Oregon has a state-administered TANF system, but local (district) offices have considerable flexibility to decide how to structure and provide employment-related services to TANF recipients. A program analyst in the state TANF agency acts as the statewide coordinator for mental health services. The program analyst oversees the policy guidelines and training for mental health and substance abuse services. The program analyst also coordinates with the mental health contracted treatment providers and addresses contractual questions. In the local offices, there is wide variation in the organization of mental health services. In two counties we visited, local program coordinators administer, monitor, and supervise the mental health and substance abuse services in their counties. Most counties have specialists in mental health and substance abuse treatment who have extensive experience and strong clinical training. Some offices have separate specialists for mental health and substance abuse treatment, while other offices have a specialist with expertise in both areas.
Most mental health services are staffed by contractors, and, in general, contracting arrangements are handled either by the Adult and Family Services (AFS)(9) district office or through the prime employment and training service contractor. For example, in Astoria, the AFS district office contracts directly with Clatsop Behavioral Healthcare for a part-time (20 hours a week) licensed counselor to provide mental health and substance abuse services to welfare recipients. This licensed counselor is co-located in the Astoria welfare office and Clatsop Behavioral Healthcare. In Multnomah County, the employment and training service providers, Mount Hood and Portland Community colleges, hire mental health specialists directly. Through a subcontract with local mental health treatment providers, these specialists work within the local welfare offices. Mental health treatment is provided by Medicaid providers. In general, the Medicaid-funded mental health agencies provide a range of outpatient mental health services, including assessment, case management, and individual and group therapy. In-patient treatment is limited to the urban areas, and treatment for co-occurring mental health and substance abuse conditions is limited throughout the state.
The advantage of this model is that local communities can develop an administrative structure that works best for them. In addition, it provides district offices with an opportunity to fully integrate their mental health services into their welfare employment services program.