Demonstration, a program that provided subsidized employment in a supported work environment to welfare recipients with limited skills, showed that program participation resulted in statistically significant gains in earnings two years after enrollment (Kemper et al. 1981).

    Effect of Disability Service and Accommodation on WELFARE RECEIPT

    • An experimental design evaluation of the National Supported Work Demonstration, a program that provided subsidized employment in a supported work environment to welfare recipients with limited skills, showed that program participation resulted in statistically significant reductions in public assistance two years after enrollment (Kemper et al. 1981).

    Program Costs

    Little data on program cost is available on the six disability programs highlighted in the section entitled Program Models. In general, however, the client identification and service coordination programs are less costly to implement than the comprehensive, employment integration programs. Data from the broader literature on disability programs allow us to provide some useful information on cost effectiveness and the approximate range of program costs for several of the different program approaches.

    Client identification programs are potentially very cost-effective, since clients with disabilities can be successful in the labor market if disabilities are identified and appropriate remediation and accommodations provided. For identifying learning disabilities, the initial cost to welfare agencies of using short screening tools is minimal. The additional cost of using more comprehensive assessment instruments can vary greatly--ranging from pencil-and-paper tests that require about one hour, can be administered by nonprofessionals, and cost only $2 to $7 per person, to comprehensive test batteries that require several days, must be administered by trained professionals, and cost up to several thousand dollars per person (Nightingale et al. 1991). Some of the less expensive assessment kits are appropriate for use by welfare agencies.

    Once a positive learning disability assessment is made, welfare agencies can implement a number of relatively low-cost strategies, for instance, using unpaid volunteers to tutor and mentor clients, modifying instructional materials to allow for differences in individual learning styles, and combining basic skills instruction with functional occupational skills training. Nevertheless, arriving at a formal learning disabilities diagnosis and developing an appropriate accommodation plan are still likely to require the more costly involvement of a trained professional. If a referral is made for such a diagnosis, the costs can be assumed by another service provider, for example, the VR program. Based on 1988 data, VR programs spent an average of $1,300 to provide evaluations and diagnoses (and sometimes other services) to people with learning disabilities (Miller et al. 1984). In other cases, when costs of learning disability assessments are assumed by welfare agencies, they can sometimes be partially offset through coordinated funding arrangements with Medicaid.

    The cost of employment integration programs may vary greatly depending on the nature of a client's disability. One program estimated that total per-person costs of comprehensive vocational rehabilitation services ranged from $3,000 to $11,000 per client.⁽⁴⁾ However, if clients successfully acquire and sustain employment and require few additional services, such programs will be very cost-effective despite the high initial investment. For instance, the National Supported Work Demonstration, a program that provided subsidized employment and various supported work services to welfare recipients with limited skills, essentially paid for itself through reductions in participants' welfare and food stamp benefits (Kemper et al. 1981). In addition, another study that examined the cost-effectiveness of rehabilitation services for people with severe disabilities showed that savings ranged from about $1.40 to $2.70 for each dollar spent on rehabilitation services (McManus 1981).

    Program Implementation

    Welfare agencies have not traditionally provided extensive supportive services to clients with disabilities, but instead have made referrals to other service providers. Moreover, the programs to which welfare agencies may make referrals--the VR program and other programs that serve disadvantaged populations with disabilities and low basic skills--have only recently begun to address the issue of assessing and serving people with learning disabilities (Nightingale et al. 1991). Therefore, very little information exists on how welfare agencies should better serve clients with disabilities. Our synthesis of various program strategies leads to a discussion of implementation issues faced by welfare agencies and other programs in three key areas: (1) program staff, (2) coordinated delivery of services, and (3) service capacity. Along with the discussion, we recommend steps that welfare agencies should take to better serve clients with disabilities.

    Program Staff

    If program implementation is to be successful, welfare agencies must make a substantial commitment to training staff on disability issues, particularly on how to use screening and assessment tools to identify clients with disabilities. Since disabilities--particularly learning disabilities and low basic skills--are very common among the welfare population, staff must understand the nature of different types of disabilities and develop the skills necessary to identify, support, and make appropriate referrals. Since learning disabilities among the welfare population are largely undiagnosed (Giovengo and Moore 1997), staff training to identify these clients is critical. Few states have even adopted a definition of learning disabilities pertinent to adults and adult service providers (Cohen et al. 1994). Doing so is a necessary first step to training staff.

    After they receive initial training to be sensitized on disability issues, staff should be trained on how to administer short screening and assessment tools and make appropriate referrals. At present, only a few states are actively screening for learning disabilities. Current screening tools to determine basic functional skills and literacy levels are not designed to detect the possibility of a learning disability. When staff screen and assess clients for learning disabilities, careful attention to technical detail is necessary, as research findings caution service providers to avoid arbitrary referral of individuals with low reading skills to possibly inappropriate remediation programs (Nightingale et al. 1991). Greater coordination and technical assistance at the national level may be needed to help welfare agencies prepare their staff to meet these goals.

    Coordinated Delivery of Services

    To serve clients with disabilities successfully, welfare agencies should develop partnerships with other organizations for the provision of remediation, rehabilitation, and employment-related services. To help clients with disabilities move from welfare to work, welfare agencies must continue to develop collaborative partnerships with other community organizations that provide rehabilitation, training, and supportive services to clients with disabilities. These include the VR program and, more broadly, employment integration programs and other organizations that conduct assessments and vocational evaluations and that provide services related to employment, education, and training. As relationships with these types of providers are developed and strengthened, care must be taken to coordinate conflicting organizational philosophies or missions. The VR program, for instance, has not traditionally served large numbers of welfare recipients, many of whom have low basic skills and limited work experience. Nor has it focused on providing fairly rapid training and employment, as is required by the current welfare law. Rather, VR clients typically have received services for a period of time ranging from two months to two years. Hence, significant attention by welfare agencies to cultivating workable partnerships with the VR program will be necessary. Coordination at the national level may also be an important factor to successful local partnerships with this program.

    To serve as a bridge between strategies provided directly by welfare agencies and strategies provided through coordinated service delivery mechanisms with partnership programs, welfare agencies should consider offering on-site vocational counseling from a trained professional who can administer disability assessments and vocational evaluations, tailor existing services to clients with disabilities, and make appropriate referrals.

    Service Capacity

    To serve clients with disabilities successfully, welfare agencies must assess the extent to which current local service capacity helps to serve, rehabilitate, and employ clients with disabilities and, where gaps exist, address the shortage. It is not clear that existing program resources are adequate to provide vocational assessment, rehabilitation, and employment-related services to welfare clients with disabilities. Some communities may not offer programs with which welfare agencies can develop collaborative partnerships. In these cases, there will be greater pressure on welfare agencies to provide supportive services directly to clients.

    In terms of existing program resources, there is generally a lack of coordination among various disability programs, leading to both service duplication and service gaps (GAO 1996). More specifically, the VR program typically serves only an estimated five to seven percent of all potentially eligible people with work-related disabilities (GAO 1993). In addition, the VR program is required to give priority in participant selection to people with severe disabilities. These factors, while not providing evidence of a service gap, do suggest that the VR program may be limited in its capacity to serve welfare recipients with disabilities.

    In terms of obtaining funds for program services, service capacity may be somewhat more problematic in those states that do not fully access available federal matching funds, for instance, for the VR program. In some states, welfare, mental health, and other agencies have already coordinated service efforts with the VR program by contributing funds to help it collect additional federal matching funds. When agencies contribute such "third-party payments" to obtain additional funds, they essentially ensure that the VR program will provide services to their clients. This is one strategy that welfare agencies may wish to consider to increase service capacity in their communities.

    Program Models⁽⁵⁾

    • What are welfare agencies doing to address this issue?
    • Whom can I contact?

    The following programs are presented alphabetically by state. The reader can determine the relevance of a program by noting its primary program strategy and geographic location and then refer to the brief descriptions and contact information on the subsequent pages. We have used primary objective(s) to assign program strategies, though a program may have many objectives.

    ---

    Alabama Department of Vocational Rehabilitation

    Vocational Rehabilitation Training Program

    Montgomery, Alabama

    Program strategy: Staff education and awareness

    Location: Available to agencies throughout the state

    ---

    Kansas Department of Social and Rehabilitation Services

    Learning Disabilities Initiative

    Topeka, Kansas

    Program strategy: Client identification

    Location: Two communities, urban/rural

    ---

    Goodwill Industries International

    Goodwill Employment and Training Welfare-to-Work Programs

    Bethesda, Maryland

    Program strategy: Employment integration

    Location: Available throughout most states

    ---

    National Center for Disability Services

    Edwin W. Martin, Jr., Career and Employment Institute (CEI)

    Albertson, New York

    Program strategy: Employment integration

    Location: One suburban location; seven urban locations

    ---

    Washington Department of Social and Health Services

    Learning Disabilities Initiative

    Olympia, Washington

    Program strategy: Client identification

    Location: Nine communities, urban/suburban/rural

    ---

    Wisconsin Department of Workforce Development

    Wisconsin Works (W2) Disabilities Hotline, Disabilities Training, and Linkages with Vocational Rehabilitation

    Madison, Wisconsin

    Program strategy: Client identification, through case worker training

    Service coordination

    Location: Statewide

    ---

    Program Name/Contact

    Alabama Department of Vocational Rehabilitation Vocational Rehabilitation Training Program Montgomery, Alabama

    Linda Haimes Alabama Department of Vocational Rehabilitation 800-441-7609

    Program strategy: Staff education and awareness Location: Available to agencies throughout the state

    Brief Program Description

    Staff from different types of social service organizations in Alabama have been trained by the Alabama Department of Vocational Rehabilitation (VR), which provides periodic training to education and training service providers and welfare agency staff on disability issues, particularly those involving learning disabilities. The one-and-a-half-day training session that VR developed is designed to increase understanding of learning disabilities among service providers, including welfare agency caseworkers. The training does not equip service providers and welfare agencies with assessment tools for identifying learning disabilities, but it does sensitize them to the importance of developing individualized education and job training plans for clients thought to have learning disabilities.

    A strong referral link exists in Alabama between the welfare agency and the VR program. Once referrals to VR are made, VR staff conduct assessments to identify and characterize disabilities. Then, they provide the accommodations and services necessary to prepare clients for work and, ultimately, to transition them into work. Typically, the assessments take up to a week to complete.

    Evaluation

    Neither the training program nor the curriculum has been formally evaluated.

    Program Name/Contact

    Kansas Department of Social and Rehabilitation Services Learning Disabilities Initiative Topeka, Kansas

    Phyllis Lewin Kansas Department of Social and Rehabilitation Services 785-296-3349

    Program strategy: Client identification Location: Two communities, urban/rural

    Brief Program Description

    The Kansas Department of Social and Rehabilitative Services (KDSRS) has examined the prevalence of learning disabilities within its welfare population. Through its Learning Disabilities Initiative, which began in early 1996, the department has designed a screening tool for welfare staff to identify those with learning disabilities and is currently working to validate it. The initiative has the following objectives: (1) provide training and a screening tool to welfare case management staff, (2) identify service delivery strategies to better serve learning-disabled clients and move them toward self-sufficiency, and (3) identify characteristics of available jobs that are suitable for learning-disabled clients.

    The initiative, conducted in two communities, is funded jointly by the Departments of Social and Rehabilitation Services, Education, Labor, and Corrections. Staff in Kansas teamed with the University of Kansas to develop a short learning disabilities screening tool that frontline welfare staff could use to identify clients with learning disabilities. About 90 welfare clients who volunteered to participate in the initiative were tested, and all participants identified as learning disabled were then referred to a clinical psychologist for further testing. This ongoing testing process helped to validate the screening tool, characterize the nature of the clients' learning disabilities, and lead to recommendations for appropriate instructional techniques, accommodations, and employment opportunities for clients. Efforts to validate and refine the short screening tool are ongoing.

    Evaluation

    This program has not been formally evaluated. The KDSRS, as part of its work developing and validating the learning disability screening tool, conducted a descriptive study of 88 participants (Kansas Department of Social and Rehabilitation Services 1998).

    Findings

    There is no information on program impacts.

    Program Name/Contact

    Goodwill Industries International Goodwill Employment and Training Welfare-to-Work Programs Bethesda, Maryland

    Jeff Foley Goodwill Industries International 301-530-6500

    Program strategy: Employment integration Location: Available throughout most states

    Brief Program Description

    Goodwill Industries is a nonprofit provider of employment, training, and job placement services for people with physical and learning disabilities and other disabling conditions (such as welfare dependency, illiteracy, criminal history, and homelessness). The Goodwill employment and training programs are funded by federal, state, and local grants, as well as by revenues from Goodwill retail stores that sell donated clothing and household goods. Nine Goodwill education and training projects are funded by the U.S. Department of Labor's Project for People with Disabilities Program, authorized under the Job Training Partnership Act (JTPA).

    The Goodwill Industry network includes 180 autonomous organizations in the United States that operate training and placement centers in 46 states. Goodwill currently operates 70 welfare-to-work centers, half through contracts with state governments. These centers provide employment, training, and supportive services for welfare recipients and others, including people with physical, learning, and other broadly defined disabilities. Client referrals are taken from welfare agencies, as well as from other organizations and agencies (for example, vocational rehabilitation programs). More than 200,000 people received Goodwill employment and training services in 1996. Of these, over half were low-income people, and at least a tenth were welfare recipients.

    Most Goodwill organizations provide a core set of services, including vocational evaluation and assessment, occupational skills training, job search development and job placement, and transitional employment support (for instance, on-the-job training). Many Goodwill programs also offer life skills training, assistance with transportation and child care, and postemployment assistance for both employers and employees. A client with learning disabilities, for instance, would be given a series of vocational assessment tests to determine the types of accommodations necessary for obtaining and staying at a job. Although a good deal of local variation exists, skills training typically prepares clients for such fields as computer programming, electronics, financial services, janitorial work, retail sales, and food service.

    Evaluation

    The National Results Council is beginning an evaluation of the Goodwill programs to assess the quality of services provided and program effects on rates of job retention and wages earned.

    Program Name/Contact

    National Center for Disability Services Edwin W. Martin, Jr., Career and Employment Institute (CEI) Albertson, New York

    Francine Tishman, Executive Director Career and Employment Institute (CEI) 516-465-1480

    Program strategy: Employment integration Location: One suburban location; seven urban locations

    Brief Program Description

    The Edwin W. Martin, Jr., Career and Employment Institute (CEI) at the National Center for Disability Services provides education, training, and supportive services for people with disabilities, with a focus on ethnic minorities who traditionally are underserved. The CEI is one of numerous programs offered through the National Center for Disability Services, a nonprofit organization that strives, through education, training, research, and leadership, to improve the self-sufficiency of people with disabilities and help them get and maintain jobs.

    CEI, which is located in a suburban area of Long Island, New York, assists more than 1,000 people each year and is expanding its services to other parts of the United States. Based on a recent contract arrangement with the New York State Vocational Rehabilitation (VR) system and the New York City welfare system, CEI will nearly double the number of welfare clients it serves, to about 15 percent of its total caseload. Under this arrangement, New York City welfare agencies refer clients who have both dependent children and disabilities (including those related to mental health or disability) to the VR program, which in turn refers them to CEI for specialized welfare-to-work services.

    Services include vocational evaluations, vocational training, remedial education (for instance, for improving math and reading skills and working toward a GED), job placement, job coaching, work experience, transitional employment services, coordinated academic programming and job search assistance for people with learning disabilities, and rehabilitation management services for injured workers. Clients typically receive services for a period of between six weeks and seven months. The estimated cost of the program per participant varies widely, ranging from a minimum of about $3,000 to a maximum of about $11,000.

    CEI also operates a National Business and Disability Council. Through this council, CEI works with Fortune 500 corporations in interviewing, hiring, and accommodating people with disabilities. CEI also operates job placement programs in numerous cities, including Albertson, Albany, and Rochester, New York; San Antonio, Texas; Denver, Colorado; St. Louis, Missouri; Louisville, Kentucky; Birmingham, Alabama; Little Rock, Arkansas; and Phoenix, Arizona.

    Evaluation

    This program has not been formally evaluated.

    Findings

    There is no information on program impacts. Descriptive data from 1996 on participant experiences indicate that more than 70 percent of people who received vocational services were placed in private-sector jobs with average starting salaries of $16,000.

    Program Name/Contact

    Washington Department of Social and Health Services Learning Disabilities Initiative Olympia, Washington

    Melinda Giovengo, Project Director Washington Department of Social and Health Services 206-760-2393

    Program strategy: Client identification Location: Nine communities, urban/suburban/rural

    Brief Program Description⁽⁶⁾

    In November 1994, Washington's Department of Social and Health Services (DSHS) launched the Learning Disabilities Initiative, which first estimated the prevalence of learning disabilities among welfare recipients and then designed and validated screening tools for welfare eligibility staff and caseworkers to use to identify clients with learning disabilities. It also developed remediation and accommodation service plans to help such clients obtain and stay at jobs. The initiative began in two communities, one urban and the other rural. Nearly 200 welfare clients participated. By the end of 1997, nine communities and nearly 500 participants were involved.

    Participants were given the Payne and Associates Special Learning Needs Inventory, a complete diagnostic assessment for learning disabilities. A clinical psychologist administered additional tests, measuring ability and achievement, to validate the initial assessment and recommend accommodation. Then two shorter screening tools with about 15 questions each were developed for use by frontline welfare staff to identify clients who may have learning disabilities. Efforts to validate these short screening tools are ongoing. Once clients are screened as learning disabled, remediation and accommodation services provided through the DSHS may include one-on-one tutoring and life skills training. Appropriate referrals to other organizations, for instance, the Vocational Rehabilitation (VR) agency are also made.

    Evaluation

    This program has not been formally evaluated, though a descriptive study of the original 193 study participants was conducted (Giovengo and Moore 1997).

    Findings

    There is no information on program impacts.

    Program Name/Contact

    Wisconsin Department of Workforce Development Wisconsin Works (W2) Disabilities Hotline, Disabilities Training, and Linkages with Vocational Rehabilitation Madison, Wisconsin

    Sue Larsen Wisconsin Department of Workforce Development 608-266-3288   Carolyn Hoffman Wisconsin Council on Developmental Disabilities 608-266-7826

    Program strategy: Client identification, through case worker training Service coordination Location: Statewide

    Brief Program Description

    Wisconsin's Council on Developmental Disabilities funds a toll-free telephone hotline--the Wisconsin Works (W2) Disabilities Hotline--to provide assistance to clients with disabilities, including clients who are not receiving Supplemental Security Income (SSI). Hotline staff answer questions and provide information on services available under the W2 TANF program. In particular, the hotline provides information on TANF work programs, education and training opportunities and requirements, medical assistance, child care, food stamps, transportation, and kinship care. The hotline is advertised among the welfare population by disability organizations and advocacy groups.

    To support the work of the hotline, the W2 program offers advanced training to case managers for identifying, working with, and making appropriate referrals for clients with disabilities, including learning, physical, and cognitive disabilities. Training is supplemented by the W2 Case Management Resource Guide, which provides case managers with information on identifying and serving clients with these types of disabilities, as well as many other barriers to employment (for instance, domestic violence, mental health, disability, and transportation).

    A well developed referral mechanism exists between the W2 program and the Department of Vocational Rehabilitation (VR), a relationship facilitated by the joint administration of the VR and the W2 programs, which are both included in the Department of Workforce Development (DWD). As long as the VR program has adequate capacity, it will provide services to referred W2 clients with disabilities. Services include individual assessment and the development of a vocational service plan. The DWD is currently working to address differences in organizational mission (clients served, relative emphasis on work, program time frames) between W2 and VR so that services and functions can become better integrated in the future.

    Evaluation

    This program has not been formally evaluated.

    Further Information

    Further information on issues related to medical needs is available from the following

    Organizations

    National Adult Literacy & Learning Disabilities Center

    202-884-8185

    Website: 1. Disabilities related to mental health are discussed separately in the section titled Mental Health Issues.

    2. The state and local estimates are based on data from only one study (Meyers et al.1996). This study examined the prevalence of disabilities among welfare recipients in the state of California.

    3. About one-third of VR clients receive some type of public assistance during the time when they participate in the program (GAO 1993).

    4. Data are based on a personal communication with Francine Tishman of the National Center for Disability Services' Career and Employment Institute, February 1998.

    5. For an explanation of how programs were selected, please refer to the discussion included in the Introduction under the paragraph heading "Program Models."

    6. Welfare agencies in both Rhode Island and Illinois have recently started learning disability initiatives modeled after Washington State's efforts. The Rhode Island initiative entails collaboration with its Vocational Rehabilitation department and the Illinois initiative entails collaboration with its Adult Education department. Both are focused on client identification and employment integration efforts.

    Domestic Violence

    Introduction

    Reported rates of domestic violence are quite high. Victims suffer not only from physical abuse, but also from low self-esteem, emotional and post-traumatic stress, substance abuse, and homelessness. In addition, they are often discouraged or prevented from attending work or a job training program. As a result, victims of domestic violence are likely to experience spells of unemployment and have high rates of job turnover. An emerging awareness of the depth and breadth of this problem is gradually forcing welfare agencies to design appropriate services in response. However, if services are to be effective, there is much to be learned and understood about what "appropriate" in this context means. Failure to address issues associated with domestic violence will place victims at greater risk of continued or increased violence and of long-term poverty. Welfare-to-work programs will need to focus on how to best address the complex needs of victims.

    This section provides information on and addresses the following questions related to domestic violence among welfare recipients:

    NEED FOR SERVICES:

    • How is domestic violence defined?
    • What percentage of the welfare population faces this barrier to employment?
    • What relationship does domestic violence have to welfare dependency and employment?

    Definition

    Domestic violence, broadly defined, is abusive or aggressive behavior by a person in an intimate relationship with the victim. Such abuse or aggression takes physical, sexual, and emotional forms. Physical abuse encompasses a wide range of specific actions, including pushing, shoving, slapping, kicking, and hitting with fists or objects; burning and scalding; assaulting with a gun, knife, or other weapon; and choking, strangling, and smothering. Sexual abuse includes rape, sexual molestation, and other forms of sexual trauma. Emotional abuse is characterized by repeated verbal criticism, psychological intimidation, and other types of behavior intended to humiliate, control, or undermine the independence of the victim. It can take the form of harassment, coercion, threats, and stalking.

    ESTIMATION OF NEED:

    • Table 9: State and local estimates: Ever Victims of Domestic Violence

    Percentage of Welfare Population Facing This Issue

    Current Victims of Domestic Violence

    National estimate:	24 percent(1)
    State/local estimates:	15 to 34 percent

    Ever Victims of Domestic Violence During Adult Life

    State/local estimates: 29 to 65 percent

    Tables 7 and 8 in Appendix A provide estimates of welfare recipients who are current victims of domestic violence. Table 9 provides state and local estimates of those who were ever victims of domestic violence. The distinction between current and past victimization is made because the difference between these two can vary substantially. However, research has shown that past victimization from domestic violence continues to affect current efforts at self-sufficiency (Bassuk et al. 1996; and Lloyd 1997b). Efforts to address domestic violence as a barrier to employment must include services that will meet the needs of clients who are current victims of domestic violence, as well as those who have ever been victims.

    The ranges in estimates, presented in the boxes above, are primarily due to the following factors:

    • Time Period. Though estimates of those who are current victims of domestic violence are differentiated from estimates of those who were ever victims, even the definition of "current" varies from study to study. Some studies focus on domestic violence incidents during only the past year, while others extend to the past two or even the past five years.
    • Study Sample. Studies may inadvertently over- or underrepresent victims of domestic violence as a result of who is included in a study sample. A study that includes a disproportionate number of homeless welfare recipients, for example, may produce relatively high estimates of domestic violence as a result of the frequent overlap between homelessness and domestic violence. In contrast, a study that surveys only welfare recipients who participated in (and did not drop out of) a life skills program may underestimate the prevalence of domestic violence, since those who dropped out of the program may have had higher rates of victimization.
    • Measurement Method. The nature of survey questions about domestic violence can affect the estimates. Surveys using sets of specific and related questions will elicit more reliable responses than surveys that use single questions with ambiguous terms. The manner in which survey questions are administered can also affect the estimates. Confidential, self-administered surveys may elicit more reliable responses than in-person interviews.
    • Geographic Location. Community transiency and local norms and attitudes can affect the extent to which domestic violence problems are underreported in surveys. People from close-knit rural communities that place a high value on family privacy, for example, may be less willing to report domestic violence, even in a survey.

    Relationship to Welfare Receipt

    • Welfare recipients are three to three-and-a-half times more likely to suffer from domestic violence than are nonrecipients (Commonwealth Fund 1993; and Lloyd 1997b).
    • Victims of domestic violence may cycle on and off welfare more frequently than other welfare recipients, often as a result of the nature of their relationship to an abuser (Brandwein 1997b). Among women who had received welfare for two years or longer, those with a lifetime history of victimization were significantly more likely to have had a greater number of welfare spells (Bassuk et al. 1996).
    • Among welfare recipients, domestic violence victims were more likely than nonvictims to be long-term (five years or longer) welfare recipients (Bassuk et al. 1996).

    Relationship to Employment Status

    • Domestic violence may depress victims' socioeconomic and job status attainment over time, compromising their ability to be consistent labor market participants. Although domestic violence victims are no less likely to be employed at a point in time than nonvictims, they are significantly more likely to have been unemployed at some point, to have held more jobs, to have suffered from a range of mental and physical health problems that can affect work, and to have lower personal incomes (Lloyd 1997b).
    • Meeting the daily requirements of a job may be difficult for victims of domestic violence. Over half of women surveyed in domestic violence shelters reported that they had missed work as a consequence of domestic violence, nearly three-fifths reported that their work was compromised by absenteeism and tardiness related to domestic violence, and nearly one-quarter reported that they lost a job partly because of domestic violence (Shepard and Pence 1988). Based on information from a small sample of domestic violence victims in a large metropolitan area, over half reported having lost at least one job and having missed an average of three days of work per month as a result of domestic violence (Friedman and Couper 1987).
    • Among welfare recipients, a partner actively prevents participation in education and training activities for two-fifths of current domestic violence victims, compared to one-eighth of those who are not victims of domestic violence (Curcio 1997).

    Welfare Agency Approaches

    • What can welfare agencies do to assist clients who face domestic violence as a barrier to employment?
    • What does the evidence suggest about the effectiveness of addressing this barrier?
    • What do we know about program costs?
    • What do we know about program implementation?

    The two critical program features of an agency's approach to addressing domestic violence as a barrier to employment are (1) identifying which clients are victims of domestic violence, and (2) determining the type of program or service to provide, including whether or not to grant a good cause waiver.

    Client Identification

    Identification of clients who are victims of domestic violence is a critical first stage in providing appropriate services. Domestic violence is best identified through voluntary disclosure of the problem by the victim. This self-disclosure is facilitated by a trusting, compassionate, nonjudgmental, and confidential environment, along with information that minimizes victims' fears and conveys the advantages related to disclosure. The sensitive nature of the topic and the increased risk that clients face once the situation is shared with others means that self-disclosure--and client identification--should not be expected to occur within a particular time frame. Because clients will feel initial reluctance to share this information and have concerns regarding the risks sharing poses, they must be able to self-disclose at whatever point they themselves deem it most appropriate.

    The process of identifying clients who are victims of domestic violence comprises two steps: screening and assessment.

    Screening refers to determining the probability that domestic violence exists, identifying signs and symptoms of domestic violence, notifying all clients of their potential eligibility for exemptions from certain program requirements if they are victims of domestic violence, and providing ongoing opportunities for individuals to voluntarily and confidentially identify themselves as victims of domestic violence.

    Assessment refers to a detailed process for collecting information to determine what form domestic violence takes and the ways in which it affects a client's life. Careful, sensitive, and accurate assessment of victims of domestic violence requires a certain level of staff expertise. Proper assessment also includes assistance with decisions about which services to provide, how to handle current and future risks posed by the perpetrator, and how to weigh the trade-offs posed by the opportunity for a good cause exemption from participation requirements and efforts to enroll in training or to secure employment.⁽²⁾

    A variety of tools and instruments are available to screen for and assess the extent to which domestic violence affects clients' lives. Many states have developed their own instruments and procedures for screening and assessment, allowing them to tailor instruments and procedures to fit the unique characteristics of their client populations appropriately. For example, Oregon and Colorado have already developed and are using screening and assessment instruments. These states have collaborated, to some extent, with local domestic violence advocacy and service organizations in the development of their instruments. In addition to these instruments, the National Resource Center on Domestic Violence provides information on training materials and screening and assessment instruments. (Additional information on these various sources is provided under the sections entitled Program Models and Further Information.)

    Program Strategies

    As awareness grows about the prevalence of domestic violence as a barrier to employment for many welfare recipients, state and local agencies have begun to respond with new and varied programs to meet the diverse needs of victims. Many efforts are in the early stages of development and there is still much to be learned about effective service delivery. In addition, agencies and organizations other than human services departments have worked together to address problems related not only to victims of domestic violence, but also to the perpetrators. A number of community-based approaches are designed to convict and treat abusers. Though we are most concerned with programs designed to meet victims' needs, lessons from these other efforts help to demonstrate how welfare agencies might coordinate with other community-based programs. Because this review is concerned chiefly with examining what welfare agencies can realistically accomplish in response to client needs, it does not extend to broader responses that address issues related to welfare policy, child support enforcement policy, or law enforcement and criminal justice policies.

    Our review of programs suggests that there are at least five broad program strategies used by agencies to address domestic violence. We categorize these strategies below. The distinctions drawn are not intended to suggest that agencies design programs around a single strategy or that these strategies are necessarily mutually exclusive. They are provided instead to foster thinking about the range of programmatic objectives possible, to help agencies define their own service needs, and to classify the programs described at the end of this section for agencies interested in pursuing further information. The five program strategies are as follows:

    Client Identification. Programs with this strategy aim primarily to improve accuracy in identifying clients who are victims of domestic violence. They usually involve the use of screening and assessment tools and specialized training for welfare caseworkers on understanding domestic violence, identifying victims, and making appropriate referrals.

    Client Confidentiality. While all strategies for assisting domestic violence victims include some measure of client confidentiality, these are programs whose direct intent is provision of a specific means of protecting the confidentiality of victims so that they can gain personal safety and independence from their abuser. That is, these are programs specifically designed to help victims re-establish certain important living routines, such as receiving mail, without facing the risk posed by a perpetrator's knowledge of their whereabouts.

    Enhanced Case Management. Programs with this strategy intend to reduce domestic violence and alleviate the problems that result from it by providing enhanced case management services through, for example, intensive service teams, case staffings, and the co-location of domestic violence advocates or counselors in welfare offices. Enhanced case management is often provided in conjunction with additional services, including peer support groups; referrals for mental health counseling, substance abuse treatment, shelter, and legal services; funds to facilitate relocation away from the abuser; and, in many states, temporary exemptions from work requirements through the Family Violence Amendment.

    Service Coordination. Programs with this strategy aim to institute improved coordination systems or procedures between welfare agencies and a wide range of other community-based agencies and organizations, including police and probation departments, prosecutors' offices, courts, child protective services, child support enforcement, health and mental health care providers, domestic violence activists, and shelters. Because good cause waivers for victims of domestic violence can be granted by both TANF and child support enforcement systems, coordination between these two is particularly important. Coordination takes many forms, including organizational partnerships, formal referral procedures, expansion of available community resources, programs to treat abusers, and community education efforts to prevent domestic violence.

    Employment Integration. Programs with this strategy offer employment-related services in combination with various supportive services to assist clients as they move from welfare to work. Such programs may combine case management services and domestic violence support with employment-related services such as literacy training, job readiness training, and job placement services.

    Program Outcomes

    Very little is known about the impact and comparative effectiveness of different types of welfare-to-work strategies that address client barriers to employment related to domestic violence. Although interventions implemented by welfare agencies to address victims' needs do show promise, they have not been rigorously evaluated. One recently implemented, comprehensive domestic violence program--the Options/Opciones Program in Chicago--includes plans for a quasi-experimental evaluation with a five-year follow-up period. This evaluation will do a great deal to increase knowledge about how programs designed to address victims' needs can affect outcomes related to employment and welfare receipt. In addition to program interventions, specific treatment strategies to address associated mental health problems among victims, including crisis counseling, brief and long-term psychotherapies, and medications, all may be helpful, but they too must be carefully evaluated to identify effective treatment approaches (Commonwealth Fund 1996).

    Although we know little about the effectiveness of welfare agency strategies that serve victims of domestic violence, there is some evidence about the effectiveness of community-based strategies that directly aim to convict and treat the abusers. An extensive review of the evaluation literature on providing treatment for men who batter women, including mandatory arrest programs, concluded that some men can be helped to change their abusive behavior (Tolman and Bennett 1990). However, results have been mixed. Descriptive data from one of the programs highlighted in this report, the Domestic Abuse Intervention Project (DAIP), do suggest that abusers can be helped: battered women reported decreases in physical and psychological abuse as their abusers progressed through the mandatory DAIP treatment program; at one-year follow-up, over two-thirds of these women had not experienced physical abuse during the past three months (Shepard 1987).

    Program Costs

    Little is known about the costs to welfare agencies and other organizations of providing different types of domestic violence services. Programs with comprehensive service coordination strategies, which are inherently more costly than client identification and client confidentiality efforts, may require a substantial financial commitment by different agencies within the community. In contrast, the client confidentiality program highlighted in this report--Washington State's Address Confidentiality Program--operates at an average per person cost of only $158 per year. In the absence of cost information on all programs, however, it is not possible to compare particular program types.

    Despite minimal data on program costs, a good deal is known about the high costs associated with domestic violence for both victims and society. The annual cost of domestic violence in New York City, for instance, is estimated at $370 million, which includes medical expenses, emergency room costs, lost work time, decreased productivity, and associated police, court, and detention costs (Victim Services 1991). Because of these high costs, domestic violence interventions are potentially very cost-effective. While program experience suggests that the benefits of domestic violence prevention and intervention programs do outweigh the costs, no data are available to support this claim or to determine what types of interventions are cost-effective (Laurence and Spalter-Roth 1996). Further research is warranted.

    Program Implementation

    Many state welfare agencies are currently developing or enhancing procedures to help staff identify, serve, and refer clients who are victims of domestic violence. Likewise, a diverse group of other organizations are involved with domestic violence issues at the community level, including police and probation departments, prosecutors' offices, courts, child protective services, child support agencies, health and mental health care providers, domestic violence activists, and shelters. These organizations all provide services that in some way affect victims. Through the experiences of all these organizations, various program implementation lessons have been learned about how to serve victims of domestic violence better, lessons relevant for welfare agencies as they help meet clients' needs and support their transition from welfare to work. Our synthesis of domestic violence issues leads to a discussion of implementation issues in three key areas: (1) program staff, (2) coordinated delivery of services, and (3) service capacity. Along with the discussion, we recommend steps welfare agencies should take to serve victims of domestic violence better.

    Program Staff

    If program implementation is to be successful, welfare agencies must make a substantial commitment to training staff on domestic violence issues, particularly on how to screen for domestic violence, ensure client confidentiality, determine an appropriate set of services, decide whether to grant a good cause waiver, and make referrals. Victims of domestic violence, particularly those receiving welfare, face a variety of risks and concerns about personal safety, childrens' safety, privacy, eligibility for welfare and child support benefits, child support enforcement, and legal issues. Staff must understand and develop the skills necessary to identify the safety, privacy, and other concerns victims face. In an implementation study of three programs, staff longevity was an important factor in successfully serving domestic violence victims (Horizon Research Services 1996). This finding underscores the important role that experienced, knowledgeable, and well-trained staff play in delivering services to victims of domestic violence.

    Staff should be trained to act in a compassionate, nonjudgmental, trustful, and confidential manner; to recognize signs and symptoms of both victims and abusers; to use screening and assessment tools to identify victims; to uphold established confidentiality procedures; and to provide relevant information to clients on programs and services, programmatic waivers and exemptions, and legal requirements and options. Developing staff capacity to perform these roles requires informative training on both an initial and an ongoing basis. In conjunction with staff training, welfare agencies may want to consider hiring or contracting with a professional domestic violence counselor or advocate who can offer some supportive services on site, facilitate appropriate referrals for other services, and foster collaborative partnerships with other agencies and organizations.

    Coordinated Delivery of Services

    To serve victims of domestic violence successfully and ensure that they have access to necessary supportive services, welfare agencies should develop coordinated service delivery strategies with other agencies and organizations. Domestic violence affects victims and their families in various ways and involves many organizations in the community. Victims often face a variety of co-occurring barriers to employment that may stem from domestic violence, including post-traumatic stress disorder, substance abuse, lack of safe and affordable housing, and lack of legal advocacy. To help victims move from welfare to work, meet their various needs, and improve their personal safety, welfare agencies must be able to provide or help clients obtain supportive services. To do so, welfare agencies should develop collaborative partnerships with a wide range of organizations in the community, including domestic violence service programs, mental health and substance abuse providers, advocacy groups, child protective services, child support enforcement, the police, public prosecutors, and other law enforcement personnel. A range of coordinated efforts are necessary to address victims' two sets of needs: needs that stem from risks posed by the perpetrator (addressed through coordination with, for example, child support enforcement and criminal justice systems), and needs that stem from personal difficulties associated with abuse (addressed through coordination with, for example, service programs, mental health and substance abuse providers, and housing agencies).

