Providing Mental Health Services to TANF Recipients: Program Design Choices and Implementation Challenges in Four States. Primary Focus on Mental Health and Substance Abuse


In general, there are high rates of co-occurrence between substance abuse and mental health conditions. A study conducted by Reis (1995) estimates that more than half of those with a mental health disorder also have problems with substance abuse. Individuals with co-occurring conditions often have treatment needs that addresses both substance abuse and mental health issues. Unfortunately, there is a shortage in most communities of treatment that addresses both conditions (U.S. Department of Health and Human Services 1999).

Oregon and Florida focus on both mental health and substance abuse needs. In Oregon, the staffing is structured in one of two ways. In some areas, one worker handles both substance abuse and mental health conditions. For example, in Astoria, the specialist has a Ph.D. in clinical psychology and is a certified substance abuse treatment provider. In other areas of the state, specialists in either function work as a team. In Multnomah County, for instance, individuals hired as either mental health or substance abuse specialists meet weekly to staff cases and coordinate the mental health and substance abuse treatment of clients.(7)

Given the prevalence of co-occurring substance abuse and mental health conditions, the service model addressing both may be especially effective. The primary challenge in implementing this model is to find staff who are clinically proficient in both areas. Typically, it is easier to find individuals with training in one area or the other. In most communities, hiring staff who perform separate functions is easier than hiring staff with combined expertise. However, in some areas, particularly in rural locations, there are not enough clients to justify the need for two specialists. For instance, the Florida state Mental Health and Substance Abuse Program Offices contract with mental health and substance abuse agencies to provide services, relying on outreach workers to link clients to these services.

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