Providing Mental Health Services to TANF Recipients: Program Design Choices and Implementation Challenges in Four States. Selection of the Sites


Our goal in selecting the sites was to include a range of programs that were operating at the state or county level, had sufficient experience in serving welfare recipients, and that varied in how they structured and provided services. We also wanted to include a mix of rural and urban sites. Specific site-selection criteria included the following:

Provision of Mental Health Services to Welfare Recipients Statewide or Countywide. Programs designed to address the mental health needs of welfare recipients vary in scale. Some operate at the state or county level and are integrated into the full range of services provided to welfare recipients. Others are individual programs run through one agency that serve a narrowly defined group of clients. We selected only programs operating on a state or county level, but they could be run out of the welfare, workforce development, or mental health systems.

Operating Before or Since the Implementation of PRWORA in 1996. Most of the programs we identified were implemented in response to state and federal welfare reform efforts. However, several programs were designed before the passage of federal welfare reform. Our goal was to include programs that, together, would represent a range of experience. For instance, from the programs that have been in operation for a longer period of time, we hoped to gather more information about how they have evolved. From the more recently established programs, we hoped to gather information on program design in the context of a work-based assistance system and a block grant funding arrangement.

Service Provision to a Relatively Large Number of Clients. We wanted to include programs that have substantial experience in providing mental health services to welfare recipients, as defined by the number of clients served. We selected statewide programs that had served at least 500 clients and countywide programs that had served at least 200 clients since inception.

Variation in the Structure and Delivery of Services. States and localities can structure and deliver mental health services to welfare recipients in a variety of ways. For example, some programs provide all of the services in-house, others use contracted service providers, and still others use a combination of the two. We attempted to include programs that would represent this variation in service type, structure, and delivery. In addition to the administrative framework for providing mental health services, we also considered the administrative structure for providing employment services, staffing for mental health services, the approach to identifying clients with mental health conditions, and the location at which mental health services are provided.

Rural/Urban Mix of Study Sites in Each State. We wanted to include an urban and a rural site for each state to learn how location, community demographics and infrastructure may influence the way mental health services are structured and delivered. In choosing the urban sites, we wanted to include at least one site with a very large and demographically diverse TANF population. In general, we let program administrators recommend sites. We were also looking for urban and rural sites in close proximity to one another or sites that may have implemented an innovative approach to providing services.(5)

Based on these criteria, we selected eight study sites   a rural and an urban site in each of four states (Table I.3). A detailed description of each state's approach to providing mental health services to welfare recipients appears in Appendix A.


State Urban Sites Rural Sites
Site TANF Cases Site TANF Cases
Florida Miami
(Dade County)
16,615 Belle Glade
(Palm Beach County)
Oregon Portland
(Multnomah County)
3,500 Astoria
(Clatsop County)
Tennessee Chattanooga
(Hamilton County)
2,450 Clarksville
(Montgomery County)
Utah Salt Lake City
(Salt Lake County)
2,165 St. George
(Washington County)

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