    As relationships with these types of organizations are developed and strengthened, care must be taken to coordinate organizational goals and priorities. Communication across agencies, for example, through joint trainings and cross-agency committees, may help to foster mutual understanding, as well as to raise awareness of domestic violence issues, educate other organizations about welfare agencies' role in working with victims of domestic violence, establish formal referral procedures, and develop coordinated community strategies.

    Service Capacity

    To serve victims of domestic violence successfully, welfare agencies must assess the extent to which current local service capacity already assists these clients with their various needs and, where gaps exist, address shortages. Progress has been made in recent years in identifying, serving, and treating victims of domestic violence. However, the programs available to help victims are still small relative to the size of the problem (Commonwealth Fund 1996). In many communities, existing resources may not be adequate to offer services to those who need them in areas such as mental health, substance abuse, safety planning, housing, and employment. Because service capacity may be inadequate in a range of areas, a community-wide collaborative effort to meet these multiple needs may be necessary. Welfare agencies may wish to play a role in developing such collaborative service delivery efforts in order to expand services to domestic violence victims. The development of creative partnerships is likely to be necessary if victims of domestic violence are to be served and helped to move from welfare to work.

    Program Models⁽³⁾

    • What are welfare agencies doing to address this issue?
    • Whom can I contact?

    The following programs are presented alphabetically by state. The reader can determine the relevance of a program by noting its primary program strategy and geographic location and then refer to the brief descriptions and contact information on the subsequent pages. We have used primary objective(s) to assign program strategies, though a program may have many objectives.

    ---

    Coordinated Community Response to Domestic Violence

    San Diego Domestic Violence Council

    San Diego, California

    Program strategy: Service coordination

    Location: One urban/suburban county

    ---

    Colorado Office of Child Support

    Model Office Project

    Denver, Colorado

    Program strategy: Client identification

    Service coordination

    Location: Four counties, urban/suburban/rural

    ---

    Options/Opciones Program

    Taylor Institute and the

    Illinois Department of Public Aid

    Chicago, Illinois

    Program strategy: Client identification

    Enhanced case management

    Service coordination

    Employment integration

    Location: One urban community

    ---

    Anne Arundel County Department of Social Services

    Domestic Violence Awareness Training and Service Planning

    Anne Arundel County, Maryland

    Program strategy: Client identification

    Enhanced case management

    Location: Statewide

    ---

    Coordinated Community Response to Domestic Violence

    Domestic Abuse Intervention Project

    Duluth, Minnesota

    Program strategy: Service coordination

    Location: Three counties, urban/suburban/rural

    ---

    Oregon Department of Human Resources

    Domestic Violence Plan

    Salem, Oregon

    Program strategy: Client identification

    Enhanced case management

    Location: Statewide

    ---

    State of Washington

    Office of the Secretary of State

    Address Confidentiality Program

    Olympia, Washington

    Program strategy: Client confidentiality

    Location: Statewide

    ---

    Program Name/Contact

    Coordinated Community Response to Domestic Violence San Diego Domestic Violence Council San Diego, California

    Gael Strack City Attorney's Office San Diego Domestic Violence Council 619-533-5515

    Program strategy: Service coordination Location: One urban/suburban county

    Brief Program Description

    The San Diego Department of Health and Human Services has recently joined other local agencies that are part of the San Diego Domestic Violence Council (DVC). Since 1989, DVC has been working to reduce and prevent domestic violence in San Diego County by increasing community awareness on domestic violence issues, expanding efforts to prosecute batterers, and strengthening services and supports for victims and their families. The council includes a diverse group of more than 200 community organizations and individuals, including the city attorney's office, the police department, the probation department, the courts, child protective services, and, most recently, the local Department of Health and Human Services. Numerous working committees have developed action plans to address specific aspects of domestic violence, for instance, law enforcement, legal action, shelter and support, child abuse, treatment, education and prevention, and grants and data collection.

    DVC efforts have involved the provision of domestic violence training for nearly all police department and other law enforcement staff; the development of protocols for law enforcement staff, prosecutors, and medical staff to follow when working with victims and batterers; the creation of a training curriculum for use with schoolteachers; and the sponsorship of activities geared toward adolescents. Through the work of the DVC, the police and other law enforcement staff have developed a more sensitive and helpful approach to working with victims and a more aggressive policy for arresting batterers and gathering evidence against them. The DVC also makes victims' advocates available through the city attorney's office. These advocates provide assistance and counseling to victims who pursue a legal course of action. Ongoing DVC activities involve strengthening coordinated efforts and training with the Department of Health and Human Services.

    The work of the council is jointly funded by the organizations involved. Although comprehensive program cost data are not available, the city attorney's office alone spends more than $800,000 annually on a special domestic violence unit, including 8 attorneys, 2 investigators, and more than 10 other staff members.

    Evaluation

    The Urban Institute (1996) conducted an implementation study of the San Diego Domestic Violence Council, along with five other communities' coordinated responses to domestic violence.

    Findings

    There is no information on program impacts. Descriptive crime data from San Diego County indicate that from 1991 to 1993, the number of domestic violence cases reported to the police nearly doubled, while domestic violence-related murders dropped by nearly 50 percent (Boyle 1995).

    Program Name/Contact

    Colorado Office of Child Support Model Office Project Denver, Colorado

    Jessica Pearson, Esther Griswold Center for Policy Research 303-837-1555

    Program strategy: Client identification Service coordination Location: Four counties, urban/suburban/rural

    Brief Program Description

    Colorado's demonstration Model Office Project, funded by the Federal Office of Child Support Enforcement, began in fall 1996 and was completed at the end of 1997. It examined the intake process relating to domestic violence and the use of good cause exemptions from child support regulations. The project focused most closely on welfare recipients who are victims of domestic violence and who need child support. The Colorado Office of Child Support (COCS) developed and implemented a standardized training plan and screening and assessment tools for intake workers in three county welfare and child support enforcement offices.

    Welfare agency case workers (from the Office of Social Services) used a one-page form to screen all public assistance applicants for domestic violence. Afterward, and if appropriate, clients were given information on community resources and referred to the Child Support Enforcement Office for a good cause evaluation. At this point, child support intake workers used a more detailed assessment tool to probe the nature of the domestic violence in clients' lives and to offer good cause exemptions to needy clients.

    Although the Model Office Project is not currently ongoing, the Denver Office of Social Services is now working with community domestic violence service providers to sponsor two paid staff in the Office of Social Services. It is intended that these staff will provide domestic violence support services to clients (for instance, help in gaining access to temporary shelter or obtaining a restraining order).

    Evaluation

    The Center for Policy Research in Denver, Colorado conducted a descriptive study of program participants (Pearson and Griswold 1998). In addition, they have collected systematic information on a sample of nearly 1,100 welfare applicants from four local Social Services offices in three different counties.

    Findings

    There is no information on program impacts.

    Program Name/Contact

    Options/Opciones Program Taylor Institute and the Illinois Department of Human Services Chicago, Illinois

    Rebekah Levin Taylor Institute 773-533-2180

    Program strategy: Client identification Enhanced case management Service coordination Employment integration Location: One urban community

    Brief Program Description

    The Illinois Department of Human Services (IDHS) funds more than 50 domestic violence prevention programs throughout the state. The Options/Opciones Program in the North Lawndale neighborhood in Chicago is one such program. The program, now in the early stages of implementation and development, intends to provide comprehensive, welfare-to-work services to victims of domestic violence. It also aims to provide educational services to communities. Viewed as a promising service delivery program model, Options/Opciones began implementation in mid-1997 and, after six months of operation, had served approximately 80 TANF recipients who are also victims of domestic violence. The program provides bilingual activities and services both within the local IDHS office and at a separate program site. It also works with IDHS and cooperating community organizations to increase understanding of domestic violence issues, develop community-based partnerships addressing domestic violence, and expand available community services.

    Through its agreement with IDHS, Options/Opciones provides training on domestic violence issues to IDHS case management staff. The training includes the use of a domestic violence screening tool. If a woman discloses domestic violence through the IDHS assessment process, she is referred to an Options/Opciones staff person in a separate and confidential office at IDHS. This Options/Opciones staff person provides initial services, counseling, and safety planning. As necessary, and to partially satisfy the TANF work requirement, the client may be referred to the off-site Options/Opciones office for further services and support. Under full implementation, the program intends to offer the following additional services to clients: (1) case management services, including helping clients access emergency shelter, physical or mental health services, legal services, domestic violence treatment, literacy training, and job readiness and placement services; (2) a preemployment 10-week training program; and (3) weekly peer support groups.

    Evaluation

    An evaluation is being conducted by the Taylor Institute, in conjunction with the University of Michigan and the Joint Center for Poverty Research at the University of Chicago and Northwestern University. Researchers are collecting extensive descriptive data on participants at intake and plan to do so every six months over the next five years. The evaluation design includes plans for constructing a matched comparison group from another welfare office and comparing outcomes of this group with outcomes of the Options/Opciones treatment group. The evaluation also includes an implementation study. Taylor Institute staff are currently assessing program implementation and modifying the program model as necessary and appropriate.

    Program Name/Contact

    Anne Arundel County Department of Social Services Domestic Violence Awareness Training and Service Planning Anne Arundel County, Maryland

    Vesta Kimble, Deputy Director Anne Arundel County Department of Social Services 410-269-4603

    Program strategy: Client identification Enhanced case management Location: Statewide

    Brief Program Description

    Beginning in fall 1996, Maryland's Anne Arundel County Department of Social Services received a grant from the U.S. Department of Health and Human Services (DHHS) to develop and pilot-test a domestic violence training curriculum for administrative and frontline social services staff. The training model, which was developed in collaboration with the YWCA of Annapolis and Anne Arundel County, is intended to (1) better equip staff to identify and serve clients of TANF and other public assistance programs who may be victims of domestic violence, and (2) provide general education to the public about domestic violence. The county implemented the three-day training program in 1997, and the Maryland Department of Human Resources is now implementing the program statewide. The model draws on the one used by the Domestic Abuse Intervention Project in Duluth, Minnesota. Videotapes are incorporated into the training and used as instructional devices.

    During Phase I of the initiative, the Anne Arundel Department of Social Services, in collaboration with the YWCA, conducted training for welfare administrators and various types of frontline staff, including welfare caseworkers, job counselors, child protective service workers, child support workers, and child care workers. Staff are trained to address the subject of domestic violence with all clients at initial intake and/or at reassessment. They are also trained to identify suspected domestic violence through subtle cues and indirect questions.

    Upon identifying serious cases of domestic violence (either suspected or acknowledged), staff form an Intensive Service Team that includes a job counselor, a welfare caseworker, a social worker, and, if necessary, a child support worker. This team develops an immediate six-month action plan and follow-up plan for the client. If an Intensive Service Team is not warranted, frontline staff either provide appropriate services or make referrals for them. These services typically include counseling and legal advocacy, funds for relocation (for example, first month's rent and security deposit), and (in some cases) temporary exemption from the work requirements under the family violence option. In addition, a civil advocate and counselor are available in the county welfare offices to meet with clients and their families and to help the families file for ex parte and protective orders.

    Evaluation

    This program has not been formally evaluated.

    Program Name/Contact

    Coordinated Community Response to Domestic Violence Domestic Abuse Intervention Project Duluth, Minnesota

    Coral McDonnell Domestic Abuse Intervention Project 218-722-2781

    Program strategy: Service coordination Location: Three counties, urban/suburban/rural

    Brief Program Description⁽⁴⁾

    The Minnesota Domestic Abuse Intervention Project (DAIP) is a comprehensive community-based program for handling domestic violence cases in the Duluth area, other areas of Minnesota, and other communities that have implemented the DAIP. Since the early 1980s, it has coordinated the responses of various community organizations to domestic violence cases, increased community awareness of domestic violence issues, strengthened procedures to screen for domestic violence, and expanded services and supports for victims and their families.

    A diverse group of community organizations participate in the DAIP, including the police department, the prosecutor's office, the probation department, the public health department, district judges, social service providers, mental health agencies, and local domestic violence advocacy and shelter groups. Key ongoing activities include training for staff from participating organizations, the use of standardized law enforcement and treatment responses to hold assailants accountable, and the provision of services to assist victims and their families. Standardized law enforcement responses include a mandatory policy of arresting assailants when probable cause exists, as well as strong prosecution policies. Assailants found guilty typically receive minimum 30-to-60 day jail sentences, followed by a probationary period that includes participation in a 29-week education course. Services available to victims and their families include, for instance, temporary shelter, safety planning, peer support groups, court advocacy services, and supervision of visits between assailants and children.

    The Duluth National Training Project offers training to other communities interested in implementing the DAIP program model; the model has been widely replicated (in both urban and rural areas).

    Evaluation

    Several studies of the program, both descriptive and quasi-experimental, have been conducted to examine outcomes related to either victims or assailants (Shepard 1987; and Shepard 1992). The Urban Institute (1996) also conducted an implementation study of the program. An impact evaluation is currently underway to compare enhanced DAIP strategies with past strategies; preliminary results may be available in 1998 (Shepard 1996).

    Findings

    One descriptive study examined victim survey data and found that battered women reported decreases in physical and psychological abuse as their abusers progressed through the program (Shepard 1987). At one-year followup, this same study showed that over two-thirds of battered women had not experienced physical abuse during the past three months.

    Program Name/Contact

    Oregon Department of Human Resources Domestic Violence Plan Salem, Oregon

    Shirley Iverson, Field Services Manager 503-945-6902 Carol Krager, Domestic-Violence Lead 503-945-5931

    Program strategy: Client identification Enhanced case management Location: Statewide

    Brief Program Description

    The Office of Adult and Family Services (AFS) within the Oregon Department of Human Resources recently developed and implemented a domestic violence service plan that includes comprehensive staff training and domestic violence services for needy clients. Each AFS district office appoints a domestic violence contact person to coordinate training and services. All welfare agency staff receive training (both initial and ongoing) on how to identify and refer victims of domestic violence. The training model includes the use of a screening and assessment tool to identify victims. The model was developed by AFS with input from the Oregon Coalition Against Domestic and Sexual Violence.

    Once clients are identified as needing domestic violence support services, AFS staff develop an individualized self-sufficiency plan for the client and the client's family and begin holding cooperative case staffings to discuss the family's situation and progress. The staffings are designed to connect victims with needed resources, such as mental health counseling and domestic violence treatment. Representatives from local partner agencies may be included. Victims may also receive help obtaining special funds through the state Emergency Assistance Program (EAP). In addition, life skills training and a new leadership developing training course ("Developing Capable People") provide additional support to domestic violence victims, as well as other AFS clients.

    Local agencies have wide latitude in providing additional services. In addition to the core set of services outlined above, some local agencies offer on-site domestic violence resource rooms, on-site domestic violence counselors, and educational victim support groups. In addition, staff in some agencies wear badges that say, "Does your partner hurt you…I will listen." Other local agencies participate in community-oriented domestic violence initiatives that may include the police department and other members of the justice system.

    Evaluation

    There has been no formal evaluation of this program. AFS recently conducted a review of more than 4,600 case files from three districts (two rural, one urban). The case files reviewed were for those clients who had been identified as having made little progress toward work, though they were not necessarily victims of domestic violence. Interviews with clients supplemented the case file reviews.

    Findings

    There is no information on program impacts. However, the case file reviews revealed that half the welfare recipients in these three districts who had made little progress toward work were current or past victims of domestic violence; that is, they reported that they had been physically or sexually abused at some time during their lives (Iverson, no date).

    Program Name/Contact

    State of Washington Office of the Secretary of State Address Confidentiality Program Olympia, Washington

    Margaret McKinney, Program Manager Address Confidentiality Program 360-753-2972

    Program strategy: Client confidentiality Location: Statewide

    Brief Program Description

    The Address Confidentiality Program (ACP), in operation since 1991, is a statewide program in Washington that provides a confidential substitute address for victims of domestic violence who wish to escape an abusive environment. Participants' mail is forwarded by the state to the confidential address. The program protects the confidentiality of participants' real addresses, as well as their voting and marriage records. It also provides them with special identification cards that can be used when applying for a driver's license or child support in the state of Washington. Neither federal agencies nor private organizations are required to accept the substitute address, although they often do.

    The ACP office provides information about the program to local domestic violence service providers and advocacy groups throughout the state. These organizations make client referrals, as appropriate, to the ACP program. Referred clients complete their application to the program in person at a local victims' assistance program. Welfare clients referred to local domestic violence service providers learn about ACP from these service providers. There is no fee for participating, and corroborative evidence of domestic violence is not required. During early 1998, the ACP program office developed a brochure that it plans to circulate to local social service agencies statewide.

    Over 940 people, including more than 450 parents and their children, participated in the ACP in 1996. The cost of the program is estimated to be $158 per participant per year.

    Evaluation

    This program has not been formally evaluated.

    Further Information

    Further information on issues related to domestic violence is available from the following

    Organizations

    National Coalition Against Domestic Violence

    202-544-7358

    The National Coalition Against Domestic Violence is a nonprofit association of grassroots shelter and service programs for battered women that serves as a national information and referral center for the general public, the media, battered women and their children, and related agencies and organizations, including welfare agencies. Services and products include advocacy, a national communications network, various publications related to domestic violence, and technical assistance in developing innovative model programs that address the needs of battered women.

    National Resource Center on Domestic Violence

    800-537-2238

    The National Resource Center on Domestic Violence provides information on domestic violence training materials, screening and assessment instruments, and various policy and programmatic issues related to domestic violence.

    National Organization for Women (NOW) Legal Defense and Education Fund

    212-925-6635

    The NOW Legal Defense and Education Fund is a legal advocacy organization focusing on issues and advocacy relating to women and girls, including those related to domestic violence.

    Taylor Institute

    773-342-5510

    The Taylor Institute is a nonprofit policy research and advocacy center that seeks to improve the quality of life of low-income and other disadvantaged people and communities by changing relevant public policies. The institute conducts demonstrations, research, and evaluations and also provides training and technical assistance. Much of its work focuses on issues related to domestic violence among the welfare population.

    Further information on issues related to domestic violence is available in the following

    Documents

    The Commonwealth Fund. "Violence Against Women in the United States: A Comprehensive Background Paper." New York, NY: The Commonwealth Fund, Commission on Women's Health, Columbia University, 1996.

    This paper reviews the literature on violence against women in the United States and offers recommendations for further research and analysis in six key areas: (1) patterns of violence, (2) gender and violence, (3) the consequences of violence against women, (4) medical and mental health care for victims, (5) help-seeking and social support, and (6) violence prevention.

    Davies, J. "The New Welfare Law: State Implementation and Use of the Family Violence Option." Welfare and Domestic Violence Series, Paper #2, National Resource Center on Domestic Violence, January 1997.

    This paper provides detailed information on the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) and the issues related to its implementation, particularly the use of the Wellstone-Murray Family Violence Amendment. Other papers in this series address issues related to implications for battered women under welfare reform, state implementation and use of the Family Violence Amendment, and child support enforcement.

    Laurence, F., and Spalter-Roth, R. "Measuring the Cost of Domestic Violence Against Women and the Cost-Effectiveness of Interventions: An Initial Assessment and Proposals for Future Research." Washington, DC: Institute for Women's Policy Research, 1996.

    This paper reviews the literature on the costs associated with domestic violence, develops an economic model for measuring both direct and indirect costs of domestic violence, outlines a plan for assessing the cost-effectiveness of domestic violence interventions, identifies gaps in the research literature on domestic violence costs, and provides an extensive list of information sources.

    Raphael, J., and R. Tolman. "Trapped by Poverty, Trapped by Abuse: New Evidence Documenting the Relationship Between Domestic Violence and Welfare." Taylor Institute and University of Michigan Research Development Center on Poverty, Risk and Mental Health, April 1997.

    This report provides a comprehensive summary analysis of ten recent research studies that examine both the extent of domestic violence among female welfare recipients and the effect of domestic violence on women's receipt of welfare, employability, and other outcomes. The report discusses policy implications and makes recommendations for serving welfare recipients who are victims of domestic violence.

    Raphael, J. (editor). "Understanding Women's Poverty: A Symposium on the Relationship of Domestic Violence and Welfare Receipt." Law and Policy, vol. 19, no. 2, April 1997.

    This edition of the Law and Policy journal is exclusively devoted to an examination of issues related to domestic violence, welfare, and the transition from welfare to work. Topics include the relationship between domestic violence and welfare, the effects of domestic violence on employment, and implications of welfare policy to domestic violence victims and the agencies that serve them.

    1. This single national estimate of current domestic violence victims is based on a measure of those welfare recipients who were "physically victimized or threatened by their current partner sometime during the past five years." However, it is important to note that, given definitional restrictions, this national estimate of current domestic violence may be biased in two ways. First, it may underreport the total number of current victims, since the definition excludes those who may have been victimized by someone other than their current partner. Second, when compared with other studies, it may overreport the total number of current victims, since it defines "current" as a period of five years while many state and local studies have defined current as a period of one or two years.

    2. As part of the recent federal welfare reform legislation, the Family Violence Amendment gives states the option to grant a good cause waiver to clients identified as victims of domestic violence, which involves suspending the welfare time limit temporarily and waiving certain requirements for these clients, including child support cooperation requirements. More than 30 states have adopted the amendment, and others have adopted some of its provisions.

    3. For an explanation of how programs were selected, please refer to the discussion included in the Introduction under the paragraph heading "Program Models."

    4. Though this program is not coordinated with the respective county welfare agencies, it is included as an example of what a coordinated effort that involves numerous service providers can look like.

    Financial Emergency

    INTRODUCTION

    What compels many to seek or continue to rely on public assistance is not a need for the ongoing support of monthly welfare payments, but rather for a far more limited form of financial support to address specific "emergency" needs. Welfare agencies can address these emergency needs through the use of financial assistance prior to welfare receipt, or coverage of employment-related expenses to assist in the transition to work. While monthly welfare checks have historically encouraged dependency, this form of limited and targeted financial assistance more directly promotes self-sufficiency. Welfare agencies that have made use of this type of targeted financial assistance are generally finding it a low-cost and effective way to provide minimal support yet reap a sizable benefit through reduced caseloads.

    This section provides information on and addresses the following questions related to a financial emergency faced by welfare recipients:

    NEED FOR SERVICES:

    • How is financial emergency defined?
    • What percentage of the welfare population faces this barrier to employment?

    Definition

    A financial emergency caused by an unexpected shortage of funds can be both a barrier to employment and a trigger for a new, renewed, or continued reliance on public assistance. States have defined what constitutes a financial emergency largely on an individual basis and then tailored assistance accordingly. Assistance can be provided to (1) potential welfare recipients, to address emergency financial needs expressly to prevent the need for public assistance (frequently referred to as diversionary assistance or lump sum payment), or (2) to current welfare recipients, to address financial needs faced in the transition from welfare to work in order to assist the progress toward independence (such assistance is frequently referred to as work-related payments or loans).

    For both forms of assistance, the financial emergency usually must be immediate and one-time (as opposed to ongoing) and generally cannot be the result of failure to accept an offer of employment or a job termination. States vary as to what expenses they cover. Some cover employment-related expenses only (commonly, uniforms and tools); others cover expenses for household (including rent and utilities), transportation (including car repairs), relocation, child care, other assistance programs, or, at the discretion of the individual case manager, other needs that, when addressed, will reduce the likelihood of welfare dependence.

    The amount and form of financial assistance varies. The final amount is often negotiated between the individual and the caseworker, and the maximum allowable varies. In general, the amount provided to potential welfare recipients in diversionary assistance is greater than the amount provided to current recipients for work-related expenses.

    Diversionary assistance is most commonly either a set amount (such as $3,000) or a multiple of what would otherwise be the monthly welfare grant. The assistance can be provided as cash, vouchers, or third-party payments. Recipients are often also eligible for other forms of transitional support (such as child care and Medicaid) but are generally required to repay the diversionary allowance if they later go on welfare.

    Work-related payments vary in amount: they can be restricted to less than $100 or amount to more than $1,000. Often the work-related expense must occur within a set period of time after employment (within the first week to within the first three or four months). There is substantial variability as to how often a client can receive either a diversionary or a work-related payment; sometimes frequency is not specified, sometimes it is restricted to a single payment, and sometimes it is multiple payments, such as one per year.

    Percentage of Welfare Population Facing This Issue

    Recipients of Diversionary Assistance:

    Percentage of Caseload

    State/local estimates:

    <5 to 20 percent

    Recipients of Work-Related Payments:

    Percentage of Caseload

    State/local estimates:

    47 percent

    There are no real estimates of the percentage of the welfare population faced with a financial emergency as a barrier to employment. Tables ⁽¹⁾

    • What can welfare agencies do to assist clients who face a financial emergency as a barrier to employment?
    • What does the evidence suggest about the effectiveness of addressing this barrier?
    • What do we know about program costs?
    • What do we know about program implementation?
    • 
       

    Welfare Agency Approaches

    The two critical program features of an agency's approach to addressing financial emergencies faced by potential or current clients are (1) determining client eligibility, and (2) deciding on the type of assistance to provide.

    Client Identification

    In general, states consider two issues when determining eligibility for emergency financial assistance: (1) an applicant's employment and welfare status, and (2) the nature of the financial emergency.

    Many states--though not all--require that the person either be currently employed or have the promise of employment and in every other respect be eligible to receive welfare. In the case of diversionary assistance, there is some variation. In at least one state (Utah), only those applicants who are single parents or come from a two-parent family where one parent is incapacitated are eligible. In some jurisdictions in Maryland, applicants are not required to be eligible for TANF.

    The nature of the financial emergency--and in particular its relationship to a client's employment status--affects a client's eligibility for assistance as well. In some cases, this relationship must be close and direct: the applicant must need financial assistance which, when provided, will directly facilitate the obtaining or maintaining of employment (such as transportation to a job interview). In other cases (truer of work-related expenses than diversionary assistance), the connection can be fairly loose, and the financial assistance is only indirectly related to employment (such as assistance with rent or child care costs).

    Because the amount of diversionary assistance tends to be greater than the amount provided for employment-related expenses, screening of potential welfare recipients for diversionary grants or loans often entails a more rigorous determination of employment status or prospects for employment. Screening current welfare recipients for financial assistance (usually for work-related expenses) is less rigorous and focuses more on verification of the expense than screening of the client.

    Program Strategies

    Our review of programs to address emergency financial needs suggests that there are two important dimensions on which to distinguish programs, both of which have been previously discussed: (1) the point in time when the assistance is provided, and (2) whether assistance must be repaid (as it must in a loan program).

    Applicant Versus Current Recipient Assistance. As discussed earlier, assistance can be provided either to divert applicants from needed sustained assistance (what we generally refer to as diversionary assistance) or to help clients move from welfare to work (assistance with work-related expenses). In our program descriptions at the end of this chapter, we categorize these two types of programs as either applicant or current recipient assistance, to indicate the point in time when assistance is provided. Because both are usually provided to address work-related expenses, the important dimension is really when the assistance is provided.

    Repayment Required Versus No Repayment. Financial assistance is sometimes provided as a loan, with an obligation to repay (either in cash or occasionally through volunteer work), other times as a grant. Though the term grant suggests that clients do not have to repay it, repayment of diversionary assistance is often expected if certain agreed-upon conditions are broken (such as leaving a job without good cause). Acceptance of a diversionary grant also often entails an agreement not to apply for public assistance for a certain period of time, which shifts much of the burden of financial risk onto the client.

    Program Outcomes

    We were unable to find any evidence concerning the effectiveness of programs that provide work-related assistance to address the emergency financial needs of current welfare recipients in either improving employment outcomes or shortening the length of need for public assistance. Analysis from the Postemployment Services Demonstration, a federal demonstration designed to test the effect of enhanced case management services and payments for work-related emergencies on clients' employment outcomes (see further description under Program Models), will examine the correlation between the use of these supportive payments and employment-related outcomes, but information from this evaluation is not yet available.

    The only evidence available on the effectiveness of diversionary financial assistance provided to welfare applicants pertains to the rates of subsequent application for welfare support. Reported percentages of those who were provided diversionary assistance and did not subsequently apply for public assistance give an indication of the success of this approach in reducing reliance on welfare. The assumption is that these clients have become gainfully employed. One note of caution with these figures, however, is that the period of time used to measure the return to welfare is often unclear. Clearly, a high percentage of those who have not applied for welfare after a long period of time is more encouraging than a high percentage that occurs only a few months after receipt of diversionary assistance. There is no information on employment outcomes for this group, however, so while we know something about the rate of success in diverting individuals from welfare, we do not know whether, with assistance, they are more likely to find employment, find employment sooner, or find employment at a higher wage, for example.

    Effect of Diversionary Grant Assistance on WELFARE RECEIPT

    • In 1997, 96 percent of those provided diversionary assistance in Maryland had not returned to apply for public assistance within twelve months.⁽²⁾
    • Since 1995, 85 percent of those provided diversionary assistance in Virginia had not returned to apply for public assistance.⁽³⁾
    • As of February 1998, 75 percent of those provided diversionary assistance in Utah had not returned to apply for public assistance.⁽⁴⁾

    Program Costs

    Financial assistance provided to welfare applicants to discourage sustained reliance on welfare is often cost-effective. Because most welfare agencies exchange diversionary assistance for a period of exclusion from welfare, agencies can recover funds spent on diversion. Even the administrative costs of program operation can be quickly recovered if clients stay off public assistance long enough for the amount they would have received in monthly TANF payments to exceed the amount of the diversionary payment. One pilot site in Iowa has projected savings of anywhere from 18 to 45 percent, based on a comparison of overall expenditures for diversion to potential expenditures if clients had become welfare recipients.

    Operations are somewhat different in Hamilton County, Ohio, where the welfare agency has contracted out for diversionary assistance. In this case, the welfare agency makes a direct payment per client for each month (up to three) that a client has been successfully diverted (further details are provided under Program Models). Under this arrangement, both agencies share the desire to increase the length of time that clients do not need public assistance. However, under these circumstances the clients themselves do not incur any of the financial risk--they are neither obligated to pay back the loan nor precluded from receiving welfare for a certain period of time. In this case, it will take longer before the welfare agency recovers the money it spends to divert a client from public assistance (though none of the money will be recovered if the client applies for assistance within a short period of time).

    Under loan programs, the bulk of the financial risk rests with clients and, in those cases where there is an external lending agency, with these organizations. Under this type of program, welfare agencies incur minimal administrative costs and face little financial risk.

    Data from the Postemployment Services Demonstration provide some information on average costs per client spent on work-related payments to help clients address needs faced in the transition from welfare to work. The average work expense payments per client ranged from just over $100 to about $250 (Haimson and Hershey 1997).⁽⁵⁾ If findings from an evaluation of this program determine that this support is related to improved employment outcomes, these payments are likely to be cost-effective.

    Program Implementation

    Our synthesis of various agency approaches to provision of emergency financial assistance suggests very few issues or obstacles for agencies to address in implementing emergency financial services, in the form either of diversionary assistance to welfare applicants or of work-related payments to current welfare recipients. Implementation of programs that provide work-related payments to current welfare recipients appears quite straightforward. Implementation of programs to divert applicants from a sustained need for welfare assistance should focus on issues related to program staff.

    Program Staff

    If program implementation is to be successful, agencies must devote resources to staff training. The extent to which clients opt to receive diversionary assistance appears to be largely a function of whether the agency promotes use of the policy and whether individual caseworkers are comfortable and skilled in promoting it. Agencies that have been successful at diverting welfare applicants from ongoing assistance have provided staff training on the use of assistance, determination of client eligibility, and how the program fits into the agency's overall approach to welfare reform. In the absence of focused staff training in this area, caseworkers are unlikely to inform clients of this option or explain its benefits and requirements carefully, and clients in turn are unlikely to choose this one-time assistance in place of ongoing welfare dependency.

    Program Models⁽⁶⁾

    • What are welfare agencies doing to address this issue?
    • Whom can I contact?

    The following programs are presented alphabetically by state. The reader can determine the relevance of a program by noting its primary program strategy and geographic location and then refer to the brief descriptions and contact information on the subsequent pages. We have used primary objective(s) to assign program strategies, though a program may have many objectives.

    ---

    Maryland Department of Human Resources

    Welfare Avoidance Grants (WAG) Program

    Baltimore, Maryland

    Program strategy: Welfare applicants; no repayment

    Location: Statewide

    ---

    State of Montana Department of Public Health and Human Services

    Job Supplement Program

    Helena, Montana

    Program strategy: Welfare applicants; no repayment

    Location: Statewide

    ---

    Hamilton County Department of Social Services

    Accountability and Credibility Together (ACT) program

    Hamilton County, Ohio

    Program strategy: Welfare applicants; no repayment

    Location: One urban county

    ---

    Virginia Department of Social Services

    Employment-related expenses of VIEW participants

    Richmond, Virginia

    Program strategy: Current welfare recipients; no repayment

    Location: Statewide

    ---

    Wisconsin Department of Workforce Development

    Job Access Loans

    Madison, Wisconsin

    Program strategy: Welfare applicants; repayment

    Location: Statewide

    ---

    Postemployment Services Demonstration

    Riverside, California; Chicago, Illinois; Portland, Oregon; San Antonio, Texas

    Program strategy: Current welfare recipients; no repayment

    Location: Four urban sites

    ---

    Program Name/Contact

    Maryland Department of Human Resources Welfare Avoidance Grants Family Investment Program Baltimore, Maryland

    Mark Millspaugh, Program Analyst Maryland Department of Human Resources 410-767-8558

    Program strategy: Welfare applicants; no repayment Location: Statewide

    Brief Program Description

    The Maryland Department of Human Resources has designed a diversionary assistance component, Welfare Avoidance Grants (WAGs), which provides a one-time cash payment to meet an immediate need related to employment or family self-sufficiency. In calendar year 1997, WAGs were issued to 643 people (or about 1 percent of the state's caseload), and only 5.4 percent required ongoing cash assistance afterward.

    The WAG is cash assistance to a family with children for the family's immediate and limited needs. The program is offered to those who are employed or are in the process of getting a job and who may qualify for only a small cash benefit. The total amount of the grant cannot exceed three times the maximum monthly amount allowable for the number of individuals in the assistance unit, or three months' worth of Temporary Cash Assistance. If the local department determines the situation to be a crisis, then the WAG may be the equivalent of up to 12 months of Temporary Cash Assistance (TCA), the Maryland TANF program.

    In Maryland, WAG programs are designed locally. Some local departments of social services have arrangements with county governments for customers to use WAG funds to purchase used automobiles from the county fleet. Others are working with day care providers or housing agencies to assist customers in times of crisis. As a result of the department's intent to provide maximum local flexibility, the WAG program has no statewide coordination between agencies.

    Evaluation

    The University of Maryland's School of Social Work is conducting a three-year evaluation of the Family Investment Program, scheduled to begin in 1998. The evaluation is designed to document the assessment process and to measure its impacts. All 24 jurisdictions in Maryland will be included.

    Findings

    No findings are available yet from this evaluation.

    Program Name/Contact

    Montana Department of Public Health and Human Services Job Supplement Program Helena, Montana

    Jan Paulsen Department of Public Health and Human Services 406-444-4139

    Program strategy: Welfare applicants; no repayment Location: Statewide

    Brief Program Description

    The State of Montana's Department of Public Health and Human Services has designed the Job Supplement Program (JSP) to divert TANF-eligible people from dependence on public assistance. As of October 1997, 3,944 people received JSP assistance (approximately 17 percent of the caseload in 1997).

    The JSP provides recipients with various forms of support other than cash on a monthly basis in order to divert them from welfare dependency. The financial assistance consists of up to $3,000 for an employment-related expense. Other forms of support provided to those diverted from ongoing public assistance include (1) Child Support Enforcement Division (CSED) assistance; (2) up to $200 in child care allowance per child (paid by voucher); (3) a $200 work expense disregard; (4) a 25 percent disregard on remaining income; (6) exclusion of one vehicle of unlimited value; (5) participation in an HMO where available or, where not available, provision of basic medical coverage; (6) full Medicaid coverage for children and pregnant women; (7) extended Medicaid coverage; (8) extended child care assistance; (9) referrals to appropriate community resources; (10) information about and assistance in applying for the Earned Income Tax Credit; and (11) Food Stamps.

    Evaluation

    An evaluation is currently being conducted.

    Findings

    No findings are available yet from this evaluation.

    Program Name/Contact

    Hamilton County Department of Human Services Accountability and Credibility Together (ACT) Program Hamilton County, Ohio

    Lora Jollis Welfare Reform Executive 513-946-1238

    Program strategy: Welfare applicants; no repayment Location: One urban county

    Brief Program Description

    The Hamilton County Department of Human Services (DHS) has contracted with a group of local service providers to dispense diversionary assistance to potential welfare recipients through the Accountability and Credibility Together (ACT) program.

    DHS caseworkers make initial referrals to ACT, which then further screens clients for program eligibility. Once clients are accepted into the program, ACT staff provide whatever services they determine are necessary to help the client stay off welfare, for example, referrals for substance abuse treatment and help in locating means of transportation.

    DHS pays ACT up to $900 for each client successfully diverted from public assistance. ACT is paid $300 if a family has not applied for TANF after 30 days, an additional $300 if the family has not applied for TANF after 60 days, and a final $300 if the family has not applied for TANF after 90 days. The program has been in operation for several months and currently serves 22 clients.

