Where mental health services are provided influences how and the extent to which clients are connected with mental health services. We observed several variations among sites with regard to where mental health services are provided. Except for Tennessee, which co-locates all mental health counselors in the welfare office or with contracted employment service providers (e.g., a local housing project), most states vary by local office as to where services are provided. In some of the study sites, mental health workers co-located in the local office that serves welfare recipients provide services in that office. In other study sites, mental health workers are co-located and provide services in other agencies that serve low-income families (e.g., public health centers, Head Start offices, etc.). Contracted mental health counselors often work out of the agency where they are employed.
Welfare Office/Employment Center (Co-located Workers)
Most mental health workers, regardless of where they work, indicated that being co-located in the welfare office is the ideal arrangement for providing mental health services. Tennessee and some offices in Utah, Oregon, and Florida co-locate mental health staff in the local welfare office. Providing mental health services in the welfare office by co-locating mental health staff has several advantages:
- Mental health staff are more integrated into the employment service delivery system. According to mental health workers, co-location helps them build a relationship with employment staff, which tends to increase the number of referrals to mental health services.
- Client access to mental health services is improved, and a direct link is created for referring clients to the program. Providing mental health services in the welfare office gives clients direct access to mental health staff because they do not have to rely exclusively on employment case managers to refer them to mental health services (especially in offices where the mental health counselor participates in orientation).
- Fewer clients may drop out of mental health treatment. Providing mental health services at the local welfare office may increase the likelihood that clients continue in treatment, especially when clients regularly attend job search workshops or other activities at the welfare office.
- Mental health counselors become an immediate resource for employment staff. The closer proximity of the two types of staff gives mental health counselors an opportunity to educate employment staff about how to handle clients with mental health conditions, to participate in agency meetings and case staffings, and to deal readily with client crises.
The primary challenge in providing mental health services in the welfare office is finding enough office space in which mental health counselors can meet privately with clients.
Contracted Service Providers
In some local offices, mental health services are provided in the contracting agency's office by a mental health counselor. The screening and assessment services provided by the mental health counselor are paid for with TANF funds, but the treatment may be paid for either by TANF or Medicaid funds. In this arrangement, the employment case manager refers clients with mental health conditions to the contracted mental health service provider. Outreach workers in Florida and some mental health counselors in Oregon provide services out of the agency where they are employed.
One advantage of providing mental health services out of the contracted service provider's offices is that clients "look like" other nonwelfare individuals receiving mental health services, removing the stigma of being identified as welfare recipients and thereby making it more likely that they will stay in treatment. The drawback is that, unless clients are directly and quickly linked to mental health staff, they may not participate in mental health services, or they may miss appointments because of the inconvenience of traveling to a location apart from the welfare office, especially if they are ambivalent about participating in mental health services to begin with.
Mental health services are also provided at locations other than the welfare office or contracted service provider agency. In Florida, outreach workers co-located in community health clinics and local Head Start offices identify families that may benefit from mental health services. In St. George, Utah, where private office space is limited in the local employment center, mental health counselors provide services in a DWS administrative office three blocks from the local employment center welfare office. Services are typically provided at these other locations when it is not possible to co-locate mental health counselors in the welfare office.
One advantage to this approach is that it allows mental health staff to network with staff at other agencies. It also helps to identify clients who are at risk for welfare involvement who may otherwise be overlooked. For the social worker in the St. George welfare office, the advantage to being co-located at the administrative office is that she has access to private office space. The drawback to providing mental health services in other locations is that it may make it more difficult to link the employment case manager's clients to mental health services staff.