Providing Mental Health Services to TANF Recipients: Program Design Choices and Implementation Challenges in Four States. Florida: Mental Health Agency Administers the Program and Contracts with Providers to Deliver Services


Florida is the only study state to transfer full responsibility for the operation of its mental health services program to an agency that has no direct ties to the welfare or the employment services system. The program is housed within the Department of Children and Families (DCF)(10) and operates under both the Mental Health and the Substance Abuse Program offices but collaborates on policy issues with the Office of Economic Self-Sufficiency.(11) A program director and three staff members in the state office administer the program. In each DCF district or region, at least one specialist oversees program activities in the local office. All program employees are hired as "other personnel services" (OPS) employees, which are temporary positions renewed every six months, without employment benefits (such as health insurance, sick leave, and retirement).

The DCF district or region administrator selects and contracts with mental health and substance abuse treatment providers in each local community. The terms of these contracts are negotiated with the TANF specialists and local district administrators. In some communities, there is one primary contractor, and in others there are many contractors. Contracted service providers include a range of organizations such as substance abuse and community mental health centers, residential treatment providers, faith-based organizations, and hospitals. The contracted service providers hire outreach workers, conduct clinical assessments, and provide mental health and substance abuse treatment.

The advantage of transferring administrative responsibility to a mental health agency is that the state can bring into play the agency's in-depth understanding of the local mental health system that the TANF agency does not have. The drawback is that it can be much harder to integrate mental health services into existing welfare employment services, and, indeed, Florida's system is the least integrated of the four study states. The integration of services is further complicated by the fact that the employment services system that serves TANF recipients is locally administered, making the employment expectations and service delivery structure different in every local office.

Communication and Collaboration between Agencies and Workers

A recurring theme in each study site is the importance of communication and collaboration among agency administrators and mental health and employment staff. Three strategies or factors appear to foster or improve communication and collaboration.

  1. Co-location of Workers. Co-location of mental health staff in the welfare office or at locations where welfare recipients are served improves the communication and collaboration between employment and mental health staff. In Tennessee, the program director of mental health services (an employee of a contracted service provider) also is co-located in the state welfare administrative office.
  2. Program Coordinators at the Local Level. Some sites have coordinators at the local level whose primary responsibility is to foster collaborative relationships among agencies. In Tennessee, eight district coordinators and, in Florida, 22 TANF substance abuse/mental health specialists facilitate communication and collaboration among workers and agencies and oversee program implementation at the local level. In Multnomah County, Oregon, the employment service provider hired a local program coordinator to oversee and administer mental health and substance abuse services in the eight welfare offices in the county.
  3. Build on Established Collaborative Relationships. Sites in which community agencies have a long history of collaboration are more likely to work effectively together to develop and deliver mental health services to welfare recipients. At the state and local level, relationships established before program implementation can be valuable in designing and implementing mental health services for welfare recipients.

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