    Evaluation

    An evaluation of this program is planned.

    Program Name/Contact

    Virginia Department of Social Services Employment-related expenses of VIEW Participants Richmond, Virginia

    Marsha Sharpe TANF and Employment Services Manager 804-692-1730

    Program strategy: Current welfare recipients; no repayment Location: Statewide

    Brief Program Description

    The Virginia Department of Social Services offers financial assistance to cover both program participation and work-related expenses to participants in its VIEW program (Virginia's Initiative for Employment Not Work). Expenses are covered to help current welfare recipients continue participating in a VIEW component or to accept or maintain employment. There are slight differences in what expenses are covered, depending upon a client's employment status. Whether for program participation or work-related needs, however, covered expenses include equipment and tools, uniforms and other clothing, professional fees and licensing costs, and car repairs. Case workers have discretion to extend financial assistance to other areas of need. There is no maximum amount, whether expenses covered are for program participation or for work-related needs.

    Local agencies individually determine their availability of funds and local resources to cover these expenses. As a result, each local agency in the state determines additional policy and procedures for approving expenses.

    Evaluation

    The Virginia Department of Social Services, in conjunction with Virginia Tech and Mathematica Policy Research, Inc., is currently evaluating the VIEW program. The evaluation will not isolate the independent effects of these forms of financial assistance, however.

    Program Name/Contact

    Wisconsin Department of Workforce Development Job Access Loans Madison, Wisconsin

    Leonor Rosas DeLeon Bureau of Welfare Initiatives Division of Economic Support 608-267-9022

    Program strategy: Welfare applicants; repayment Location: Statewide

    Brief Program Description

    The State of Wisconsin Department of Workforce Development has designed the Job Access Loans (JAL) program to meet expenses related to obtaining or maintaining employment. JALs are designed for a person needing assistance because a discrete financial crisis cannot be resolved with personal resources and other funding sources are either unavailable or exhausted. As of the end of February 1998, there were 235 current participants statewide.

    To be eligible for the program, a person must meet nonfinancial and financial eligibility conditions, need the loan to address an immediate and discrete financial crisis, need the loan to obtain or continue employment, not be in default with respect to the repayment of any other financial obligations, and not be a migrant worker. In addition, the applicant must be able to verify that he or she cannot reasonably obtain payment for the specific items through any other source. All TANF-eligible individuals will be eligible for JALs except minor teen parents, unless they will turn 18 within two months and the loan is imperative for obtaining or maintaining employment.

    Approved JAL uses include (1) car loans; (2) fees for obtaining a driver's license; (3) clothing/uniforms for work; (4) rent or security deposits, to prevent eviction and enable the person to obtain or maintain employment; and (5) moving expenses (only as they relate to obtaining or maintaining employment). JALs may be extended to a maximum credit line of up to $1,600, based on need, for a 12-month period. JALs typically are to be repaid within a 12-month period, which can be extended up to a maximum of 24 months.

    Evaluation

    Evaluation of the JAL program is scheduled to occur as a part of the general TANF program evaluation.

    Program Name/Contact

    Postemployment Services Demonstration Riverside, California; Chicago, Illinois; Portland, Oregon; San Antonio, Texas

    Anu Rangarajan Project Director, Mathematica Policy Research, Inc. (MPR) 609-936-2765

    Program strategy: Current welfare recipients; no repayment Location: Four urban sites

    Brief Program Description

    The Postemployment Services Demonstration (PESD) was initiated by the Administration for Children and Families of the U.S. Department of Health and Human Services in 1993 in the welfare agencies of four sites around the country: Riverside, California; Chicago, Illinois; Portland, Oregon; and San Antonio, Texas. The demonstration's purpose was to test ways of promoting job retention among welfare recipients and to collect systematic information on employment paths out of welfare. Services included (1) extended case management for employed welfare recipients, which was flexible and nonbureaucratic and included reemployment services; and (2) support service payments to cover temporary employment-related emergencies.

    Some form of financial assistance under the JOBS program was already provided to welfare clients in each of the four sites. PESD expanded this assistance by increasing the amount provided and/or allowing greater flexibility in coverage. The payments for work-related expenses were authorized by case managers and designed to cover temporary expenses associated with job search, employment, and other emergencies that can affect employment. The assistance was expected to prevent small difficulties from leading to job loss. The amounts provided, expenses covered, and periods of eligibility ranged across the four sites. In Chicago, for example, regular JOBS participants could receive up to $400 in employment expenses, but this had to be within the first 30 days after the start of employment. PESD participants could be reimbursed for up to $1,000 of employment-related expenses per year, which could cover not only strict work-related expenses but also rent, phone and utility bills, and moving expenses, and payments could be issued at any time. In San Antonio, in contrast, JOBS participants were eligible for a single payment of no more than $65, with only one such payment allowable per year. PESD participants could receive several $65 payments for uniforms, clothing, or tools in a single year, and those who lost their jobs could also receive a small daily transportation allowance while in job search, education, or training.

    Evaluation

    MPR is currently evaluating the PESD program. This study uses a random assignment design to examine the combined effects of extended case management and enhanced financial support payments on employment and welfare over a two-year period after job start. The evaluation will not examine the independent effect of work-related payments, since the design was not set up to examine the effects of financial payments in isolation. However, the study will examine simple correlations between the use of supportive service payments and employment-related outcomes.

    Findings

    Findings will be available in the summer of 1998.

    Further information on issues related to substance abuse is available in the following

    Documents

    Social Research Institute at the University of Utah. "Evaluation of the Utah Single Parent Employment Demonstration Program." Salt Lake City, UT: Social Research Institute, 1997.

    This document provides information on the implementation and impacts of the Single Parent Employment Demonstration in Utah, the first state to implement a diversion program. `

    1. Take-up rates are reportedly higher than the 20 percent statewide average in Utah in those agencies that have offered this type of assistance longer and have more caseworker experience.

    2. Data are based on a personal communication with staff from the Maryland Department of Human Resources, April 1998.

    3. Data are based on an internal document from the Virginia Department of Social Services.

    4. Data are based on a personal communication with staff from the Utah Department of Workforce Services, April 1998.

    5. These data are for three of the four demonstration sites.

    6. For an explanation of how programs were selected, please refer to the discussion included in the Introduction under the paragraph heading "Program Models."

    Housing Instability

    INTRODUCTION

    Housing instability can cause a continued reliance or return to public assistance. Welfare agencies have begun to address several issues related to housing instability that can impede a successful transition from welfare to work: the financial burden of meeting the cost of housing and limited housing options in areas near job opportunities or served by local transit systems. Left unaddressed, welfare clients' successful transition to economic self-sufficiency is jeopardized by these issues. Self-sufficiency, if attained, is often temporary in the face of such obstacles. If agencies are to successfully support clients, they must consider approaches to dealing with a range of housing barriers to employment caused by unstable housing conditions.

    This section provides information on and addresses the following questions related to housing instability among welfare recipients:

    NEED FOR SERVICES:

    • How is housing instability defined?
    • What percentage of the welfare population faces this barrier to employment?
    • What relationship does housing instability have to welfare dependency and employment?

    Definition

    Five different housing conditions contribute to the definition of housing instability: (1) high housing costs, (2) poor housing quality, (3) unstable neighborhoods, (4) overcrowding, and (5) homelessness.

    • High housing costs refers to housing that takes up more than thirty percent of a household's gross monthly income. Since poor families must pay higher proportions of their income on rent, high housing costs disproportionately affect this population (Housing Assistance Council 1997).
    • Poor housing quality refers to housing that is lacking complete plumbing or a kitchen, has inadequate heating, has inadequate electricity, or has "upkeep problems" (such as leaks, holes, or peeling paint) (Housing Assistance Council 1997).
    • Unstable neighborhoods are those characterized by conditions such as poverty, crime, and lack of job opportunities. Most subsidized housing is located in neighborhoods with these characteristics (Brandon 1995). Other problems that characterize unstable neighborhoods include noise, traffic, litter, poor or very limited city services, and undesirable neighbors (Newman and Schnare 1993).
    • Overcrowding refers to more than one person living in a room (Housing Assistance Council 1997). Overcrowding is often the result of high housing costs or the lack of housing assistance.
    • Homelessness refers to the lack of a fixed, regular, and adequate nighttime residence.

    Percentage of Welfare Population Facing This Issue

    National and state estimates:

    5 to 72 percent

    ⁽¹⁾

  • Poor housing quality can lead to interruptions in--and possible loss of--employment. Interruptions may be caused by health problems that arise from inadequate plumbing, lack of heat or electricity, or high lead levels.
  • Lack of housing makes finding employment difficult, since many job applications require an applicant's address, and lack of a telephone makes communication difficult (Sard 1993).
  • Sixty-seven percent of those homeless reported ever working, while 73 percent of those housed reported ever working (Bassuk et al. 1995).

  Welfare Agency Approaches

  • What can welfare agencies do to assist clients who face housing instability as a barrier to employment?
  • What does the evidence suggest about the effectiveness of addressing this barrier?
  • What do we know about program costs?
  • What do we know about program implementation?

  The two critical program features of an agency's approach to addressing housing instability are (1) identifying which clients to serve, and (2) determining the appropriate type of program to implement.

  Client Identification

  Because of the financial risks and the limited supply of housing, welfare agencies are generally exercising care in screening and selecting clients for many of the new initiatives designed to provide housing assistance. Agencies commonly consider some combination of information pertaining to a client's employment status, welfare status, income level, and other characteristics.

  Programs often require clients either to be employed or to be enrolled in an approved job training program with the promise of employment. Some programs target clients no longer eligible for TANF, some target those who have recently exited the welfare rolls as a result of employment, while others target those still receiving welfare.

  Income level is considered in an effort to provide housing support to those with greater need. There is often an income limit for eligibility, such as 150 percent of the federal poverty level.

  Other client characteristics sometimes considered are previous housing circumstances (such as paying high housing costs), a client's TANF performance record (such as the number of sanctions received), or personal circumstances (such as the ages or number of children).

  Identification is often based on a caseworker's determination of the extent to which a client meets objective eligibility criteria, with minimal opportunity for subjective input. In some cases, subjective input is considered, and a caseworker's recommendation regarding client participation is weighed along with the objective criteria.

  Program Strategies

  State and local welfare agencies are beginning to develop initiatives in response to clients' housing needs. Our review of programs focuses on welfare agency efforts and does not extend to potential responses such as changes in housing policy or the large number of efforts on the part of the public housing authorities. On the whole, programs are geared more toward assisting clients with housing costs so that they can remain employed rather than toward addressing more severe housing circumstances, such as homelessness, that hinder a welfare recipient from becoming employed. Our review suggests that there are at least two program strategies used by agencies to address housing instability. We categorize these strategies below. The distinctions drawn are not intended to suggest that agencies design programs around a single strategy or that these strategies are necessarily mutually exclusive. They are provided instead to foster thinking about the range of programmatic objectives possible, to help agencies define their own service needs, and to classify the programs described at the end of this section for agencies interested in pursuing further information.

  Enhanced Service Capacity. Programs with this strategy are designed to improve clients' housing circumstances, though there are at least three important distinctions within these efforts: (1) programs that provide financial support for current or pending housing (such as those that freeze rents or provide assistance with a downpayment), (2) programs that offer expanded but designated housing options (such as specified units set aside for welfare clients), and (3) programs that provide expanded and unrestricted options, allowing clients greater opportunity to locate in areas near jobs (such as rental subsidies for housing of choice or home ownership opportunities).

  Program Staff. Programs with this strategy add staff training to their efforts at enhanced service capacity. Staff training can be designed to increase caseworkers' awareness and understanding of how housing instability can affect clients, what types of housing-related services may be needed to help clients move from welfare to work, or how they can become active housing advocates on behalf of clients in their interactions and negotiations with landlords.

  Program Outcomes

  To date, there is minimal evidence on the effectiveness of welfare agency efforts to provide housing assistance in improving recipients' employment status or prospects for employment. There are currently plans for an evaluation of the Work First New Jersey Housing Assistance Program, and the findings should help to fill this gap (further information is provided under Program Models). Findings from an evaluation of the Gatreaux Program, however, are relevant, particularly to enhanced service capacity programs that permit clients to find housing wherever they choose.

  The Gatreaux Program was launched in 1976 in Chicago in response to the discriminatory nature of the city's public housing program, which restricted beneficiaries to economically depressed neighborhoods. It provided housing vouchers (Section 8 certificates) to help low-income families move to areas with better employment prospects--chiefly, to the suburbs. Chicago, like many other cities, lost a large number of low-skilled jobs to the suburbs, while low-skilled workers remained in the city with few employment prospects. In this respect, the Gatreaux Program used expanded housing options to address the issue of spatial mismatch--housing located in areas far from jobs. Findings from a 1988 evaluation of the Gatreaux Program showed that those with no previous work experience who moved to the suburbs were over 50 percent more likely to find a job than were those who moved but were limited to housing options within the city (46 percent to 30 percent) (Rosenbaum 1991).

  Though the focus in the evaluation of the Gatreaux Program is on differences between relocating to the suburbs versus relocating within the city, the findings suggest that provision of housing support that permits choice of location--presumably in an area with greater job availability--can have a significant effect on employment outcomes. This is the design behind current welfare agency efforts that provide rental subsidies that can be used in a location of the client's choice.

  Program Costs

  Information on the costs to welfare agencies of efforts to address housing needs indicates a substantial range, from very minimal to millions of dollars. Costs will vary depending upon the program's design--specifically, how much direct financial support is provided to each client--and upon the extent to which the program is able to draw on funds from other sources. Funding beyond TANF block grant dollars for the programs reviewed here comes from a variety of sources, including city "housing levy" dollars, low-income housing tax credits, and state government.

  The Lease Purchase Program in Ohio, which offers expanded but designated housing options through salvaged single-family homes, is paid for largely through the low-income housing tax credit. The Housing Program in Seattle, Washington, offers expanded but designated housing options by requiring developers to set aside units for welfare participants as a condition for receiving city "housing levy" dollars. The least restrictive and most financially generous programs are those that provide expanded and unrestricted housing options through provision of rental subsidies. The amount paid by the client is often on a sliding scale, with some increasing percentage of income paid toward rent each year. The subsidy to cover the remainder can be as much as five or six thousand dollars per year per family.

  Program Implementation

  Our synthesis of agency efforts to address client housing needs leads to a discussion of implementation issues welfare agencies face in two key areas: (1) program staff, and (2) service coordination and cooperation.

  Program Staff

  If programs rely on new roles or responsibilities for caseworkers, agencies must devote resources toward staff training if implementation is to be successful. A sizable portion of welfare clients face the range of housing barriers noted earlier. For the most part, caseworkers have not been trained to deal with these issues or to advocate on behalf of clients. Efforts that rely on caseworkers to interact with landlords or others in the housing sector or to identify clients appropriate for housing assistance programs such as those described in this chapter should include resources devoted to staff training in these areas. Welfare agency staff are generally unaware of the earned income disregards that are available in housing programs and, as a result, fail to include this information when advising clients about the financial consequences of becoming employed. In addition, staff rarely recognize the value of tenant-based vouchers and certificates in helping families to locate housing in areas close to jobs (Sard and Daskal 1998). If caseworkers are not knowledgeable or comfortable in handling these issues, they are unlikely to address clients' needs appropriately.

  Service Coordination and Cooperation

  If program implementation is to be successful, welfare agencies should cultivate strong partnerships with other agencies and organizations and develop coordinated strategies for delivering services. Many of the recent welfare agency efforts to address housing needs go far beyond any prior efforts. Because of their increased ambition, they are largely reliant on coordination and cooperation with external agencies. Efforts often need--and can benefit from--the cooperation of public housing authorities, landlords, and financial institutions. They frequently require coordination of one or more sources of funding or coordination with a contracted program operator. In general, everybody--from clients to welfare agencies, landlords, and financial institutions--wins if clients obtain or maintain gainful employment. This shared objective helps to align those with whom welfare agencies must coordinate and cooperate.

  Coordination may entail clearly specified roles and responsibilities, clear agreements concerning the terms of client participation, and clear arrangements for program funding. The success of a coordinated effort will depend upon recognition of its importance, willingness to devote resources toward it, and patience with the process of securing full cooperation from all those involved.

  • What are welfare agencies doing to address this issue?
  • Whom can I contact?

  Program Models⁽²⁾

  The following programs are presented alphabetically by state. The reader can determine the relevance of a program by noting its primary program strategy and geographic location and then refer to the brief descriptions and contact information on the subsequent pages. We have used primary objective(s) to assign program strategies, though a program may have many objectives.

  ---

  Connecticut Department of Social Services

  Time Limited Rental Assistance Program

  Hartford, Connecticut

  Program strategy: Enhanced service capacity: expanded and unrestricted options

  Location: Statewide

  ---

  New Jersey Department of Community Affairs

  Work First New Jersey Housing Assistance Program

  Trenton, New Jersey

  Program strategy: Enhanced service capacity: expanded and unrestricted options

  Enhanced case management

  Location: Five selected cities statewide

  ---

  Cleveland Housing Network

  Lease Purchase Program

  Cleveland, Ohio

  Program strategy: Enhanced service capacity: expanded but designated options

  Location: Seventeen neighborhoods in one city

  ---

  Tennessee Department of Human Services

  Families First Housing Program

  Nashville, Tennessee

  Program strategy: Enhanced service capacity: financial support for current housing

  Location: Statewide

  ---

  Seattle Department of Housing and Human Services

  Seattle Jobs Initiative (SJI) Housing Program

  Seattle, Washington

  Program strategy: Enhanced service capacity: expanded but designated options

  Enhanced case management

  Location: Seattle, Washington

  ---

  Program Name/Contact

  Connecticut's Time Limited Rental Assistance Program Hartford, Connecticut

  Kevin Loveland Connecticut Department of Social Services 860-424-5031

  Program strategy: Enhanced service capacity: expanded and unrestricted options Location: Statewide

  Brief Program Description

  The State of Connecticut Department of Social Services (DSS) has designed the Time Limited Rental Assistance Program (TLRAP) to assist participants in the state's Temporary Family Assistance (TFA) program with the transition from assistance to independence. The program is administered by selected community action agencies whose services are contracted by DSS. The projected number of families to be assisted by the program is 2,300 (or an estimated 115 new families each month in a 20-month period). The program's goal is to provide a monthly rental assistance payment to landlords to make safe, affordable housing available for needy families.

  Eligible families must be former participants in the TFA program, and an adult member of the household must be employed at the time of application and have earnings within standards set by the program. The TRLAP offers, for a maximum of one year, a housing subsidy to participants living in privately owned rental property. The subsidy is about $500 per month and represents 40 percent of the tenant's adjusted gross income minus a utility allowance (or 20 percent of the gross monthly income, whichever is greater) and state-set maximum rent. The rent may exceed the maximum state-set rent only if the family remains in the current rental unit. The family is then responsible for payment of the difference between the state-set maximum and the actual rent in addition to the income-based contribution. If a family moves to a new rental unit, the rent must not exceed the state-set maximum. All subsidized units must meet certain housing standards.

  The Connecticut Time Limited Rental Assistance Program has been funded at $10 million for two years. Funding for the program is from state TANF maintenance of effort funds.

  Evaluation

  This program has not been formally evaluated. DSS is conducting an ongoing internal evaluation that includes housing inspections (conducted randomly) and case file reviews. Findings from the evaluation are not yet available.

  Program Name/Contact

  New Jersey Department of Community Affairs Work First New Jersey Housing Assistance Program Trenton, New Jersey

  Roy Ziegler New Jersey Department of Community Affairs, Division of Housing and Community Resources 609-633-6150

  Program strategy: Enhanced service capacity: expanded and unrestricted options Enhanced case management Location: Five selected cities statewide

  Brief Program Description

  The State of New Jersey Department of Community Affairs designed the Work First New Jersey Housing Assistance Program to address the housing needs of the area's welfare-to-work population. The program provides temporary rental subsidies to supplement the wages of certain entry-level workers. Rental subsidies are provided to about 350 eligible families for up to three years.

  Eligible families or individuals include people no longer receiving TANF because of placement in unsubsidized employment. The program includes three components. First, it provides a rental subsidy whereby participating families pay a percentage of their monthly income toward their rent: 45 percent of the rent during year 1, 55 percent during year 2, and 65 percent during year 3. The program pays the rest of the rent directly to the property owner, up to the established payment standard for the rental costs in each county. Second, the program establishes an escrow/savings account to support assisted tenants whose income does not increase. The account is funded by rental payments that the program would normally make to landlords. Third, the program provides home ownership opportunities: the New Jersey Housing and Mortgage Finance Agency extends home ownership opportunities to families who wish to purchase their own homes.

  The program is funded for up to $2 million in N.J. Department of Human Services funds each year for three years. The cities in which the program will be implemented and the amount of funding for assisted families in each city are as follows: (1) Asbury Park ($95,000), (2) Camden ($860,400), (3) Elizabeth ($324,000), (4) New Brunswick ($113,400), and (5) Trenton ($406,800).

  Evaluation

  A comprehensive evaluation of the program, consisting of both an impact and a cost-benefit analysis, will be conducted by the Departments of Community Affairs and Human Services. It will measure the impact of the program on employment success rates and will analyze types and levels of supportive services that were provided to participants. The cost-benefit analysis will compare the costs of housing subsidies and supportive services to the outcomes of participants by examining salaries and reduced state aid.

  Program Name/Contact

  Lease Purchase Program Cleveland Housing Network (CHN) Cleveland, Ohio

  Kate Monter Durban Cleveland Housing Network (CHN) 216-574-7100

  Program strategy: Enhanced service capacity: expanded but designated options Location: 17 neighborhoods in one city

  Brief Program Description

  The Cleveland Housing Network (CHN) designed the Lease Purchase Program to address housing instability among the low-income and welfare populations in Cleveland, Ohio. The goal of these programs is to provide affordable and quality housing to Cleveland's low-income and welfare populations. CHN currently manages 1,500 units of scattered site housing through the program. About half of the units are rental housing, and the other half offer the lease-purchase opportunity of eventual home ownership after 15 years of responsible tenancy.

  The Lease Purchase Program offers very low-income and welfare families the opportunity to eventually own their own home while salvaging single family houses that are badly in need of fundamental repair. After a comprehensive screening process [ADD DETAILS], a Lease Purchase family is selected for each property as it is nearing completion. The program is specifically designed to keep monthly payments as low as possible through reduced first mortgage rates and soft second funds contributed by the city of Cleveland and the state of Ohio.

  The program is financed through the consolidation of Low Income Housing Tax Credits. Through the lease purchase program, families on public assistance are able to secure rents as low as $250 a month. In general, lease purchasers pay rent of between $225 and $390 a month, depending on the size and product type of the house. At some point between the first and seventh year of the lease, the tenant will be able to enter into an agreement to purchase the home at the end of the 15-year tax credit compliance period.

  Program Name/Contact

  Families First Program Tennessee Department of Human Services Nashville, Tennessee

  Bettie Teasley Tennessee Department of Human Services 615-313-5652

  Program strategy: Enhanced service capacity: financial support for current housing Location: Statewide

  Brief Program Description

  The Families First Program of the Tennessee Department of Human Services includes training participation requirements that enable participants to qualify for existing U.S. Department of Housing and Urban Development (HUD) income exclusions.⁽³⁾ Qualification of participants for this income exclusion resulted from formal collaboration and interpretation from HUD regarding the state's TANF policies.⁽⁴⁾ For Families First participants who reside in public housing, incremental increases in income received as a result of participation in approved training programs are excluded from rent computations. In addition, upon completion of training, employment-related income is excluded for an additional 18-month period. The rent is instead based on the amount of income received prior to the start of job training. For Families First participants who reside in Section 8 housing, all compensation received as a result of participation in approved training programs is excluded from rent computations, though the exclusion covers only income received during the training program and does not extend beyond its completion.

  Welfare agency staff have been trained on promotion of this option for their clients, and actively promote its use. Formal collaboration between the welfare agency and the local housing authority includes the housing authority's review of Families First participants' Personal Responsibility Plans, to determine eligibility for the income exclusion. Participants must notify the housing authority staff of any changes that would impact rent computation. Because this program entails determination of clients' eligibility for an existing HUD income disregard, there are no additional costs to local welfare agencies.

  Evaluation

  This program has not been formally evaluated. The University of Memphis will conduct an evaluation of the outcomes of the Families First Program and may include an assessment of this program.

  Program Name/Contact

  Seattle Jobs Initiative--Housing Program Department of Housing and Human Services Seattle, Washington

  Sunny Coulson Seattle Jobs Initiative 206-628-6975

  Program strategy: Enhanced service capacity: expanded but designated options Enhanced case management Location: One urban site

  Brief Program Description

  The Seattle Department of Housing and Human Services designed the Housing Program as part of the Seattle Jobs Initiative (SJI) to address the housing needs of the program's clients. The goal of the program is to provide stable housing for the 1,400 families enrolled in SJI. The Housing Program has two primary components: (1) set aside units, (2) financial assistance. The emphasis of both is to utilize existing housing resources and to take advantage of service efficiencies to better serve the rapidly emerging housing needs of SJI participants.

  Set Aside Units: Housing units, serving the transitional needs of SJI participants, will be "set aside" or reserved for SJI participants by housing developers as a condition of their receipt of City of Seattle Housing Levy dollars. Units created as a result of this funding condition will be held in reserve for SJI participants alone, for as long as the unit's term of affordability and SJI continues operation. SJI is working in partnership with the Low-Income Housing Institute to provide stable transitional housing for homeless SJI participants during training and job search. Residents establish individual transition plans when they move into a designated house and staff work with them to meet goals that will enable them to find permanent housing. SJI has been able to obtain housing for 13 participants and is currently working to secure housing for five homeless SJI participants with children. SJI participants live in self-managed housing and receive social support from case managers and colleagues. Over the course of 1998, SJI will reduce the cost of transitional housing through its arrangement with the Low-Income Housing Institute by almost $50,000.

  Financial Assistance: SJI provides subsidies that assist participants with back rent, housing deposits, credit checks, eviction prevention, and moving costs, as well as referrals to stable housing. During Phase 2 of the program, financial assistance will be provided in two ways: (1) rent assistance, and (2) Ready-To-Earn (RTE) Fund assistance. The City's rent assistance program provides assistance with deposits and/or first months rent to families at risk of homelessness. This program is operated within the Department of Housing and Human Services and is funded with federal HOME dollars. It is anticipated that the rental assistance program will serve six additional SJI families this year and over ten families through 1999. During Phase 1, housing assistance--whether for rent, deposits, or eviction prevention--comprised up to 30% of all fund requests made to the RTE Fund.

  Evaluation

  This program has not been formally evaluated. Abt Associates is conducting the evaluation of the Seattle JOBS Initiative. The SJI Housing Program is incorporated in this larger evaluation but will not undergo a separate evaluation.

  Further Information

  Further information on issues related to housing is available from the following

  Organizations

  Better Homes Fund

  Newton Centre, MA

  617-964-3834

  The Better Homes Fund is a nonprofit organization dedicated to developing and implementing long-term solutions to family homelessness. Its mission is to translate research findings and field experience into state-of-the art programs, education, and policies benefiting homeless families.

  Housing Assistance Council (HAC)

  Washington, DC

  202-842-8600

  Website:1. The section titled "Inadequate Transportation" provides further discussion on the issue of spatial mismatch--housing located far from available jobs--and describes transportation efforts to bridge this geographic gap.

  2. For an explanation of how programs were selected, please refer to the discussion included in the Introduction under the paragraph heading "Program Models."

  3. The HUD regulations governing income exclusions were amended in April, 1995, and are included in 24 CFR, Section 913.106(c)(13) for public housing residents and Section 913.106(c)(8)(v) for Section 8 housing resident.

  4. Tennessee operates their TANF program under a waiver from the U.S. Department of Health and Human Services that permits more education and training components than may be allowed in other states under federal law.

  Lack of Health Insurance

  Introduction

  Concerns regarding the need for health care benefits may deter many welfare recipients from leaving public assistance and seeking employment. Because time limits will force a severance from welfare, agencies must address both clients' lack of awareness of transitional Medicaid benefits and their limited opportunities for employment that provides private health coverage. Without adequate health coverage, former welfare recipients, particularly those with poor health, chronic medical conditions, and disabilities, may be forced to return to welfare in order to meet their health insurance needs.

  This section provides information on and addresses the following questions related to health insurance needs among welfare recipients:

  ---

  NEED FOR SERVICES

  • How is the lack of health insurance defined?
  • What percentage of the welfare population faces this barrier to employment?
  • What relationship does the lack of health insurance have to welfare dependency and employment?

  Definition

  All welfare recipients need health insurance when they exit welfare for work. The need for health insurance is particularly acute for those clients with poor health, chronic medical conditions, or disabilities, all of which can require relatively large medical expenses. We define the barrier to employment posed by the lack of health insurance simply as the proportion of the welfare population that does not receive health insurance upon exiting welfare, either from a private insurance agency, through employer-provided coverage, or through the Medicaid program. Particularly through Medicaid, adult welfare recipients may qualify for extended benefits via several routes, including Transitional Medicaid Assistance (TMA), medically needy coverage or, in some states, programs that offer extended health care coverage for people with low income. We devote particular attention to transitional Medicaid (TMA), since it is the primary route to Medicaid coverage for adults leaving welfare for work.

  We concentrate our discussion on health care coverage for adult welfare recipients. Nevertheless, it is important to note that many former welfare recipients and families with low income also face significant barriers to employment because of lack of health insurance for their children, particularly children who suffer from poor health, chronic medical conditions, and disabilities.⁽¹⁾ Children are eligible for Medicaid through several routes, including TMA and expanded Medicaid coverage for children from families with low income. In addition, the recently-enacted State Children's Health Insurance Program (CHIP) provides funding for states to develop comprehensive health insurance coverage for children not covered by either Medicaid or employer-sponsored health insurance.⁽²⁾ Health insurance coverage for children from low-income families is generally available over longer periods of time than it is for adults. Although we do not examine health insurance coverage for children in this report, many of the same program implementation issues related to coverage for adults (and discussed in this chapter) are also relevant for children.

  ESTIMATION OF NEED:

  Percentage of Welfare Population Facing This Issue

  Health Insurance Receipt of Adult Welfare Recipients

  (Medicaid) Three Months After Exiting Welfare

  State/local estimates:

  17 to 29 percent

  Health Insurance Receipt of Adult Welfare Recipients

  (Either Medicaid or Private)

  One Year After Exiting Welfare

  National estimate:	77 percent
  	25 percent insured privately 52 percent insured by Medicaid

  Health Insurance Receipt

  (Either Medicaid or Private)

  Three Years After Exiting Welfare

  National estimate:	55 percent
  	38 percent insured privately 17 percent insured by Medicaid

  The estimates suggest that many eligible clients do not receive available Medicaid benefits when they leave welfare, either because they are not easily identified by case workers as eligible for these benefits, and/or because they do not know themselves that they are eligible. During the year after leaving welfare, enrollment in Medicaid increases, suggesting that clients are enrolled not at the time they exit, but throughout the following year. Over time, as eligibility for Medicaid expires, more clients rely on private insurance. However, more also go uninsured--estimates show that close to half of former welfare recipients were not covered by health insurance three years after exiting welfare. These health insurance needs are particularly acute for the estimated 10 to 20 percent of welfare recipients nationwide who suffer from a work-related (physical) disability. The chapter on Disability in this document provides more information on this topic.

  Table ⁽³⁾ We categorize these strategies below. The distinctions drawn are not intended to suggest that agencies design programs around a single strategy or that these strategies are necessarily mutually exclusive. They are provided instead to foster thinking about the range of programmatic objectives possible, to help agencies define their own service needs, and to classify the programs described at the end of this section for agencies interested in pursuing further information. The three broad program strategies are as follows:

  Educational Outreach. Programs with this strategy, by providing training to staff from welfare agencies, community organizations, and employers of low-income workers, aim to increase awareness and use of public assistance benefits, including those available through the Medicaid program after clients exit welfare for work. Informational brochures and other materials are used to supplement training and increase staff (and ultimately client) awareness of these benefits.

  Service Coordination. Programs with this strategy strive to institute improved coordination systems or procedures between agencies to help clients access services and benefits. Coordination takes numerous forms, including the availability of on-site medical services and the use of statewide automated information systems to track client needs, benefits, and services over time.

  Increased Service Capacity. Programs with this strategy aim to support clients moving from welfare to work by increasing the availability of some form of health coverage. These programs include those that offer subsidized private health insurance, cover part of the cost of employer-sponsored health insurance (for instance, employee premiums), and expand public health care benefits.

  Program Outcomes

  We know very little about the impact and comparative effectiveness of different types of welfare agency strategies that aim to increase clients' access to and receipt of health insurance after they exit welfare. Educational outreach efforts, in combination with sophisticated management information systems, represent simple and sensible approaches to increasing Medicaid participation after clients exit welfare, for instance, through TMA. Moreover, timely and accurate dissemination of benefit information can help prevent clients from avoiding work out of a mistaken fear of losing health insurance after exiting welfare. While results from a study of the outreach initiative of the Southern Institute on Children and Families suggest that this initiative led to increased knowledge about transitional and other benefits (Shuptrine and McKenzie 1996a), no evidence exists about whether actual enrollment in TMA increased or whether the disincentive to work was minimized. Likewise, while enhancements to management information systems in several states may increase the likelihood that TMA participation will increase, studies to support this have not been identified. While TMA participation data from several states are available through the Health Care Financing Administration's Medicaid State Information System, few states have systematically tracked the use of TMA benefits.

  Although evidence is not available on the impact of welfare agency efforts to meet clients' medical needs through assistance with procuring health insurance, research consistently has shown that health insurance is a critical factor in helping clients make a successful transition from welfare to work. Although most of this research was conducted prior to welfare reform, recent extensions to transitional Medicaid benefits and welfare time limits have probably offset some of the disincentive to work of clients fearing the loss of health insurance when they exit welfare. Relevant findings that support the importance of health insurance to clients as they exit welfare for work are highlighted below.

  Effect of Health Insurance on EMPLOYMENT⁽⁴⁾

  • Projections suggest that if private health coverage were extended to all working female heads of household, employment would increase by 14 percent (Moffitt and Wolfe 1992).
  • In the context of welfare reform, if the TMA participation rate were increased from 20 percent to 50 percent during the first six months after clients leave welfare and from 15 to 25 percent during the second six months, the employment of former welfare recipients would increase by 6 percent during the four-year period after clients exit welfare (Wooldridge et al. 1997).

  Effect of Health Insurance on WELFARE RECEIPT

  • Projections suggest that if private health coverage were extended to all working female heads of household, welfare caseloads would be reduced by 11 percent (Moffitt and Wolfe 1992).
  • Extending private health insurance to clients when they exit welfare reduces by five percentage points the likelihood of returning to welfare one year later (Davidson and Moscovice 1989).
  • Descriptive data collected by the state of Minnesota suggest that the MinnesotaCare program (a managed care program for low-income families not receiving welfare) has led to small reductions in the welfare caseload (press release 1995).

  Program Costs

  No information was identified in the literature on the actual costs to welfare agencies of operating programs designed to increase health insurance coverage among clients after they exit welfare for work. The relative cost of different types of program strategies, however, varies considerably. For instance, straightforward educational outreach efforts are relatively inexpensive to develop, though may require modest amounts of staff time once implemented. Service coordination strategies that use sophisticated management information systems to improve the processes of client tracking, eligibility determination, and service delivery are likely to decrease staff time necessary to complete tasks and, ultimately, increase the overall efficiency of welfare agency operations. In contrast, strategies to increase service capacity by extending transitional Medicaid coverage have relatively high initial costs; however, these may be assumed largely by the state Medicaid agency.

  All these strategies seek to increase health care coverage among welfare clients as they make the transition to work. When health care coverage expands through increases in Medicaid utilization rates, the costs of the Medicaid program will increase as well. To the extent that these initial Medicaid cost increases are offset by longer-term reductions in welfare--as more clients are able to sustain employment and, ultimately, shift their health care coverage from Medicaid to private insurance--long-term savings to states are likely to be result. Recent microsimulation analyses show that, in the context of welfare reform, increases in Medicaid utilization through TMA would ultimately lead to small cost savings for states, as increases in state Medicaid expenditures due to higher TMA enrollment would be offset by reductions in welfare costs and increases in federal Medicaid matching funds (Wooldridge et al. 1997).

  Program Implementation

  Some welfare agencies have recently increased efforts to ensure that welfare clients are enrolled in health insurance plans such as transitional Medicaid when they leave welfare for work. In addition, state governments have expanded the period over which welfare clients can receive health care benefits after they exit welfare, and some private social services organizations have coordinated efforts with health care systems to help underwrite low-cost health coverage for low-income workers. Lessons have been learned from all these efforts about how to provide health insurance to low-income workers. At some level, these lessons are all relevant to welfare agencies as they address clients' health insurance needs. Our synthesis of various program strategies leads to a discussion of implementation issues welfare agencies and other organizations face in four key areas: (1) program staff, (2) coordinated delivery of services through enhanced management information systems, (3) employment integration, and (4) service capacity. Along with the discussion, we recommend steps welfare agencies should take to successfully meet clients' health care needs.

