Providing Mental Health Services to TANF Recipients: Program Design Choices and Implementation Challenges in Four States. Broad Screening for Mental Health Needs and Informing Clients about Services


Broad screenings during client orientation to employment services and job club workshops are one way in which clients are informed about and identified for mental health services. In some local offices, mental health staff administer screening tools to all welfare recipients during orientation to identify those at risk for mental health conditions. Welfare recipients in Miami, Florida, who receive employment services from the AWI (Agency for Workforce Innovation) Hialeah One-Stop Center, are screened by a bachelor's level outreach worker. A licensed clinical social worker in the St. John's welfare office in Portland, Oregon, talks with new welfare recipients during orientation and administers a depression scale and a general mental health screening.

A local welfare office in Astoria, Oregon, which has a unique approach to screening, identifies clients as candidates for mental health services during the initial intake. For instance, when clients first apply for cash assistance, they meet with the lead staff person, who has more than 20 years of experience as a welfare case manager. This lead staff person screens for TANF eligibility, informs clients about mental health services, and conducts a brief assessment to identify clients who may have a mental health condition. This type of approach may be more realistic in rural areas, where the caseloads are relatively small and staff are familiar with the families who receive cash assistance.

The advantage of broadly screening welfare recipients in the welfare office ensures that clients are identified and linked to services. The drawback of broad screening is that clients who may not need mental health services or who are not willing to participate in treatment are referred to mental health staff, which may overload mental health staff.

Clients also are informed about mental health services during formal presentations given during individual or group orientations, or during other meetings in the welfare office. Clients may then self-refer to mental health services. In Tennessee and Utah, mental health services are described to new and returning clients as part of their standard orientation. Clients receiving employment services in the Caleb One-Stop Center in Miami, Florida, learn about mental health services during the job club workshop. Clients may refer themselves to the program based on the information they obtain during the presentations.

Formal presentations ensure not only that clients are informed about mental health services, but also that they receive the same information about the services. Furthermore, it brings clients and mental health staff together, creating a direct link to services, rather than relying on a referral from employment staff. One challenge is obtaining permission from local welfare administrators to participate in client TANF orientation or during job search workshops to talk about mental health services.

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