Providing Mental Health Services to TANF Recipients: Program Design Choices and Implementation Challenges in Four States. Integrating Mental Health Services into Work Activities


One of the distinguishing features about programs designed to address the mental health needs of welfare recipients is the strong emphasis on employment. In all of the study sites, mental health program workers reiterated that the goal of mental health services is to help the client move from welfare to work. Some of the ways states integrate work into mental health services include the following.

Counting participation in mental health services toward the TANF work requirement. All of the study states allow mental health services to be counted as a work activity in the client's employment plan. This policy not only creates an incentive for clients to participate in treatment but also encourages employment and mental health staff to work together in helping the client progress toward self-sufficiency.

States vary in who can modify employment plans. In Tennessee, the mental health counselor is the only person who can modify the client's employment plan, whereas in Utah and Oregon, mental health counselors make recommendations about the types and amount of activities, but the employment case manager makes the final decision. In most cases, the employment case manager accepts the recommendations of the mental health staff. When mental health is written into the employment plan, the employment case manager is also responsible for ensuring that the client participates in treatment.

Educating treatment providers about work and participation requirements. At many of the study sites, mental health staff help mental health treatment providers understand the TANF requirements for receiving cash assistance, such as work requirements, time limits, sanctions, etc. In Multnomah County, Oregon, mental health counselors specifically said that educating treatment providers about TANF requirements is one of their job responsibilities. This educational experience not only strengthens the relationship between mental health and employment staff but also brings dual-system support to the effort to move welfare recipients into jobs by building the treatment providers' understanding of the circumstances of welfare recipients and the demands placed on them to become employed.

Allowing Mental Health Activities in Client Employment Plans

PRWORA requires states to meet increasingly higher work participation rates and specifies which work-related and mental health activities can count toward that requirement. However, because of substantial caseload declines, states actually have considerable flexibility in defining the types of mental health activities that can count toward the work requirement. In fiscal year 1999, states were required to have 35 percent of all families participating in work activities, less any caseload reduction credit. On the basis of caseload declines, 23 states were not required to have families participating in work activities, and only 2 states were required to have 20 percent or more of their TANF caseload participating in work activities (U.S. Department of Health and Human Services 2000). This loosening of the work requirement has allowed states to approve participation in activities such as mental health counseling or to temporarily defer clients from participation in work activities while they address issues that may be interfering with their ability to find or maintain employment. The biggest challenge states are likely to face in permitting mental health activities to be included in employment plans is overcoming the belief by policymakers that participation in mental health counseling or other similar activities may weaken the emphasis on work. This need not be the case if these activities are provided with an eye toward helping clients find and maintain employment. Oregon and Utah are two states that have broadly defined the activities that can be included in a clients self-sufficiency plan, and neither their participation rates nor their program emphasis has been negatively affected.

Using a short-term, employment-focused and/or solution-focused mental health treatment model. Some states, such as Tennessee and Utah, have encouraged mental health counselors and treatment providers to use a short-term, employment-focused mental health treatment model for working with TANF clients. In fact, family services counselors in Tennessee have been trained to use a short-term, solution-focused mental health treatment approach. District coordinators in the state review case files at random to ensure that mental health counselors use this approach. Similarly, mental health counselors in Utah work closely with contracted mental health treatment providers to ensure that treatment is short-term and employment-focused. Mental health counselors in Tennessee and Utah indicated, however, that some clients require a different approach However, in general, mental health staff believe that the short-term, solution-focused method is effective for welfare recipients with less severe mental health conditions.

Providing employment services in mental health treatment facilities. In Florida, where mental health treatment is provided by using TANF funds, some of the mental health treatment facilities have developed employment-focused activities exclusively for welfare recipients referred to them. For example, Western Palm Beach County Mental Health, a contracted treatment provider in Belle Glade, developed a job-seekers club, in which TANF recipients receiving mental health services meet to talk about life skills such as prioritizing, balancing work and family responsibilities, and child rearing.

Developing a plan to transition clients from mental health treatment to work. Mental health staff at most of the sites work closely with employment case managers to monitor client progress in treatment and to recommend ways for gradually increasing work activities. Recommendations may be given during case staffings or during informal conversations between employment case managers and mental health staff.

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