  Program Staff

  A critical first step for successfully increasing Medicaid coverage for eligible clients after they exit welfare involves educating clients about available transitional Medicaid benefits. This requires a substantial commitment to training staff and providing them with appropriate outreach materials. TMA participation is lower than expected (Kaplan 1997). Since clients must be informed about the availability of these transitional Medicaid benefits and welfare agency staff must take administrative steps to determine eligibility and enroll clients in the program, accessing benefits can be difficult and burdensome for both clients and staff. The underutilization of benefits results in large part from low awareness of available benefits among clients. For instance, when clients exit welfare for work without notifying caseworkers of their employment status, it can make it much more difficult for caseworkers to determine if a client is eligible for transitional benefits. The underutilization of transitional benefits may be heightened if clients mistakenly believe that Medicaid benefits are time-limited or count towards clients' lifetime welfare limits. In addition, the administrative burden on staff is exacerbated by limits on their time during client interactions and scarcity of appropriate educational materials (Kaplan 1997).

  Staff play a critical role informing clients about benefits, determining eligibility, and helping clients obtain appropriate benefits as their needs change. To prepare staff to perform these roles requires initial and ongoing training on transitional benefit issues, including how to convey critical information to clients, as well as how to conduct outreach to provide information on transitional benefits to community-based service providers and employers of low-income workers. The use of informational brochures and other materials can be used to strengthen staff capacity to disseminate this information effectively. In addition, periodic follow-up with clients after they exit welfare could be used as a means to discuss the availability of continued Medicaid coverage.

  Recent legislation authorizes $500 million in federal funds to be used to match, at an enhanced rate, state expenditures on Medicaid outreach and educational activities. Welfare agencies might wish to consider working with Medicaid agencies to tap into federal matching funds that support outreach and educational activities aimed at increasing TMA enrollment (Kaplan 1997).

  Coordinated Delivery of Services

  To facilitate the process of enrolling eligible clients in Medicaid, welfare agencies should design management information systems that better track and identify clients who lack insurance and then automatically enroll these clients in available health insurance plans. Eligibility for welfare and Medicaid are currently less closely linked than they were before welfare reform, which makes the procedures related to administering transitional Medicaid benefits somewhat more burdensome (Ku and Coughlin 1997). As a result, many states have enhanced or are currently enhancing their management information systems in order to simplify and expedite Medicaid eligibility determination and enrollment after clients exit welfare. If welfare agencies more closely integrate or link the TANF system and its data with those from the Medicaid agency, they might help minimize administrative steps, better track clients once they exit welfare, facilitate the timely determination of transitional Medicaid eligibility, and expedite the enrollment of eligible clients. Improving management information systems to better track clients and identify their needs after they leave welfare for work is a step that welfare agencies should take to ensure that more clients receive health insurance. Doing so will require that welfare agencies closely coordinate efforts with state Medicaid agencies.

  Employment Integration

  To support clients as they move from welfare to work, welfare agencies should offer services directly linked to helping clients obtain jobs that provide health insurance and other important benefits. Since less than half of welfare recipients who exit welfare for work get jobs that offer employer-sponsored health insurance as a benefit (Rangarajan 1996), developing ways to help clients access such jobs is an important challenge for welfare agencies. Few welfare agencies offer programs that directly combine job search assistance and other employment-related strategies with systematic efforts to access jobs that provide health insurance. Meeting this challenge will require balancing the need to employ clients quickly because of the welfare time limits with the need to help clients identify and obtain jobs that offer adequate health care benefits.

  Welfare agencies, on both a state and a local level, should develop job banks highlighting potential employers who offer health insurance and other important benefits, either at the point of hire or after a specified period of time. Welfare clients and staff can use such job banks to search for appropriate long-term employment. To the extent possible, welfare agencies should also tailor education and job-training strategies to better fit the hiring criteria of employers who offer important benefits. Conducting outreach with these employers may help to strengthen the relationship between welfare agencies and employers, increase employer awareness of clients' need for health insurance after Medicaid benefits expire, and, ultimately, facilitate the process of helping clients obtain good jobs.

  Service Capacity

  To meet the health care needs of welfare clients and former clients successfully, welfare agencies must assess the extent to which current local health care capacity provides insurance for clients and, where gaps exist, help to address shortages. Since most states do not provide indefinite health insurance benefits to low-income families, and since few welfare recipients get jobs that offer health insurance as a benefit, increasing the availability of health insurance for clients as they move from welfare to work is a priority. State governments have already taken a variety of steps to expand health care coverage for clients, through both the Medicaid program and private and employer-sponsored plans. In addition, welfare agencies could contribute to subsidized efforts that expand transitional Medicaid benefits or that insure more clients through private or employer-sponsored health insurance. To the extent possible, welfare agencies should consider coordinating efforts with state Medicaid agencies, employers of low-income workers, HMOs, and other managed care plans to help increase the capacity of the health care system to provide insurance to former welfare clients.

  Program Models⁽⁵⁾

  • What are welfare agencies doing to address this issue?
  • Whom can I contact?

  The following programs are presented alphabetically by state. The reader can determine the relevance of a program by noting its primary program strategy and geographic location and then refer to the brief descriptions and contact information on the subsequent pages. We have used primary objective(s) to assign program strategies, though a program may have many objectives.

  ---

  Expansions to State Health Care Benefits

  States of Maryland, Minnesota, Vermont, and Wisconsin

  Program strategy: Service capacity

  Location: Statewide

  ---

  Improvements to Automated Management Information Systems

  States of Ohio and Tennessee

  Program strategy: Service coordination

  Location: Statewide

  ---

  Southern Institute on Children and Families

  Educational Outreach Initiative

  Columbia, South Carolina

  Program strategy: Educational outreach

  Location: Available in urban/suburban/rural counties in most southern states

  ---

  New Hope Project, Inc.

  New Hope Demonstration Program

  Milwaukee, Wisconsin

  Program strategy: Service capacity

  Location: One urban community

  ---

  Program Name

  Expansions to State Health Care Benefits States of Maryland, Minnesota, Vermont, and Wisconsin

  Program strategy: Service capacity Location: Statewide

  Brief Program Description

  To expand access to health insurance and minimize the extent to which medical needs act as a barrier to employment for welfare recipients, many states have expanded health insurance for individuals through, for instance, changes to Transitional Medicaid Assistance (TMA). Such expansions have been realized under federal waivers and in a variety of different ways, for example:

  • Maryland, TMA Benefits in Lieu of Cash Assistance. Maryland extended TMA to include low-income families who are at-risk of receiving cash assistance through welfare. TMA benefits are extended to such families for up to 15 months in order to divert them from welfare.
  • Minnesota, Expanded Enrollment in the MinnesotaCare Program. Minnesota expanded access to health care for low-income families who do not qualify for Medicaid. Families with income up to 275 percent of the federal poverty level can buy into the MinnesotaCare program, with the buy-in cost determined by a sliding-fee scale.
  • Vermont, Extended TMA Benefits. Vermont extended Transitional Medicaid Assistance to 36 months after clients exit welfare or until the family's income reaches 185 percent of the poverty level, whichever comes first. Reporting of income is required semiannually. Benefits over the extended period are intended to enable former welfare clients to move into higher-wage jobs that provide health insurance coverage before their transitional benefits are exhausted.
  • Wisconsin, Expanded Health Insurance Coverage. The state of Wisconsin plans to offer expanded access to health insurance for families with incomes up to 185 percent of the poverty level, with copayments required for families with incomes exceeding 165 percent of the poverty level.

  Program Name/Contact

  Improvements to Automated Management Information Systems States of Ohio and Tennessee

  State of Ohio: Greg DePorter Ohio Department of Human Services, Office of Communications 614-466-6650   State of Tennessee: Carol Brown Tennessee Department of Human Services, Information Technology 615-313-5197

  Program strategy: Service coordination Location: Statewide

  Brief Program Description

  Through coordinated efforts with state Medicaid agencies, many state welfare agencies have enhanced or are currently enhancing their management information systems in order to simplify and expedite the process of determining client eligibility, tracking client needs, and enrolling clients in Transitional Medicaid Assistance (TMA). These systems help to ensure that more clients receive health insurance when they exit welfare for work.

  State of Ohio. The Ohio Department of Human Services' CRIS-E management information system has enabled Ohio to improve its outreach capabilities to ensure that clients eligible for Medicaid after they exit welfare are identified correctly. Ohio uses a common application form for all public assistance programs except emergency assistance. This has helped to streamline the public assistance eligibility process and to facilitate the tracking of clients over time. Since the CRIS-E system links eligibility for welfare with eligibility for Medicaid and other public assistance programs, eligibility for transitional Medicaid and other benefits can be easily identified when clients exit welfare. For instance, when case workers update client files, the system automatically guides them through a series of steps, allowing them to ensure quickly and easily that eligible clients are enrolled in transitional Medicaid.

  State of Tennessee. Tennessee's ACCENT management information system, an adaptation of Ohio's CRIS-E system, links together client data related to welfare, Medicaid, and food stamps and permits eligibility for these programs to be determined. The state Medicaid program uses ACCENT to track clients' eligibility for TMA and 45 other categories of Medicaid coverage. Prompted by the ACCENT system, eligibility for 18 months of TMA is established by the case manager at the point when the welfare cash grant is closed. The use of the integrated ACCENT system helps to ensure that a seamless transfer of Medicaid benefits occurs when families move from welfare to work.

  Program Name/Contact

  Southern Institute on Children and Families, Educational Outreach Initiative Columbia, South Carolina

  Sarah Shuptrine, Gerry McKenzie Southern Institute on Children and Families 803-779-2607

  Program strategy: Educational outreach Location: Available in urban/suburban/rural counties in most southern states

  Brief Program Description

  The Southern Institute on Children and Families is an independent, nonprofit public policy organization that seeks to improve opportunities for children and families in the South, with a focus on serving disadvantaged children. Through special projects and surveys, the institute focuses on health, social, educational, and economic issues of regional significance. For instance, it seeks to increase health coverage for children and their families. It also works to encourage public/private sector collaboration and seeks to remove bureaucratic and other barriers that restrict access to needed services.

  The Southern Institute conducted an educational outreach initiative in numerous southern states during 1996 and 1997 to educate different groups about public assistance benefits for individuals exiting welfare, including transitional Medicaid, transitional child care, the Earned Income Tax Credit (EITC), food stamps, Medicaid for children, and state income credits and policies. The groups targeted by the educational initiative were welfare recipients (particularly those exiting welfare), low-income working families, community organizations, and employers who hire low-income workers. The Southern Institute developed brochures, videos, and other materials to increase knowledge of and access to transitional benefits for families exiting welfare. Three versions of the brochure were developed, each targeted to a different audience: welfare recipients, low-income working families, and low-wage employers. Training was provided on the use of the materials--caseworkers were instructed about how to review transitional benefits with clients, and employers were instructed about how they could help low-income workers connect with benefits. To date, 10 southern states have adopted this educational outreach initiative, and the remaining 7 (plus the District of Columbia) plan to do so.

  Evaluation

  The Southern Institute conducted a descriptive study and pre-post survey in Georgia to measure knowledge of transitional and post-transitional benefits among recipients of welfare or transitional Medicaid, representatives of community organizations, and employers. A similar study was conducted in North Carolina (Shuptrine and McKenzie 1996b).

  Findings

  The study in Georgia showed that focus group participants--including welfare clients, transitional Medicaid recipients, community organization representatives, and employers--had fairly low levels of knowledge about transitional benefits before the educational initiative. However, after being exposed to the brochures, these groups attained noteworthy gains in knowledge.

  Program Name/Contact

  New Hope Project, Inc. New Hope Demonstration Program Milwaukee, Wisconsin

  Julie Kerksick, Executive Director New Hope Demonstration Program 414-342-3338

  Program strategy: Service capacity Location: One urban community

  Brief Program Description

  The New Hope Project, a demonstration program operated in Milwaukee, Wisconsin, by a community-based nonprofit organization, is designed to move low-income individuals into long-term employment and to reduce poverty. Four key service methods are used: (1) job search development and job search assistance, including access to a short-term community service job if competitive employment can not be obtained; (2) subsidized health insurance, which phases out gradually with increases in earnings; (3) subsidized child care, which phases out gradually with increases in earnings; and (4) monthly earnings supplements for full-time workers that, combined with federal and state Earned Income Tax Credits, brings income near or above the poverty level.

  The project targets individuals age 18 and over whose household income is at or below 150 percent of the federal poverty level, who are willing and able to work at least 30 hours per week, and who live in one of two urban neighborhoods in Milwaukee, Wisconsin. The project serves the welfare population, as well as others meeting the eligibility criteria. Using a case management model of service delivery, New Hope staff actively work with clients to provide employment-related assistance, to explain benefits and services, and to make appropriate referrals. Health insurance is viewed by many clients and staff as the most important benefit offered by the program (Brock et al. 1997). Those participants who are not covered by Medicaid or employer-provided insurance and who meet the program's work requirement are eligible to receive insurance through a choice of HMOs that provide comprehensive services. The New Hope project subsidizes the cost of this insurance by paying the per-capita Medicaid rate for clients who participate. Participant copayments are set to reflect income and household size and are intended to fall within the range of premiums typical of employer-sponsored plans.

  Evaluation

  The New Hope Project is currently under evaluation by the Manpower Research Demonstration Corporation. A randomized experimental design is being used to compare the employment and other experiences of a New Hope treatment group with those of a control group. The evaluation also includes cost-benefit, implementation, and ethnographic studies.

  Findings

  Although impact results are not yet available, an interim implementation study has been completed (Brock et al. 1997). Program data show that in the first year of implementation nearly three-quarters of clients worked full time and received an earnings supplement, nearly two-fifths accessed private health insurance through New Hope, and nearly one-quarter accessed child care assistance through New Hope.

  Further Information

  Further information on issues related to medical needs is available from the following

  Organizations

  American Public Welfare Association of Information Systems Management (APWA-ISM)

  202-682-0100

  Website: 1. A review of national, state, and local studies shows that between 11 and 21 percent of children from welfare families have some medical limitation or disability (Olson and Pavetti 1996).

  2. For more information on health care coverage for children from low-income families, refer to the "Southern Regional Initiative to Improve Access to Benefits for Low-Income Families with Children" (Shuptrine et al. 1998).

  3. Our review did not identify programs that specifically address the health insurance needs of individuals with poor health, chronic medical conditions, or disability, for whom the magnitude of the health insurance barrier is relatively greater.

  4. Reported impacts are not always impacts that have occurred exclusively for welfare recipients.

  5. For an explanation of how programs were selected, please refer to the discussion included in the Introduction under the paragraph heading "Program Models."

  Mental Health Issues

  INTRODUCTION

  Emerging evidence about the obstacles that mental illness poses to productive employment is raising awareness of how prevalent and detrimental these obstacles are. Welfare clients with mental health difficulties are more likely than others to receive public assistance and, unless treated, are likely to continue to need assistance for long periods. These clients, who are the least likely to respond to the pressures of time limits, are in real jeopardy of facing severe and long-term poverty. Welfare-to-work programs will have to determine how best to assess these clients' needs and to design services in ways that will facilitate steps toward employment.

  This section provides information on and addresses the following questions related to mental health issues among welfare recipients:

  NEED FOR SERVICES:

  How are mental health issues defined?

  What percentage of the welfare population faces this barrier to employment?

  What relationship do mental health issues have to welfare dependency and employment?

  Definition

  Mental health issues are defined in a variety of ways, which results in different assessments of the severity of mental illness. Narrowly defined, serious mental health issues are psychiatric disabilities that seriously interfere with one or more aspects of a person's daily life (Barker et al. 1992). Such disabilities or illnesses meet diagnostic criteria for affective disorders, including major depressive disorder. More broadly defined, with less rigorous assessment criteria, mental health issues may also include symptomatic problems or indicators of risk for mental illness. Although diagnosable mental illnesses may exist in these cases, these broadly defined mental health issues may actually be merely symptoms of other difficulties in a welfare recipient's life.

  Percentage of Welfare Population Facing This Issue

  National estimates: 4 to 28 percent State/local estimates: 13 to 39 percent

  ⁽¹⁾

Welfare Agency Approaches

• What can welfare agencies do to assist clients who face mental health issues as a barrier to employment?
• What does the evidence suggest about the effectiveness of addressing this barrier?
• What do we know about program costs?
• What do we know about program implementation?

The two critical program features of an agency's approach to addressing mental health issues as a barrier to employment are (1) identifying which clients have mental health needs, and (2) determining the type of program or service to provide.

Client Identification

Accurate identification and proper diagnosis of clients with mental health needs is the first stage in welfare agencies' effort to help clients move from welfare to work. There are two steps in this process of identification and diagnosis: screening and assessment.

Screening refers to determining the probability that a mental health need exists, often by identifying symptoms of mental illness or other mental health needs.

Assessment refers to a formal psychiatric diagnosis of the type and severity of mental illness.

Few welfare agencies use formal screening instruments to identify clients with mental health needs. Rather, welfare agency staff generally identify clients in need of mental health services by observing symptoms of mental illness, such as anxiety, behavior problems, and depression, or by incorporating questions into intake and follow-up interviews that are designed to elicit information on symptoms. Questions based on the widely recognized Diagnostics and Statistical Manual of Mental Disorders (DSM) are somewhat more valid and reliable than other questions (American Psychiatric Association 1987). For instance, a four-item scale based on the DSM and adapted from the Center for Epidemiological Studies Depression Scale has been used in research studies to measure risk for clinical depression among clients (Quint et al. 1994; and Moore et al. 1996). Such a scale, or some adaptation of it, may be appropriate for use by welfare agencies. In short, the development of effective mental health screening instruments for use by welfare agencies is much needed and has been recommended by the National Technical Assistance Center for State Mental Health Planning (Emery 1997).

Once clients are screened for mental illness, mental health professionals conduct psychiatric evaluations to arrive at comprehensive assessments. Assessments not only allow diagnosis of a client's mental illness, but also understanding of how it interacts with other possible personal difficulties, such as substance abuse, homelessness, or domestic violence.

Program Strategies

As clients adjust to the new welfare work requirements, welfare agencies are developing and enhancing service delivery strategies to improve treatment for and provide employment support to clients who have mental health needs, particularly clients who are not covered by the Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) programs. In addition, mental health agencies are continuing to work with vocational rehabilitation and supported employment providers to help people with mental health needs become successfully employed. Welfare agencies often refer clients with mental health needs to these types of organizations. Lessons from all these program efforts are relevant for welfare agencies as they develop their own approaches to better serve clients with mental health needs.

Our review of programs suggests that there are at least three broad program strategies welfare and other agencies are currently using to address mental health needs. This review is concerned chiefly with examining what welfare agencies can realistically hope to accomplish in response to client needs and does not extend to potential responses beyond the scope of the welfare agency, for example, to address changes in mental health service infrastructure or changes in Medicaid, SSI, or SSDI policy. We categorize these strategies below. The distinctions drawn are not intended to suggest that agencies design programs around a single strategy or that these strategies are necessarily mutually exclusive. They are provided instead to foster thinking about the range of programmatic objectives possible, to help agencies define their own service needs, and to classify the programs described at the end of this section for agencies interested in pursuing further information. The three broad program strategies are as follows:

Enhanced Case Management. Programs with this strategy intend to strengthen treatment services for patients with mental health needs by providing enhanced case management services, for example, through home visits, case staffings, interactive service plans, and the involvement of specialized mental health treatment workers.

Service Coordination. Programs with this strategy strive to institute improved coordination systems and collaborative service efforts between agencies. They include coordinated efforts between welfare agencies and mental health agencies, as well as between mental health agencies, the Vocational Rehabilitation Services (VR) Program, and other supported employment providers. Coordination takes many forms, including structured referral mechanisms and shared funding arrangements.

Employment Integration. Programs with this strategy primarily offer services that are directly linked to preparing clients for employment, usually combining mental health care and counseling with employment-related services such as vocational assessment and training, job preparation and placement, work experience, on-the-job coaching and accommodations, postemployment support, and interpersonal and life skills training. These programs are typically operated not by welfare agencies, but rather by mental health agencies in coordination with the VR program and other supported employment providers. Some of the people served by such programs are on welfare.

Program Outcomes

There is very little empirical evidence about the effectiveness of welfare agency efforts to help clients with mental health issues make the transition from welfare to work. Evaluations of welfare-to-work programs have not isolated the role of mental health strategies in their evaluation designs and analyses. Although little evidence exists about welfare agency efforts, a review of research from the mental health field generally shows that mental health treatment can lead to consistent and significant improvements in client work outcomes over time. Moreover, an examination of programs that integrate mental health treatment with employment-related services shows that this combination of services, when properly implemented, can help clients with mental health needs prepare for and sustain employment. Experience suggests that programs that employ clients quickly and then provide ongoing support and accommodations can help people with mental illness stay employed successfully (National Technical Assistance Center for State Mental Health Planning 1997a).

Data from a number of programs that integrate mental health treatment with employment-related services are presented below. Most of these programs are not administered by welfare agencies, nor do they target welfare recipients exclusively. However, they are relevant for welfare agencies, since they suggest types of strategies that welfare agencies might consider as they improve their own efforts to serve clients with mental health needs better. Additional information on referenced programs is provided in the section entitled Program Models.

Program Effect on EMPLOYMENT⁽²⁾

• Descriptive program data from Nevada County's intensive GAIN program for clients with mental health and substance abuse needs show that, after six months of participation, over 70 percent of welfare recipients moved from the intensive program into either employment or the regular GAIN program (Pavetti et al. 1996).

• Descriptive program data from Wisconsin's Transition Services for Persons with Severe Mental Illness show that, after the first year of implementation, 50 percent of clients had been placed in competitive employment.⁽³⁾
• Descriptive program data from New Jersey's Supported Employment Program show that, of the 2,000 people served by the supported employment providers over the past 10 years, 65 percent were placed in full- or part-time employment.⁽⁴⁾
• A quasi-experimental evaluation of the VR program in Virginia compared participants (both successful and unsuccessful rehabilitants) with program dropouts and found that female participants with mental and emotional disabilities had significantly greater earnings at one-year followup than did dropouts (Dean and Dolan 1991).

Program Costs

The literature contains little data on the costs to welfare agencies and other organizations of operating programs that address employment barriers related to mental health. Costs will vary according to differences in program approach. For instance, the cost to welfare agencies of using screening instruments to identify mental health needs among clients is minimal. Once a client is identified as having mental health needs, welfare agencies can then often make referrals to other organizations for specialized assistance. If a referral is made, for instance, to a mental health center, a supported employment program, or the VR program, the costs can be assumed by the other program. According to program data from 1984 to 1988, VR programs spent an average of $985 on services to help employ people with mental health needs (Rutman et al. 1994). The cost of welfare agency efforts to provide enhanced case management services to clients, for example, by including a mental health professional on staff, will be much higher, since it must be assumed directly by the welfare agencies.

Although little data is available on program costs or on the cost-effectiveness of different program approaches, a good deal is known about the high costs associated with mental illness. One study estimated that costs related to lost productivity, treatment, and other needs associated with people with mental illness equaled nearly $148 billion in 1990 (Rice and Miller 1992). Because of these high costs, programs that provide treatment and employment-related services are potentially very cost-effective, since clients with mental health needs can be productively employed if those needs are identified and treated and if appropriate employment-related assistance is provided.

Program Implementation

Welfare agencies are continuing to develop and enhance strategies to identify, serve, and refer clients with mental health needs. These agencies have not traditionally provided extensive supportive services to clients with these needs but instead have made referrals to other service providers, most often mental health agencies. Mental health agencies, in turn, often coordinate efforts with vocational rehabilitation and supported employment providers to meet both the mental health and employment needs of their clients, some of whom receive welfare. Through the experiences of both welfare and mental health agencies, many lessons have been learned about how to better serve people with mental health needs, lessons relevant for welfare agencies as they help these clients make a successful transition from welfare to work.

Our synthesis of various program strategies leads to a discussion of implementation issues that welfare agencies and other organizations face in four key areas: (1) client identification, (2) program staff, (3) coordinated delivery of services, and (4) service capacity. Along with the discussion, we recommend steps that welfare agencies should take to serve clients with mental health needs better.

Client Identification

If program implementation is to be successful, welfare agencies must develop screening and assessment tools that staff can use to identify clients with mental health needs. Only a very small number of state welfare agencies use formal screening tools or questions to identify mental health needs among their clients. Instead, welfare staff are more likely to rely on enhanced case management techniques, such as case staffings or interdisciplinary service teams. Reliance on these methods, however, will not ensure that clients' needs are identified in a timely manner. To ensure that these clients are accurately identified at intake and then provided with appropriate services, welfare agencies need effective screening instruments (Emery 1997). In developing such instruments, agencies would likely benefit from coordination and technical assistance at the national level.

Program Staff

If program implementation is to be successful, welfare agencies must make a substantial commitment to training staff on mental health issues, particularly on how to screen for mental illness and make appropriate service referrals. Welfare clients with mental health needs require various supportive services to help them get and maintain a job, so sensitizing staff to their unique counseling, rehabilitative, and on-the-job needs is a critical first step. After initial training to sensitize staff on mental health issues, training must also be provided to help them recognize symptoms of mental illness, use screening instruments to identify it, provide support and services to clients, and make appropriate referrals to specialized welfare agency staff and outside professionals. Developing staff capacity to perform these roles is likely to require both initial and ongoing training.

Coordinated Delivery of Services

To serve clients with mental health needs successfully, welfare agencies should develop partnerships with other organizations for the provision of mental health counseling and treatment, vocational rehabilitation, and other employment-related services. Welfare clients with mental health needs require a broad range of supportive services to help them get and then maintain a job. These services include mental health counseling and treatment, employment-related assistance, and, to the extent that clients face multiple barriers to employment, services that address other areas, such as domestic violence, substance abuse, or housing. This broad range of needed services makes coordinating service delivery with other organizations an important challenge. To meet this challenge, welfare agencies must devote the time necessary to develop and strengthen collaborative partnerships with other organizations, the most important being mental health service providers, vocational rehabilitation programs, and other employment-related service providers.

Mental health service providers offer counseling and treatment, as well as an established referral link to vocational rehabilitation and other employment-related programs. In addition, mental health providers can act as a source of technical assistance to welfare agencies as they improve their staff training and client identification methods. Welfare agencies should also develop and strengthen direct referral linkages with employment-related programs that serve people with mental health needs, including the VR and supported employment programs. All states offer VR programs, and most states offer some type of supported employment program that serves individuals with mental health needs (Emery 1997). Finally, as necessary and with the consent of clients, welfare agencies should consider communicating with the employers of clients with mental health needs to negotiate individualized on-the-job accommodations. With appropriate accommodations--many of which are very simple and cost-effective--clients with mental health needs are more likely to stay employed; without them, their chances of losing jobs and returning to welfare increases.

To link services provided directly by welfare agencies with those provided through referrals to other organizations, welfare agencies should consider hiring or contracting with a professional mental health and vocational counselor who could offer specialized support to both case managers and clients. This strategy is consistent with research and practice from the mental health field, which shows that service delivery is facilitated by a multidisciplinary approach that combines case managers with other staff who specialize in mental health and vocational rehabilitation counseling (National Technical Assistance Center for State Mental Health Planning 1997a). A mental health and vocational counselor could perform a number of functions, including offering on-site counseling and employment-related services to clients, fostering collaborative partnerships with other organizations, facilitating appropriate referrals, and communicating as necessary with clients' employers.

Service Capacity

To serve clients with mental health needs successfully, welfare agencies must assess the extent to which current local service capacity helps to treat, rehabilitate, and employ clients with mental health needs and, where gaps exist, address shortages. Program resources to provide mental health treatment, vocational rehabilitation, and employment-related services to welfare clients with mental health needs may be limited in many communities. That is, the service infrastructure may not offer programs with which welfare agencies can develop collaborative partnerships to serve clients with mental health needs. For instance, referrals for specialized mental health care are often difficult to obtain in some communities (Pavetti et al. 1996). This is particularly true in rural areas where relatively few resources are available. In terms of employment-related programs, existing resources may also not be adequate in some communities. For instance, the VR program typically serves only an estimated five to seven percent of all potentially eligible people (GAO 1993). In addition, the VR program is required to give priority in participant selection to people with the most severe disabling conditions. These factors, while not providing evidence of a service gap, do suggest that the VR program may be limited in its capacity to serve welfare recipients with mental health needs.

Service capacity related to the VR program may also be somewhat more problematic in those states that do not fully access available federal matching funds for the VR program. In some states, welfare, mental health, and other agencies have already coordinated efforts with the state VR program by contributing funds to help the VR program access additional federal matching funds. When agencies contribute such "third-party payments" to access additional funds, they essentially ensure that the VR program will provide services to their clients. This is one strategy that welfare agencies may wish to consider in order to increase service capacity in their communities. When welfare agencies cannot make referrals to or otherwise coordinate with other organizations to meet the mental health needs of their clients, there will be greater pressure on them to develop and enhance their own programs to provide treatment, counseling and employment-related support.

Program Models⁽⁵⁾

• What are welfare agencies doing to address this issue?
• Whom can I contact?

The following programs are presented alphabetically by state. The reader can determine the relevance of a program by noting its primary program strategy and geographic location and then refer to the brief descriptions and contact information on the subsequent pages. We have used primary objective(s) to assign program strategies, though a program may have many objectives.

---

Nevada County Department of Public Social Services

Greater Avenues for Independence (GAIN) Employment Services Program

Nevada County, CA

Program strategy: Enhanced case management

Location: One rural county

---

New Jersey Division of Mental Health Services

Supported Employment Program

Trenton, New Jersey

Program strategy: Service coordination

Employment integration

Location: Statewide

---

Ohio Department of Mental Health

Employment and Training Projects

Columbus, Ohio

Program strategy: Service coordination

Employment integration

Location: Most counties statewide, urban/suburban/rural

---

Oregon Adult and Family Services

JOBS Program

Salem, Oregon

Program strategy: Enhanced case management

Service coordination

Location: Statewide

---

Utah Departments of Workforce Services and Human Services

Family Employment Program (Single Parent Employment Demonstration)

Salt Lake City, UT

Program strategy: Enhanced case management

Location: Statewide

---

Wisconsin Bureau of Community Mental Health

Transition Services for Persons with Severe Mental Illness

Madison, Wisconsin

Program strategy: Service coordination

Employment integration

Location: Ten (mostly) rural counties

---

Program Name/Contact

Nevada County Public Social Services Greater Avenues for Independence (GAIN) Employment Services Program(6) Nevada County, California *Note: This program model is also relevant for the substance abuse service area.

Suzanne Nobles, 916-265-7171 Terri Fransen, 916-265-1760

Program strategy: Enhanced case management Location: One rural county

Brief Program Description

California's GAIN program, a welfare-to-work initiative started under the JOBS program, operated in all California counties. Its efforts continue in the form of the CalWORKS TANF program, which seeks to expedite job search and job placement while providing a range of supportive services. In addition to core services, the Nevada County program provides intensive and specialized case management to clients exempt from program requirements because of mental illness, mental health problems, family crises, or legal difficulties. Clients are identified and referred for intensive, specialized services through a one-on-one interview with an employment and training counselor, primarily to cover employability and job readiness issues. Clients referred for intensive GAIN services faced financial penalties for failure to participate.

At the Nevada County GAIN office, a social worker with an advanced degree provides intensive and specialized case management services to referred clients, including the following types of services: assessment of mental health and other problems, crisis counseling, support dealing with stressful situations, regular home visits, and referrals to specialized community resources. The social worker and the client together develop an individualized, interactive service plan that includes setting short-term client goals. Clients identified as having severe and diagnosed mental health illnesses are referred to appropriate providers in the community. Once such a referral is made, the social worker communicates with the service provider and offers ongoing support to the client.

Evaluation

There has been no impact evaluation of Nevada County's GAIN program. However, a case study analysis of the program was conducted by the Urban Institute (Pavetti et al. 1996).

Findings

Program data for Nevada County's intensive case management program show that, after six months of participation, more than 70 percent of participants moved from the intensive program into either employment or the regular GAIN program (Pavetti et al. 1996).

Program Name/Contact

New Jersey Division of Mental Health Services Supported Employment Program Trenton, New Jersey

Steve Fishbein New Jersey Division of Mental Health Services 609-777-0708

Program strategy: Service coordination Employment integration Location: Statewide

Brief Program Description

New Jersey's Supported Employment Program, an ongoing 10-year collaborative effort between the Department of Labor's Division of Vocational Rehabilitation (VR) and the Department of Human Services' Division of Mental Health Services, provides individualized job placement and supported employment services to people with severe and persistent diagnosed mental illnesses. About two-thirds of clients receive SSI or SSDI; the rest are mostly people receiving public assistance, many of whom are subject to the TANF work requirements. Services are provided through contracts with 21 nonprofit supported employment providers--one provider for each of New Jersey's 21 counties. Referrals are typically made by VR or by community mental health services providers. Welfare recipients are usually referred to the program through one of these organizations.

The supported employment providers offer the following individualized services to clients: mental health counseling, vocational and skill assessments, development of client work profiles, identification of necessary job supports and accommodations, interpersonal and life skills training, job preparation, job coaching, work experience internships, and individualized job placement. All but two of the supported employment providers are also community mental health providers; the remaining two work with community mental health centers to obtain the necessary psychiatric services. In facilitating job placement, the supported employment providers have had contact with more than 520 businesses statewide. Clients are usually placed in jobs 1 to 6 months after beginning the program, and postemployment support is provided as long as necessary. The statewide program operates at an annual cost of $2.4 million. The Division of Mental Health Services provides money to help VR access additional federal VR matching funds.

Evaluation

There has been no formal evaluation of this program. However, a three-state implementation study that included the New Jersey program was recently conducted on reasonable work accommodations for people with psychiatric illnesses (MacDonald-Wilson 1997).

Findings

There is no information on program impacts. Descriptive data show that, of the 2,000 people served by the supported employment providers over the past 10 years, 65 percent were placed in full- or part-time employment. Program staff generally find that emotional encouragement, problem-solving support, and mental health counseling are useful postemployment services.

Program Name/Contact

Ohio Department of Mental Health Job Training and Rehabilitation Services Project Columbus, Ohio

Roy Pierson Ohio Department of Mental Health 614-466-7347

Program strategy: Service coordination Employment integration Location: Most counties statewide, urban/suburban/rural

Brief Program Description

The Ohio Department of Mental Health (ODMH) offers job training and rehabilitation services to people with serious mental illness. Independent local programs are operated through county mental health boards. Most clients suffer from serious mental illness. About 14 percent are welfare recipients, many of whom are not exempt from the TANF work requirements. Welfare recipients are usually referred to the local programs by a local welfare office.

The county mental health boards, through contracts with local mental health centers and collaborative arrangements with the Department of Rehabilitation Services and other local service providers, offer a full range of mental health services, along with extensive job training and vocational rehabilitation services. Local programs operate in about two-thirds of Ohio's counties. The ODMH provides incentive payments to the county mental health boards to collaborate more closely with local service providers and to make successful job placements for clients. This program has operated in its current form for two years.

Case managers from the mental health centers work with participants to develop a service plan for both mental health and vocational rehabilitation services. A supported employment model of service delivery is used. To assist the case managers, vocational counselors are co-located in mental health centers in some counties. The following types of individualized services are typically offered, either on site at the mental health center or through a referral to another service provider: mental health counseling, vocational and skill assessments, identification of necessary job supports and accommodations, job coaching, individualized job placement, and postemployment support.

Evaluation

This program has not been formally evaluated.

Program Name/Contact

Oregon Adult and Family Services JOBS Program(7) Salem, Oregon *Note: This program model is also relevant for the substance abuse service area.

April Lackey Adult and Family Services/Office of Alcohol and Drug Abuse Programs 503-945-6197   Christa Sprinkle Mount Hood Community College Steps to Success Program Portland, Oregon 503-256-0432

Program strategy: Enhanced case management Service coordination Location: Statewide

Brief Program Description

Since the early 1990s, Oregon has included mental health screening, counseling, and treatment services in its Job Opportunities and Basic Skills Training (JOBS) program. Mental health problems among welfare participants are identified by case managers through ongoing interactions with clients, home visits, and observations of clients during Life Skills sessions and other JOBS-related classes. Case managers are supported by mental health professionals, some of whom are also located in the welfare offices. Clients may be referred for mental health assessment if they exhibit problems with attendance, behavior, or attention; appear to be anxious, depressed, or isolated; or show signs of drug or alcohol use or domestic violence.

Mental health counseling and treatment is coordinated among case managers, mental health therapists or counselors, and, in some cases, district mental health coordinators. Individual districts determine how to provide the services. In several districts, for example, strong partnerships have been formed with local mental health providers. In these cases, counties in the district contract with a local mental health service organization for the provision of services. A professional therapist from the service organization provides assessment, counseling, and treatment services to referred clients. In many cases, these therapists are also located in the welfare office, which facilitates easy access to services and allows them to provide both education and counseling to clients more easily. When therapists are not co-located in the welfare office, case managers refer the client to a mental health service provider. Funding for mental health services is included in the Oregon state health plan.

Clients in treatment receive regular mental health counseling services for an average of three months. Counseling services, however, can last as long as a year. Although individual counseling is standard, some group counseling may be used. Oregon has a waiver to mandate participation in mental health services, although it does so only in cases when staff believe participation to be in the best interests of the client.

