Providing Mental Health Services to TANF Recipients: Program Design Choices and Implementation Challenges in Four States. Strategies to Encourage Employment Case Managers to Refer Clients to Mental Health Services


Addressing the mental health needs of welfare recipients represents a dramatic shift in the focus of welfare programs. Before welfare reform, there was little emphasis on encouraging welfare recipients to find employment and even less on helping individuals resolve personal and family challenges that may form obstacles to work. While some welfare staff have adapted easily to the new emphasis on work and mental health, using all of the resources at their disposal, others not yet comfortable delving into recipients' personal lives may not see the value of programs designed to address the mental health needs of their clients. In addition, some staff may be overwhelmed by their broad range of responsibilities unrelated to client mental health needs, while still others with high caseloads may be able to accomplish only tasks that require immediate attention.

Given that the system is still in flux, the study sites, acknowledging that referrals from welfare staff are critical to the success of their programs, make a concerted effort to educate welfare staff about the availability and usefulness of mental health services. The most common strategies for encouraging referrals include the following:

Training workers to identify a mental health condition. For employment case managers to refer clients to mental health services, they must be able to identify clients who may have mental health conditions that prevent or restrict employability. Mental health staff frequently work with employment case managers individually and in groups to teach them how to recognize some of the behaviors or characteristics that may signal the need for mental health services.

Developing a simple referral process or a "clear pathway" for linking clients to mental health services. Most of the study sites have developed a simple and quick process for referring clients to mental health services. Typically, employment case managers submit a short form to the mental health counselor to refer clients to treatment. Some mental health staff have used flow charts to illustrate for employment case managers the process for referring clients to mental health services.

Keeping caseloads manageable. The size of an employment case manager's caseload often influences the relationship between the case manager and client, which may affect the number of referrals to mental health services. According to some case managers, clients are more likely to disclose mental health conditions once they have developed trust in the case manager, which is more likely to happen when a caseload is small and the manager has more time for each client. A manageable caseload also allows the employment case manager to follow up with clients who are referred to mental health services.

Stationing mental health and welfare staff closer together. In general, the more accessible mental health staff and service providers are to welfare staff, the greater the likelihood of referrals. According to program staff at all levels, co-locating mental health staff in welfare offices and employment centers (one-stop centers) is the most efficient way to make mental health workers accessible to welfare staff. The physical proximity encourages more contact, more communication, and, hence, more trust on the part of welfare staff in mental health staff. Because of this trust, welfare staff feel more comfortable about, and are therefore more inclined to, refer their clients to mental health services. Mental health staff members who are not co-located in the welfare office may find other ways to develop relationships with the employment case managers. In St. George, Utah, where the social worker is not co-located in the employment center that serves welfare recipients, the social worker regularly attends staff meetings, participates in agency functions, and finds ways to interact with agency staff on an individual and ongoing basis.

View full report


"TANF-MH01.pdf" (pdf, 763.2Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®