Ancillary Services to Support Welfare to Work. Multiple Barriers

06/22/1998

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 Tables 21, 22, and 23 in Appendix A. These studies have analyzed the extent to which a sample of welfare recipients experiences the co-occurrence of any combination of barriers to employment, rather than a specific combination of barriers (for example, domestic violence and substance abuse). The range in these estimates, presented in the box above, is largely explained by three key factors:

  • Barrier Definition. Studies that use a broader definition of multiple barriers elicit a higher estimate of need. The upper-bound estimate, for instance, is based on a broad definition of multiple barriers that includes those problems that are either severe or moderate in nature (Olson and Pavetti 1996). This definition, however, only examines five different barrier areas.
  • Study Sample. While all the samples include welfare recipients, some are more representative than others. Estimates from the New Chance Demonstration (Quint et al. 1991) were obtained from interviews in which staff were asked about the characteristics of welfare clients whose cases they knew well. Since clients who are best known by staff are the ones most likely to have multiple barriers, this study may overestimate the prevalence of multiple barriers among the welfare population. Estimates from the National Longitudinal Survey of Youth were obtained only for clients between the ages of 27 and 35 (Olson and Pavetti 1996).
  • Measurement Method. The three studies examined used different methods to collect the data, from client surveys, to case reviews, to staff surveys. These differing methods are likely to cause some variance in the estimates.

Other studies have presented data on specific combinations of barriers. Among welfare recipients with multiple barriers, low basic skills (discussed as a type of disability) is the most common barrier to occur in conjunction with another barrier (Olson and Pavetti 1996). Several other commonly co-occurring barriers are mental illness, housing instability, domestic violence, and substance abuse. It is difficult to summarize or compare estimates of specific co-occurring barriers both because they measure different barriers and because they are either not confined to the welfare population or include only a segment of it. However, the extent to which particular barriers co-occur is important, and these estimates are presented in a separate table (Table 23).

Relationship to Welfare Receipt

  • People with multiple barriers are more likely to receive welfare for extended periods of time. During a two-year period, more than 50 percent of those who received welfare for longer than one-and-a-half years had multiple barriers; in contrast, only 5 percent of those who received welfare for less than six months had multiple barriers (Pavetti 1995).
  • Long-term welfare recipients (five years or more) are more likely to have severe barriers to employment than are short-term welfare recipients (less than two years)--54 percent, compared to 40 percent (Olson and Pavetti 1996).

Relationship to Employment Status

  • Welfare recipients with multiple barriers are less likely to maintain continuous employment throughout a given year.(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).