Evaluation

MDRC is conducting an ongoing evaluation of the JOBS program, including the Portland site. This experimental design evaluation includes an impact, cost-benefit, and implementation study (MDRC 1994). The effect of the mental health services program, however, will not be isolated, and mental health outcomes will not be assessed.

Program Name/Contact

Utah Departments of Workforce Services and Human Services Family Employment Program (Single Parent Employment Demonstration)(8) Salt Lake City, Utah *Note: This program model is also relevant for the substance abuse service area.

Helen Thatcher Family Employment Program 801-468-0177

Program strategy: Enhanced case management Location: Statewide

Brief Program Description

Utah's original welfare reform program--the Single Parent Employment Demonstration--began in 1993 with the requirement that all participants work or take part in work-related activities. As part of this program and currently under Utah's Family Employment Program (FEP), participants who are unable to work or to participate in work-related activities receive a variety of supportive services, including mental health counseling and mental health treatment. The identification of needs and delivery of services is facilitated by the involvement of case staffing teams and treatment workers. In addition, participants are responsible for taking part in program activities, with financial penalties for choosing not to participate and financial incentives for full-time participation.

Caseworkers, called employment counselors, negotiate individualized plans for all participant families to achieve self-sufficiency. Utah's FEP is currently finalizing the development of a standardized screening tool to identify, at the initial intake interview, clients with mental health and substance abuse needs. The screening tool is currently being pilot-tested in one FEP office and will ultimately be used statewide. Participants with identifiable barriers to employment are referred to a case-staffing team, which includes staff who have expertise and experience in different service areas and who work together to assess participant needs and determine the best service strategies. A participant with mental health problems, for instance, is referred to a specialized treatment worker, who is often co-located in the local FEP offices.

The treatment staff in some offices may manage caseloads about half the size of those of regular self-sufficiency employment counselors. They provide a variety of services to participants with mental health needs, including one-on-one counseling, home visits, referrals to specialized mental health resources in the community, and, in some areas, group counseling sessions. In providing one-on-one counseling, a "brief therapy" model is typically used, usually involving 8 to 10 counseling sessions aimed at overcoming one single issue that makes employment more difficult.

Evaluation

The Social Research Institute at the University of Utah is conducting a descriptive study of the program, based on participant survey data. Preliminary results are expected in late 1998. In addition, a case study analysis of the program was conducted by the Urban Institute (Pavetti et al. 1996).

Program Name/Contact

Wisconsin Bureau of Community Mental Health Transition Services for Persons with Severe Mental Illness Madison, Wisconsin

Patricia Rutkowski Wisconsin Bureau of Community Mental Health 608-266-9331

Program strategy: Service coordination Employment integration Location: 10 (mostly) rural counties

Brief Program Description

The Wisconsin Bureau of Community Mental Health (BCMH), in partnership with the Division of Vocational Rehabilitation (VR), initiated, in 10 mainly rural counties in 1996, pilot programs intended to promote employment for people with serious mental illnesses. The pilot programs use the Program for Assertive Community Treatment (PACT) model of service delivery, an individualized and comprehensive approach to providing employment and support to people with psychiatric disabilities. They focus on transitioning clients into work while providing a comprehensive mix of ongoing supportive services, such as psychiatric care and counseling, vocational assessment and training, assistance with life skills (for example, housing, mental health, and social skills), and postemployment training (for example, counseling, assistance with transportation and work clothing, and off-site job coaching).

Participating clients are those with functional difficulties and a clinical diagnosis of a serious psychiatric disability. Referrals to the pilot programs are made jointly by the mental health agency and VR. Most clients are low-income people who have received public assistance; a little over half are men. Each pilot program actively serves 15 clients at any given time. The staff:client ratio is typically 1:10.

To support the programs, CMH contributed $100,000 in matching funds to obtain an additional $370,0000 in federal funds from the Wisconsin VR. The money pays for additional vocational rehabilitation staff, monthly consultation visits between VR and CMH staff, and quarterly training sessions for VR staff.

Evaluation

This program has not been formally evaluated.

Findings

There is no information on program impacts. However, program data show that after the first year of implementation, 50 percent of clients had been placed in competitive employment.

Further Information

Further information on issues related to mental health is available from the following

Organizations

Center for Psychiatric Rehabilitation

617-353-3549

Website: 1. Most of these studies examine men with mental health problems, not women receiving welfare.

2. Reported impacts are not always impacts that have occurred exclusively for welfare recipients.

3. Data are based on a personal communication with Patricia Rutkowski of the Wisconsin Bureau of Community Mental Health, February 1988.

4. Data are based on a personal communication with Steve Fishbein of the New Jersey Division of Mental Health Services, February 1998.

5. For an explanation of how programs were selected, please refer to the discussion included in the Introduction under the paragraph heading "Program Models."

6. This program summary benefited from a previously published description of the program (Pavetti et al. 1996).

7. This program summary benefited from a previously published description of the program (Pavetti et al. 1996).

8. This program summary benefited from a previously published description of the program (Pavetti et al. 1996).

Substance Abuse

INTRODUCTION

 

Most states need, but do not yet have, a clear course of action for helping welfare recipients for whom substance abuse is a barrier to employment. Estimates of the population facing this barrier vary but suggest that it is significant. The rationale for a clear, aggressive approach to providing treatment for people with substance abuse problems is clear. First, substance abuse directly impairs a person's ability to secure and retain a job, and ignoring the problem will result in fewer successful exits from welfare. Second, children of adult substance abusers are affected, and welfare agencies that ignore this intergenerational impact will contribute to the need for additional social services in both the short and the long term. Finally, ample research evidence shows that not only is treatment effective, it is cost-effective, since it reduces the need for social services in a range of other areas. Welfare-to-work programs will have to deal with issues of client screening and assessment, treatment options, and coordination of services, but the needs are clear and the payoffs indisputable.

This section provides information on and addresses the following questions related to substance abuse among welfare recipients:

NEED FOR SERVICES:

How is substance abuse defined?

What percentage of the welfare population faces this barrier to employment?

• What relationship does substance abuse have to welfare dependency and employment?

Definition

As a barrier to a successful transition from welfare to work, substance abuse, often referred to as AOD (alcohol and other drug) abuse, has a wide range of definitions, which vary according to the role of the definer. People who treat AOD abuse define it based on their interest in determining the need for treatment; welfare agency staff and employers are more likely to define it by some measure of client or employee performance; and researchers often use a broader definition based on the number of people who need assistance, whether they receive it or not.

From the perspective of those who treat AOD abuse, substance "dependence" is different from substance "abuse." Dependence entails three or more exhibited behaviors from a set of seven, including the level of tolerance, difficulty of withdrawal, extent of use, and various other behavioral responses. Abuse is defined by the extent to which recurrent substance use has impaired performance at work or school, caused legal or personal problems, or endangered another's life (American Psychiatric Association 1994). This differentiation has important implications for coverage of treatment: under managed care, treatment for substance dependence is generally covered, but treatment for substance abuse often is not.

Welfare agencies and employers define substance abusers as those who fail an employer's drug test, those for whom AOD abuse interferes with a welfare agency's program participation requirements, or those who face legal problems as a result of their habit. A client may be defined as having a substance abuse problem because a caseworker documented repeated incidents of intoxication at the welfare office.

From the research perspective, abuse is often defined by the amount of substance consumed: the number of drinks consumed or the frequency of using illicit drugs. Researchers at DHHS have, in turn, assigned amounts of use to increasingly severe "levels of impairment," from none, to little, to some, to significant. Significant impairment, for example, applies to people who use an illicit drug at least monthly, used heroin at least once in the past year, or are intoxicated weekly or more (Young 1996).

Percentage of Welfare Population Facing This Issue

National estimates:	5 to 27 percent
State/local estimates:	9 to 60 percent

⁽¹⁾

Evidence suggests that substance-abusing welfare recipients place greater demands on other areas within social services. It is estimated that 78 percent of children entering foster care are from families in which substance abuse is a significant factor in placement (General Accounting Office 1994a). In Sacramento County, California, an average of 490 substance-exposed infants were referred to Children's Protective Services each year between 1989 and 1992 . In Oregon, the costs per case rose 28 percent during 1997, a result of the increased expense in services--from drug treatment to wage subsidies--needed by clients who faced serious barriers to self-sufficiency.⁽²⁾

Relationship to Employment Status

• Those who are unemployed have substantially higher rates of substance abuse than those who are employed. Among welfare recipients, a 1994 DHHS study found that nearly 16 percent of unemployed females reported past-month drug use and nearly 30 percent reported past-year use, compared to 8.9 percent and 17.8 percent respectively for females who were employed full-time (U.S. Department of Health and Human Services 1994d, cited in Olson and Pavetti 1996).
• Much of the challenge for substance abusers is job retention. Although the 1991 National Longitudinal Survey of Youth (NLSY) showed that 63 percent of current welfare recipients who were substance abusers were working in the present or previous year (compared to 58 percent of those who were not), 15 percent of the substance abusers were employed for a full year, compared to 22 percent of those who were not substance abusers (Olson and Pavetti 1996).
• Research that looks at the effect of past abuse, rather than current abuse, shows that past abusers continue to have low self-esteem. Low self-esteem, in turn, hampers employment and weakens the ability to make a successful transition from welfare to work (Renwick and Krywonis 1992, cited in Olson and Pavetti 1996).

Welfare Agency Approaches

• What can welfare agencies do to assist clients whose substance abuse is a barrier to employment?
• What does the evidence suggest about effective ways to address this barrier?
• What do we know about program costs?
• What do we know about program implementation?

The two critical program features of an agency's approach to addressing substance abuse as a barrier to employment are (1) identifying which clients are appropriate for a targeted program, and (2) determining the type of program to provide.

Client Identification

Accurate identification of clients with substance abuse barriers to employment--and reliable determination of the severity of the barrier--is the first step to agencies' success in helping welfare recipients move from welfare to work. Three steps in this process are widely recognized: client screening, assessment, and drug testing.

Screening refers to determining the probability that a problem exists.

Assessment refers to collecting information to determine which aspects of a client's life are affected by substance abuse.

Drug testing refers to a process for detecting drug (not alcohol) use, most commonly from urine but also from hair, blood, and sweat (Young and Gardner 1997).

A number of instruments are used either to screen or to assess a client's level of substance abuse. The choice of instrument depends both upon its purpose--whether to do an initial screen or to assess the nature and severity of the substance abuse problem--and upon who will administer it. Two instruments are commonly used for an initial client screening: the CAGE and the Substance Abuse Subtle Screening Inventory (SASSI). Caseworkers in a number of sites have been trained to use one or the other. After an initial screening, a comprehensive assessment is performed with a different instrument, generally by a clinically trained professional in the treatment agency or, less commonly, by a professional who is co-located in the welfare office.

Program Strategies

As awareness grows of the extent to which substance abuse poses a barrier to employment for welfare recipients, state and local agencies are launching new and varied programs in response. Our review of programs suggests that there are at least five broad program strategies agencies currently use to address barriers to employment posed by substance abuse. This review is chiefly concerned with examining what welfare agencies can realistically hope to do in response to client needs and does not extend to potential responses that would go well beyond the welfare agency, for example, to address issues of infrastructure or changes in Medicaid policy. We categorize these strategies below. The distinctions drawn are not intended to suggest that agencies design programs around a single strategy or that these strategies are necessarily mutually exclusive. They are provided instead to foster thinking about the range of programmatic objectives possible, to help agencies define their own service needs, and to classify the programs described at the end of this section for agencies interested in pursuing further information. The five broad program strategies are categorized as follows:

Client Identification. Programs with this strategy are principally about improved accuracy in identification of clients who need further assessment and are likely to need treatment for substance abuse. These include programs that employ clinically trained staff in partnership with caseworkers to identify and refer clients to treatment, as well as programs that invest in developing caseworkers' own identification and referral skills.

Enhanced Case Management. Programs with this strategy approach substance abuse barriers to employment through the provision of some type of enhanced case management, for example, the addition of periodic home visits, development of a detailed and closely monitored self-sufficiency plan, reduced caseloads, volunteer mentors, or special program participation incentives. Enhanced case management is often provided in conjunction with treatment by an external agency.

Service Coordination. Programs with this strategy aim to institute improved coordination systems or procedures between welfare agencies (and possibly other social service agencies) and substance abuse treatment providers. Coordination itself can take any number of forms, including computer-based information systems, designated liaisons to communicate information, formal cross-agency advisory groups, and cross-agency training.

Increased Service Capacity. Programs with this strategy aim to increase the availability of substance abuse treatment. A limited supply of treatment providers poses a significant obstacle to addressing clients' needs. Programs designed to address the lack of supply include those that train caseworkers and others to provide short-term, interim counseling support for clients, as well as those that attempt to monitor available treatment slots through a coordinated information system.

Employment Integration. Programs with this strategy are more explicitly tied to employment, for example, through some level of employer cooperation or participation, through employer-provided incentives, or through the coupling (co-location and simultaneous provision) of substance abuse treatment and employment training.

Program Outcomes

Although there is a wealth of information on the effectiveness of substance abuse treatment in general, very little is specific to the welfare population. In addition, there is minimal evidence on the effectiveness of welfare agency efforts (as opposed to the efforts of people who treat AOD abuse clinically) to address substance abuse barriers to employment. We know almost nothing about the comparative effectiveness in improving client outcomes of one programmatic strategy versus another--for example, staff training for improved client screening versus establishing close linkages with treatment providers--and know very little even about the impacts that can be expected from a given program model. Several programs currently in design or operation include a rigorous evaluation component that will do much to increase our knowledge in this area (see individual program descriptions that follow). However, currently available evaluation findings tell us more about a program's impact on worker attitudes and skills, for example, than about client outcomes and there is not yet sufficient quantitative evidence on which welfare agencies can base important operational decisions. Nevertheless, while we may not know the effectiveness of an agency's programmatic approach, we do have ample evidence about the effectiveness of substance abuse treatment itself.

Substance abuse treatment, as provided by the alcohol and drug treatment system, is clearly effective in reducing negative behaviors related to employment, welfare dependency, and a number of other areas. Though much of the empirical evidence is based on data from the treatment system itself and therefore does not always pertain exclusively to the welfare population, there is sufficient evidence of consistent and positive outcomes for this group.

Effect of Substance Abuse Treatment on EMPLOYMENT⁽³⁾

• Data from several states, including Minnesota, Colorado, Florida, and Missouri, indicate significant increases in rates of employment for welfare recipients who complete a treatment program (Young 1996).
• Data from Kansas show that monthly employment earnings of those who completed treatment were 33 times higher than earnings received before treatment. Similarly, data from Oregon show that those who completed treatment earned 65 percent more than those who did not complete treatment (Young 1996).
• Data from Ohio show a substantial decrease in the percentage of clients who missed work after completing treatment. While about 34 percent of treatment participants missed work before enrolling in treatment, only about 13 percent missed work after treatment. Participants also experienced decreases in other work-related problems, including interpersonal conflicts, mistakes, and completion rates (Young 1996).

Effect of Substance Abuse Treatment on WELFARE RECEIPT

• Data from treatment programs in Oregon show that participation resulted in a number of impacts for those who completed treatment, including significantly less use of food stamps (Finigan 1996).
• In Florida, more than half the participants in one treatment program reduced their receipt of public assistance within twelve months of leaving treatment (Young 1996).

Effect of Substance Abuse Treatment on OTHER AREAS

• Data from treatment programs in Oregon also show that the group completing treatment experienced a 50 percent reduction in child welfare cases, a 58 percent reduction in hospitalization rates, a 45 percent decline in arrest rates during the three years after treatment, a 70 percent decrease in incarceration rates, and a 61 percent drop in the rate of homelessness for two or more days (Finigan 1996).
• Data from a treatment program in Wisconsin showed that 65 percent of women who completed treatment had children returned from foster care (Young 1996).

Program Costs

We know very little about the costs to a welfare agency of operating a program designed to address employment barriers faced by welfare recipients with substance abuse problems. Each of the five program types listed above will undoubtedly have different costs. Some programs rely heavily on staff training, others on the administrative burden associated with agency coordination. In the absence of any comparative information, however, it is impossible to know whether one programmatic approach is more cost-effective than another.

What is known is the cost-effectiveness of actual substance abuse treatment--the ultimate objective of virtually all programs. So while we know almost nothing about the associated agency costs--whether for staffing, administration, training, or something else--we do know that the long-term societal savings, mostly from reductions in health care use and criminal activity, far exceed the amount spent on the actual treatment.

• Data from the state of Washington showed that 23 percent of public costs for treatment participants who were on some form of public assistance were avoided in a subsequent year (Young 1996).
• Calculations based on treatment costs in Oregon revealed that for every dollar spent on treatment, $5.60 was saved on other social services (Finigan 1996).
• Calculations based on treatment costs in California--specifically for female welfare recipients with children--indicated that for every dollar spent on treatment, $2.50 was saved on other social services. (The cost savings for this group are somewhat lower than the savings for other populations, principally because these women initially commit fewer crimes than do others [Gerstein et al. 1997].)

Program Implementation

There is very limited information on strategies for effectively integrating substance abuse treatment into welfare programs. The summary below discusses implementation issues and approaches that people who operate (or plan to operate) programs face in three key areas: (1) program staff, (2) coordination of client information, and (3) service capacity. We also make recommendations about steps welfare agencies should take to serve clients facing substance abuse as a barrier to employment.

Program Staff

If program implementation is to be successful, welfare agencies must make a substantial commitment to staff training. As the urgency increases among welfare agency staff to address client substance abuse, so does the responsibility for implementing effective solutions. As a result, caseworkers are being given increasing responsibility and discretion over whom, how, and for how long to serve, but with minimal guidance. Caseworkers' natural tendency to feel discomfort in this area is likely to be exacerbated if there is no clear policy on when and for which clients an assessment is to be conducted, no detailed procedures for conducting and reporting the assessment, or no clear support from supervisors and managers for the assessment protocols.

Staff training should focus on at least two areas: (1) concerns and comfort with delving into substance abuse-related issues with clients, and (2) interviewing, screening, and referral skills (Legal Action Center 1997). In addition, if program implementation is to be successful, the screening and referral processes must contain clear and consistent procedures, coupled with supervisory recognition and support of the increased demands on caseworkers.

Coordination of Client Information

If program implementation is to be successful, welfare agencies need to develop coordinated systems for communicating client information. Procedures related to client identification and referral, monitoring of treatment participation, and client progress toward self-sufficiency have spurred the need for carefully coordinated systems of information. Successful implementation of all programs designed to address substance abuse barriers to employment requires some level of coordination between caseworkers and other agencies' staff. The success of coordination, however, depends on close working relationships between agencies--relationships that are often difficult to establish and that take focused attention and time to develop. Agencies frequently operate under different assumptions, use different assessment instruments, have incompatible reporting procedures, and even use different language when discussing clients.

Relationships need to be established with those who assess client needs, who provide treatment, who monitor treatment participation, who address the needs of clients' children while in treatment, and who potentially will employ clients once they complete treatment (a group often left out).

Service Capacity

If program implementation is to be successful, welfare agencies must assess the extent to which current local treatment capacity meets the need for services and, where gaps exist, take steps to address the shortage. In 1990, the Institute of Medicine estimated that 5.5 million Americans clearly or probably needed substance abuse treatment, while programs then in operation could treat roughly 1.4 million. In 1994, the federal government estimated that nearly 4 million Americans needed treatment for "chronic and persistent drug problems," but only 1.8 million received it (Legal Action Center 1997). Treatment capacity can be limited by a sheer lack of enough providers for those needing treatment, a lack of programs that address the unique problems of those needing services, and insufficient financial support, including obstacles that managed care poses to treatment. Estimates on the percentage of the welfare population in need of treatment but for whom treatment is not available are limited. In addition, estimates that do exist will be relevant only to a particular service delivery area. The anecdotal evidence strongly suggests, however, that an insufficient supply of local providers is a critical problem for many social service agencies. Sacramento County, California, estimated that the current local supply in that area was able to meet only 23 percent of the need for services.

With a large number of substance-abusing welfare recipients no longer eligible for SSI or SSDI and now subject to TANF work requirements, many more public assistance recipients than before will need effective substance abuse treatment if they are to become productively employed. And while sheer capacity itself must be addressed, many note that programs deter enrollment when they do not consider the unique needs of women and mothers (the need for child care, the fear of losing custody of a child, the need for a nonconfrontational approach to substance abuse treatment, the high rate of victimization from domestic abuse) (Legal Action Center 1997).

In addition, Medicaid and managed care policies complicate service provision. The federal regulation that prohibits Medicaid spending on services to people between 21 and 65 in an "institution of mental diseases" with more than 16 beds in effect precludes residential treatment for substance abuse. As a result, many clients needing inpatient treatment are limited to short-term detoxification and emergency services provided through hospitals. Managed care policies and procedures also make treatment difficult to obtain (Pavetti et al. 1996). Managed care reportedly often results in denial of appropriate treatment, inaccurate diagnoses, referrals to inaccessible providers, and retroactive denial of benefits (Legal Action Center 1997).

Though these are not issues welfare agencies will generally address, it is important to acknowledge the extent to which they complicate efforts to overcome this employment barrier. In meeting the needs of their clients, agencies must increase staff awareness of providers' programs and evaluate the appropriateness of each program. Finally, understanding and anticipating the limitations posed by both Medicaid and managed care might help to avoid additional complications with client referrals.

Program Models⁽⁴⁾

• What are welfare agencies doing to address this issue?
• Whom can I contact?

The following programs are presented alphabetically by state. The reader can determine the relevance of a program by noting its primary program strategy and geographic location and then refer to the brief descriptions and contact information on the subsequent pages. We have used primary objective(s) to assign program strategies, though a program may have many objectives.

---

County of Sacramento Department of Health and Human Services

Alcohol and Other Drug Treatment Initiative (AODTI)

Sacramento, California

Program strategy: Increased service capacity, through caseworker training

Location: Available to agencies throughout the state

---

Kansas Department of Social and Rehabilitation Services

Alcohol and Other Drug Screening Assessment and Treatment (AODAT)

Topeka, Kansas

Program strategy: Service coordination with external agencies

Location: Statewide

---

New Jersey Department of Human Services Work First New Jersey Substance Abuse Research Demonstration Project

Trenton, New Jersey

Program strategy: Enhanced case management

Location: One urban location; one rural/suburban location

---

The National Center on Addiction and Substance Abuse at Columbia University FamilyWorks

New York, New York

Program strategy: Employment integration

Location: NA (sites not yet selected)

---

Oregon JOBS Program

Oregon Adult and Family Services

Salem, Oregon

Program strategy: Service coordination with on-site substance abuse counselors

Location: Urban

---

Oregon Department of Human Resources Office of Alcohol and Drug Abuse Programs

Training Unit

Salem, Oregon

Program strategy: Client identification, through caseworker training

Location: Statewide

---

Program Name/Contact

County of Sacramento Department of Health and Human Services Alcohol and Other Drug Treatment Initiative Sacramento, California

Guy Howard Klopp Special Projects Alcohol and Drug Bureau 916-874-9754

Program strategy: Increased service capacity, through caseworker training Location: Available to agencies throughout the state

Brief Program Description

The Sacramento County Department of Health and Human Services has developed the Alcohol and Other Drug Treatment Initiative (AODTI) to address the limited treatment capacity of county agencies to serve people with substance abuse problems. Officials determined that local capacity was able to meet only 23 percent of demand. AODTI includes three areas of effort:

1. To Train Staff to Recognize, Assess, and Work with Clients Who Have Substance Abuse Problems. The department has developed materials for three distinct and successively more advanced levels of training designed to enable frontline workers to screen for substance abuse.

2. To Expand Treatment Resources. The AODTI trains workers to provide informational, educational, and pre-treatment group services. More than 450 new treatment slots have been added.

3. To Monitor and Access Available Treatment Resources Through an Automated Service Requisition and Client-Tracking System. This computer-based system, still in the design stages, will coordinate information on treatment availability and client status from all community-based and in-house service providers.

The AODTI training program and consultation are available to other jurisdictions. Services provided to interested sites include training an agency's designated trainers, providing on-site training and curriculum materials, and consultation. The cost ranges from $40,000 to $75,000.

Evaluation

Children and Family Futures has provided consultation to assist with the evaluation of this program. Preliminary findings are based on a pre- post-training questionnaire administered to all staff who complete the first two levels of training. The evaluation is designed to determine the training program's impact on workers' ability and comfort in dealing with substance-abusing clients, on clients' entrance into and completion of treatment, and on the expansion of treatment capacity.

Findings

Findings assessing the program's impact on workers' skills have shown significant changes in knowledge, capacity, and comfort level in addressing substance abuse issues. Preliminary findings from the client evaluation indicate increased levels of family stability, reduced substance use, and improved use of other systems of support. Similar findings have been found in other sites. The evaluation of systemwide impacts has not yet begun.

Program Name/Contact

Kansas Department of Social and Rehabilitation Services Alcohol and Other Drug Screening Assessment and Treatment (AODAT) Topeka, Kansas

Katie Evans Welfare Reform Coordinator 785-296-0147

Program strategy: Service coordination with external agencies Location: Statewide

Brief Program Description

The Kansas Department of Social and Rehabilitation Services has made Alcohol and Other Drug Assessment and Treatment (AODAT) a mandatory component for Employment Preparation Services (EPS) participants who meet certain criteria. The department's approach is based on a close working relationship with Regional Alcohol and Drug Assessment Centers (RADACs).

EPS case managers initially determine whether clients should be referred for additional assessment and treatment based on specific criteria, including a positive outcome from the CAGE instrument that they administer.⁽⁵⁾ Where warranted, clients are then referred to a RADAC. The RADAC closely monitors clients' participation and treatment and is responsible for determining and reporting noncompliance and status changes to the EPS case managers. Some counties have designated a liaison to handle coordination and communication issues between the two agencies. Those clients who do not comply with treatment are subject to sanction, based on a determination by the EPS case manager. Clients who are in outpatient treatment for less than 20 hours per week are also required to participate in additional program activities.

Evaluation

At present, there are no plans to evaluate this program.

Program Name/Contact

New Jersey Department of Human Services Work First New Jersey Substance Abuse Research Demonstration Project Trenton, New Jersey

Annette Riordan Project Manager 609-292-9686

Program strategy: Enhanced case management Location: One urban location; one rural/suburban location

Brief Program Description

The New Jersey Department of Human Services plans to implement and evaluate the Substance Abuse Research Demonstration (SARD) Project in Essex and Atlantic counties. The goal of SARD is to test innovative strategies that address issues substance abuse clients face.

Strategies for addressing substance abuse issues will include specially trained case managers; collaboration between client and case manager in development of a treatment plan; creative, low-cost incentives (gift certificates for clothing, home accessories, hair cuts, cosmetics) to provide additional motivation and increase self-esteem; and low-intensity support services to assist clients in the transition from treatment to community life.

The case managers will conduct a thorough assessment of the professional and social support needs of each client (including mental health, medical care, child care, housing, and transportation). They will link clients to appropriate treatment programs, provide outreach and crisis assistance, coordinate aftercare treatment, develop and coordinate supportive housing options, and establish formal and informal linkages among relevant organizations. These linkages are designed to facilitate cross training and to establish consistency in planning and implementing services.

Evaluation

SARD will undergo a rigorous evaluation based on an experimental design that entails random assignment of clients to control and treatment service groups. The evaluation, to be conducted by researchers at the Rutgers University Center on Alcohol Studies, will compare the effectiveness of this enhanced service model to the state's Substance Abuse Initiative (SAI), which provides a much more limited set of services.

Findings

Information on program impacts and costs is not yet available.

Program Name/Contact

The National Center on Addiction and Substance Abuse at Columbia University New York, New York

Diana D. Woolis Co-principal Investigator 212-841-5200

Program strategy: Employment integration Location: NA (sites not yet selected)

Brief Program Description

The National Center on Addiction and Substance Abuse at Columbia University (CASA), through funding from the Robert Wood Johnson Foundation, is developing an intervention strategy that will combine substance abuse treatment and job training for welfare mothers. The initiative will be implemented and evaluated in ten states, which CASA will identify and select.

The initiative is designed to integrate employment and sobriety goals in a comprehensive approach delivered by a unified service team. The main program goals will be to (1) help participants get and keep their jobs, (2) prevent further psychological and physical risk to children, (3) foster healthy families, (4) facilitate productive participation in society, and (5) develop participants' life skills. The demonstration will also be designed to determine appropriate and effective assessment techniques and instruments, establish a coordinated support system, enlist the involvement of area employers, and develop mechanisms for ongoing dissemination of information relevant to policy or program development.

The FamilyWorks Guide Book, available from CASA in summer 1998, provides guidance on each of the initiative's strategic objectives for programs addressing the dual goals of substance abuse treatment and job training. The book answers key questions about program design, addresses issues concerning developing standards and measures, and includes specific exercises for those who want to use the CASA approach to service.

CASA plans to offer technical assistance to states not selected for their demonstration. Assistance can include training, implementation support, and general consulting.

Evaluation

CASA will be selecting an external evaluator for this demonstration.

Program Name/Contact

Oregon JOBS Program Oregon Adult and Family Services Salem, Oregon

April Lackey Oregon Adult and Family Services Office of Alcohol and Drug Abuse Programs Salem, Oregon 503-945-6197   Christa Sprinkle, Coordinator Mental Health/Alcohol and Drug Treatment Services Portland, Oregon 503-256-0432

Program strategy: Service coordination with on-site substance abuse counselors Location: One urban site

Brief Program Description

Since 1992, Oregon has included substance abuse diagnostic, counseling, and treatment programs in its JOBS program. Oregon was the first state to require abusers to attend treatment as a condition of welfare receipt. Responsibility for referral and intervention for client substance abuse is shared among case managers, substance abuse counselors, and treatment providers.

There are some differences in how local programs operate. The following description is based on operations in Portland. All assistance applicants complete an initial two-hour Addictions Awareness class, during which they are screened for substance abuse by completing the Substance Abuse Subtle Screen Inventory (SASSI). If results of the screening indicate a high probability of substance abuse, the client is referred to a substance abuse counselor located in the same welfare office as the caseworkers. The substance abuse counselor helps the client get into treatment and then coordinates information between the treatment provider and the caseworker. Treatment, if determined necessary, is mandatory and subject to sanction. Clients are responsible for tracking treatment participation through the use of signed time cards. Referrals can be made to approximately 40 substance abuse treatment providers, and the state's Medicaid program--Oregon Health Plan--provides coverage for all nonresidential services. Residential treatment, which about one-third of the substance abuse clients need, is paid for by separate mechanisms, including funds from the federal Substance Abuse Block Grant and state and county funds.

Evaluation

No evaluation of the agency's effectiveness in addressing the needs of substance abusing clients has been conducted. A forthcoming evaluation by the Manpower Demonstration Research Corporation evaluates the Oregon JOBS program, but does not include a specific analysis of the agency efforts above. Michael Finigan, of the Northwest Professional Consortium, has evaluated substance abuse treatment in Oregon for the Office of Alcohol and Drug Abuse Programs, the Oregon Department of Human Resources, and the Governor's Council on Alcohol and Drug Abuse Programs.

Program Name/Contact

Oregon Department of Human Resources Office of Alcohol and Drug Abuse Programs Training Unit Salem, Oregon

Frank Munson 503-373-1650

Program strategy: Client identification, through caseworker training Location: Statewide

Brief Program Description

The Office of Alcohol and Drug Abuse Programs (OADAP) within the Oregon Department of Human Resources has designed a substance abuse training program to retrain the state's entire staff of about 750 welfare caseworkers to act as service brokers between the welfare and treatment agencies. Specific goals of the training include an increased understanding of alcohol and drug dependency, an ability to identify problems and to make referrals to appropriate resources, improved skills for intervening when and where appropriate, and encouraging the establishment of local interagency networks. The state has chosen to invest in such comprehensive staff training because an increasing proportion of its welfare caseload has a substance abuse problem (as the more self-sufficient clients exit from the rolls), and caseworkers, who have been given enormous discretion, have limited skills in addressing this issue.

The OADAP Training Unit is currently pilot-testing the training in Portland. Caseworkers will attend four separate one-day training sessions over the next 18 months. Human services agencies pay OADAP approximately $85 for each of their caseworkers to attend one day of training. OADAP will also work with other Oregon agencies interested in improving the skills of staff who work with substance abuse victims.

Evaluation

There are plans to evaluate this program.

Further Information

Further information on issues related to substance abuse is available from the following

Organizations

The Substance Abuse and Mental Health Services Administration

U.S. Department of Health and Human Services

301-443-8956

Website: 1. Some of this gap in estimates is due to differences in demographic characteristics between welfare recipients and the general population, as discussed above (Olson and Pavetti 1996).

2. Oregon staff point out that spending for more expensive services has been more than offset by savings from recent declines in caseloads.

3. Reported impacts are not always impacts that have occurred exclusively for welfare recipients.

4. For an explanation of how programs were selected, please refer to the discussion included in the Introduction under the paragraph heading "Program Models."

5. Case managers in several counties have begun to use the Substance Abuse Subtle Screening Inventory (SASSI), and staff from the Kansas Department of Social and Rehabilitation Services have indicated that additional counties will begin to make this shift in screening instrument from the CAGE to SASSI.

Inadequate Transportation

INTRODUCTION

Inadequate public transportation, a lack of personal transportation, and the location of suitable jobs in areas inaccessible to welfare recipients--spatial mismatch--each pose a formidable barrier to obtaining and maintaining employment for those seeking to make the transition from welfare to work. The increased concentration of welfare recipients in inner cities, along with a shifting of employment opportunities to the suburbs, has magnified the challenges of job placement for welfare clients. Welfare agencies must develop strategies that overcome such transportation barriers if clients are to become economically self-sufficient.

This section provides information on and addresses the following questions related to the need for transportation among welfare recipients:

• What can welfare agencies do to assist clients who face transportation as a barrier to employment?
• What does the evidence suggest about the effectiveness of addressing this barrier?

Definition

Inadequate transportation is a barrier for many welfare recipients trying to make the transition to work. Without reliable, safe, and efficient transportation, welfare clients are unable to obtain needed services, such as child care, or to participate in work or work-related activities. Transportation barriers are defined in the following three ways: (1) inadequate public transportation, (2) lack of personal transportation, and (3) spatial mismatch. Issues of affordability underlie all three.

• Inadequate public transportation means (1) limited, infrequent, or unaffordable transit service, (2) limited routes covered by transit operation, or (3) security concerns at transit stations during off-peak hours.
• A lack of personal transportation means there is no privately owned car available for travel to work. This creates a problem particularly for people in areas with limited public transportation. Welfare recipients without cars often face unreliable or untenable alternatives, such as having to rely on transportation provided by a neighbor or having to take three or four buses each way to work.
• Spatial mismatch, an increasingly serious barrier to employment, refers to the location of suitable jobs in areas that are inaccessible by public transportation (Coulton et al. 1996). This is a result of the recent growth of new jobs in areas outside the city.

Percentage of Welfare Population Facing This Issue

⁽¹⁾

Service Coordination. Programs with this strategy entail some level of coordination between a welfare agency and the local public or private transportation system(s), for services such as discounted fares for clients or caseworker training by the local transit authority on available transit routes, or that have developed a computer-based mapping system to coordinate client needs with available services. The emphasis of these programs is on improving access to and increasing use of existing transportation systems.

Enhanced Service Capacity. Programs with this strategy aim to increase the supply of either (1) personal transportation, or (2) a public or private system of transportation. Those that aim to increase the supply of personal transportation are efforts such as vehicle leasing or purchase programs or arrangements for discounted repairs. Those that aim to increase the supply of a public or private system of transportation are efforts designed to expand routes or increase the hours of operation of the public transportation system or to contract with a private provider for specific, dedicated transportation. Those aimed at enhancing an area's existing public transit system are the most ambitious, as they can entail extensive coordination among multiple service agencies and address large-scale issues of infrastructure. All these programs are designed to provide new or expanded transportation options.

Employment Integration. Programs with this strategy are more explicitly tied to employment through, for example, some level of employer cooperation or participation in a shuttle service to a job site, a van providing reverse commute service, or transportation assistance to employees in exchange for an employer tax deduction. These types of programs are often designed to address directly the issues of spatial mismatch by helping welfare recipients get to otherwise inaccessible jobs. Other programs included here, increasingly common among welfare agencies, are those that create employment opportunities for welfare recipients by training them to become transportation providers themselves. (This in turn creates enhanced service capacity.)

Program Outcomes

There is no doubt that the many transportation efforts welfare agencies have launched have made a difference in the lives of their clients. Whether a handful purchasing vehicles or a large number using public transit, welfare recipients have been enabled to get to places they previously could not--from child care providers to jobs. The available evidence concerning program outcomes, however, is limited, and because so many local variables influence the design and operation of each transportation initiative, outcomes cannot be compared. The information that is available generally tells us only about the number of clients served and nothing about the comparative effectiveness of one approach over another, the cost-effectiveness of the approach, or how the outcomes for those who receive transportation services might compare to the outcomes for a group that does not.

Service coordination efforts may hold the promise of providing services to large numbers of welfare clients, but they are not always designed for direct provision of transportation. Programs that train caseworkers to learn more about local transit routes, for example, theoretically will translate into a service for all of agency's clients, but they will do much less to expand transportation to recipients whose needs cannot be met by existing services. In general, these programs focus on improving access to transportation rather than on expansion of available options.

