Providing Mental Health Services to TANF Recipients: Program Design Choices and Implementation Challenges in Four States. Automatic Referrals to Mental Services


In some states, certain subgroups of the TANF population are automatically referred to mental health services. These subgroups include families who have been sanctioned for noncompliance in work activities, families nearing the end of their time limit on cash assistance, and clients with a potential drug or alcohol addiction. In Tennessee, sanctioned families are referred to the Family Services Counseling program. In Utah, licensed clinical social workers participate in extension hearings for families nearing their time limit. In addition, welfare recipients in Utah who respond "yes" to two or more questions on the four-question CAGE(8) substance abuse screening questionnaire are automatically referred to mental health services by the employment case manager.

The advantage of automatic referrals to mental health services is that clients most in need of these services are likely to get them. That is, the automatic referrals apply to people who are sanctioned or who are reaching their time limit but have not found employment, and we would assume that these clients are in this position because they face more severe barriers to employment, one of which could be a mental health condition. The challenge for the system is getting these clients to participate in mental health services. Some of the same barriers that prevented them from working or from participating in their employment plan may also be obstacles to participating in mental health treatment.

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