Enhanced service capacity programs, which focus on expansion of available options, can range from very small to quite large, but those that target personal transportation serve few welfare clients. The CARING program in Wytheville, Virginia, for example, has provided vehicles to just under 10 welfare recipients per year through its lease purchase program. Programs that aim to create new private transportation systems can range in size but will most likely serve fewer clients than programs that aim to create enhanced services, such as extended hours or additional routes, within the existing public transit system. These initiatives for enhanced service capacity can potentially provide services to a very large number of both welfare recipients and nonrecipients.

Employment integration efforts can also range from quite small to fairly large. The AdVANtage program in Anne Arundel County, Maryland, for example, has trained slightly less than ten welfare recipients to become van company owners. The Job Ride program in Wisconsin, a very different employment integration initiative, has provided reverse commute or some other form of transportation to job sites for more than 500 welfare recipients and enabled them to obtain full-time employment.

Program Costs

Not surprisingly, the costs of addressing transportation barriers to employment vary widely across different types of projects. Depending on the level of service and number of clients served, overall program costs can range from almost nothing to more than $10,000 per client. Direct costs to the welfare agency can also range considerably, depending upon the program and the extent to which an agency has arranged to share costs with others or obtained funding through sources beyond the TANF block grant.

While actual cost figures are sparse, it appears that the employment integration programs that seek to train welfare recipients to become owners or operators of their own transportation services have the highest per-client costs. In Anne Arundel County, Maryland, the program spends about $10,500 for each client it trains.

Enhanced service capacity programs that provide transportation through privately operated systems can spend anywhere from less than $10 to more than $100 per client per ride (Applied Management and Planning Group 1997). The Job Ride program in Wisconsin falls close to the low end of this range, reportedly spending about $19 per client per ride. Enhanced service capacity programs that provide transportation through helping a person obtain personal transportation, such as programs that lease vehicles or distribute donated vehicles, are very inexpensive, since costs are either donated or covered by the welfare recipients themselves. In Wytheville, Virginia, for example, cars are purchased at low cost through the Commonwealth of Virginia Department of General Services Division of Purchases and Supply, and in Ventura County, California, cars are purchased at public auction. For six vehicles, Wytheville officials paid $9,450, and Ventura County agency officials pay from $1,500 to $2,000 for each car--minimal short-term costs. Both programs enter into monthly payment plans with their welfare clients so that the lease or loan repayment can be expedited and the welfare agency can recycle the recovered vehicle costs for future lease purchases. In Wytheville, all repayment funds are used to purchase future surplus vehicles for lease.

Service coordination programs, because they generally provide services to the largest number of clients, will tend to have the lowest per-client costs. The Work Pass Program in New Jersey, which involves coordination with the state's transit system (New Jersey Transit), costs on average about $50 to $60 per month per client, or about $600 to $720 per year (further details on this program are provided under Program Models). Administrative costs are donated by the transit authority. The program reportedly costs the New Jersey Department of Human Services less than was spent previously on client transportation assistance.

Program Implementation

The transportation services an agency provides clearly need to reflect local needs--they must be built upon knowledge of existing resources and designed to fill current gaps. In a rural area with no public transit system, for example, a small shuttle service program may the only option. To address welfare recipients' transportation barriers, welfare agencies throughout the country have launched innovative and diverse programs, from small-scale efforts that serve a limited number of specified clients to large-scale efforts that seek to expand the local infrastructure. With such a diverse set, implementation issues will certainly vary. The summary below discusses broad implementation issues that those operating programs have faced, and those planning to operate programs will likely face, in three areas: (1) local needs assessment, (2) coordination, and (3) program funding. Along with the discussion, we recommend steps welfare agencies should take to develop successful programs in this area.

Local Needs Assessment

If programs are to be effective, they must be designed to address the specific transportation barriers an agency's clients face. Welfare agencies with experience in developing transportation initiatives have indicated that effective implementation requires a clear understanding of what clients need. Because of the wide range of options in designing programs to address transportation barriers (from improved information about the existing transit system to electronic mapping of routes, shuttle services, and expansion of the existing transit system), welfare agencies need to begin with an assessment of their clients' needs and follow with an inventory of existing transportation services. This should lead to a clear understanding of the real source of transportation gaps and to the design of a program that addresses these gaps directly. Welfare agencies should seek to participate and provide input, even in cases where initiatives are directed by others.

This process of needs assessment applies not only to the design of a new transportation initiative, but to the day-to-day interactions between caseworkers and clients as well. Caseworkers need to address clients' individual transportation barriers through this same process of understanding needs, reviewing existing options, and addressing gaps in services.

Coordination

If program implementation is to be successful, welfare agencies must devote the time necessary to develop coordinated partnerships. Many transportation initiatives rely upon coordination between two or more agencies or groups, from the local public transit authority to local public and private nonprofit organizations, insurance providers, employers and other community representatives. Unless agencies devote resources to developing smooth procedures for coordination, the transportation program is likely to be undermined by misunderstanding, inappropriate or unnecessary services (often through duplication of effort), insufficient funding, or unnecessarily high coordination costs.

Program Funding

If program implementation is to be successful, welfare agencies must identify funding sources and ensure that funds will meet program needs. A by-product of effective coordination among stakeholders is both increased funding and the opportunity to serve larger numbers of clients. A number of sources are available for funding local transportation initiatives, from the Federal Transit Administration of the U.S. Department of Transportation to the Community Transportation Association of America. In addition, federal tax law has established the Transit Benefit Program, which allows employers to claim a tax deduction if they provide employees with transportation assistance. Local planners and service providers should be certain they understand all available sources of funding (see Further Information section for sources) and optimize their opportunities by combining federal, state, and local resources. In addition, planners and service providers need to assess all program costs carefully before implementing a program. Because transportation initiatives can be expensive to operate and can entail unforeseen costs (such as for marketing), program operations can be adversely affected without careful assessment.

Program Models⁽²⁾

• What are welfare agencies doing to address this issue?
• Whom can I contact?

The following programs are presented alphabetically by state. The reader can determine the relevance of a program by noting its primary program strategy and geographic location and then refer to the brief descriptions and contact information on the subsequent pages. We have used primary objective(s) to assign program strategies, though a program may have many objectives.

---

Job Opportunity Transportation Program

Human Services Agency

County of Ventura

Ventura, California

Program strategy: Enhanced service capacity

Location: One suburban county

---

Community Self-Sufficiency Grant

Transportation Initiative in Scott County

Iowa Department of Human Services

Des Moines, Iowa

Program strategy: Service coordination

Location: One urban county

---

AdVANtage Van Service Entrepreneurs Project

Anne Arundel County Department of Social Services

Anne Arundel County, Maryland

Program strategy: Enhanced service capacity

Employment integration

Location: One urban/rural county

---

WorkPass Program

New Jersey Transit and New Jersey Department of Human Services

Trenton, NJ

Program strategy: Service coordination

Location: Statewide

---

CARING (Cars Assist Recipients in New Growth) Program

Wythe County Department of Social Services

Wytheville, VA

Program strategy: Enhanced service capacity

Location: One rural location

---

Job Ride

State of Wisconsin Department of Workforce Development

Madison, Wisconsin

Program strategy: Service coordination

Enhanced service capacity

Employment integration

Location: Statewide

---

Program Name/Contact

Human Services Agency Job Opportunity Transportation Program County of Ventura Ventura, California

Jim Becker Human Services Agency 805-652-7835

Program strategy: Enhanced service capacity Location: One suburban county

Brief Program Description

The Human Services Agency (HSA) of the Ventura Department of Social Services operates the Job Opportunity Transportation Program, a self-funding program that provides people enrolled in California's welfare program (CalWORKs) with reliable transportation for work. The initiative's primary goal is to assist CalWORKs families in obtaining reliable transportation to maintain employment, get off welfare, and achieve long-term financial self-sufficiency.

The program operates as an auto loan initiative which purchases economy vehicles that fleet operators (such as local government or large private employers) plan to dispose of because of age or mileage or as surplus. The vehicles obtained are inspected, and all necessary repairs are completed by a private sector auto repair facility or by auto repair classes at local community colleges. The vehicles are then sold at minimal cost to prescreened welfare families to be used to get to and from work. The Ventura County Federal Credit Union will be providing loans to these families to purchase the vehicles.

Evaluation

This program has not been evaluated.

Program Name/Contact

Iowa Department of Human Services Community Self-Sufficiency Grant Transportation Initiative in Scott County Des Moines, Iowa

David Perret, Coordinator Community Self-Sufficiency Grant Iowa Department of Human Services (515) 281-4187

Program strategy: Service coordination Location: One urban county

Brief Program Description

The Division of Economic Assistance of the Iowa Department of Human Services and the Iowa Workforce Development Department approved the Community Self-Sufficiency Grant Scott County Transportation Initiative to respond to an identified need for transportation to employment in Scott County. The program's goal is to remove the employment barrier of transportation for PROMISE JOBS (TANF) participants.

The Scott County transportation initiative has two main objectives: (1) to establish a database to serve as a transportation resource and referral system for PROMISE JOBS participants, and (2) to link PROMISE JOBS participants with the proper transportation for obtaining and maintaining employment. The transportation database will contain information on PROMISE JOBS participants' employment history, area transportation services, and area employers in order to link them to jobs and training. The database will store and retrieve this information. To link PROMISE JOBS participants to adequate transportation services, agency caseworkers will supply local transportation providers with written referrals that describe participants' specific transportation needs. In addition, neighborhood organizations will coordinate PROMISE JOBS participants who live near each other so that they can share car or van transportation. Participants will be supplied with the necessary training and information regarding their assigned transportation mode(s) and how to access them. To facilitate the process, the Welfare Reform Coalition (a cooperative partner) will establish a centralized transportation project office to overcome the transportation barriers of 40 to 70 PROMISE JOBS participants in the service area. The centralized office will serve as the main hub for providing PROMISE JOBS transportation solutions, as well as the liaison office for area agencies, employers, service providers, and other active participants in the effort. The program is funded at $32,798 by the Iowa legislature.

Evaluation

Program coordinators plan to contract with an independent vendor for the initiative's evaluation. The project will be evaluated with criteria that are consistent with the objectives of the Community Self-Sufficiency Grant. These will include the number of PROMISE JOBS participants served by the transportation project, the percentage of PROMISE JOBS participants retained in employment as a result of this project, and the satisfaction of participants and employers with the project as expressed in surveys and focus groups. The evaluation will also examine the number of participants placed on waiting lists for service and the number who cannot be served, so that the program can improve the availability of transportation resources in the area.

Findings

Findings from the evaluation are not yet available.

Program Name/Contact

Anne Arundel County Department of Social Services AdVANtage Van Service Entrepreneurs Project Anne Arundel County, Maryland

Vesta Kimble, Deputy Director Anne Arundel County Department of Social Services 410-269-4603

Program strategy: Enhanced service capacity Employment integration Location: One urban/rural county

Brief Program Description

The Anne Arundel County Department of Social Services, in collaboration with the Community Transportation Association of America and the YWCA of Annapolis and Anne Arundel County, has designed the AdVANtage Van Service Entrepreneurs Project to address the transportation needs of welfare recipients in the area. The program's goal is to help welfare recipients become van company owners in Anne Arundel County.

The AdVANtage program offers two services: (1) microenterprise development, and (2) fully subsidized transportation. The microenterprise development program, the AdVANtage Van Service Entrepreneurs Project, trains welfare recipients to become van company owners. The YWCA conducts business training, helps negotiate lease-purchase agreements and insurance policies, develops rate schedules and routes/areas, and assists entrepreneurs in obtaining Public Service Commission and Minority Business Enterprise certification. Subsidized transportation is provided to any clients enrolled in job search. Once they find a job, the program provides a copayment based on their income.

The program costs $90,000 (approximately $10,500 per entrepreneur). The research and development funding was provided by the U.S. Department of Transportation.

Evaluation

Applied Management and Planning Group (AMPG) is conducting an evaluation of this program.

Findings

Findings from the evaluation of the AdVANtage program are not yet available.

Program Name/Contact

New Jersey Transit and New Jersey Department of Human Services WorkPass Program Trenton, New Jersey

Lou Capadona Director of Sales 973-491-7109

Program strategy: Service coordination Location: Statewide

Brief Program Description

New Jersey Transit, in cooperation with the New Jersey Department of Human Services, designed the WorkPass Program to help welfare recipients use mass transit (either bus or rail) to get to their work-related activities. The goal of WorkPass is to make it simple for welfare clients to receive monthly bus and rail passes at various facilities.

The WorkPass program supplies Work First New Jersey participants with monthly New Jersey Transit passes so that they can get to their jobs. Each county will manage its own WorkPass program, responding to the distinct needs of its clients. A caseworker reviews individual clients' circumstances to determine the following: (1) the client's starting point and job destination, and (2) whether the client should use bus or rail transportation.

To help participants gain access to transportation, NJ Transit will provide training to county Work First agency staffs on reading bus schedules, determining fares and transit availability, and ordering bus/rail passes and transit scrip tickets for their clients. In addition, NJ Transit will conduct research to determine the transit availability of different work sites and work activities and will set up resource centers at each county Work First Agency, displaying transit timetables, maps, guides and informational brochures on special services.

Evaluation

Evaluation information on the WorkPass program is not yet available but is forthcoming.

Findings

Findings from the evaluation of the AdVANtage program are not yet available.

Program Name/Contact

Wythe County Department of Social Services CARING (Cars Assist Recipients in New Growth) Program Wytheville, Virginia

A. Michael Hall Director, Wythe County Department of Social Services 540-228-5493

Program strategy: Enhanced service capacity Location: One rural location

Brief Program Description

The Wythe County Department of Social Services in Wytheville, Virginia, has designed the CARING (Cars Assist Recipients in New Growth) program to help the area's welfare recipients overcome transportation barriers to employment and self-sufficiency. The program's goal is to address what it sees as the most formidable barrier to the successful outcome of welfare reform in its community transportation. CARING is averaging six or seven welfare recipients a year. To date, they have a total of 14 vehicles, and about half the recipients own their own vehicles.

The intent of the CARING Program is to provide qualified welfare participants with a vehicle through a lease purchase program. The length of the lease agreement is negotiated with each potential lessee. A monthly vehicle maintenance fee established for each vehicle is deposited in an account for reimbursement of maintenance or repair costs, on presentation of an appropriate invoice. Any unutilized maintenance funds are reimbursed to the lessee at the end of the lease agreement or are used, at the participant's option, to reduce the final installment payment.

The initial purchase of vehicles was financed through planning and administrative funds from Virginia's welfare reform program, the Virginia Initiative for Employment not Welfare (VIEW). In May 1996, six vehicles were purchased for $9,450, and in June 1997, seven more for $11,650. Costs to the department are minimal. Cars are purchased at public auction for prices ranging from $1,500 to $2,000.

Evaluation

This program has not been evaluated.

Program Name/Contact

Job Ride State of Wisconsin Department of Workforce Development Division of Economic Support Madison, Wisconsin

Leonor Rosas DeLeon Bureau of Welfare Initiatives Division of Economic Support 608-267-9022

Program strategy: Service coordination Enhanced service capacity Employment integration Location: Statewide

Brief Program Description

The State of Wisconsin Department of Workforce Development designed the Job Ride program as an employment transportation assistance program to address the transportation needs of the area's welfare applicants and participants. The program's goal is to help job seekers gain access to transportation to employment. From July 1, 1997, through December 31, 1997, 517 people were served, with 250 to 300 riders at a time, for a total of 21,173 work trips.

Job Ride provides reverse commute services in Milwaukee and provides transportation support in other parts of the state. Job Ride seeks to do the following: (1) expand transit service (including route extensions, increased evening and weekend service hours, feeder-shuttle service, and evening shared-ride taxi service); (2) provide new transit service (including express service, reverse commute van service, shuttle service or other services to specific job sites, or purchased service); (3) create employer initiatives (such as employer-sponsored van service, car pool, or shuttle service); (4) provide volunteer driver programs; and (5) improve coordination, clearinghouse, and central dispatch among existing public and private providers of employment transportation, social services, and specialized transportation.

The Job Ride program has been consistently funded at $579,000 per year. Program officials also report that the average cost per one-way passenger trip is $19.21 and that the average cost per job placement is $805.17. This year, Wisconsin has chosen to allocate an additional $200,000 out of the TANF Block Grant for expansion of services (for a total of $770,000 in 1998).

Evaluation

This program has not been formally evaluated. However, the state will do a year-end analysis.

Further Information

Further information on issues related to transportation is available from the following

Organizations

American Public Transit Association (APTA)

Washington, DC

(202) 898-4000

The American Public Transit Association (APTA) is a nonprofit international association that includes transit systems; planning, design, construction, and finance firms; product and service providers; academic institutions; and state association and departments of transportation. APTA serves the public by providing safe, efficient, and economical transit services and products.

Community Transportation Association of America (CTAA)

Washington, DC

(202) 628-1480

or (800) 527-8279

The Community Transportation Association of America (CTAA) is an association of organizations committed to improving mobility for all people. CTAA conducts research, provides technical assistance, offers educational programs, and serves as an advocate for available, affordable, and accessible community transportation.

Federal Transit Administration (FTA)

Washington, DC

(202) 366-4043

Website: 1. Several of these programs are designed to provide support to potential welfare recipients in an effort to prevent a need for cash assistance. As such, they overlap with other efforts described in the "Financial Emergency" section.

2. For an explanation of how programs were selected, please refer to the discussion included in the Introduction under the paragraph heading "Program Models."

Multiple Barriers

INTRODUCTION

 

A sizable portion of the welfare population poses a particularly complex challenge to welfare agency staff in that they have not just one but two or more concurrent barriers to employment. These are clients who cycle on and off welfare frequently and will need careful assessment, carefully designed service provision, and close monitoring of individual progress. To assist this portion of their caseload, welfare agencies will need to give special attention to their unique needs and design services in response.

This section provides information on and addresses the following questions related to multiple barriers among welfare recipients:

NEED FOR SERVICES:

• How are multiple barriers defined?
• What percentage of the welfare population faces more than one barrier to employment?
• What relationship do multiple barriers have to welfare dependency and employment?

Definition

Those who have the greatest difficulty making the transition from welfare to work are often clients facing multiple barriers to employment. These are welfare recipients who experience not just one, but a combination of barriers, and need assistance with serious problems in two or more of the following areas:

• Child care
• Disabilities
• Domestic violence
• Emergency financial needs
• Housing instability
• Lack of health insurance
• Mental health
• Substance abuse
• Transportation

While multiple barriers are sometimes defined based on the co-occurrence of explicitly identified barriers from the list above, sometimes they are defined based on the severity (and number) of barriers faced. Moderate barriers are those that restrict the amount or type of work that a client can perform or those that interfere with an ability to sustain continuous employment (Olsen and Pavetti 1996). Severe barriers, on the other hand, are pervasive problems that consistently hinder a client's ability to get a job and stay employed.

Percentage of Welfare Population with Multiple Barriers

National estimates:	13 to 50 percent
State/local estimates:	34 percent

Estimates from studies that have systematically examined the prevalence of multiple barriers among the welfare population are presented in ⁽¹⁾ Only 7 percent of welfare recipients with severe multiple barriers to employment worked continuously during a given year, compared with 25 percent of welfare recipients without severe multiple barriers to employment (Olson and Pavetti 1996).

Welfare Agency Approaches

• What can welfare agencies do to assist clients who face multiple barriers to employment?
• What does the evidence suggest about the effectiveness of addressing this barrier?
• What do we know about program costs?
• What do we know about program implementation?
• 
   

The two critical program features of an agency's approach to addressing the needs of clients with multiple barriers to employment are (1) identifying which clients have multiple barriers to employment, and (2) determining the type of program or set of services to provide.

Client Identification

Accurate and timely identification of clients with multiple barriers and a determination of the relative severity of these barriers is critical to service provision, particularly since these clients are often the most difficult to employ. Part of the challenge of serving these clients involves understanding the relationship between their different barriers and identifying how the barriers interact with each other. There are two key steps in the process of identifying multiple barriers among clients: screening and assessment.

Screening refers to determining the probability that multiple barriers exist.

Assessment refers to a process for collecting information, on an initial and ongoing basis, to determine or diagnose the type and severity of each barrier, how multiple barriers are inter-connected, and which aspects of a client's life are affected.

Many welfare agencies rely on enhanced case management methods, such as case staffings and interdisciplinary service teams, to identify clients' barriers to employment, make referrals for formal assessments of specific barriers, and deliver appropriate supportive services. No standard screening instrument exists, however, for welfare agencies to use to identify clients' multiple barriers comprehensively. Although some states have developed instruments and questionnaires to screen for multiple barriers, there is wide variation in the extent to which these instruments incorporate sophisticated screening techniques.

Although no standard screening instrument is available, welfare agencies in several states are using a locally developed assessment tool--the Family Assessment Tool (FAT)--to identify and collect information on clients' multiple barriers. The FAT was developed by the Lincoln Action Program, with assistance from the Gallup Organization, for use by its staff. It is viewed as a comprehensive and highly effective tool for identifying and understanding a wide range of barriers and for measuring progress on these barriers over time. This tool has now been adopted in several other states. The FAT, by allowing staff to categorize the level of seriousness of different barriers, helps to disentangle the relationships between co-occurring barriers and develop service strategies that address barriers appropriately and in the best order. (Additional information on the FAT is provided under the section entitled Program Models.)

Program Strategies

To help clients adjust to the new welfare work requirements, agencies must use creative program approaches to address the complex needs of the most difficult-to-serve clients, many of whom experience multiple barriers to employment.

Our review of programs designed to address multiple barriers suggests that there are at least four broad program types, differentiated according to objective. While some of the programs are operated by welfare agencies, others are operated by other types of agencies and organizations that serve both welfare clients and other low-income people with multiple barriers. Lessons from all of these efforts are relevant for welfare agencies as they develop their own strategies to better serve clients with multiple barriers to employment. This review is concerned chiefly with examining what welfare agencies can realistically hope to accomplish in their communities in response to client needs. It does not extend to potential responses that would go well beyond the scope of the welfare agency, for example, to address issues of community infrastructure or changes in welfare policy. We categorize these strategies below. The distinctions drawn are not intended to suggest that agencies design programs around a single strategy or that these strategies are necessarily mutually exclusive. They are provided instead to foster thinking about the range of programmatic objectives possible, to help agencies define their own service needs, and to classify the programs described at the end of this section for agencies interested in pursuing further information. The four broad program types as they relate to serving clients with multiple barriers to employment are categorized as follows:

Client Identification. Programs with this strategy focus primarily on accurate identification of client and family needs. They generally entail the use of assessment tools along a wide variety of dimensions. Client identification is often followed by referrals to external agencies for specialized services.

Enhanced Case Management. Programs with this strategy are designed to alleviate multiple barriers to employment and help clients overcome personal difficulties through enhanced case management services. These programs may involve intensive, interdisciplinary service teams, mentoring by community volunteers, and regular home visiting. (These types of services are often provided in conjunction with efforts to coordinate service delivery with other organizations in the community, for example, mental health and substance abuse treatment providers.)

Service Coordination. Programs with this strategy focus on instituting improved coordination and collaborative service efforts between agencies, including mental health and substance abuse treatment providers, public housing authorities, domestic violence victim advocacy groups, and other community service organizations. Coordination takes many forms, including structured referral mechanisms, complementary staff responsibilities and client procedures, uniform intake forms, cross-training of staff, interagency coalitions and service delivery teams, co-location of services, linked information systems, and shared funding approaches.

Employment Integration. Programs with this strategy offer employment-related services in combination with an extensive set of supportive services to help clients manage their multiple barriers and move from welfare to work. Such programs often use a case management model of service delivery to provide employment-related services such as career counseling, job readiness training, referrals to education and training programs, and job placement services.

Program Outcomes

A review of findings from rigorous evaluations of welfare-to-work programs suggests that those programs that encourage, help, or require welfare recipients to find jobs, while also providing various supportive services, can lead to gains in employment and earnings, as well as reductions in welfare receipt (Nightingale and Holcomb 1997). Further research is needed, however, to better understand program effectiveness in terms of helping clients with multiple and serious barriers become and stay employed. Research and practice do suggest that clients with multiple and serious barriers, many of whom also have low basic skills, may benefit from employment-related strategies that link education and training activities with work. Examples might include linkages among classroom-based vocational training, job-readiness training, on-the-job training and work experience (for instance, in subsidized community service jobs), supported work, and work-based accommodations. A number of studies, some of which are summarized below, suggest that welfare agency and welfare-to-work programs that provide a wide range of both personal and employment-related services show promise of helping clients with multiple barriers make a successful transition to work.

Effect of Program Treatment on EMPLOYMENT

• An experimental design evaluation of the National Supported Work Demonstration, a program that provided subsidized employment in a supported work environment to welfare recipients with limited skills, long histories of welfare receipt, and, in many cases, multiple barriers to employment, showed that program participation resulted in statistically significant gains in earnings two years after enrollment (Kemper et al. 1981).
• Data from the Chicago Commons Employment and Training Center, a welfare-to-work program serving clients with multiple barriers, found that 18 to 27 months after participants enrolled, more than half were either employed (29 percent), enrolled in a job training program (12 percent), or still attending CCETC classes (14 percent); the remaining 45 percent, however, had dropped out (Pavetti et al. 1996).
• Data from the Southwest Women Working Together Program, a welfare-to-work program serving clients with multiple barriers, show that in 1995, more than 75 percent of clients who completed the employment workshops eventually obtained full-time work, and four-fifths of their jobs included benefits (Southwest Women Working Together 1997).
• Data from Project Zero, a welfare-to-work program serving clients with multiple barriers, show that during the first year of program implementation, the number of clients not earning income fell by more than 60 percent, compared to a 28 percent reduction among all welfare clients statewide (Michigan Family Independence Agency 1998).
• An evaluation of the Lincoln Action Program, which serves clients with serious, and in some cases, multiple barriers, found no significant impacts on either employment or welfare receipt but did find that the earnings trajectory of clients who received program services was promising (SRI Gallup 1990).

Effect of Program Treatment WELFARE RECEIPT

• An experimental design evaluation of the National Supported Work Demonstration, which provided subsidized employment in a supported work environment to welfare recipients with limited skills, long histories of welfare receipt, and, in many cases, multiple barriers to employment, showed that program participation resulted in statistically significant reductions in public assistance two years after enrollment (Kemper et al. 1981).

Program Costs

Although data are limited about the costs to welfare agencies and other service providers of operating programs designed to serve clients with multiple barriers, we do know that costs vary based on differences in program approach. Client identification programs, though they appear inexpensive, undoubtedly take up a fair amount of staff time. Integrating screening and assessment tools into program operations in order to identify the needs of clients with multiple barriers requires resources for staff time but is a potentially cost-effective step, since clients with multiple barriers can be helped only if barriers are identified and appropriate services provided.

Once clients are identified as having multiple barriers, welfare agencies often use case management and service coordination strategies to assist them. The initial cost of many enhanced case management services--for instance, hiring specialized counselors or treatment providers--can be high. However, agencies may choose to implement low-cost strategies to enhance case management capabilities, for instance, recruiting unpaid volunteers to support and mentor clients. Likewise, some service coordination strategies--such as cross-agency coordinating committees or case management teams, shared intake forms, and formal referral procedures and networks--can also be inexpensive, once initial steps are taken to implement them. Moreover, these types of strategies may ultimately result in improved service delivery processes and increased operational efficiency.

Employment integration programs that offer a broad range of supportive services are somewhat more expensive to implement and operate. Costs of these programs may vary greatly based on the nature and extent of the needs of clients with multiple barriers and the range of services provided. Average costs for one program--the Chicago Commons Employment and Training Center--were recently estimated to be about $3,500 per participant per year (Pavetti et al. 1996). In addition, a review of employment and training programs for welfare recipients, some of which also offered extensive supportive services, showed that the cost of most programs ranged from $1,000 to $13,000 per participant per year (based on 1995 dollars), with more intensive programs having costs in the higher end of the range (Nightingale and Holcomb 1997).

To the extent that program costs are offset by long-term increases in employment and reductions in welfare, they are likely to be cost-effective. For instance, the National Supported Work Demonstration, which provided subsidized employment and various supported work services to welfare recipients with limited skills, essentially paid for itself through reductions in participants' welfare and food stamp benefits (Kemper et al. 1981). Further research is warranted to determine both the cost and the cost-effectiveness of different program approaches to serving welfare clients with multiple barriers to employment.

Program Implementation

Welfare agencies are enhancing their own program strategies and coordinating more closely with other service providers to address the complex needs of clients with multiple barriers and support them as they move from welfare to work. These clients are more likely to rely on welfare for longer periods of time and are less likely to sustain employment once they become employed. Consequently, they will need a broad range of services and intensive support over a longer period of time than clients with fewer needs. Working intensively with these clients in a time-limited welfare environment presents new challenges for welfare agencies and their staff.

Welfare agencies and other service providers have learned important lessons about how to implement programs to better serve clients with multiple barriers. These lessons are relevant for welfare agencies as they design, enhance, and restructure their service delivery strategies to assist clients with multiple barriers and support their transition to employment and self-sufficiency. Our synthesis of issues related to clients with multiple barriers leads to a discussion in three key areas: (1) case management, (2) coordinated delivery of services, and (3) employment integration. Along with the discussion, we recommend steps welfare agencies should take to serve clients with multiple barriers to employment successfully.

Case Management

To serve clients with multiple barriers to employment successfully, welfare agencies must make a substantial commitment to increasing staff capacity to identify barriers to employment and develop appropriate service plans. In the context of time-limited welfare benefits, agencies will need to develop effective and creative solutions for addressing the needs of clients with multiple barriers. This responsibility requires case managers to assume new and more challenging roles that extend far beyond those prior to welfare reform. Case managers' primary roles have shifted from determining eligibility and benefits to identifying a diverse set of client needs, providing counseling and support, and developing individualized service strategies. Despite these new roles and responsibilities, many case managers have not been given adequate guidance, training, tools, or time to do their job properly. The focus of case management training should be threefold: (1) expanding skills through comprehensive training and technical assistance, (2) developing and using comprehensive screening and assessment tools to identify clients' multiple barriers, and (3) re-structuring job descriptions to decrease caseload sizes and increase staff time to work with individual clients.

1. Training and Technical Assistance. Experienced, knowledgeable, and sensitive staff are key to gaining clients' trust, identifying barriers, and helping clients obtain services. Preparing staff for these tasks requires initial and ongoing training on a wide range of issues. Sensitizing staff to the unique needs of clients with particular co-occurring barriers is a necessary first step to preparing them to identify problems, use screening and assessment instruments, offer support and services in a trustful and knowledgeable manner, and make appropriate service referrals.

2. Client Identification. Only a small number of welfare agencies are using sophisticated screening and assessment tools to identify clients' multiple barriers to employment comprehensively. Instead, staff are more likely to rely on case management techniques such as case staffings and interdisciplinary service teams. Reliance on these efforts, however, does not ensure that barriers are identified at the earliest point possible, particulary those that may be difficult to identify, such as learning disabilities, mental health needs, and domestic violence. To ensure that staff accurately identify clients' barriers as soon as possible, welfare agencies should develop and use comprehensive and holistic screening and assessment tools and train their staff on how to use them. (Information on techniques for identifying individual barriers to employment is provided in each of the previous chapters.)

3. Adequate Time to Work with Clients. Identification of client needs, help in obtaining services, and support in getting and maintaining employment all require substantial time. Current staff caseloads are probably too high in most welfare agencies to provide the types of individual attention clients with multiple barriers need. In addition to reducing client-staff ratios, several strategies can facilitate effective and individualized case management, including maintaining continuity in client-staff relationships, assigning specialized case managers to work with the neediest clients, using case staffing and interdisciplinary service teams that include specialized staff (for instance, counselors in substance abuse, mental health, domestic violence, and vocational rehabilitation), and involving volunteer mentors to assist and support clients.

Coordinated Delivery of Services

If program implementation is to be successful, welfare agencies should cultivate strong partnerships with other agencies and organizations and develop coordinated systems for delivering services. Welfare clients with multiple barriers to employment require a broad range of supportive services over an extended period of time to help them get jobs and remain employed. To help clients obtain needed services, welfare agencies must develop strong collaborative partnerships with other organizations, including vocational rehabilitation providers, mental health and substance abuse providers, advocates for victims of domestic violence, shelter programs, child care providers, and housing assistance and transportation programs. While some welfare agencies have already begun to develop these types of relationships, few have developed well-integrated systems of service delivery that engage a broad range of organizations in the community.

Coordinated efforts may include joint staff trainings, established referral procedures and networks, contractual arrangements for services, integrated case management teams, common intake forms and client tracking procedures, shared service locations, integrated management information systems, and joint or shared funding approaches. To coordinate goals and priorities across organizations and facilitate coordinated efforts, welfare agencies may wish to establish the following: frequent communication with staff from other agencies, cross-agency coalitions or strategic planning committees, compatible administrative regulations and operational procedures, and formal cooperative agreements about roles and responsibilities. Appointing one staff member to take primary responsibility for developing and strengthening coordinated methods of service delivery may facilitate these efforts.

Employment Integration

To support clients as they move from welfare to work, welfare agencies should offer or link clients to services that are directly related to helping them get and maintain jobs. Because many clients with multiple barriers to employment also have low basic skills, it is often difficult for them to get and maintain jobs. To assist these clients, agencies must balance the need to employ them quickly because of welfare time limits with the need to provide supportive services and remedial education and training. A review of welfare-related research suggests that clients with multiple and serious barriers to employment, many of whom also have low basic skills, may benefit from a variety of specialized employment strategies that link education and training activities with work, such as classroom-based vocational training, job-readiness training, on-the-job training and coaching, incremental work experience (for instance, through subsidized community service jobs), supported work and work-based accommodations, and postemployment support. Welfare agencies should consider offering these types of services or providing referrals to other programs that can supply them.

Welfare agencies should also consider conducting outreach to develop and strengthen relationships with employers, particularly those willing to participate in work experience programs and make accommodations for clients with special needs. With a broad mix of available employment-related services and accommodations, clients with multiple barriers to employment may be more likely to become and remain employed; without them, their chances of losing jobs and returning to welfare may increase.

Program Models⁽²⁾

• What are welfare agencies doing to address this issue?
• Whom can I contact?

The following programs are presented alphabetically by state. The reader can determine the relevance of a program by noting its primary program strategy and geographic location and then refer to the brief descriptions and contact information on the subsequent pages. We have used primary objective(s) to assign program strategies, though a program may have many objectives.

---

San Diego County Mental Health Services

McKinney Demonstration Program for Homeless Adults with Serious Mental Illness

San Diego, California

Program strategy: Enhanced case management

Service coordination

Location: One urban/suburban county

---

U.S. Department of Health and Human Services, Center for Mental Health Services

Access to Community Care and Effective Services and Supports (ACCESS) Program

Washington, DC

Program strategy: Service coordination

Location: Nine states, 18 communities, urban/suburban

---

Chicago Commons West Humboldt Park Employment and Training Center

Chicago, Illinois

Program strategy: Employment integration

Location: One urban community

---

Southwest Women Working Together Program

Chicago, Illinois

Program strategy: Employment integration

Location: One urban community

---

Baltimore Mental Health Systems

McKinney Demonstration Program for Homeless Adults with Serious Mental Illness

Baltimore, Maryland

Program strategy: Enhanced case management

Service coordination

Location: One urban community

---

Michigan Family Independence Agency

Project Zero

Lansing, Michigan

Program strategy: Enhanced case management

Service coordination

Location: Twelve counties, urban/suburban/rural

---

Lincoln Action Program

Job Readiness Program

Lincoln, Nebraska

Program strategy: Client identification

Enhanced case management

Location: One urban community

---

Program Name/Contact

San Diego County Mental Health Services McKinney Demonstration Program for Homeless Adults with Serious Mental Illness San Diego, California

Richard Hough, Principal Investigator San Diego State University 619-594-5457

Program strategy: Enhanced case management Service coordination Location: One urban/suburban county

Brief Program Description

The McKinney Act awarded funds in 1990 to develop and test the effectiveness of a variety of approaches to providing comprehensive services to homeless adults with severe and persistent mental illnesses, many of whom were also substance abusers. Five demonstration projects were funded. Each offered case management services and housing to participants. Although the projects served primarily men and were not directly linked to welfare agencies, they are relevant because of their coordinated community response and their goal of improving the capacity of the service system to meet the needs of people with multiple barriers. McKinney projects are located in Baltimore, San Diego, Boston, and New York (two projects). We describe the San Diego Project here.

The San Diego Project serves homeless people with severe mental illness who are referred from community mental health organizations and homeless shelters. Over half the clients are also (current or past) substance abusers. Service delivery efforts are coordinated among the local mental health authority, the public housing authority, various mental health providers, and a community services organization, who work together to coordinate both the delivery of services for the target population and case management services. Comprehensive case management teams identify and deliver appropriate services to clients, who have access to these services 24 hours a day. The case managers leading the teams serve about half as many clients as do traditional case managers.

Evaluation

Using a randomized experimental design and a sample size of 360 individuals, the evaluation tested whether the combination of HUD Section 8 housing certificates and intensive case management is more effective than three alternative approaches (intensive case management only, housing certificates with traditional case management, and traditional case management only) (U.S. Department of Health and Human Services 1994a).

Findings

Early impact results indicate some evidence of a greater decline in symptoms of mental illness among clients who receive comprehensive case management rather than traditional case management services. The authors conclude that some degree of case management is critical to helping homeless people with severe mental illnesses negotiate a fragmented service system (U.S. Department of Health and Human Services 1994a).

Program Name/Contact

U.S. Department of Health and Human Services, Center for Mental Health Services Access to Community Care and Effective Services and Supports (ACCESS) Program Washington, DC

Margaret Blasinsky R.O.W. Sciences, Inc. ACCESS National Evaluation Project 301-294-5432

Program strategy: Service coordination Location: Nine states, 18 communities, urban/suburban

Brief Program Description

ACCESS programs are strategic systems integration efforts to better serve homeless people with mental illness and substance abuse problems. Although the ACCESS programs do not have direct links with welfare agencies, they are relevant to this study because of their focus on systems integration efforts to serve people with multiple barriers. In spring 1993, each of nine states (Connecticut, Illinois, Kansas, Missouri, North Carolina, Pennsylvania, Texas, Virginia, and Washington) was funded to develop and implement an ACCESS program in one community. Funding was provided over a five-year period, with each state receiving up to $2 million per year. The program is funded through a collaborative agreement involving SAMHSA's Center for Mental Health Services and the Departments of Labor, Housing and Urban Development, Education, Veterans Affairs, and Agriculture.

The long-term goal of ACCESS is to foster enduring community-based partnerships to improve the integration of existing service systems. The programs aim to identify promising service delivery approaches to serving homeless people with serious mental illness, particularly those with co-occurring alcohol or other substance abuse disorders. These efforts are typically coordinated by state mental health authorities that provide outreach and case management services to this population. The core types of strategies that ACCESS programs implement include (1) interagency coalitions and service delivery teams, (2) co-location of services in the same office, (3) linked information systems, (4) uniform application and intake forms, (5) cross-training of staff, and (6) flexible funding.

Evaluation

R.O.W. Sciences, Inc., in collaboration with Northeast Program Evaluation, Policy Research Associates, and the Cecil G. Sheps Center, is evaluating the ACCESS Program. Using a comparison group design, ACCESS communities are being compared with similar communities in the same state. A third-year implementation study has been completed (Center for Mental Health Services 1997). The evaluation is identifying factors that promote integrated service systems and is also measuring the impact of changes on client outcomes.

Findings

Program impacts are not yet available. The implementation study, however, suggests that strategic planning and interagency coalitions are critical to increasing community collaboration, decreasing fragmentation within the service delivery system, and developing integrated service systems (DHHS 1997). Dedicating a single staff person to the role of systems integration coordinator has facilitated the work of the ACCESS programs.

Program Name/Contact

Chicago Commons West Humboldt Park Employment Training Center(3) Chicago, Illinois

Jenny Wittner Chicago Commons West Humboldt Park Employment Training Center 773-772-0900

Program strategy: Employment integration Location: One urban community

Brief Program Description

The Chicago Commons West Humboldt Park Employment and Training Center (ETC) is a welfare-to-work program that provides comprehensive services to welfare recipients and their families, most of whom have multiple barriers to employment. The program has operated since 1991, focusing on serving clients age 21 and over. Of the approximately 120 families it serves, most are long-term welfare recipients with low basic skills and a history of domestic violence or substance abuse (Raphael 1995). Client families are referred to ETC from the Illinois Department of Human Services in Chicago; others are recruited through ETC outreach efforts. The ETC program fulfills the role of JOBS/TANF case manager for participants.

CCETC provides a variety of educational and supportive services to help clients obtain employment, work toward a GED, or enroll in a job training program. The program often acts as a precursor to client participation in more intensive vocational training programs. While some services are provided through individual case management, many are provided in a group-oriented manner. The following supportive services are available: individual counseling and support, literacy classes, learning disability assessment, parenting classes and counseling, on-site child care and Head Start programs, career counseling and job placement. On-site medical services were previously available, but were recently discontinued. An 80-hour life skills training class is also offered, which provides education and group support on matters such as domestic violence, mental health and depression, alcoholism, parenting, and children with special needs. The length of time families spend in the program typically varies from six months to two years, depending on need and skill level. The annual ETC budget is currently $650,000, with per-participant costs of about $3,500 per year.

Evaluation

This program has not been formally evaluated. The Urban Institute conducted a case study analysis (Pavetti et al. 1996).

Findings

Although a formal evaluation has not been conducted, program data on participants enrolled during the 1996-97 program year show that, after 18 to 27 months, 44 percent of clients were employed, 18 percent were enrolled in a job training program, 6 percent were still attending ETC classes, and 33 percent had dropped out of the program.

Program Name/Contact

Southwest Women Working Together Program Chicago, Illinois

Shelley Crump, Executive Director Southwest Women Working Together 773-582-0550 Web site: www.swwt.org

Program strategy: Employment integration Location: One urban community

Brief Program Description

Southwest Women Working Together, a private, nonprofit service provider since 1975, provides a comprehensive set of employment, training, and supportive services to low-income women. Most clients are welfare recipients referred from local welfare offices of the Illinois Department of Human Services (IDHS). Staff from Southwest Women conduct some of the client job assessments at local IDHS offices and, as appropriate, make referrals to the program. A variety of long-term supportive services are provided using a case management model, including those related to domestic violence, housing, child care, transportation, and emergency financial assistance. Southwest Women serves primarily single parents, over three-fifths of whom are victims of domestic violence or sexual assault. Homeless and abused children are also served. More than 230 families were served in 1997.

Southwest Women offers a variety of components, including (1) the Women's Employment and Training Program, (2) the Counseling Program, (3) the Family and Children Services Program, (4) the Housing and Advocacy Program, and (5) Amani House (a transitional shelter for homeless women and children). It also sponsors a community-organizing initiative to develop indigenous neighborhood leadership. The program operates at an annual cost of about $1.1 million.

The employment and training component provides a wide range of services to clients, including career counseling, skills assessment, job readiness workshops, job placement assistance, financial assistance for education and training, and referrals to Adult Basic Education, GED courses, and vocational training programs. The Counseling Program offers individual therapy and group counseling, as well as safety planning for victims of domestic violence. The Family and Children Services Program conducts training on daily living, parenting, self-esteem, and budgeting skills. It also provides an after-school program for children. The Housing and Advocacy Program serves more than 600 families annually by providing secured housing, security deposit guarantees, advocacy, referrals, and emergency grants to cover rent, mortgage, and utility bills.

Evaluation

No evaluation of the program has been conducted.

Findings

No impact data are available. However, descriptive program data show that, in 1995, three-quarters of clients who completed employment workshops eventually became employed full-time; four-fifths of these had jobs with benefits.

Program Name/Contact

Baltimore Mental Health Systems McKinney Demonstration Program for Homeless Adults with Serious Mental Illness Baltimore, Maryland

Anthony Lehman, Principal Investigator University of Maryland School of Medicine Department of Psychiatry 410-706-2490

Program strategy: Enhanced case management Service coordination Location: One urban community

Brief Program Description

The McKinney Act awarded funds in 1990 to develop and test the effectiveness of a variety of approaches to providing comprehensive services to homeless adults with severe and persistent mental illnesses, many of whom were also substance abusers. Five demonstration projects were funded. Each offered case management services and housing to participants. Although the projects served primarily men and were not directly linked to welfare agencies, they are relevant because of their coordinated community response and their goal of improving the capacity of the service system to meet the needs of people with multiple barriers. McKinney projects are located in Baltimore, San Diego, Boston, and New York (two projects). We describe the Baltimore Project here.

Services the Baltimore Project provides are coordinated by a community mental health center, a health clinic, and a homeless shelter, all part of a local mental health authority. Potential clients are recruited for the project from inpatient mental health sites, homeless shelters, and the streets. Before they are enrolled, the potential clients are diagnosed for mental illness through an on-site psychiatric evaluation. Those diagnosed as having a serious mental illness are enrolled. The project uses an Assertive Community Treatment (ACT) team approach to identifying and delivering services, focusing on those that help alleviate problems related to mental health, physical health, substance abuse, and other barriers. The ACT comprises various clinical staff members, a family liaison who works to reestablish ties between homeless people and their families, and two client advocates with expertise in mental illness and/or homelessness.

Evaluation

Using a randomized experimental design and a sample size of more than 150 individuals, the evaluation compared outcomes of a treatment group that received intensive ACT services with a control group that received "usual and customary" mental health services (U.S. Department of Health and Human Services 1994a). A cost-benefit analysis and ethnographic study are also part of the evaluation.

Findings

At 12-month followup, the ACT treatment group members, compared to control group members, spent significantly more days in stable community housing and experienced significantly greater improvements in symptoms of mental illness, life satisfaction, and perceived health status (Lehman et al. 1997). There was no difference at 12-month followup in terms of employment-related outcomes. This is not surprising, however, since the intervention focused on clinical stability and housing, rather than employment.

Program Name/Contact

Michigan Family Independence Agency Project Zero Lansing, Michigan

Donna O'Grady Family Independence Agency 517-373-1585

Program strategy: Enhanced case management Service coordination Location: Twelve counties, urban/suburban/rural

Brief Program Description

Project Zero is a pilot program implemented in 12 Michigan counties, both urban and rural. It is run by the Michigan Family Independence Agency (FIA) as part of the state's larger welfare-to-work initiative, To Strengthen Michigan Families. Project Zero began in 1996 in six counties. By providing an extensive set of supportive services to help clients overcome barriers to employment, Project Zero seeks to employ welfare recipients and eliminate (or "bring to zero") the number of welfare households that have no earned income. The project also seeks to achieve the following goals: develop community partnerships between state agencies, local FIA offices, and local service providers; streamline staff responsibilities; and implement new client work standards and sanction policies.

The project uses a case management model of service delivery, including regular home visits and mentoring by community volunteers, to provide a comprehensive set of services. Services are designed to address barriers to employment in the following areas: child care, health care, substance abuse, housing, transportation, and domestic violence. Staff act as case managers, linking families to community services and resources as needed to remove barriers. Volunteer mentors assist families by providing encouragement and support and helping with issues related to budgeting, household management, transportation, child care, and employment. The projects access additional resources by coordinating with community organizations and other government departments (for instance, the Michigan Department of Transportation and the Jobs Commission).

Evaluation

A descriptive study currently being conducted will compare the experiences of three different subgroups of project clients: those without earned income, those earning income by working less than 20 hours per week, and those earning income by working 20 hours or more per week.

Findings

An impact study is not being conducted. However, existing program data show that the number of Project Zero clients who did not earn income fell by 63 percent during the first year of program implementation, compared to a 28 percent reduction among all FIA clients statewide (Michigan Family Independence Agency 1998).

Program Name/Contact

Lincoln Action Program Job Readiness Program Lincoln, Nebraska

Brian Mathers Community Services Director 402-471-4515

Program strategy: Client identification Enhanced case management Location: One urban community

Brief Program Description

The Lincoln Action Program (LAP) is a private, nonprofit, community action agency that takes a holistic approach to serving clients. LAP's Job Readiness Program addresses chronic barriers to employment and self-sufficiency through the provision of intensive case management. The area's Department of Social Services refers its hardest-to-serve cases to LAP.

Job Readiness includes a comprehensive family assessment and plan of action, in which families identify barriers to self-sufficiency and determine outcomes using the Family Outreach Workers' Manual and Family Assessment Tool (FAT), developed with the assistance of SRI Gallup. FAT is composed of 20 dimensions, each rated on a multipoint scale. Among the areas measured are housing, food and clothing, medical needs and services, parenting, domestic violence, substance abuse, child care, and transportation. FAT is considered a highly effective tool for measuring and facilitating progress on this wide range of barriers and has been adopted by welfare agencies outside Nebraska.

Job Readiness also includes in-home case management with home visits at least once per month and coordination of all available local social services. Regular meetings between staff of the area's Department of Social Services and LAP workers foster a team approach intended to ensure that client needs are met, service gaps are filled, and bureaucratic hurdles are addressed.

Evaluation

In 1990, SRI Gallup conducted an evaluation of this program, using an experimental design that included client assignment to three- and nine-month intervention samples. The evaluation compared client outcomes for those who received services of the JOBS program alone versus those who received services of the JOBS program supplemented by services offered through LAP.

Findings

Results of the evaluation indicated no significant impacts on either employment or welfare receipt, though the earnings trajectory of clients who received LAP services appeared promising. The program did have a significant impact on client attitudes and behaviors in a number of areas measured in the FAT, although chiefly in those areas more susceptible to immediate effect, such as obtaining medical services, rather than in those that require a longer period of time, such as substance abuse and domestic violence.

Further Information

Further information on issues related to multiple barriers is available from the following

Organizations

The Substance Abuse and Mental Health Services Administration

U.S. Department of Health and Human Services

301-443-8956

Website: www.samhsa.gov

The Substance Abuse and Mental Health Services Administration (SAMHSA) supports research and disseminates information on the prevention, treatment, financing, and design of services to address substance abuse and mental health issues.

Welfare Information Network (WIN)

Washington, DC

202-628-5790

Website: www.welfareinfo.org

The Welfare Information Network (WIN) serves as a clearinghouse of information on more than 40 substantive areas related to welfare programs and issues. For each substantive area, information is provided on the following types of topics: program and management-related issues, federal and state legislation, research projects, data sources, grant and contracting opportunities, and technical assistance. WIN also provides information on and links to a broad network of other organizations involved with welfare-related issues.

Welfare-to-Work Initiative

U.S. Department of Labor

202-208-7185

Website: wtw.doleta/gov

Legislation during 1997 authorized the U.S. Department of Labor to provide Welfare-to-Work grants to states and communities. These grants allow states and communities to create additional job opportunities for the hardest-to-employ welfare recipients by providing various supportive services and offering employment-related assistance such as job creation through public- or private-sector wage subsidies, on-the-job training, community service jobs and work experience, and job retention and postemployment services.

For other agencies and organizations that provide information on individual barrier areas, please refer to the chapters on these individual barrier areas.

Further information on issues related to multiple barriers is available in the following

Documents

Olson, K., and L. Pavetti. "Personal and Family Challenges to the Successful Transition from Welfare to Work." Washington, DC: Urban Institute, 1996.

This report examines the proportion of the welfare population that is likely to need more assistance than traditional welfare-to-work programs have provided in order to get and sustain employment. In doing so, it reviews the following: different types of personal and family challenges that act as barriers to employment, the prevalence of these barriers to employment, the relationship between barriers and actual work experience, and implications for program design and service delivery.

Pavetti, L., K. Olson, N. Pindus, and M. Pernas. "Designing Welfare-to-Work Programs for Families Facing Personal or Family Challenges: Lessons from the Field." Washington, DC: Urban Institute, December 1996.

This report summarizes information and implementation lessons from case studies of eight programs that serve clients with multiple barriers to employment. It examines program design issues such as client identification, the use of sanctions, and the delivery of supportive services (crisis counseling, intensive case management, support groups, referrals to community resources, specialized support for clients with low basic skills, and transitional support).

Pavetti, L., K. Olson, D. Nightingale, and A. Duke. "Welfare-to-Work Options for Families Facing Personal and Family Challenges: Rationale and Program Strategies." Washington, DC: Urban Institute, 1997.

This report discusses ways to expand traditional welfare-to-work programs to include strategies that address clients' multiple barriers to employment. In particular, it describes program activities that could be integrated into traditional welfare-to-work programs to meet the needs of clients with multiple barriers and it discusses key implications for programs, particularly those programs that emphasize clients' immediate entry into the labor force.

U.S. Department of Health and Human Services. Blueprint for a Cooperative Agreement Between Public Housing Agencies and Local Mental Health Authorities. Washington, DC: Public Health Service, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, no date.

The Center for Mental Health Services developed a cooperative agreement between Public Housing Agencies (PHAs) and local Mental Health Authorities (MHAs) in order to encourage cooperation in helping persons with serious mental illness access appropriate housing, treatment, and supportive services. The agreement outlines roles and responsibilities for both PHAs and MHAs in terms of coordinating the delivery of these services.

1. Barriers included in the definition used here are medical needs, children's chronic medical needs, substance abuse, and mental illness, but not low basic skills.

2. For an explanation of how programs were selected, please refer to the discussion included in the Introduction under the paragraph heading "Program Models."

3. This program summary benefited from a previously published description of the program (Pavetti et al. 1996).

A Summary of Overarching Issues

The preceding ten chapters review the need for and provision of services to address barriers to employment. Several issues common to each are important to highlight and discuss more explicitly: (1) interagency coordination, (2) infrastructure, and (3) additional research needs. While much of this report has focused on what local welfare agencies should be and are doing to help clients overcome barriers to employment, these three crucial areas need the attention of a community much broader than local welfare agency staff. These issues suggest that stakeholders at the state and federal levels have additional roles to play in addressing the nation's goal of helping those on welfare become productive, self-sufficient members of society.

Interagency Coordination

The descriptions of current welfare agency programs in the preceding ten chapters make clear the extent to which service provision for welfare clients is increasingly dependent upon a coordinated system of service delivery. This dependency has resulted from agencies' need to coordinate with other local and specialized providers for services that address barriers to employment faced by clients previously exempt from participation requirements. Current efforts to coordinate services reveal several areas of concern, however, that should be addressed at the federal, state, or local level: (1) overlap or duplication of effort, (2) incompatible service systems, (3) minimal employer involvement, and (4) limited funding coordination.

There is likely to be duplication of effort and overlap of services provided by welfare, health, labor, housing, criminal justice, and educational organizations in the absence of a well-coordinated system. There are two reasons in particular to be concerned about this duplication or overlap: (1) with limited resources, social service providers cannot afford to waste funds; and (2) clients could be faced with a fragmented and confusing set of services characterized by gaps, inconsistencies, and incompatible procedures and expectations. Part of the challenge in developing a coordinated system within the social service community is addressing the fact that agencies often differ in their missions or objectives, levels of staff expertise, participant expectations, time frames for service provision, assessment methods, intake and monitoring procedures, and the language they use in discussing mutual concerns. Efforts that fail to acknowledge and address these crucial differences jeopardize successful service provision. Efforts that instead establish cross-agency committees, provide cross-agency staff training, or physically locate staff from different agencies together, for example, hold greater promise of fostering the kind of partnerships necessary to coordinate services effectively.

Because welfare agencies are working toward moving clients into the workforce, coordinated efforts need to extend to employers as well. However, there is little evidence of much coordination involving employers directly. Program models that we have categorized as "employment integration" are generally those for which the welfare agency has included a work-related component, for example, treatment in conjunction with skills training or job placement services. Other than in the case of employer-sponsored transportation services or employer accommodations for those with disabilities, programs tend not to include the direct involvement of employers. As a result, employers are too often missing from local area discussions and efforts aimed at designing a coordinated system of services that will move welfare clients into the workforce. Without greater employer involvement, welfare recipients are at risk of losing their jobs and returning to public assistance.

Finally, a coordinated system of service provision is constrained by the current fragmentation of funding. The system generates confusion about which agency is responsible for shouldering the costs of service provision and is hampered by legislative constraints on expenditures, including restrictions on the use of TANF funds for medical services, on the amount of TANF funds that can be transferred to the Social Services Block Grant, and on the use of Medicaid funding.

This fragmented and restrictive system also complicates decisions concerning the appropriate allocation of resources: whether to focus on the harder-to-serve or the more easily employed populations, on the welfare or the low-income populations, on those faced with one barrier to employment as opposed to another, or on those in need of expensive as opposed to low-cost services. A coordinated system that permits combining funding from a variety of sources would allow state and local agencies the flexibility they need to design services in response to client needs rather than funding constraints.

Additional federal or state responses that might assist with service coordination include (1) requiring that funding proposals be based on joint funding arrangements, (2) providing incentive payments to social service agencies that cooperate with other organizations, (3) supporting cross-agency training efforts that help staff develop common systems and assumptions for client services, (4) encouraging efforts designed specifically to support technical teams that help create partnerships between local service agencies, and (5) investing in computerized information systems that coordinate client information across a number of organizations and that track service provision.

To address the issues of service coordination, state-level staff from Ohio Family and Children First and the Ohio Department of Human Services have recently published a report entitled "State Resources Guidebook: 101 Ideas for Partnering at the Local Level."⁽¹⁾ This is a compilation of welfare agency efforts throughout the state to provide services to welfare recipients; these services are largely designed around coordinated systems and partnerships between social service agencies. Because the sharing between agencies of experiences and lessons learned provides some of the best direction for future efforts at service coordination, this step toward equipping staff with a critical tool toward this effort--the means to establish relationships and communicate with peers--holds promise for future efforts in the state.

Infrastructure

As welfare agencies assume more responsibility for meeting the diverse and demanding needs of their clients, they are faced increasingly with issues of infrastructure, both external and internal. Agencies are both reliant upon and obstructed in their efforts by the state of the external infrastructure, one of whose central features is the health of the local economy. Both the local unemployment rate and the location of job opportunities play an enormous role in whether clients are able to find productive employment and sever their reliance on public assistance. Other infrastructure issues external to the welfare agency itself include the adequacy of an area's local transportation system, which may or may not be able to address issues related to spatial mismatch, and the availability of local housing. In addition, agency efforts to expand the number of service providers--in the areas of child care, substance abuse, mental health, domestic violence, and vocational rehabilitation--are a direct response to an external infrastructure that is not able to respond to the needs of today's welfare clients.

Local welfare agencies are being forced to take on these issues of infrastructure in their efforts to serve clients successfully. This is, however, an enormous, unrealistic, and inappropriate responsibility for a local welfare agency to assume alone. For the most part, welfare agencies cannot do much, if anything, to address these broad issues of local infrastructure. An appropriate response should begin with state or federal recognition of the critical role that an area's infrastructure plays to the successful transition of clients from welfare to work. This should be followed by comprehensive and well-planned efforts to develop the local infrastructure. Such approaches will be more time-consuming than band-aid efforts that respond to immediate needs, however, and are therefore incompatible with the constraints that time limits place on service provision. A combined approach that facilitates the means to address clients' short-term needs but includes development of longer-term efforts to address these larger issues of local infrastructure will, then, be the most effective.

If forced to address the broad external infrastructure, welfare agencies risk devoting insufficient attention to the internal infrastructure--program staffing needs or internal systems for service provision. In each of the ten areas in this report, one or more of the central implementation issues pertained to these internal matters. What is undeniably clear from current agency efforts is that caseworker roles and responsibilities are changing rapidly and drastically and that the skills needed for these new roles are not always adequately considered or developed. Caseworkers are increasingly expected to assess clients' needs, be familiar with an extensive range of service options in numerous areas, operate effectively with external service providers, interview and interact with clients effectively, monitor client progress in several areas, and coordinate and prioritize services. Agencies are at risk of a significant "skills mismatch" as they assume the increased burdens for client needs that stem from welfare reform. If this skills mismatch is not adequately addressed, there is little reason to believe that any approach will prove effective. Efforts to address this skills mismatch, however, cost both time and money--resources that are generally in short supply within welfare agencies. Federal and state resources or statewide efforts, such as the one under way in Oregon to train the state's entire staff of caseworkers, are needed (see Program Models under Substance Abuse). The alternative of ignoring this issue could seriously impede the overarching objective of the recent legislation to help those on public assistance move from welfare to work.

Additional Research Needs

The implication, implementation, and effect of drastic policy changes such as those contained in the recent welfare reform legislation are understood only through adequate research. There is now sufficient experience with operational responses to welfare reform to indicate several areas in which we clearly need additional research to grasp its full impacts.

The first entails rethinking how clients should be appropriately and adequately assessed for services. Assessments can be made through the use of specific instruments (such as the SASSI, used for substance abuse) or through informal caseworker-client interactions that take place over a period of time. Choice of approach should be determined based on local preferences, but additional attention is needed in either case. A more formal method requires identification of the appropriate instrument, coupled with caseworker training to ensure that staff are comfortable with it and skilled in its use. Assessments conducted through informal client interactions require sensitivity to time limits and training of caseworkers so that an appropriate diagnosis does not allow client needs to be overlooked. By whatever method, the focus needs to be on identifying individual client problems and on determining the service or set of services that will help clients become or stay employed. Because the profile of the welfare population could change drastically and continuously under welfare reform, and because neither clients nor agencies can afford to let needs go unmet, this needs assessment must be done more efficiently, more regularly, and more thoroughly than at present.

Part of this effort will require greater consensus on how each of these ten barriers should be defined within a welfare context. Clearer barrier definitions and more regular methods of client assessment will, in turn, help to measure the percentage of recipients that face each barrier. Understanding how many clients are faced with which barriers to employment is the foundation for appropriate program design at the state and local levels. The wide ranges in estimates presented at the start of each chapter (and the full tables included in Appendix A) highlight the need for a clearer means of such determination. Current estimates are based on an ad hoc system that leaves large gaps in our knowledge concerning the magnitude of the problem. Though in some areas there is a convergence within these estimates that engenders some confidence about the magnitude of the problem, for many areas figures diverge substantially. We need additional research in several areas that contain few estimates (in particular, child care, housing, transportation, mental health, and multiple barriers), and we need current research that measures the TANF population rather than the AFDC population.

The second area in which we need additional research is program effectiveness, which is clear from the dearth of information available for the preceding ten chapters. Though a rigorous evaluation that involves random assignment of welfare recipients to different packages of services is generally not feasible or desirable for all agencies to conduct, a more modest approach that includes some measure of client performance and program costs would be informative. In addition to permitting some comparative analysis between programs, it would help staff at the local level measure program effectiveness and cost-effectiveness and gauge the need for program modifications. State and local agencies should require that programs be accompanied at least by small-scale efforts to collect this type of information.

A handful of current efforts that include rigorous evaluation or extensive data collection promise to provide some very helpful information concerning program effectiveness. These include evaluations of the Goodwill Employment and Training Welfare-to-Work Programs for those with disabilities; the Options/Opciones Program for victims of domestic violence in Chicago, Illinois, and the Minnesota Domestic Abuse Intervention Project in Duluth; the Maryland Department of Human Resources Welfare Assistance Grants program, which provides diversionary assistance to potential welfare recipients; the Work First New Jersey Housing Assistance Program, which addresses housing barriers for welfare clients in New Jersey; the New Hope Demonstration Project in Milwaukee, Wisconsin, which provides subsidized health insurance; the Work First New Jersey Substance Abuse Research Demonstration Project and the ten-state demonstration by the National Center on Addiction and Substance Abuse at Columbia University, which address substance abuse among welfare recipients; and the ACCESS programs in nine states, for those with multiple barriers to employment. It is critical that the level of support that has permitted the kinds of evaluations noted above be extended to evaluations of other efforts in other sites. Only with a broad base of research that permits an analysis of client outcomes, from data collected at the local level to these more extensive evaluation efforts, will we increase our understanding of the most effective and promising program designs.

Before efforts to evaluate programs' effectiveness go much further, however, agreement must be reached on what constitutes an appropriate measure of effectiveness. Measures of a program's effectiveness could range, for example, from employment-related outcomes (such as wages, hours worked, employer satisfaction, number of jobs held, length of employment) to parenting outcomes (such as abuse and neglect, measures of child health or development, use of good parenting skills, foster care placement rates), personal outcomes more directly related to treatment (such as abstinence from alcohol or drug use, separation from an abusive partner, reduction of a stress disorder), and agency outcomes related to program implementation (such as the number of clients served or caseworker satisfaction with new service approaches). Different service agencies often have differing performance objectives, making agreement on a measurement of effectiveness potentially difficult. It is not clear, for example, whether an agency's efforts to assist clients with serious substance addiction should be gauged by the employment earnings of those clients or on some measure of their abstinence from drug use. Development of consensus on appropriate performance measures may require a formal and coordinated effort at the national, state, or local level. However, without some process toward building this consensus, program evaluations are likely to measure a wide range of outcomes and to remain largely uninformative.

The third area in which we need additional research is understanding appropriate and effective service provision in the context of time limits. The pressure of time-limited welfare receipt has affected the design--chiefly the duration--of services to address the barriers discussed in this report. In some cases, this is resulting in both an appropriate and a welcome increase in efficiency. In areas where barriers can be addressed through tangible resources--areas such as specialized child care, transportation, housing, medical needs, and financial assistance--time limits are beginning to encourage welfare agencies to develop innovative and effective ways to bring clients and services together more quickly. In other cases, however, where barriers are addressed through some form of referral to "treatment"--for barriers such as disability, domestic violence, mental health, and substance abuse--the appropriate balance of the duration of services and a service response sensitive to time limits is much less clear. Are time limits allowing adequate opportunity for treatment, or are they restricting the length of treatment provision to the point of compromising its effectiveness? Are agencies and other service providers being forced to design programs that address client needs only in the short term and not in the long term? Additional research is needed to address these questions. Programs risk providing inadequate assistance if they give undue preference to the concern for time limits over the concern for addressing basic client needs.

TANF entails a fundamental shift to a work-oriented approach to assistance. This shift, in turn, requires a systemic response that demands more of the welfare system than previously. Provision of services to address the full range of barriers to employment will take creativity, a willingness to take risks, additional financial resources, and coordination between agencies that are not used to working together. Because our current knowledge regarding program practices is limited and the options for program design unlimited, progress toward a better understanding of what services to provide for which clients will depend upon a willingness to carefully examine programs. Equipped with better information, agencies can replicate programs that show the most promise of helping clients address barriers and make the transition from welfare to work.

1. For further information on this initiative, contact Marlene Preston-Rombach, Ohio Department of Human Services, at 513-852-3283.

REFERENCES

Acs, G., and P. Loprest. "The Effect of Disabilities on Exits from AFDC." Paper presented at the 17th Annual Research Conference of the Association for Public Policy Analysis and Management, November 1995.

Adler, M. "Disability Among Women on AFDC: An Issue Revisited." Proceedings of the American Statistical Association: Government Statistics Section, 1993.

Allard, M.A., M.E. Colten, R. Albelda, and C. Cosenza. "In Harm's Way? Domestic Violence, AFDC Receipt and Welfare Reform in Massachusetts." Boston: The University of Massachusetts, McCormack Institute and the Center for Survey Research. In Trapped by Poverty, Trapped by Abuse: New Evidence Documenting the Relationship Between Domestic Violence and Welfare, by J. Raphael and R. Tolman, Chicago, IL: The Project for Research on Welfare, Work, and Domestic Violence, April 1997.

Alter, C., and J.L. Losby. Evaluation of Iowa's FaDSS Program: A Family Support Program for Long-Term Welfare Recipients. Iowa City, IA: Institute for Social and Economic Development, December 1995.

American Psychiatric Association. DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC. 1994.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Washington, DC: APA, 1987.

Anthony, W., J. Howell, and K. Danley. "The Vocational Rehabilitation of Psychiatrically Disabled." In The Chronically Mentally Ill: Research and Services, edited by M. Mirabi. Jamaica, NY: SP Medical and Scientific Books, 1984.

Applied Management and Planning Group. "JOBLINKS Post-Project Analysis: 1995-96 Demonstration Projects." Applied Management and Planning Group, 1997.

Bassuk, E., and L. Rosenberg. "Why Does Family Homelessness Occur? A Case Control Study."American Journal of Public Health, vol. 78, 1988.

Bassuk, Ellen, L. Weinreb, J. Buckner, A. Browne, A. Salomon, and S. Bassuk. "The Characteristics and Needs of Sheltered Homeless and Low-Income Housed Mothers." Journal of the American Medical Association, vol. 276, no. 8, 1996, pp. 640-646.

Benham, L., and A. Benham. "Employment, Earnings, and Psychiatric Diagnosis." In Economic Aspects of Health, edited by V. Fuchs. Chicago: University of Press, 1982.

Bland, R., G. Stebelsky, H. Orn, and S. Newman. "Psychiatric Disorders and Unemployment in Edmonton." Acta Psychiatrica, vol. 77, pp. 72-80.

Bloom, Howard S. "Building a Convincing Test of a Public Housing Employment Program Using Non-Experimental Methods: Planning for the JOBS-Plus Demonstration." New York: New York University, 1996.

Booth, Cathryn L., and J.F. Kelly. "Child-Care Characteristics of Infants with and Without Special Needs: Comparisons and Concerns." Seattle, WA: University of Washington, 1997.

Boyle, M. "San Diego Program Has Reduced Domestic Violence Slayings by Half." The Standard Times. [http://www.s-t.com/projects/DomVio/sandiegoprogram.HTML]. June 4, 1995.

Brandon, Peter David. "Vulnerability to Future Dependence Among Former AFDC Mothers." Institute for Research on Poverty discussion paper no. 1055-95. Madison, WI: Institute for Research on Poverty, 1995.

Brandwein, R. "Family Violence and Welfare Reform: The Utah Experience and National Implications." Salt Lake City, UT: University of Utah, May 1997a.

Brandwein, R. "The Use of Public Welfare by Family Violence Victims: Implications of New Federal Welfare 'Reform'." Paper presented at the Fifth International Family Violence Research Conference, Durham, NH, May 1997b.

Brock, T., F. Doolittle, V. Fellerath, and M. Wiseman. Creating New Hope: Implementation of a Program to Reduce Poverty and Reform Welfare. New York: Manpower Demonstration Research Corporation, October 1997.

Bureau of Labor Statistics. "Workers on Flexible and Shift Schedules." U.S. Department of Labor publication no. USDL92-491. August 1992.

Burghardt, J., and A. Gordon. More Jobs and Higher Pay: How an Integrated Program Compares with Traditional Programs. New York: The Rockefeller Foundation, 1990.

Burtless, G. "Welfare Recipients' Job Skills and Employment Prospects." The Future of Children, vol. 7, no. 1, spring 1997, pp. 39-51.

Center for Developmental Disabilities. "ABC Child Care Voucher System for Children with Special Needs." Brochure. Columbia, SC: University of South Carolina. No date.

Center for Law and Social Policy. "Substance Abuse and Welfare Reform." Audio conference. October 24, 1997.

Center for Law and Social Policy. "Housing Audio Conference and Welfare Reform." Audio conference. October 17, 1997.

Center for Law and Social Policy. "Working with Disability." Family Matters, vol. 5, no. 4, fall 1993.

Center for Mental Health Services. Manderscheid, R., and M. Sonnenschein (eds.). Mental Health, United States, 1996. U.S. Department of Health and Human Services publication no. SMA 96-3098. Washington, DC: U.S. Government Printing Office, 1996.

Center for Mental Health Services. Manderscheid, R., and M. Sonnenschein (eds.). Mental Health, United States, 1994. U.S. Department of Health and Human Services publication no. SMA 94-3000. Washington, DC: U.S. Government Printing Office, 1994.

City of Seattle, Department of Housing and Human Services. Seattle JOBS Initiative paper summary. 1997.

Clark, S.J., M.R. Burt, M.M. Schulte, and K. Maguire. "Coordinated Community Responses to Domestic Violence in Six Communities: Beyond the Justice System." Washington, DC: Urban Institute, 1996.

Cohen, E., S. Golonka, T. Ooms, and T. Owen. "Literacy and Welfare Reform: Are We Making the Connection?" Meeting highlights and background briefing report. Washington, DC: Family Impact Seminar, 1994.

The Commonwealth Fund. Violence Against Women in the United States: A Comprehensive Background Paper. New York: Columbia University, 1996.

The Commonwealth Fund. The Health of American Women. New York: Louis Harris and Associates, 1993.

Community Transportation Association of America. "People, Jobs, and Transportation: The First National Conference on Employment and Transportation." Washington, DC: CTAA, 1996.

Coulton, Claudia, et al. "Housing, Transportation and Access to Suburban Jobs by Welfare Recipients in the Cleveland Area." Cleveland, OH: Mandel School of Applied Social Science, 1997.

Culkin, Mary L., Scott Groginsky, and Steve Christian. "Building Blocks: A Legislator's Guide to Child Care Policy." Denver, CO: National Conference of State Legislatures, 1997.

Curcio, W. "Passaic County Study of AFDC Recipients in a Welfare-to-Work Program: A Preliminary Analysis." In Trapped by Poverty, Trapped by Abuse: New Evidence Documenting the Relationship Between Domestic Violence and Welfare, by J. Raphael and R. Tolman. Chicago, IL: The Project for Research on Welfare, Work, and Domestic Violence, April 1997.

Davidson, G., and I. Moscovice. "Health Insurance and Welfare Reentry." Health Services Research, vol. 24, no. 5, December 1989.

Dean, D., and R. Dolan. "Fixed Effects Estimates of Earnings Impacts for the Vocational Rehabilitation Program." Journal of Human Resources, spring 1991, pp. 381-391.

Domestic Abuse Intervention Project. "Domestic Abuse Intervention Project: An Overview." Duluth, MN, no date.

Economic Services Administration. "Barriers to Employment Among Washington's AFDC/TANF Recipients. Findings from 1997 WorkFirst Baseline Client Survey." State of Washington Department of Social and Health Services, February 1998.

Ellwood, D.T., and E.K. Adams. "Medicaid Mysteries: Transitional Benefits, Medicaid Coverage, and Welfare Exits." Health Care Financing Review, 1990 annual supplement, pp. 119-131.

Emery, B. "Welfare Reform Briefing Paper on the Personal Responsibility and Work Opportunity Reconciliation Act of 1996." Alexandria, VA: National Technical Assistance Center for State Mental Health Planning, December 1997.

Ettner, S., R. Frank, and R. Kessler. "The Impact of Psychiatric Disorder on Labor Market Outcomes." Boston, MA: Harvard Medical School, 1996.

Fabian, E.S. "Supported Employment and the Quality of Life: Does a Job Make a Difference?" Rehabilitation Counseling Bulletin, vol. 36, 1992, pp. 84-97.

Fewell, Rebecca R. "Child Care for Children with Special Needs." Pediatrics, vol. 91, no. 1, 1993, pp. 193-198.

Finigan, Michael. "Societal Outcomes and Cost Savings of Drug and Alcohol Treatment in the State of Oregon." Salem, OR: Department of Human Resources and Governor's Council on Alcohol and Drug Abuse Programs, 1996.

Friedlander, D., and K. Martinson. "Effects of Mandatory Basic Education for Adult AFDC Recipients." Educational Evaluation and Policy Analysis, vol. 18, no. 4, winter 1996, pp. 327-337.

Friedman, L., and S. Couper. The Cost of Domestic Violence: A Preliminary Investigation of the Financial Cost of Domestic Violence. New York: Victim Services Agency, 1987.

Gerber, P., and H. Reiff. Learning Disabilities in Adulthood. Boston, MA: Andover Medical Publishers, 1994.

Gerstein, Dean R., et al. "Alcohol and Other Drug Treatment for Parents and Welfare Recipients: Outcomes, Costs, and Benefits." Washington, DC: U.S. Department of Health and Human Services, January 1997.

Giovengo, M., and E.J. Moore. "Washington State Division of Employment and Social Services: Learning Disabilities Initiative, Final Report, Phase I." State of Washington, Department of Social and Health Services, June 1997.

Goldman, H., J. Morrissey, et al. "Lessons from the Program on Chronic Mental Illness." Health Affairs, vol. 11, no. 3, 1992, pp. 51-68.

Greenberg, P., L. Stiglin, S. Finkelstein, and E. Berndt. "The Economic Burden of Depression in 1990." Journal of Clinical Psychiatry, vol. 54, November 1993.

Haimson, J., and A. Hershey. "Getting Help to Stay Employed: The Use of Postemployment Services." Princeton, NJ: Mathematica Policy Research, Inc., April 1997.

Haimson, Joshua, Alan Hershey, and Anu Rangarajan. "Providing Services to Promote Job Retention." Report submitted to the Illinois Department of Public Aid. Princeton, NJ: Mathematica Policy Research, Inc., December 1995.

Harding, C., G. Brooks, T. Ashikaga, J. Strauss, and A. Breier. "The Vermont Longitudinal Study of Persons with Severe Mental Illness." American Journal of Psychiatry, vol. Reform: HAC's 1997 Report on the State of the Nation's Rural Housing. Washington, DC: HAC, 1997.

Institute of Applied Research. "Child Care and AFDC Recipients in Illinois: Patterns, Problems, and Needs." Chicago, IL: IAR, 1991.

Iowa Department of Human Rights, Bureau of Community Services, Division of Community Action Agencies. "Family Development and Self-Sufficiency Grant Program. Fiscal Year 1995 Annual Report." Des Moines, IA: Iowa Department of Human Rights, 1995.

Iverson, S. "Oregon Adult and Family Services Division: Client Characteristics Affecting Employment and Self-Sufficiency Study." Salem, OR: Oregon Adult and Family Services, no date.

Jacobs, H., S. Kardashian, P. Kreinbring, R. Ponder, and A. Simpson. "A Skills-Oriented Model Facilitating Employment Among Psychiatrically Disabled Persons." Rehabilitation Counseling Bulletin, vol. 2, 1984, pp. 87-96.

Jayakody, R., and H. Pollack. "Barriers to Self-Sufficiency Among Low-Income, Single Mothers: Substance Use, Mental Health Problems, and Welfare Reform." Paper presented at the Association for Public Policy Analysis and Management, Washington, DC, November 1997.

Jones, Pamela, Stuart Kerachsky, and Christine Ross. "Spending on Early Childhood Care Programs and Research: An Analysis of Federal Departments, State Governments, and Foundations." Princeton, NJ: Mathematica Policy Research, Inc., 1998.

Kansas Department of Social and Rehabilitation Services. "Learning Disability Initiative: Briefing Paper, Preliminary Results." Unpublished program document. Topeka, KS: February 1998.

Kansas Department of Social and Rehabilitation Services. "Kansas Learning Disability Initiative." Unpublished program document. Topeka, KS: October 20, 1997.

Kaplan, April. "Transportation and Welfare Reform." [http://www.mfia.state.mi.us/ projzero/].1998.

Miller, J., S. Mulkey, and K. Kopp. "Public Rehabilitation Services for Individuals with Specific Learning Disabilities." Journal of Rehabilitation, April/May/June, 1984.

Mitchell, J., H. Jacobs, and F.Yen. "Costs and Response Rates in a Community Follow-up for a Psychiatric Vocational Rehabilitation Program." Rehabilitation Counseling Bulletin, vol. 31, 1987, pp. 273-277.

Moffitt, R., and B. Wolfe. "The Effect of the Medicaid Program on Welfare Participation and Labor Supply." Review of Economics and Statistics, vol. 47, no. 4, November 1992, pp. 615-626.

Moffitt, R., and E. Slade. "Health Care Coverage for Children On and Off Welfare." The Future of Children:Welfare to Work, vol.7, no.1, spring 1997, pp. 87-98.

Moore, K., M. Zaslow, M. Coiro, and S.M. Miller. "How Well Are They Faring? AFDC Families with Preschool-Aged Children in Atlanta at the Outset of the JOBS Evaluation." Washington, DC: U.S. Department of Health and Human Services, 1996.

Murphy, P. "Recovering from the Effects of Domestic Violence: Implications for Welfare Reform Policy." In Law and Policy: Understanding Women's Poverty: A Symposium on the Relationship of Domestic Violence and Welfare Receipt, vol. 19, no. 2, April 1997.

Najavits, L. "Group Therapy Helps Addicted Women with Abuse History." Alcoholism and Drug Abuse Weekly, vol. 9, no. 33, September 1, 1997, pp. 5-6.

National Association of Sick Child Daycare. National Association of Sick Child Daycare brochure. Richmond, VA: NASCD, 1997.

National Center for Disability Services. "National Center for Disability Services Fact Sheet." Unpublished program document. Albertson, NY, 1996.

National Conference of State Legislatures. "On the Road to Self-Sufficiency." [http://www.urban.org/periodcl/prrzs_2h.htm.]. 1997.

U.S. Bureau of the Census. "Poverty in the United States: 1992." Current Population Reports, P60-185. Washington, DC: U.S. Bureau of the Census, September 1993.

U.S. Department of Health and Human Services. "Blueprint for a Cooperative Agreement Between Public Housing Agencies and Local Mental Health Authorities." Washington, DC: Public Health Service, no date.

U.S. Department of Health and Human Services. Cost of Addictive and Mental Health Disorders and Effectivness of Treatment. Washington, DC: Public Health Service, Substance Abuse and Mental Health Services Administration, no date.

U.S. Department of Health and Human Services. "Process Evaluation of the ACCESS Demonstration Projects for Homeless Persons with Mental Illness: Third Year Implementation Case Studies." Rockville, MD: Substance Abuse and Mental Health Services Administration, September 1997.

U.S. Department of Health and Human Services. Cooperation/Good Cause Forum Report. Washington, DC: Administration for Children and Families, Office of Child Support Enforcement, February 1997.

U.S. Department of Health and Human Services. "Making a Difference: Interim Status Report of the McKinney Demonstration Program for Homeless Adults with Serious Mental Illness." Washington, DC: Substance Abuse and Mental Health Services Administration 1994a.

U.S. Department of Health and Human Services. "Substance Abuse Among Women and Parents." Washington, DC: Office of the Assistant Secretary for Planning and Evaluation and the Public Health Service, National Institute on Drug Abuse, 1994b.

U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, and the National Institute on Drug Abuse. "Patterns of Substance Abuse Among Women and Parents." Washington, DC: DHHS, 1994c.

U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, and the National Institute on Drug Abuse. "Patterns of Substance Abuse and Program Participation." Washington, DC: DHHS/ASPE, 1994d.

U.S. Department of Health and Human Services. "Serious Mental Illness and Disability in the Adult Household Population: United States, 1989." Advance Data, from Vital and Health Statistics of the Centers for Disease Control/National Center for Health Statistics, U.S. Department of Health and Human Services, no. 218. September 16, 1992.

U.S. Department of Health and Human Services. "Drug Abuse Treatment: An Economical Approach to Addressing the Drug Problem in America." Washington, DC: 1991.

U.S. Department of Health and Human Services. "Federal Programs for Persons with Disabilities." Washington, DC: DHHS, 1990.

U.S. Department of Housing and Urban Development. "An Overview of the JOBS-Plus Community Revitalization Initiative for Public Housing Families." Washington, DC: HUD, 1997.

U.S. Department of Housing and Urban Development. "Rental Housing Assistance at Crossroads: A Report to Congress on Worst Case Housing Needs." Washington, DC: HUD, 1996.

U.S. Department of Labor, Women's Bureau. "Care Around the Clock: Developing Child Care Resources Before 9 and After 5." Washington, DC: Women's Bureau, 1995.

U.S. General Accounting Office. Welfare Reform: States' Efforts to Expand Child Care Programs. GAO/HEHS-98-27. Washington, DC: GAO, 1998.

U.S. General Accounting Office. Implications of Increased Work Participation for Child Care. GAO/HEHS-97-75. Washington, DC: 1997.

U.S. General Accounting Office. Welfare Reform: Implications of Increased Work Participation for Child Care. GAO/HEHS-97-75. Washington, DC: GAO, 1997.

U.S. General Accounting Office. Welfare to Work: Child Care Assistance Limited; Welfare Reform May Expand Needs. GAO/HEHS-95-220, Washington, DC: 1995.

U.S. General Accounting Office. Foster Care: Parental Drug Abuse Has Alarming Impact on Young Children. GAO/HEHS-94-89. Washington, DC: GAO, 1994a.

U.S. General Accounting Office. Child Care: Child Care Subsidies Increase Likelihood that Low-Income Mothers Will Work. Washington, DC: GAO, 1994b.

U.S. General Accounting Office. Vocational Rehabilitation: Evidence for Federal Program's Effectiveness Is Mixed. GAO/PEMD-93-19. Washington, DC: 1993.

Victim Services, Inc. "The Costs of Domestic Violence: Fact Sheet." New York: 1991.

Weeks, G., V. Gecas, R. Lidman, M. Seff, E. Stromsdorer, and J. Tarnai. "Washington State's Family Income Study: Results from the First Year." Olympia, WA: Washington State Institute for Public Policy, 1990.

Weeks, G. The Washington State Institute for Public Policy Family Income Study, Evergreen State College program data. In Trapped by Poverty, Trapped by Abuse: New Evidence Documenting the Relationship Between Domestic Violence and Welfare, by J. Raphael, and R. Tolman. Chicago, IL: The Project for Research on Welfare, Work, and Domestic Violence, April 1997.

Welfare Research Group. "The Effects of Welfare Changes on AFDC Recipients in Connecticut, Interim Report." Storrs, CT: University of Connecticut, 1997.

Willer, Barbara, Sandra L. Hofferth, Ellen E. Kisker, Patricia Divine-Hawkins, Elizabeth Farquhar, and Frederic B. Glantz. "The Demand and Supply of Child Care in 1990." Joint findings from the National Child Care Survey 1990 and a Profile of Child Care Settings." Washington, DC: National Association for the Education of Young Children, 1991.

Wood, D., R. Burciaga Valdez, J. Hayashi, and A. Shen. "Homeless and Housed Families in Los Angeles: A Study Comparing Demographic, Economic, and Family Function Characteristics. American Journal of Public Health, vol. 80, no. 9, 1990, pp. 1049-1052.

Wooldridge, J., D. Besharov, J. Jacobson, and J. Verdier. "Medicaid Policy and Welfare: How Do They Interact?" Paper presented at the National Association of State Medicaid Directors' Annual Conference, Alexandria, VA, October 1997.

Wooldridge, J., and S. Hoag. "Medicaid's Role in Encouraging Transitions from Welfare to Work." Princeton, NJ: Mathematica Policy Research, Inc., October 1996.

Working Woman. "Women's Shelters: Demand Up, Donations Down." In Measuring the Cost of Domestic Violence Against Women and the Cost-Effectiveness of Interventions: An Initial Assessment and Proposals for Future Research," by F. Laurence and R. Spalter-Roth. Washington, DC: Institute for Women's Policy Research, 1995.

Young, Nancy K. "Alcohol and Other Drug Treatment: Policy Choices in Welfare Reform." Washington, DC: Center for Substance Abuse Treatment and the National Association of State Alcohol and Drug Abuse Directors, 1996.

Young, Nancy K., and Sidney L. Gardner. "Implementing Welfare Reform: Solutions to the Substance Abuse Problem." Irvine, CA: Children and Family Futures, and Washington, DC: Drug Strategies, 1997.

Zill, N., K. Moore, C.W. Nord, and T. Stief. "Welfare Mothers as Potential Employees: A Statistical Profile Based on National Survey Data." Washington, DC: Child Trends, 1991.

Appendix A: Estimation of Need

Table 1

National and State Estimates:

Need for Child Care

Source and Population	Barrier Definition	Percentage
DURING NONSTANDARD HOURS
Kisker and Ross 1997 National Child Care Survey Working poor parents	Approximate percentage of those who work: Evenings Weekends Rotating or changing schedule	10 33 50
Long and Clark 1995 CCR&R staff and databases CCR&R staff in Chicago, Illinois	Requests to referral agencies for evening or weekend care	30
Economic Services Administration 1998 Baseline client survey Welfare recipients in Washington	Welfare clients who worked nonstandard hours	44
Smith 1995 Illinois Department of Public Aid Survey Welfare recipients in Illinois	Survey respondents who worked nontraditional hours	72

FOR SICK CHILD
Siegel and Loman 1991 Mail survey, focus groups, and in-person interviews Welfare recipients in Illinois	Problem finding care when child was sick: Major problem Problem For children 0 to 5 For children 6 to 13	29 62 61 65

FOR SPECIAL-NEEDS CHILD
Pavetti and Duke 1995 Case record reviews Welfare recipients in Utah, Colorado, and Iowa	Cases noting a child's behavioral or medical problem as a barrier to employment: Utah Colorado Iowa	13 15 18
Pavetti and Duke 1995 Survey of FaDSS program staff Welfare families in Iowa	Families who have children with special needs	25
Siegel and Loman 1991 Mail surveys, focus groups, and in-person interviews Welfare recipients in Illinois	Problem finding care when child has lengthy health problems Major problem Problem	17 36

Table 2

National and State Estimates:

Supply of Child Care

Source and Population	Barrier Definition	Percentage
DURING NONSTANDARD HOURS
GAO 1997 CCR&R staff and databases Baltimore, MD; Benton County, OR; Chicago, IL; and Linn County, OR	Known child care providers that offer care during nontraditional hours in poor areas: Baltimore, Maryland Benton County, Oregon Chicago, Illinois Linn County, Oregon	12 19 20 41
Lawson 1993a Data source unknown National estimate.	There are an estimated 12 centers in the country that offer 24-hour care

FOR SICK CHILD
Willer et al. 1991 National Child Care Survey Child Care Settings	Care providers, by type, that allow for sick-child care: Center care (spots or rash) Center care (feverish) Center care (severe cough)   Regulated family day care (spots or rash) Regulated family day care (feverish) Regulated family day care (severe cough)   Nonregulated family day care (spots or rash) Nonregulated family day care (feverish) Nonregulated family day care (severe cough)	3 6 15   10 20 25   36 50 50

FOR SPECIAL NEEDS CHILD
GAO 1997 CCR&R staff and databases Baltimore, Maryland	Known child care providers that offer care for special-needs children in poor areas in Baltimore, MD	13
Willer et al. 1991 National Child Care Survey Child Care Settings	Care providers, by type, that allow for special-needs children: Nonregulated family day care Regulated family day care Early education and care centers	23   39 74

^aCited in U.S. Department of Labor Women's Bureau 1995.

Table 3

National Estimates:

Work-Related Disabilities

Source and Population	Barrier Definition	Percentage
Olson and Pavetti 1996 National Longitudinal Survey of Youth (NLSY) 1991 Female welfare recipients	Welfare recipients not seeking work because of own medical problems	10
Loprest and Acs 1996 National Health Interview Survey (NHIS) 1991 Female welfare recipients	Welfare recipients unable to work due to a serious disability   Welfare recipients with a work limitation	10   18
Loprest and Acs 1996 National Longitudinal Survey of Youth (NLSY) 1991 Female welfare recipients (ages 27 to 34)	Welfare recipients with a work limitation	19
Adler 1993 Survey of Income and Program Participation (SIPP) 1990 Female welfare recipients (ages 15 to 45)	Welfare recipients with any functional disability	19
Loprest and Acs 1996 Survey of Income and Program Participation (SIPP) 1990 Female welfare recipients	Welfare recipients with a work limitation   Welfare recipients with any functional limitation	17   20

Table 4

State and Local Estimates:

Work-Related Disabilities

Source and Population	Barrier Definition	Percentage
Meyers et al. 1996 AFDC Household Sample 1992 Female welfare recipients in California	Welfare recipients unable to work due to a serious disability   Welfare recipients with a work limitation	11   31

Table 5

National Estimates:

Learning Disabilities, Including Low Basic Skills

Source and Population	Barrier Definition	Percentage
Nightingale et al. 1991 Adult Basic Education participation data Female welfare recipients	Welfare recipients with learning disabilities (estimated by applying the incidence of learning disabilities among Adult Basic Education participants to the proportion of welfare recipients who are known to have similarly low reading levels)	25 to 40
Quint et al. 1991 New Chance Demonstration Reading tests of participants Female welfare recipients from 15 sites	Welfare recipients reading at or below sixth-grade level	30
Zill et al. 1991 National Longitudinal Survey of Youth (NLSY) 1980 and 1991 Armed Forces Qualification Test Female welfare recipients	Welfare recipients with low basic skills (Low basic skills are defined by test scores below the minimum skill level of women in a low-skill occupation [manual laborers])	31
Olson and Pavetti 1996 National Longitudinal Survey of Youth (NLSY) 1980 and 1991 Armed Forces Qualification Test Female welfare recipients	Welfare recipients with low basic skills (Low basic skills are defined by scores in the bottom decile of the Armed Forces Qualification Test )	33

Table 6

State and Local Estimates:

Learning Disabilities, Including Low Basic Skills

Source and Population	Barrier Definition	Percentage
Giovengo and Moore 1997 Learning Disabilities Initiative Female welfare recipients in Washington	Welfare recipients with learning disabilities   Welfare recipients with learning disabilities and special learning needs (measured by low scores on an IQ test)	36   54
Kansas Department of Social and Rehabilitation Services 1997, 1998 Learning Disability Initiative Female welfare recipients in Kansas	Welfare recipients with learning disabilities   Welfare recipients with learning disabilities and special learning needs (measured by low scores on an IQ test)	36   up to 66

Table 7

National Estimates:

Domestic Violence

Source and Population	Barrier Definition	Percentage
Commonwealth Fund 1993 Survey of Women's Health National Sample of Women	Welfare recipients who were physically victimized or threatened by their current partner sometime during the past five years	24

^aCited in U.S. Department of Labor Women's Bureau 1995.

Table 8

State and Local Estimates:

Current Victims of Domestic Violence

Source and Population	Barrier Definition	Percentage
Curcio 1997 Passaic County Survey Female welfare recipients in New Jersey	Welfare recipients who are current victims of physical abuse	15
Iowa Department of Human Rights 1996 Survey data Program staff assessment of female welfare recipients in Iowa	Welfare recipients who are current victims of domestic violence	18
Lloyd 1997b Survey data Low-income women (including welfare recipients) in Chicago	Low-income women (including welfare recipients) who were victims of severe aggression from their partner during the past year	20
Allard et al. 1997 McCormick Institute survey data Female welfare recipients in Massachusetts	Welfare recipients who were victims of physical domestic violence (including threatening behavior) during the past year	20
Lloyd 1997a Utah Single Parent Demonstration Case reviews Female welfare recipients in Utah	Welfare recipients who are current victims of domestic violence	27
Bassuk et al. 1996 Better Homes Fund Survey Low-income women in Massachusetts (mostly welfare recipients)	Low-income women (mostly welfare recipients) who experienced severe physical violence from their partner within the past two years	32

Table 9

State and Local Estimates:

Ever Victims of Domestic Violence During Adult Life

Source and Population	Barrier Definition	Percentage
Horizon Research Services 1996 Survey data Female welfare recipients in Missouri	Welfare recipients who are current or past victims of physical domestic abuse	29
Lloyd 1997b Survey data Low-income women (including welfare recipients) in Chicago	Welfare recipients who were ever victims of severe aggression from their male partners during their adult life	34
Pearson and Griswold 1998 Colorado Model Office Project Survey Female welfare recipients for whom child support is an issue	Welfare recipients who are current or past victims of physical, emotional, or sexual domestic abuse	40
Iowa Department of Human Rights 1996 Survey data Program staff assessment of female welfare recipients in Iowa	Welfare recipients who are current or past victims of domestic violence	47
Iverson (no date) Case reviews Female welfare recipients in Oregon not making adequate progress toward work	Welfare recipients who have ever been physically or sexually abused	50
Weeks (no date) Survey data Female welfare recipients in the state of Washington	Welfare recipients who are or were victims of physical abuse or aggression by male partner	55
Curcio 1997 Passaic County Survey Female welfare recipients in New Jersey	Welfare recipients who have ever been victims of physical domestic violence in their adult life	57
Bassuk et al. 1996 Better Homes Fund Survey Low-income women in Massachusetts (mostly welfare recipients)	Welfare recipients who ever experienced severe physical violence from their partner in their adult life	61
Allard et al. 1997 McCormick Institute Survey data Female welfare recipients in Massachusetts	Welfare recipients who ever experienced physical domestic violence (including threatened behavior) in their adult life	65

Table 10

State and Local Estimates:

Recipients of Diversionary Assistance

Source and Population	Barrier Definition	Percentage
Program descriptions State caseload data Welfare applicants	Potential welfare recipients diverted from public assistance in: Maryland Wisconsin Virginia Montana Utah	<5 <5 <5 12 20

Table 11

State/Local Estimates:

Recipients of Work-Related Payments

Source and Population	Barrier Definition	Percentage
Rangarajan 1998 Postemployment Services Demonstration Welfare recipients in four sites (Riverside, California; Chicago, Illinois; Portland, Oregon; San Antonio, Texas)	Current welfare recipients who were assisted with work-related payments	47

Table 12

National and State Estimates:

Housing Instability

Source and Population	Barrier Definition	Percentage
U.S. Department of the Census and the U.S. Department of Housing and Urban Development 1995a American Housing Survey Welfare recipients in households	Households with poor quality housing	5
Pavetti 1995b Review of JOBS case records Welfare recipients in the State of Utah	Welfare recipients who reported homelessness as a barrier to employment	9
U.S. Department of the Census and the U.S. Department of Housing and Urban Development 1995a American Housing Survey Welfare recipients in households	Households who reported that housing had moderate physical inadequacies Suburban Urban Rural	9 10 12
U.S. Department of the Census and the U.S. Department of Housing and Urban Development 1989c American Housing Survey National sample of households	Certificate/voucher holders who reported a problem with noise	12
U.S. Department of the Census and the U.S. Department of Housing and Urban Development 1995a American Housing Survey Welfare recipients in households	Households with overcrowding problems Rural Urban Suburban	12 18 19
U.S. Department of the Census and the U.S. Department of Housing and Urban Development 1989c American Housing Survey National sample of households	Certificate/Voucher holders who reported a problem with crime	17
U.S. Department of the Census and the U.S. Department of Housing and Urban Development 1989c American Housing Survey National sample of households	Public housing residents who reported a problem with undesirable neighbors	23

Source and Population	Barrier Definition	Percentage
U.S. Department of the Census and the U.S. Department of Housing and Urban Development 1995a American Housing Survey Welfare recipients in households	Households with severe cost problems only	26
U.S. Department of the Census and the U.S. Department of Housing and Urban Development 1989c American Housing Survey National sample of households	Public housing residents who reported a problem with crime	37
Quint et al. 1991b New Chance Demonstration Staff Survey Program participants	Program participants who faced a housing problem that interfered with their ability to participate in a training program	48
U.S. Department of the Census and the U.S. Department of Housing and Urban Development 1995a American Housing Survey Welfare recipients in households	Households with major housing problems (either cost, quality, and/or crowding problems): Rural Suburban Urban	64 68 72

^aCited in Housing Assistance Council 1996.

^bCited in Olson and Pavetti 1996.

^cCited in Newman and Schnare 1993.

Table 13

State Estimates of Health Insurance Receipt

(Medicaid)

Three Months After Exiting Welfare

Data Source and Population	Barrier Definition	Percentage
Ellwood and Adams 1990 State of California Medicaid Enrollee and Claim Data, 1980-86 Former welfare recipients in California	Former welfare recipients (all eligible for Medicaid) who were insured by Medicaid three months after exiting welfare	17
Ellwood and Adams 1990 State of Georgia Medicaid Enrollee and Claim Data, 1980-86 Female welfare recipients in Georgia	Former welfare recipients (all eligible for Medicaid) who were insured by Medicaid three months after exiting welfare	29

Table 14

National Estimates of Health Insurance Receipt

(Either Medicaid or Private)

One Year After Exiting Welfare

Data Source and Population	Barrier Definition	Percentage
Moffitt and Slade 1997 National Longitudinal Survey of Youth (NLSY) 1989-1992 Female welfare recipients	Former welfare recipients receiving insurance (either Medicaid or Private) one year after leaving AFDC   Former welfare recipients receiving private insurance one year after leaving AFDC   Former welfare recipients receiving Medicaid one year after leaving AFDC	77   25   52

Table 15

National Estimates of Health Insurance Receipt

(Either Medicaid or Private)

Three Years After Exiting Welfare

Data Source and Population	Barrier Definition	Percentage
Moffitt and Slade 1997 National Longitudinal Survey of Youth (NLSY) 1989-1992 Female welfare recipients	Former welfare recipients receiving insurance (either Medicaid or Private) three years after leaving AFDC   Former welfare recipients receiving private insurance three years after leaving AFDC   Former welfare recipients receiving Medicaid three years after leaving AFDC	55   38   17

Table 16

National Estimates:

Mental Health Issues

Data Source and Population	Barrier Definition	Percentage
Barker et al. 1992 National Health Interview Survey (NHIS)- Mental Health 1989 Low-income adults	Low-income adults who have a serious mental illness	4
Leon and Weissman 1993 National Institute of Mental Health Epidemiologic Catchment Area Program, Survey Data 1979-82 Female welfare recipients in five sites	Welfare recipients meeting diagnostic criteria for major depressive disorder   Welfare recipients meeting diagnostic criteria for any affective disorder	6   13
Olson and Pavetti 1996 National Longitudinal Survey of Youth (NLSY) 1991 Female welfare recipients	Welfare recipients suffering from feelings of depression between three and five days per week   Welfare recipients suffering from feelings of depression between five and seven days per week	11   13
Jayakody and Pollack 1997 National Household Survey of Drug Abuse 1994 and 1995 Female welfare recipients	Welfare recipients meeting diagnostic criteria for a psychiatric problem sometime during the past year (including depression, generalized anxiety disorder, panic attack, or agoraphobia)	23
Quint et al. 1994 New Chance Demonstration Program, Survey Data Female welfare recipients in 15 sites	Welfare recipients at high risk of clinical depression based on responses to a four-item scale adapted from the Center for Epidemiological Studies Depression Scale	28

Table 17

State and Local Estimates:

Mental Health Issues

Data Source and Population	Barrier Definition	Percentage
Weeks et al. 1990 Survey data Female welfare recipients in Washington	Welfare recipients with symptoms of serious depression based on a 10-item scale	13
Moore et al. 1996 Survey data of JOBS participants Female welfare recipients with children in Fulton County, Georgia	Welfare recipients with symptoms of moderate or severe depression based on a four-item scale adapted from the Center for Epidemiological Studies Depression Scale	27
Iowa Department of Human Rights 1995 Survey of program staff about welfare recipients in Iowa	Welfare recipients with mental health issues	39

Table 18

National Estimates:

Substance Abuse

Source and Population	Barrier Definition	Percentage
Olson and Pavetti 1996 National Longitudinal Survey of Youth 1991 Welfare recipients	Concerned about being an alcoholic or had recent problems	5
	Has used or currently uses cocaine or crack extensively	9
	Has used or currently uses marijuana extensively	16
	Some physical indications of problem drinking	20
DHHS 1994b National Household Survey on Drug Abuse 1991 Female welfare recipients	Women on welfare who were significantly impaired by their use of AOD	5
	Women in welfare households who reported heavy alcohol use	8
	Women on welfare who were somewhat impaired by their use of AOD	11
	Women in welfare households who reported illicit drug use	11
Merrill 1996a National Longitudinal Survey of Youth 1992 Female welfare recipients	Women on welfare between 27 and 35 who abused alcohol or drugs	26
Merrill 1994a National Household Survey on Drug Abuse 1991 Female welfare recipients	Percentage of women on welfare who used drugs or were heavy drinkers	27

^a Cited in Young 1996.

Table 19

State and Local Estimates:

Substance Abuse

Source and Population	Barrier Definition	Percentage
Sisco and Pearson 1994a Project Independence Montgomery County, Maryland Female welfare recipients	Drug abusers	9
	Alcoholics	11
	Possible alcoholics	15
	Alcoholics and/or drug users	16
	Drug users	17
	Possible alcoholics and/or drug users	21
Olson and Pavetti 1996 New Chance Demonstration Teen mothers on welfare	Alcoholics	12
	Drugs interfered with program participation	15
Iowa Department of Human Rights 1995 Caseworker responses Families on welfare	Alcoholics and/or drug users (current)	24
	Alcoholics and/or drug users (past)	32
Legal Action Center 1997 State survey data State estimates of welfare caseload	Oklahoma: percentage of caseload with AOD problem	5 to 30
	North Carolina: percentage of caseload at risk for AOD and needs treatment	35
	Kansas: percentage of caseload that would fail a drug test	20 to 50
	Oregon: percentage of caseload with AOD problem	50 to 60

^aCited in Olson and Pavetti 1996.

Table 20

National, State and Local Estimates:

Transportation Barriers

Source and Population	Barrier Definition	Percentage
GENERAL
Welfare Research Group 1997 Welfare Research Group Study Welfare recipients in the state of Connecticut	Welfare recipients in Connecticut who perceive transportation as a barrier to employment	40
USE AND ADEQUACY OF PUBLIC TRANSPORTATION
U.S. Bureau of the Census and U.S. Department of Housing and Urban Development 1995 American Housing Survey National sample of households Welfare recipients	Welfare recipients who consider public transportation to be inadequate, by area: Urban Suburban Rural	7 11 12
Community Transportation Association of America 1994 Survey of rural FTA grant recipients National sample of FTA grant recipients	Rural counties in the U.S. with no public transportation	40
Leete and Bania 1995 Census Public Use Microdata Sample (PUMS) 1990 National sample of welfare recipients	Welfare recipients who rely on public transportation	42
Leete and Bania 1995 Census Public Use Microdata Sample (PUMS) 1990 Housing units in Cleveland-Akron area, Ohio	Welfare recipients who rely on public transportation	52
Lacombe 1998 Geographic Information System (GIS) Boston, Massachusetts	Welfare recipients who live within one mile of a bus route or transit station	58
Table 20 (continued) Transportation Barriers
Source and Population	Barrier Definition	Percentage
AVAILABILITY OF PERSONAL TRANSPORTATION
U.S. Department of the Census and the U.S. Department of Housing and Urban Development 1995b American Housing Survey National sample of households	Welfare households that do not own a car: Rural households Suburban households Urban households	28 33 57
Public Social Services Agency 1997 GAIN Program Survey 1996 Welfare recipients in Ventura County, CA	Welfare recipients who do not own a working car	50
Edin and Lein 1997a Study of welfare mothers Welfare mothers in selected cities	Welfare mothers in Boston who do not own a car	76
SPATIAL MISMATCH: EMPLOYMENT
Lacombe 1998 Massachusetts Division of Employment and Training Database Companies in the Boston area	Employers in areas of high growth for entry-level work, who can be reached within 30 minutes by transit	0
U.S. Bureau of the Census Public Use Microdata Survey Housing units in Cleveland-Akron area, Ohioa	Available jobs accessible by public transportation in less than 40 minutes	8 to 15
Lacombe 1998 Massachusetts Division of Employment and Training Database Companies in the Boston area	Employers in the Boston area who are within one-quarter mile of transit	32
Rich 1997 Survey of Businesses Employers in Atlanta, Georgia	Entry-level jobs that are transit accessible	46

^aCited in LaCombe 1998.

^bCited in Housing Assistance Council 1997.

^aCited in Coulton et al. 1996.

Table 21

National Estimates:

Multiple Barriers

Data Source and Population	Barrier Definition	Percentage
Olson and Pavetti 1996 National Longitudinal Survey of Youth (NLSY) 1991 Female welfare recipients	Welfare recipients facing two or more severe barriers to employment. (Barriers examined include own medical needs, children's chronic medical needs, substance abuse, mental illness, and low basic skills.)   Welfare recipients facing two or more severe or moderate barriers to employment. (Barriers examined include own medical needs, children's chronic medical needs, substance abuse, mental illness, and low basic skills.)	13   50
Quint et al. 1991 New Chance Demonstration Program, Survey of staff about participants Female welfare recipients from 15 sites	Welfare recipients facing two or more barriers to employment. (Barriers examined include substance abuse, housing, and domestic violence.)	40

Table 22

State and Local Estimates:

Multiple Barriers

Data Source and Population	Barrier Definition	Percentage
Pavetti 1995 Case file reviews Female welfare recipients in Utah	Welfare recipients facing two or more barriers to employment (Barriers examined include domestic violence, housing, medical needs, disabilities, substance abuse, mental health, and children's medical needs or behavioral problems.)	34

Table 23

State and Local Estimates:

Subgroups with Specific Co-Occurring Barriers

Data Source and Population	Barrier Definition	Percentage
MENTAL ILLNESS, SUBSTANCE ABUSE, AND HOUSING INSTABILITY
U.S. Department of Health and Human Services 1994a Survey and clinical records data Homeless men and women from four McKinney Demonstration sites	Homeless adults with co-occurring mental health and substance abuse problems	58
MENTAL ILLNESS AND HOUSING INSTABILITY
Wood et al. 1990 Survey data Low-income families in Los Angeles (half of whom were homeless)	Homeless women with a history of hospitalization for mental health problems	14
Padgett et al. 1990 Survey data, several mental health status scales, and clinical observations Homeless men and women in New York City	Homeless adults who need psychiatric treatment	50
SUBSTANCE ABUSE AND HOUSING INSTABILITY
Padgett et al. 1990 Survey data, hospital records data, and the Michigan Alcohol Screening Test Homeless men and women in New York City	Homeless adults who need drug treatment	24
Padgett et al. 1990 Survey data, hospital records data, and the Michigan Alcohol Screening Test Homeless men and women in New York City	Homeless adults who need treatment for alcoholism	29
Wood et al. 1990 Survey data Low-income families in Los Angeles (half of whom were homeless)	Homeless women who abuse drugs	32

Table 23 (continued) Subgroups with Specific Co-Occurring Barriers DOMESTIC VIOLENCE AND SUBSTANCE ABUSE
Curcio 1997 Passaic County Survey Female welfare recipients in New Jersey	Domestic violence victims receiving welfare who have drug or alcohol problems	19
Bassuk et al. 1996 Better Homes Fund Survey and substance abuse assessment instruments Low-income women in Massachusetts (most were welfare recipients, half were homeless)	Domestic violence victims receiving welfare who suffer from alcohol/drug abuse or dependency	38
Najavits 1997 Estimates based on hospital data Women in substance abuse treatment, McLean Hospital, Belmont, MA	Women in substance abuse treatment who have been physically or sexually abused during their lifetime	50 to 90
Stevens and Arbiter 1995 Survey data Women in substance abuse treatment	Women in substance abuse treatment who reported being assaulted or raped	90 to 95
DOMESTIC VIOLENCE AND MENTAL ILLNESS
Lloyd 1997 Survey data Low-income women (including welfare recipients) in Chicago	Domestic violence victims receiving welfare who report problems with depression	42
Curcio 1997 Passaic County Survey Female welfare recipients in New Jersey	Domestic violence victims receiving welfare who suffer from severe depression	54
DOMESTIC VIOLENCE AND HOUSING INSTABILITY
Bassuk et al. 1996 Better Homes Fund Survey and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders Low-income women in Massachusetts (most were welfare recipients, half were homeless)	Homeless women who were also victims of severe domestic violence during the past two years	32
Wood et al. 1990 Survey data Low-income families in Los Angeles (half of whom were homeless)	Homeless women who were also victims of domestic violence	35